Intestinal obstruction surgery adult health nursing.pptx

 Definition :
Intestinal obstruction exists when blockage prevents the normal flow of
intestinal contents through the intestinal tract.
Two types of processes can impede this flow: •
 Mechanical obstruction:
An intraluminal obstruction or a mural obstruction from pressure
on the intestinal wall occurs. Examples :
 Intussusception, polypoid tumors and neoplasms, stenosis, strictures,
adhesions, hernias, and abscesses. • Functional obstruction:
The intestinal musculature cannot propel the contents along the
bowel.
Examples :
Amyloidosis, muscular dystrophy, endocrine disorders such as diabetes
mellitus, or neurologic disorders such as Parkinson’s disease. The blockage
also can be temporary and the result of the manipulation of the bowel
during surgery.

 The obstruction can be partial or complete.
 Its severity depends on the region of bowel affected, the degree
to which the lumen is occluded, and especially the degree to
which the vascular supply to the bowel wall is disturbed.
 Most bowel obstructions occur in the small intestine.
 Adhesions are the most common cause of small bowel
obstruction, followed by hernias and neoplasms. Other causes
include intussusception, volvulus (ie, twisting of the bowel),
and paralytic ileus.
 Most obstructions in the large bowel occur in the sigmoid
colon. The most common causes are carcinoma, diverticulitis,
inflammatory bowel disorders, and benign tumors.

 The small intestine is the part of the digestive system that
absorbs much of the liquid and nutrients from food.
 It consists of three segments:
 The Duodenum
 The Jejunum
 The Ileum and is followed by the large intestine (colon).

Definition :
Small bowel obstruction can
have abdominal pain with
frequent vomiting.
True bowel obstruction can be very
serious.

o Intestinal contents, fluid, and gas accumulate above the intestinal obstruction.
o The abdominal distention and retention of fluid reduce the absorption of fluids
and stimulate more gastric secretion.
o With increasing distention, pressure within the intestinal lumen increases,
causing a decrease in venous and arteriolar capillary pressure.
o This causes edema, congestion, necrosis, and eventual rupture or perforation of
the intestinal wall, with resultant peritonitis.
o Reflux vomiting may be caused by abdominal distention.
o Vomiting results in loss of hydrogen ions and potassium from the stomach,
leading to reduction of chlorides and potassium in the blood and to metabolic
alkalosis.
o Dehydration and acidosis develop from loss of water and sodium.
o With acute fluid losses, hypovolemic shock may occur.

 Crampy pain
 Voimiting
 Dehydration
 Intense thirst
 Drowsiness
 Malaise
 Aching
 Parched tongue and mucous membrane
 Acidosis
 Alkalosis
 Hypovolemic shock
 Septic shock

 Adhesions, or tissue that can develop after abdominal or pelvic
surgery
 Diverticulitis
 A foreign object, if swallowed
 Gallstones, though this is a rarer cause of obstruction
 Hernias
 Impacted stools
 Infection
 Inflammatory bowel diseases (IBDs)
 Intussusception, which is when a segment of the bowel pushes
into the next segment, making it collapse
 Meconium plug, which is the first stool that newborns pass
 Tumors
 A twisted bowel

 dehydration
 electrolyte imbalance
 tissue death in the bowels
 abscess within the abdomen
 kidney failure
 a hole in the bowel, which could lead to infection
 pulmonary aspiration, wherein a person inhales solids
such as vomit
 Sepsis a potentially fatal blood infection

 Cancer, especially in the abdomen
 Crohn's disease or other IBDs, which can thicken the walls of
the intestines
 previous abdominal or pelvic surgery, which may increase the
risk of adhesions.
 radiation therapy.
 bulging through the incision (incisional hernia)
 narrowing (stricture) of the opening (stoma)
 blockage (obstruction) of the intestine from scar tissue

 Diagnosis is based on the symptoms described
previously and on imaging studies.
 Abdominal x-ray and CT findings include abnormal
quantities of gas, fluid, or both in the intestines.
 Laboratory studies (ie, electrolyte studies and a
complete blood cell count) reveal a picture of
dehydration, loss of plasma volume, and possible
infection.

Treatment options for small bowel obstruction can include:
 Medication.
 Observation
 Nasogastric tube
 Surgery
 Therapeutic enema

Treatment include:
 Medical
 Nursing
 surgical
 Nutritional management

 Decompression of the bowel through a nasogastric tube is successful in
most cases.
 When the bowel is completely obstructed, the possibility of strangulation
and tissue necrosis (ie, tissue death) warrants surgical intervention.
 Before surgery, IV fluids are necessary to replace the depleted water,
sodium, chloride, and potassium.
 The surgical treatment of intestinal obstruction depends on the cause of the
obstruction.
 For 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.
 The complexity of the surgical procedure depends on the duration of the
intestinal obstruction and the condition of the intestine.

