6. Causes of mechanical obstruction;
Adhesions;
the most common cause of small
bowel obstruction.
Intussusceptions;
One part of the intestine slips into
another part located below it.
10. Volvulus;
-Bowel twists and turns on itself.
Strangulated Hernia;
-Protrusion of intestine through a
weakened area in the abdominal
muscle or wall.
13. 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;
14. 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.
15. Causes;
Abdominal surgery and trauma.
Spinal injuries
Peritonitis
Vascular insufficiency
muscular dystrophy,
17. the severity of obstruction
depends on;
the region of bowel affected
the degree to which the
lumen is occluded.
18. Most bowel obstructions occur
in the small intestine.
About 15% of intestinal
obstructions occur in the large
bowel; most of these are found
in the sigmoid colon.
19.
20. Pathophysiology
Intestinal contents, fluid, and gas
accumulate above the obstruction.
Resulting in abdominal distention and
retention of fluid.
With increasing distention, pressure
within the lumen increases, causing a
decrease in venous and arteriolar
capillary pressure.
This causes edema, congestion,
necrosis, and perforation of the
intestinal wall.
21.
22. vomiting may be caused by
abdominal distention.
Vomiting results in a loss of H+ and
K+ from the stomach, leading to a
reduction of CL- and K+ in the
blood, resulting in metabolic
alkalosis.
With acute fluid losses,
hypovolemic shock may occur.
23. Complications
Hypovolemia and hypovolemic
shock can result in multiple organ
dysfunction.
Strangulated bowel can result
in;
-Perforation peritonitis septic
shock
24. Clinical Manifestations:-
depend on level & type of
obstruction.
The patient initially complains of
wavelike abdominal pain
abdominal distention.
vomiting.
The patient may pass blood and
mucus, but no fecal no flatus.
Signs of dehydration
25. in complete obstruction ,
peristaltic waves reverse,
propelling the intestinal contents
toward the mouth, leading to
fecal vomiting.
26. Peristaltic waves may be visible in a
thin person.
In mechanical obstructions, high-
pitched, bowel sounds are heard
proximal to the obstruction and are
absent distal to it.
If the obstruction is nonmechanical,
there is an absence of bowel sounds.
27. Large Bowel Obstruction;
a. Only accounts for 15% of obstructions
b. Causes include cancer of bowel,
volvulus, diverticular disease,
inflammatory disorders, fecal
impaction.
c. c.Manifestations: deep, cramping pain;
localized tenderness or palpable mass may
be noted.
28. Assessment and Diagnostic Findings;
Diagnosis is based on the history.
Physical examination
x-ray; show abnormal quantities
of gas, fluid, or both in the bowel.
Laboratory studies (ie, electrolyte
studies).
29. Medical Treatment
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.
Sometimes IV antibiotics are begun.
30. Surgical treatment;
Required in Complete mechanical
obstruction.
Preoperative care;
1.Insertion of NG tube to relieve
vomiting, abdominal distention, and to
prevent aspiration of intestinal
contents.
2.Restore fluid and electrolyte balance;
correct acid and alkaline imbalances.
.
31. 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
32.
33. Nursing Process
ASSESSMENT.
Assess pain
assessment of Abdomen by
auscultation of bowel for 5 minutes .
Palpation for distention, firmness,
and tenderness.
assess the vomiting .
Assess S/S of dehydration.
Vital signs are assessed.
34. NURSING DIAGNOSIS:
acutepain R/T abdominal
distention and ineffective tissue
perfusion
Goals; to reduce or relive pain.
35. IMPL; NGT is maintained on low
intermittent suction to relieve
discomfort from distention.
NPO to rest the bowel
The patient is placed in semi-Fowler’s
position to reduce tension on the
abdomen.
pain killers as ordered.
Opioids are given cautiously because
they may mask symptoms of
perforation and decrease intestinal
motility.
36. deficient fluid volume R/T collection of
fluid in the intestine and vomiting.
Goal ; prevention of dehydration and
electrolyte imbalance.
IMPL;
- assess fluid status
Ineffective Breathing Pattern R/T
abdominal distention.
Knowledge deficit about disease,
surgery
37. Choose the best answer:
The nurse is listening to a patient’s abdomen
and determines that bowel sounds are absent.
To make this determination, the nurse would
listen for which of the following time frames?
a. 2 minutes in each quadrant
b. 5 minutes in each quadrant
c. 7 minutes in each quadrant
d. 10 minutes in each quadrant
