1. Introduction

2. Definition

3. Classification

4. Causes of intestinal obstruction

5. Anatomy & physiology

6. Pathophysiology , s&s

7. Diagnostic test

8. Complication

9. Treatment

10. Nursing interventions

11. Patients health education

12. reference

The bowel, or intestine, is the part of the

digestive tract that absorbs nutrients from

foods we eat. The residue of digested food

passes through the bowel and is excreted during

elimination, the final stage of digestion. This

process can be interrupted or halted by the

presence of a bowel obstruction,

The term intestinal obstruction refers

to any form of impedance to the

normal passage of the bowel

contents through the small or large

intestine.

Intestinal Obstruction

Mechanical Functional

Intraluminal

(foreign bodies)

Intramural

(tumors and

polyps)

Intussusception Volvulus

Hypodynamic state (ileus) Strangulation/

incarceration

Congenital

Classification

Dynamic/Mechanical obstruction

Intramural(tumors and

polyps)

Intussusception

Volvulus

Congenital

Intraluminal

(foreign bodies)

Adynamic obstruction.

Hypodynamic state (ileus)

Strangulation/

incarceration

Adhesions

the most common

cause of small bowel

obstruction.

Intussusceptions

One part of the

intestine slips into

another part located

below it.

Volvulus

-Bowel twists and turns on itself.

Strangulated Hernia

-Protrusion of intestine through a weakened area in the

abdominal muscle or wall.

Tumor

-a tumor that exists within the wall of the intestine or

a tumor outside the intestine causes pressure on the

wall of the intestine.

Impaction of stool

Foreign bodies

paralytic /Functional obstruction:

Failure of peristalsis to move intestinal

contents: due to neurologic or

muscular impairment.

• in which The intestinal muscles cannot

propel(push) the contents along the

bowel.

Causes;

Abdominal surgery and trauma.

Spinal injuries

Peritonitis

Vascular insufficiency

muscular dystrophy,

H+

K+

CL- K+

metabolic

alkalosis.

•Dehydration

•Ischemic bowel disease

•Intestinal perforation

•Peritonitis

•sepsis

:

In most cases the patient is kept NPO.

NG tube to decompressed , which relieves

symptoms and may resolve the obstruction.

I.V solution with electrolytes is initiated to

correct the fluid and electrolyte imbalance.

IV antibiotics .

The surgical treatment of intestinal obstruction

depends largely on the cause of the

obstruction.

In the most common causes of obstruction, such as

hernia and adhesions, the surgical procedure involves

repairing the hernia or dividing the adhesion to which

the intestine is attached.

• In some instances, the portion of affected bowel may be

removed and an anastomosis performed.

• A colonoscopy may be performed to untwist and

decompress the bowel. A cecostomy, in which a surgical

opening is made into the cecum, may be performed for

patients who are poor surgical risks and urgently need

relief from the obstruction. The procedure provides an

outlet for releasing gas and a small amount of drainage.

• A rectal tube may be used to decompress an area that

is lower in the bowel. The usual treatment, however,

is surgical resection to remove the obstructing lesion.

• A temporary or permanent colostomy may be

necessary.

• An ileoanal anastomosis may be performed if it is

necessary to remove the entire large colon.

3. Laparotomy: inspection of intestine and

removal of infracted or gangrenous tissue.

4.Removal of cause of obstruction, gangrenous

portion of intestines and anastomosis or

creation of colostomy depending on

individual case

1. Assess the nature and location of the patient's

pain, the presence or absence of distention,

flatus, defecation, emesis, obstipation.

2. Listen for high-pitched bowel sounds,

peristaltic rushes, or absence of bowel sounds.

3. Assess vital signs.

1. Acute Pain related to obstruction, distention, and strangulation.

2. Risk for Deficient Fluid Volume related to impaired fluid

intake, vomiting, and diarrhea from intestinal obstruction.

3. Diarrhea/Constipation may be related to presence of

obstruction/changes in peristalsis, possibly evidenced by changes

in frequency and consistency or absence of stool, alterations in

bowel sounds, presence of pain, and cramping.

4. Ineffective Breathing Pattern related to abdominal distention,

interfering with normal lung expansion.

5. Risk for Injury related to complications and severity of illness.

6. Fear related to life-threatening symptoms of intestinal

obstruction.

Nursing Interventions

Achieving Pain Relief:

Administer prescribed analgesics.

Provide supportive care during NG intubation to

assist with discomfort.

To relieve air-fluid lock syndrome, turn the patient

from supine to prone position every 10 minutes

until enough flatus is passed to decompress the

abdomen.

