Intestinal Obstructions

Question 1

What is an intestinal obstruction?

Answer 1

This disorder occurs when the intestinal contents are unable to pass through the GI system due to a blockage. It can occur in the small or large intestine. It can be a complete or partial blockage.

Question 2

What are some types of intestinal obstructions?

Answer 2

1. Mechanical Obstructions
2. Non-Mechanical Obstructions

Question 3

Mechanical Obstructions

Answer 3

There is a detectable obstruction such as a tumor, an adhesion, or a twisting of the intestine

Question 4

Non-mechanical obstruction

Answer 4

Results from neuromuscular or vascular deficiency. Peristalsis has ceased to move intestinal contents along the tract or portion of the intestine has lost adequate blood supply to maintain the tissue integrity and function

Question 5

Diagnostic testing for intestinal obstructions

Answer 5

1. Colonoscopy
2. Barium Enema
3. Upper or lower barium swallow or series
4. Plain film x-rays or CT scan may be used

Question 6

Causes of Intestinal Obstructions

Answer 6

1. Adhesions and strangulated hernias
2. Volvulus (twisting of intestine)
3. Instussusception (telescoping of intestine strictures)
4. Fecal or barium impaction
5. Hirshsprung Disease
6. Paralytic Ileus (nonmechanical)
7. Pseudoobstruction (nonmechanical)

Question 7

Hirshsprung Disease

Answer 7

Inadequate motility of part of the intestine Megacolon due to failure of development of myentericplexus of rectosigmoid area of large intestine

Question 8

Volvulus

Answer 8

twisting of intestine

Question 9

Intussusception

Answer 9

telescoping of intestine strictures

Question 10

Paralytic Ileus

Answer 10

paralysis of intestines, occurs to some degree after abdominal surgery

Question 11

Pseudoobstruction

Answer 11

idiopathic

Question 12

Assessment of Intestinal Obstructions in the Small Intestine

Answer 12

1. Rapid Onset
2. Frequent and copious vomiting
3. Cramp like, intermittent pain
4. Feces for a short time
5. Abdominal distention greatly increased

Question 13

Assessment of Large Intestine

Answer 13

1. Gradual onset
2. Rarely vomits
3. Low grade and crampy pain
4. Constipation
5. Increased abdominal distention

Question 14

Dianostic Testing for intestinal obstructions

Answer 14

1. Physical Exam
2. x-ray, CT scan

Question 15

Nursing Diagnoses for Intestinal Obstructions

Answer 15

1. Acute Pain r/t abdominal distention and increased peristalsis
2. Deficient Fluid Volume r/t decrease in intestinal reabsorption and loss of fluid
3. Imbalanced nutrition: less than body requirments r/t intestinal obstruction and vomiting

Question 16

Nursing Interventions for Intestinal Obstructions

Answer 16

Assess:

1. VS
2. Pain and treatment
3. Monitor for dehydration and electrolyte imbalance
4. Monitor NG tube patency q4h
5. Strict I&O
6. IV fluids as ordered

Question 17

Surgical Management of Intestinal Obstructions

Answer 17

1. Most obstructions treated surgically may involve simple resection of obstructed segment of bowel
2. Partial or total colectomy, colostomy, or ileostomy required with extensive obstruction or necrosis

Question 18

Post-operative for intestinal obstruction abdominal surgery

Answer 18

1. VS
2. Pain
3. Incision care and teaching
4. TCDB
5. Splinting
6. Teach progression of activities
7. Instruct patients on signs and symptoms of complications that should be reported
8. Ostomy teaching as needed

Question 19

Intestinal Obstruction Important Information

Answer 19

1. Obstruction in the intestine can be a surgical emergency
2. Can cause abdominal pain and distention, the absence of fecal excretion, and sometimes vomiting and dehydration
3. Can be confirmed by x-rays
4. treatment usually includes the administration of IV fluids and the use of a NG or nasintestinal tube to suction fluid from the intestinal tract

Question 20

General Information Hirschsprung Disease

Answer 20

1. Caused by inadequate motility of part of intestine
2. 1/4 of all cases of neonatal obstructions
3. Most cases require surgery: temporary ostomy

Question 21

General Information Intussusception

Answer 21

1. One of the most frequent causes of obstruction in children between 3 months and 3 years of age
2. Proximal segment of bowel telescopes inito a distal segment
3. Can result in lymphatic, venous and nervous compression
4. Venous engorgement leads to leaking of blood into intestine forming classic currant jelly like stools
5. Treatment of choice is hyrostatic reduction with barium or air enema
6. If enema unscuccessful, will require surgery

Question 22

General Information Volvulus

Answer 22

1. Intestine twisting around itself
2. Can compromise blood flow to intestine leading to necrosis, peritonitis, perforation, and death
3. Occurs in children usually secondary to being born with malrotation in which the intestines are not in the anatomically correct position and are twisting upon themselves
4. Requires surgical Correction