 Nursing management of the nonsurgical patient with a small bowel
obstruction includes maintaining the function of the nasogastric tube,
assessing and measuring the nasogastric output, assessing for fluid and
electrolyte imbalance, monitoring nutritional status, and assessing
improvement (eg, return of normal bowel sounds, decreased abdominal
distention, subjective improvement in abdominal pain and tenderness,
passage of flatus or stool).
 The nurse reports discrepancies in intake and output, worsening of pain or
abdominal distention, and increased nasogastric output.
 If the patient’s condition does not improve, the nurse prepares him or her
for surgery.
 Nursing care of the patient after surgical repair of a small bowel
obstruction is similar to that for other abdominal surgeries.

Principles:
• Management of segment at site of obstruction.
• Management of distended proximal bowel.
• Management of underlying cause of
obstruction.

Steps:
• Nasogastric intubation and suction
• Anaesthesia
• Incision
• Handling of gut
• Assess the viability of the bowel
• Prevention of reperfusion
• Closing the abdomen

 Eat 6 to 8 small meals a day
 Only drink ½ cup (4 ounces) of liquids during each
meal
 Include enough nutrients in your meals to help you
heal.
 Your meals should be:
 High in proteins
 Moderate in fats.
 Low in sugary foods
 Fiber

 The patient was encouraged to drink plenty of
fluids
 Avoid to drink carbonated beverages and gas
producing foods.

Pain
Constipation
Fluid volume deficit
Hyperthermia
Anxiety

The large intestine, also known as the large
bowel, is the last part of the gastrointestinal
tract and of the digestive system in vertebrates.
Water is absorbed here and the remaining
waste material is stored as feces before being
removed by defecation.

Definition :
A large bowel obstruction is when the
large intestine, which is also known as
the colon or large bowel, is partially or
completely blocked.
Large bowel obstruction is less
common & can be
from cancer or diverticulitis.
Lack of bowel movement
with colon obstruction.

 As in small bowel obstruction, large bowel obstruction results in an accumulation
of intestinal contents, fluid, and gas proximal to the obstruction.
 It can lead to severe distention and perforation unless some gas and fluid can flow
back through the ileal valve. Large bowel obstruction, even if complete, may be
undramatic if the blood supply to the colon is not disturbed.
 However, if the blood supply is cut off, intestinal strangulation and necrosis occur;
this condition is life-threatening.
 In the large intestine, dehydration occurs more slowly than in the small intestine
because the colon can absorb its fluid contents and can distend to a size
considerably beyond its normal full capacity.
 Adenocarcinoid tumors account for the majority of large bowel obstructions.
 Most tumors occur beyond the splenic flexure, making them accessible with a
flexible sigmoidoscope.

Constipation
Anemia
Weakness
Weight loss
Anorexia
Crampy lower abdominal pain
Fecal voimiting
shock

Adhesions
Constipation
Fecal impaction
Hernias
Neoplasm
Strictures
Volvulus
Adhesions
Diverticulitis

infection
tissue death
intestinal perforation
sepsis
multisystem organ failure
death

 colon cancer
 diverticulitis
 sigmoid volvulus
 cecal volvulus
Previous abdominal or pelvic radiation.
Hernias.
Twists in the bowel

Diagnosis is based on symptoms and on
imaging studies.
 Abdominal x-ray and abdominal CT or
MRI findings reveal a distended colon
and pinpoint the site of the obstruction.
Barium studies are contraindicated

 Fluid replacement therapy
 Electrolyte correction
 Surgery
 Stent
 Medications

Medical
Nursing
Surgical
Nutritional

 Restoration of intravascular volume, correction of electrolyte abnormalities,
and nasogastric aspiration and decompression are instituted immediately.
 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 in 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.
 However, the usual treatment is surgical resection to remove the obstructing
lesion.
 A temporary or permanent colostomy may be necessary.
 An ileoanal anastomosis may be performed if removal of the entire large
bowel is necessary.

 The nurse’s role is to monitor the patient for symptoms that
indicate that the intestinal obstruction is worsening and to
provide emotional support and comfort.
 The nurse administers IV fluids and electrolytes as prescribed.
 If the patient’s condition does not respond to nonsurgical
treatment, the nurse prepares the patient for surgery.
 This preparation includes preoperative teaching as the patient’s
condition indicates.
 After surgery, general abdominal wound care and routine
postoperative nursing care are provided.

Resuscitation •
 Operative intervention
 Exploratory laparotomy- frozen abdomen,
no frank perforation.
Abdominal washout
 Generous use of fibrin glue
 Drainage with large Jackson Pratt tubes

 diet of patient should be:
 Clear Liquid Diet
 Full Liquid Diet
 Low fibre diet
 keep a record of the foods that cause you nausea, cramping, or
bloating and share the list with your doctor and dietician.
 Eat only as much as you feel comfortable with and don’t force
food into your mouth.
 Chew all foods well.
 Eat small meals instead of large. Five to six small meals rather
than three large may be helpful to you.
 Try to drink six to eight cups of fluids each day.
 Consider taking a multivitamin if you can’t eat as much as you
usually do

Pain
Constipation
Ineffective breathing pattern
Deficit fluid volume
Anxiety

Intestinal obstruction surgery adult health nursing.pptx

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Intestinal obstruction surgery adult health nursing.pptx