Intestinal Obstruction Essay Example

symptoms include abdominal swelling, constipation, severe and intermittent abdominal cramps, nausea and vomiting (including green vomit), fecal vomiting (vomit resembling feces), blood-stained mucus passed, and passing jelly-like mucus. Risk factors for intestinal obstruction include abdominal or pelvic surgery which can cause adhesions, Crohn's disease which thickens the intestine's walls and narrows its passageway, and cancer within the abdomen especially after surgery to remove an abdominal tumor or radiation therapy.

Objectives

After completing this case study, the student nurse should be able to recognize and understand this disease condition.

Identify predisposing and precipitating factors that could possibly contribute to the occurrence of the disease. Understand the normal anatomy and physiology of the organs affected by the underlying disease. Review literature and background of the signs and symptoms manifested by the client. Identify specific theoretical and/or research-based causes and clinical manifestations of the disease, and trace the pathophysiology of the disease condition.

Assess the following: Personal history such as demographic data, pertinent family health and history diagram, history of past and present illness. Formulate nursing diagnosis to address patient needs and plan nursing interventions to meet those needs. Conduct physical assessment using a cephalo-caudal approach and review of systems. Review and monitor diagnostic and laboratory results. Construct individualized nursing care plans. Able to formulate discharge planning.

Anatomy and Physiology: The GI System The gastro-intestinal system is essentially a long tube running through the body, with specialized sections that can digest material from the top end, extract useful components, and expel waste products from the bottom end.

The entire system operates under hormonal regulation. When food is present in the mouth, it initiates a series of hormonal actions. In the stomach, various hormones stimulate

acid secretion, enhance gut motility, release enzymes, and more. Nutrients from the gastrointestinal tract are not processed on-site; instead, they are transported to the liver for further breakdown, storage, or distribution. The digestive system comprises the alimentary canal (also known as the digestive tract) along with other abdominal organs involved in digestion such as the liver and pancreas.

The alimentary canal, which includes the esophagus, stomach, and intestines, is a long tube that extends from mouth to anus. It has an average length of 30 feet (around 9 meters) in adults. By the time digested substances reach the large intestine, most of their valuable nutrients have already been absorbed. The primary function of the large intestine is to extract water from the remaining material, resulting in partially solid feces that are then expelled through the anus after being stored in the rectum. The mucosa consists of tightly-packed straight tubular glands that contain specialized cells responsible for absorbing water. These glands also contain goblet cells that produce mucus to aid in the passage of feces.

The lymphoid tissue (L), known as Peyer's patches, offers immune protection to vulnerable areas in the body. These patches are located in both the large intestine and the ileum. Given the abundance of bacteria in the gut, it is crucial to enhance standard surface defenses. A muscular ring or valve prevents undigested food and some water from moving back when transitioning from the small intestine to the large intestine. At this point, nutrient absorption is nearly complete. The primary function of the large intestine is to extract water from undigested material and produce solid waste for elimination.

The large intestine comprises three sections, namely

the cecum - a connecting pouch between the small and large intestines facilitating food passage. The appendix, a small finger-like pouch, is located at the end of the cecum.

Doctors believe that the appendix is a remnant of an earlier stage in human evolution and does not play a part in digestion. In contrast, the colon has a vital role in the digestive system. It originates at the cecum on the right side of the abdomen, traverses across the upper abdomen, descends on the left side, and links to the rectum. The colon comprises three sections: the ascending colon, which absorbs fluids and salts; the transverse colon, which carries out this identical function; and lastly, there is the descending colon that retains and expels waste material.

Bacteria in the colon aid in the digestion of residual food, while the rectum retains waste until it is expelled from the digestive system through the anus as a bowel movement. The pathophysiology includes complications such as:

Complications:

• Dehydration may occur due to the loss of water, sodium, and chloride
• Peritonitis
• Shock resulting from electrolyte loss and dehydration

If there is an elevated level, it may indicate reduced kidney function.

