48/51 CARE FOR PTS WITH NON-INFLAMMATORY INTESTINAL CONDITIONS; INTESTINALOBSTRUCTION PART 1

Barbara Matallana DNP, APRN, FNP-BC, RN, IFMCP・2 minutes read

Intestinal obstruction is a complex issue that can be classified as mechanical or non-mechanical, causing complications like electrolyte imbalances and hypovolemia. Key concepts to understand include types of obstruction, causes, complications, diagnostic tests, and treatment strategies to ensure proper patient care.

Insights

  • Mechanical intestinal obstruction involves physical blockages like tumors or Crohn's disease, while non-mechanical obstruction is related to neuromuscular issues, impacting bowel movement and leading to abdominal distension.
  • Health promotion strategies for preventing intestinal obstruction in older adults include increasing fluid intake, regular exercise, high-fiber diet, and stool softeners if needed, emphasizing the importance of lifestyle choices in mitigating risks associated with this condition.

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Recent questions

  • What are the key terms related to intestinal obstruction?

    Abdominal compartment, exploratory laparotomy, blood tests, intussusception, irritable bowel syndrome.

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Summary

00:00

Understanding Intestinal Obstruction: Key Concepts and Complications

  • Intestinal obstruction is a crucial concept in patient care, requiring a thorough understanding for proper management.
  • Key terms to review at home include abdominal compartment, exploratory laparotomy, blood tests, intussusception, and irritable bowel syndrome.
  • Emphasize studying intussusception and obstipation for a comprehensive grasp of the topic.
  • Intestinal obstruction can be partial or complete, classified as mechanical or non-mechanical, affecting bowel movement.
  • Mechanical obstruction involves physical blockages like tumors or Crohn's disease, while non-mechanical obstruction is related to neuromuscular issues.
  • In both types of obstruction, intestinal contents accumulate above the blockage, leading to abdominal distension.
  • Non-mechanical obstruction, also known as paralytic ileus, results from decreased peristalsis due to neuromuscular issues.
  • Intestinal contents consist of fluids, food, secretions, and air, impacting absorption and leading to fluid and electrolyte imbalances.
  • Abdominal distension occurs due to the inability of the intestine to move contents past the obstruction, causing peristalsis to increase.
  • Complications of intestinal obstruction include hypovolemia, electrolyte imbalances, acid-base disturbances, and potential severe outcomes like acute kidney injury or death.

20:05

Causes and Prevention of Postoperative Ileus

  • Postoperative ileus can be caused by handling of the intestine during abdominal surgery, leading to a loss of intestinal function for hours to days.
  • Electrolyte disturbances, especially hypokalemia, can predispose patients to postoperative ileus.
  • Peritonitis due to leakage of colonic contents can also cause postoperative ileus, which is a neuromuscular disturbance leading to severe irritation and inflammation.
  • Intestinal ischemia results from arterial or venous thrombosis, reducing blood flow to the mesenteric vessels and surrounding tissues.
  • Mesentery, formed by a double fold of peritoneal tissue, attaches the intestines to the posterior abdominal wall, aiding in fat storage and supplying blood vessels, lymphatics, and nerves.
  • Severe blood supply insufficiency can lead to organ infection, gangrene, and sepsis in cases of intestinal ischemia.
  • Intussusception involves the telescoping of the bowel, while volvulus is the twisting of the bowel due to increased peristalsis in response to obstruction.
  • Bowel obstruction is more common in patients with a history of bowel surgery or intestinal tumors, with the elderly at higher risk due to slow peristalsis.
  • Health promotion strategies for preventing intestinal obstruction in older adults include increasing fluid intake, regular exercise, high-fiber diet, and stool softeners if needed.
  • Assessment of patients with suspected intestinal obstruction involves history-taking, pain assessment, elimination pattern evaluation, and monitoring for signs like fever, tachycardia, and abdominal rigidity.

41:08

Intestinal Obstruction: Causes, Symptoms, and Treatment

  • The visible peristaltic small bowel obstruction in the mid abdomen above the umbilicus causes early profuse vomiting and bacterial overgrowth, leading to severe fluid and electrolyte imbalances.
  • Large bowel obstruction in the lower abdomen results in minimal or no vomiting, obstipation, and ribbon-like stools, with no major fluid and electrolyte imbalances due to the colon's absorption properties.
  • Laboratory assessments for intestinal obstruction show normal white blood cell counts unless strangulation occurs, with elevated blood urea nitrogen values indicating dehydration and decreased serum electrolytes.
  • Diagnostic tests like abdominal CT scans or MRIs reveal fluid and gas in the small intestine, indicating an obstruction, while ultrasounds and endoscopies help determine the cause of the obstruction.
  • Nursing care for patients with intestinal obstruction focuses on monitoring vital signs, assessing abdomen for bowel sounds and distension, maintaining fluid and electrolyte balance, and ensuring proper care of nasogastric tubes.
  • Treatment strategies aim to resolve the obstruction through nonsurgical management for partial obstructions without strangulation, restoring normal bowel elimination, preventing complications, and managing pain effectively.
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