Most bowel obstructions will require hospital admission and surgical consultation. Prompt recognition and diagnosis are critical in improving morbidity and mortality. The most important step in the initial management of bowel obstruction is identifying the type, severity, and cause.
Initial emergency department (ED) treatment of small-bowel obstruction (SBO) consists of aggressive fluid resuscitation, bowel decompression, administration of analgesia and antiemetic as indicated clinically, early surgical consultation, and administration of antibiotics.
Depending on the severity of the blockage, patients will need to receive IV fluids to maintain hydration and nasogastric suctioning to allow the bowel to rest and recover. Nurses will educate patients on risk factors, symptoms, and management of their condition.
Initial therapy in patients with suspected large-bowel obstruction (LBO) includes volume resuscitation, appropriate preoperative broad-spectrum antibiotics, and timely surgical consultation. A nasogastric tube should be considered for patients with severe colonic distention and vomiting.
Constipation. Vomiting. Inability to have a bowel movement or pass gas. Swelling of the abdomen.
A bowel blockage can stop blood flow, causing part of the intestine to die. As pressure builds up from the blockage, intestinal bacteria can leak into the bloodstream. You may develop peritonitis, an abdominal infection. You are also at risk for a life-threatening system-wide infection called sepsis.
Get medical help right away if you have symptoms of intestinal obstruction. These include severe abdominal pain, vomiting, and inability to pass stool.
Management of uncomplicated obstructions includes fluid resuscitation with correction of metabolic derangements, intestinal decompression, and bowel rest. Evidence of vascular compromise or perforation, or failure to resolve with adequate bowel decompression is an indication for surgical intervention.
Nursing care plans should include monitoring ins and outs, nutritional support, meeting comfort needs including assessing for pain. Measures should be taken to minimize the risk of nosocomial infections. Bandage and wound care should be performed. Non-ambulatory patients will require recumbent patient care.
eg. a nursing implication of administering blood pressure medication is that you may make the patient hypotensive and cause dizziness etc. As a result, you would want to be on the look out for safety concerns like the patient falling over. That is a basic one, but you get the idea.
Nursing Interventions:
-The nurse will encourage and help the patient develop a daily bowel program based on the patients wants and needs. -The nurse will assess the patients bowel movements and frequencies daily. -The nurse will assess the patients feelings regarding self-control of bowel movements daily.
Obstruction frequently causes abdominal pain, nausea, vomiting, constipation, obstipation, and distention.
Adhesions: The most common cause for small bowel obstruction is intra-abdominal adhesions. Adhesions caused by abdominal or pelvic surgery cause about 65% to 75% of all small bowel obstructions. Adhesions are scar tissue that can form after infection, radiation therapy, inflammation and most commonly, surgery.
In some cases, intestinal obstruction can cause serious and debilitating acute abdominal pain. If you experience sudden, severe abdominal pain in addition to any of the above symptoms, seek emergency medical attention, immediately, by calling 911 or visiting an Emergency Room.
Non-operative treatment includes gastrointestinal decompression and water-soluble contrast. Success rates vary by etiology of bowel obstruction. Bowel obstruction caused by adhesion has a high success rate of resolving non-surgical, where as complete obstruction have low success rates.
The management of bowel obstruction depends upon the etiology, severity, and location of the obstruction. The goals of initial management are to relieve discomfort and restore normal fluid volume, acid-base balance, and electrolytes.
Bowel Elimination Assessment
Subjective assessment of the bowel system includes asking about the patient's normal bowel pattern, the date of the last bowel movement, characteristics of the stool, and if any changes have occurred recently in stool characteristics or pattern.
Nurses need to assist with healthy elimination patterns to ensure patients are having regular soft bowel movements and adequate urination and to identify abnormal patterns such as flatulence, constipation, diarrhea, incontinence, fecal impaction, hemorrhoids as well as polyuria, anuria, and other abnormalities which ...
These are assessment, diagnosis, planning, implementation, and evaluation.
What is a Nursing Consideration? Although not a separate step in the nursing care plan, nursing considerations are the implications of the interventions a nurse is providing. Nursing considerations may take the form of assessments that must be done before an intervention can be performed.
Classification of Nursing Interventions. There are three types of nursing interventions: independent, dependent, and collaborative. (See Figure 4.12 for an image of a nurse collaborating with the health care team when planning interventions.)