A rectal tube may be indicated.

Maintaining Electrolyte and Fluid Balance:

Measure and record all intake and output.

Administer I.V. fluids and parenteral nutrition as

prescribed.

Monitor electrolytes, urinalysis, hemoglobin, and blood

cell counts, and report any abnormalities.

Monitor urine output to assess renal function and to

detect urine retention due to bladder compressions by

the distended intestine.

Monitor vital signs; a drop in BP may indicate

decreased circulatory volume due to blood loss from

strangulated hernia.

Maintaining Normal Bowel Elimination:

Collect stool samples to test for occult blood if

ordered.

Maintain adequate fluid balance.

Record amount and consistency of stools.

Maintain NG tube as prescribed to

decompress bowel.

Maintaining Proper Lung Ventilation:

Keep the patient in Fowler's position to

promote ventilation and relieve abdominal

distention.

Monitor ABG levels for oxygenation levels if

ordered.

Preventing Injury Due to Complications:

Prevent infarction by carefully assessing the

patient's status; pain that increases in intensity or

becomes localized or continuous may herald

strangulation.

Detect early signs of peritonitis to minimize this

complication.

Avoid enemas, which may distort an X-ray or make

a partial obstruction worse.

Observe for signs of shock.

Watch for signs of (metabolic alkalosis and

metabolic acidosis.

• When client is to be discharged from the hospital,

nursing care is still continued. With sufficient

support at home, most client recover gradually.

During home visits, the client’s physical status and

progress towards recovery is assessed. The client’s

understanding of therapeutic regimen is also assessed,

and previous teaching is reinforced.

•Instruct the significant others to take the following home

medication as ordered by the physician.

•Explain to the significant others the drug names as well as the

right route and dosage.

•Inform the significant others about the side effects that may

occur brought by the medication.

•Encourage the significant others to comply and follow religiously

the right timing in taking the medication.

•Confer with the patient’s family the need take precautions

regarding medication therapy, activity, and dietary restriction.

•Discuss with the patient’s family ways to cope with stressful

situations in positive manner.

• Instruct patient’s family to report for immediate

occurrence of signs and symptoms to a health care

professional.

•Reinforce and supplement patient’s family knowledge

about diagnosis, prognosis, and expected level of function.

•Provide patient’s family with specific directions about

when to call the physician and what complications require

prompt attention.

•Peer support and psychological counseling may be helpful

for some families.

•Once at home, patient may resume much of the normal activity

short of aggressive physical exercise.

•Walk short distances everyday and gradually increase activity.

•No lifting of a weight greater than 20 lbs (9kg) for 6 weeks.

Exercise should be started cautiously.

•Encourage to practice deep breathing exercise and range of

motion exercises up to the level of capability.

•Explain the need for rest periods both before and after

certain activities.

•Teach client the importance of stress management

through relaxation technique,

•Help improve patient’s self-concept by providing

positive feedback, emphasizing strengths and

encouraging social interaction and pursuit of interests.

•Explain to the significant others the need to continue

drug therapy

•Provide patient’s family with a list of medications,

with information on action, purpose and possible side

effects.

•Advise significant others to always comply with the

medications. Call the physician if there is a problem

taking them.

Hygiene

•Keep proper hygiene. Teach client’s family

the importance of hygiene like daily oral

care, bathing and changing clothes.

•Proper Wound care must be observed.

•Emphasize to the client’s family the importance of proper

nutrition, its need for early recovery. This can aid in

restoring body functioning.

•Provide dietary instructions to help patient’s family

identify and eliminate foods that is needed by the patient.

• Soft or low residue diet upon discharge; this should be

continued at home for approximately 2 weeks (this

includes breads, cereals, chicken, fish, and soup).

• Avoid large quantities of raw fruits and vegetables.

• After 2 weeks, gradually reintroduce your regular diet.

• Encourage to drink plenty of fluids.

• Take nutrition supplements

•Advise to visit or have her follow up check-up

with her attending physician.

•Advise to call and notify the attending physician

for any unusual ties that may occur

•Routinely, follow up check – up with patients

within two weeks. If there are staples that require

removal, postoperative problems, or wound issues, a

follow-up appointment will be scheduled sooner.

Smeltzer, S.C. & Bare, B.G. Brunner and Suddarth’s

Textbook of Medical Surgical Nursing. 12th Ed.

Philadelphia: Lippincott Company, 2010.

http:// www MedicinePlus.com

http://nanda-nursinginterventions.blogspot.com