Medical 4-Ms60-Interventions Noninflammatory Intestinal Disorders-Intestinal Obstruction

Front 1

What is mechanical obstruction?

Back 1

bowel is physically obstructed by disorders outside the intestine
ex: adhesions or hernias
or by blockage in the lumen of the intestine
ex: tumors, inflammation,
strictures, fecal
impactions

Front 2

What is nonmechanical obstruction?
(also known as paralytic ileus or adynamic ileus because it is a result of neuromuscular disturbance)

it is decreased or absent which results in a slowing of
the movement or a backup of intestinal contents

Back 2

does not involve a physical obstruction in or outside the intestine...what happens to peristalsis?

Front 3

What are intestinal contents composed of?

Back 3

ingested fluid and saliva

gastric, pancreatic, and biliary secretions

swallowed air

Front 4

In mechanical and nonmechanical obstructions, where do the intestinal contents accumulate?

Back 4

at and above the area of obstruction

Front 5

How does intestinal distention result?

by increasing the effort to move the intestinal contents forward...what does increased peristalsis stimulate?

edema of the bowel with increased capillary permeability....there is plasma leaking into the peritoneal cavity and where is fluid trapped?

there is reduced circulatory blood volume and electrolyte imbalances, called HYPOVOLEMIA!
(if not dealt with, renal
insufficiency then death
can occur)

Back 5

from the intestine's inability to absorb the contents and mobilize them down the intestinal tract...how does peristalsis compensate for the lag?

more secretions, which leads to additional distention...what does this create in the bowel?

in intestinal lumen which markedly decreases the absorption of fluid and electrolyte into the vascular space...then what typically occurs?

Front 6

The type of f&e loss depends on what?

Back 6

which part of intestine is blocked

Front 7

If the obstruction occurs high in the small intestine, what happens?

Back 7

there is a loss of gastric hydrochloride, which can lead to METABOLIC ALKALOSIS.

Front 8

Obstruction below the duodenum but have the large bowel results in?

Back 8

loss of both acids and bases, so that acid-base imbalance is usually not compromised

Front 9

Obstruction at the end of the small intestine and lower intestinal tract causes?

Back 9

loss of slkaline fluids, which can lead to METABOLIC ACIDOSIS

Front 10

What is a closed-loop obstruction?

peritonitis...why does this occur?

because bacteria without blood supply form an endotoxin...and this endotoxin is released into the peritoneal of systemic circulation which results in septic shock

(same for strangulated obstruction)

Back 10

blockage in two different areas and what is patient at great risk for?

because bacteria lie stagnant in the obstructed intestine which is not a problem until blood flow to the intestine is compromised...why does that make a difference?

Front 11

What is a strangulated obstruction?

peritonitis...why does this occur?

because bacteria without blood supply form an endotoxin...and this endotoxin is released into the peritoneal of systemic circulation which results in septic shock

(same for closed-loop obstruction)

Back 11

obstruction with compromised blood flow...and what is patient at great risk for?

because bacteria lie stagnant in the obstructed intestine which is not a problem until blood flow to the intestine is compromised...why does that make a difference?

Front 12

What is the most common site for bowel obstruction and why?

Back 12

ileum because it's the narrowest part of the small intestine

Front 13

Mechanical obstruction can result from?

Back 13

adhesions
tumors
hernias
fecal impactions (esp elders)
strictures due to Crohn's
disease or radiation
intussusception (telescoping
of a segment of the
intestine within self
volvulus (twisting of
intestine)
fibrosis due to disorders
such as endometriosis
vascular disorders
ex: emboli and arterio-
scerlotic narrowing
of mesenteric vessels

Front 14

What are the most common causes of obstruction in age 65 and older?

Back 14

diverticulitis
tumors

Front 15

What are the most common cause of mechanical obstruction regardless of age?

Back 15

adhesions in about 45% to 60%
of cases

Front 16

<What are adhesions?>

Back 16

bands of granulation and scar tissue that develop as <a result of an inflammatory response, encircling the intestine and constricting its lumen>

Front 17

What is paralytic or adynamic ileus?

following abdominal surgery or trauma because of handling of the intestines during abdominal surgery...intestinal function lost for a few hours to a few days

Back 17

a nonmechanical obstruction caused by physiologic, neurogenic, or chemical imbalances associated with decreased peristalsis from trauma or effect of a toxin on autonomic intestinal control...can occur to some degree when and why?

