A serious and life-threatening complication of bowel obstruction is strangulation. Strangulation is more commonly seen in closed-loop obstructions. If the strangulated bowel is not treated promptly, it eventually becomes ischemic, and tissue infarction occurs.
Potential Complications from a bowel obstruction
This leads to dehydration and kidney failure. Nausea and vomiting will also cause dehydration. Excess swelling of the intestine can cause the intestine to rupture or burst. A ruptured intestine can lead to peritonitis, or a severe infection in the abdominal cavity.
The Nursing Process
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.
Bowel obstructions usually cause cramping, abdominal pain, vomiting and inability to pass bowel motions (faeces or poo) or gas. A bowel obstruction is an emergency and needs treatment in hospital to prevent serious complications. You may need surgery or another procedure to remove the blockage.
Some signs and symptoms associated with SBO include the following: Nausea/vomiting (60-80%): The vomitus can often be bilious in nature. Constipation/absence of flatus (80-90%): Typically a later finding of SBO. Abdominal distention (60%)
The patient with a small bowel obstruction will usually present with abdominal pain, abdominal distension, vomiting, and inability to pass flatus. In a proximal obstruction, nausea and vomiting are more prevalent. Pain is frequently described as crampy and intermittent with a simple obstruction.
The rule of 3-6-9-12 for bowel obstruction
The small bowel is normally <3cm in diameter. If it is >6cm it is at high risk of rupture. The large bowel is normally <6cm in diameter. If it is >9cm it is at high risk of rupture.
Bowel Obstruction Symptoms
Signs of an intestinal blockage will depend on how severe the obstruction is. But it almost always comes with belly pain, usually around your belly button, and cramping. Other signs include: Constipation.
Most patients stay in the hospital for between five and seven days following bowel obstruction surgery. It can take several weeks or months to fully return to normal activities. Your medical team with work with you to manage post-surgical pain.
Small bowel obstruction (SBO) is a common disease, accounting for 12 to 16 percent of surgical admissions and more than 300,000 operations annually in the United States [1]. Patients diagnosed with acute SBO should be admitted to the hospital and evaluated by a surgeon.
The cornerstone of non-operative management includes bowel rest, nasogastric tube decompression, fluid resuscitation, correction of electrolyte abnormalities, serial abdominal examination, and observation for the passage of flatus or bowel movement.
NURSING DIAGNOSIS Deficient fluid volume related to decrease in intestinal fluid absorption and loss of fluids secondary to vomiting.
If the intestine is completely blocked, it is a medical emergency needing immediate attention. Symptoms of an intestinal blockage include severe belly pain or cramping, vomiting, not being able to pass stool or gas, and other signs of belly distress.
Barium may cause constipation or possible impaction after the procedure if it isn't completely eliminated from your body. You may be advised to drink plenty of fluids to expel the barium from the body. You may be given a laxative to help expel the barium.
Hernias are the most common cause of strangulation in patients presenting with small bowel obstruction.
The four cardinal symptoms of bowel obstruction are pain, vomiting, obstipation/absolute constipation, and distention.
Avoid high-fibre foods and raw vegetables and fruits with skins, husks, strings, or seeds. These can form a ball of undigested material that can cause a blockage if a part of your bowel is scarred or narrowed.
The signs and symptoms of intestinal obstruction are the same as in the nonpregnant patient. The classic triad of abdominal pain, vomiting, and obstipation is noted, although these symptoms may occur in normal pregnancy.
Treatment includes intravenous (in the vein) fluids, bowel rest with nothing to eat (NPO), and, sometimes, bowel decompression through a nasogastric tube (a tube that is inserted into the nose and goes directly to the stomach). Anti-emetics: Medications may be required to relieve nausea and vomiting.
Initial management should always include an assessment of the patient's airway, breathing, and circulation. If resuscitation is required, it should be performed with isotonic saline and electrolyte replacement.
Severe bowel obstruction can entirely block part of the intestine. This may stop all solids, liquids, and gases from passing through the digestive system. Someone with a complete obstruction will find passing a stool or gas difficult, if not impossible.
If the bowel becomes trapped in adhesions, it may lead to a small bowel obstruction. In severe cases, the blood supply might be compromised, and the bowel tissues might die. This is a life-threatening situation. The small bowel constantly moves digested food and stomach juices forward from the stomach to the colon.
It is often difficult to differentiate between normal small and large bowel, but this often becomes easier when the bowel is abnormally distended. The upper limit of normal diameter of the bowel is generally accepted as 3cm for the small bowel, 6cm for the colon and 9cm for the caecum (3/6/9 rule).