Surgical Management: Colostomy involves creating an opening in the colon onto the abdominal surface. It is performed in situations where feces cannot flow naturally from the colon to the anus. Some reasons for performing a colostomy include diverting feces for paraplegics or when the rectum or anus is nonfunctional due to disease, a birth defect, or a traumatic condition. It can also be done to redirect fecal flow away from an inflamed area or

around an operative site. The general procedure for changing an ostomy pouch includes assessing the type and location of the ostomy, examining the skin around the stoma, observing the amount and characteristics of fecal material or urine in the pouch, and determining if the patient is being taught self-care.

• 1. Identify the type of ostomy and its location (Bowel Urinary Diversion)
• 2. Assess skin integrity around the stoma and general appearance
• 3. Note amount and character of fecal material or urine in the pouch
• 4. Determine if patient is currently learning self-care

Planning

1. Wash your hands

Gather the necessary equipment for changing a pouch or dressing, including cleansing supplies (tissues, warm water, mild soap, wash cloth, towel), a clean pouch of the same type being used (seal or use tape to prevent leakage), belt cleaning materials, dressing materials, receptacle for soiled pouch/dressing (bedpan or paper bag/newspaper for wrapping), protective spray on hand, and clean gloves.

Determine if the patient will actively participate in the procedure. Choose the appropriate location for performing the procedure (bathroom or bedside).

Implementation

Identify the patient. Explain the procedure to the patient.

Put on clean gloves for infection. Assist the patient to the bathroom or provide privacy. Remove the soiled dressing. Using warm water and a mild soap, thoroughly cleanse the skin around the stoma. Inspect the skin for redness or irritation.

7. Protect the stoma by placing a tissue over it to prevent any feces or urine from coming into contact. Remember to replace the tissue as needed during

the procedure.
8. Thoroughly dry the surrounding skin of the stoma by gently patting it.
9.

Apply a skin protective spray if necessary. Allow the skin to dry completely so that the pouch will stick securely (a hair dryer on a low setting, at least 18 inches away from the skin, can be used). Remove the tissue from the stoma and apply the clean pouch or dressing. Remove gloves and wash hands.

Evaluation

1.

The following criteria should be evaluated when assessing the patient's condition:
- The pouch or dressing should be secure.
- The area surrounding the pouch should be clean.
- There should be no odor present.
- The patient should feel comfortable.

If the patient is being instructed on how to perform the procedure, additional criteria to consider are:
- The patient's ability to change the pouch using the correct technique.
- The patient's verbalization of understanding key points in care.

Documentation must include information about:
- The amount, color, and consistency of fecal material or urine in the pouch.
- How the clean pouch and dressing were applied during a change.
- Whether or not the patient has sufficient knowledge and ability to participate in or independently perform the procedure.

Medical management options for bowel obstruction include:
- Most cases can be addressed by decompressing the bowel through a nasogastric or small bowel tube.
- In cases where complete obstruction occurs, surgical intervention may be necessary due to potential strangulation risks.
-The complexity of surgical procedures for intestinal obstruction depends on how long it has been obstructed and overall intestine health.

A colonoscopy may sometimes be performed as a means of untwisting and decompressing a twisted bowel.- A cecostomy may be performed for patients who

are poor surgical risks and urgently need relief from the obstruction by making a surgical opening into the cecum.

Nursing Management

• The nursing management involves several tasks including maintaining the function of the nasogastric tube, assessing and measuring output from it, evaluating for fluid and electrolyte imbalance, monitoring nutritional status, and assessing improvement of symptoms such as normal bowel sounds, reduced abdominal distention, subjective improvement in abdominal pain and tenderness, and passage of flatus or stool. Additionally, it is crucial to observe any worsening symptoms of intestinal obstruction while providing emotional support and comfort to the patient.
• In situations where nonsurgical treatment does not yield positive results, preparation for surgical intervention will be done by the nurse. This includes preoperative teaching based on the patient's condition. Moreover, after surgery, general care for the abdominal wound along with routine postoperative nursing care will be provided.