Front 18

What thoracic diseases can cause paralytic ileus?

Back 18

MI
rib fractures
pneumonia

Front 19

Which "kalemia" can especially predispose patient to ileus?

Back 19

HYPOkalemia

Front 20

Why can paralytic ileus be a consequence of peritonitis?

Back 20

because leakage of colonic contents causes severe irritation and triggers inflammatory response

Front 21

What is intestinal ischemia?

Back 21

vascular insufficiency to the bowel which is a potential cause of adynamic ileus

Front 22

How can heaert failure or severe shock affect intestines?

Back 22

vascular insufficiency can occur because there is arterial and venous thrombosis or an embolus which decreases blood flow to the mesenteric blood vessels surrounding the intestines...severe insufficiency of blood supply can result in infarction of surrounding organs

Front 23

What is the most common reason for surgery of the small intestine?

Back 23

obstruction

Front 24

In adults, what percentage of all obstructions occur in the small intestine?

Back 24

75%

Front 25

In adults, what percentage of all obstructions occur in the large intestine?

Back 25

15%

Front 26

What type of questions should the nurse ask regarding assessment?

Back 26

past or recent abdominal
surgery
radiation therapy
history of inflammatory
bowel disease
gallstones
hernias
trauma
peritonitis
cancer

nausea or vomiting?
flatus?
bowel movement time,
character, and consistency
hiccups (singultus)
family history of colorectal
cancer (CRC)?
ask about blood in the stool
or a change in bowel
pattern?

temperature rarely greater
than 100F...if it's
higher, with or without
guarding and tenderness,
and there is a sustained
elevation
in pulse, it could indicate
a strangulated obstruction
or peritonitis

Front 27

<What is obstipation?>

Back 27

<no passage of stool
(which may accompany complete obstruction)>

Front 28

What symptoms does the patient with mechanical obstruction in small intestine often have?

Back 28

mid-abdominal pain or
cramping
pain can be sporadic and
then he'll be comfortable
between episodes

Front 29

What kind of pain might a patient with strangulated obstruction have?

Back 29

pain becomes more localized and steady

Front 30

When might vomiting occur?

may contain bile and mucus or be orange-brown and foul
smelling as a result of
bacterial overgrowth with low ilial obstruction

Back 30

when obstruction occurs in the proximal small intestine...and what might the vomitus look like?

Front 31

How does the older client present with strangulated hernia?

Back 31

may not complain of pain, but instead may only present with n&v...may require surgery

Front 32

How does mechanical colonic obstruction differ from small bowel obstruction?

Back 32

m.c.o. causes a milder, more intermittent colicky abdominal pain...lower abdominal distention may be present, as well as obstipation, or ribbon-like stools if obstruction is partial

Front 33

<Strangulated obstructions result from?>

Back 33

<tumors
hernias
strictures
volvulus
vascular disorder
intussusception
fecal in??
fibrosis
adhesions>

Front 34

<Clinical manifestations of mechanical obstruction are?>

Back 34

<midabdominal pain or
cramping
vomiting
obstipation
diarrhea
alteration if bowel
pattern and stool
abdominal distention
abdominal tenderness>

Front 35

<Clinical manifestations of
nonmechanical obstruction
are?>

Back 35

<constant diffuse discomfort
abdominal distention
decreased to absent bowel
sounds
vomiting
obstipation (severe
obstruction to the normal
flow of feces through
the bowel)>

Front 36

How is the pain described in most types of nonmechanical obstruction?

Back 36

constant
diffuse
discomfort
COLICKY CRAMPING NOT a
characteristic!

Front 37

How is the pain characterized if obstruction is due to vascular insufficiency or infarction?

Back 37

severe and constant

Front 38

On INSPECTION for nonmechanical obstruction, what might the abdomen look like?

Back 38

abdominal distention

Front 39

On AUSCULTATION, the abdominal bowel sounds might be?

Back 39

decreased in early obstruction and absent in later stages

Front 40

Explain vomiting in nonmechanical obstruction?

Back 40

vomiting of gastric contents and bile is frequent, but vomitus rarely has foul odor and is rarely profuse.

Front 41

true or false?
There is no definitive lab test to confirm a diagnosis of mechanical or nonmechanical obstruction?

Back 41

true

Front 42

WBC is probably normal unless
there is?

Back 42

leukocytosis

Front 43

Elevataed h&h, creatinine, and BUN probably indicate?

Back 43

dehydration

Front 44

Serum electrolytes are reduced because?

Back 44

loss of fluid and electrolytes

Front 45

High obstruction in small intestine is likely to show an elevated serum venous carbon dioxide concentration indicating?

Back 45

metabolic acidosis

Front 46

Why is a nasogastric tube usually placed in bowel obstructed patients?

Back 46

provides decompression of bowel by draining fluid and air

Front 47

How often should the NG tube be assessed for proper placement?

Back 47

every 4 hours

(also monitor nasal skin daily)

Front 48

If the NG tube is repositioned or replaced, confirmation of proper placement is obtained by?

Back 48

x-ray

(and then be sure to aspirate and irrigate with 30 mL of NS every 4 hours or as needed)

Front 49

Because of fluid loss and electrolyte loss and NPO status, patient should have?

Back 49

IV hookup

Front 50

What measures of fluid status should be assessed that might indicate possible third-spacing (peritonitis for example)?

Back 50

urine output
skin turgor
mucous membranes

Front 51

What center in the brain is commonly stimulated in a bowel obstruction patient?

Back 51

thirst...so ice chips are okay if doctor says so...as patient may be having impending surgery

Front 52

What might be happening if the pain associated with bowel obstruction goes from colicky, crampy pain to constant discomfort?

Back 52

perforation of intestine or peritonitis...so continually assess where pain is coming from because it can come from being thirsty, vomiting, obstruction itself, dry mucous membranes, etcet.

Front 53

Opioid analgesics are not commonly given because?

Back 53

they can mask perforation or peritonitis...and they can slow motility and may cause vomiting...so let family know

Front 54

Differentiate between what is causing nausea and vomiting because?

Back 54

it may be poor positioning of NG tube or it may be some type of analgesic/medication causing it

Front 55

An intervention for helping increase peristalsis is to?

alleviates pressure of abdominal distention on chest; facilitates adequate thoracic excursion and normal breathing patterns

Back 55

perform frequent position changes...including semi-Fowlers position...which does what?

Front 56

<Drug therapy for bowel obstruction may include which type of drugs?>

Back 56

<broad-spectrum IV antibiotics
and something to enhance gastric motility (Sandostatin)>

Front 57

What type of surgical procedure may be performed?

Back 57

exploratory laparotomy

Front 58

The primary preop procedure performed prior to exploratory laparotomy is?

Back 58

NG tube insertion if indicated

Front 59

What does surgeon do if obstruction is caused by adhesions?

Back 59

they're cut (lysed)

Front 60

What does the surgeon do if obstruction caused by tumor or diverticulitis?

Back 60

performs colon resection with primary anastomosis or temporary or permanent colostomy

Front 61

What does surgeon do if obstruction caused by intestinal infarction?

Back 61

embolectomy
thrombectomy
resection of gangrenous
bowel

Front 62

How long does the NG tube stay in following surgery?

peristalis must be assessed over time...so clamp tube for a while, and assess at certain stages to make sure peristalsis is occurring without decompression

Back 62

until peristalsis returns...but the NG tube removal is gradual because?

Front 63

If the patient's obstruction was due to fecal impaction, before he goes home, have him demonstrate what?

Back 63

ability to carry out bowel regimen independently

Front 64

What health teaching might nurse help client with if he's had mechanical obstruction?

Back 64

high-fiber diet
exercise
fluid intake increase
possible rx for bulk-forming
laxatives

Front 65

If the patient had surgery for nonmechanical obstruction, patient teaching includes?

Back 65

incision care
drug therapy for incisional
discomfort (add stool
softener)
activity limitations