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Bowel Obstruction
| Question | Answer |
|---|---|
| What is a mechnical bowel obstruction? | It is when there is an occlusion either inside or outside the lumen of the bowel. |
| What are the two different types of mechanicl bowel obstruction? | Small Intestine and Large Intestine Mechanical Bowel Obstructions |
| What amount of mechanical obstructions occur in the small intestine? | 2/3 |
| Most of the time when a blockage or occlusion is in the small intestine they are caused by: | adhesions |
| What are adhesions? | Scar tissue that is real sticky. |
| What could cause adhesions? | Prior surgery, trauma, inflammation or infection. |
| Most of the time when you have an obstruction in the large intestine it is caused by: | Malignancy |
| Characteristics of Small Intestine Mechanical Obstructions. | Abrupt onset, more intense pain, and the patient may have projectile vomiting. |
| In small intestine mechanical obstructions, the higher up the obstruction the: | More intense the pain is. |
| As a nurse what do we need to remember about small intestine mechanical obstructions? | Caused by adhesions, recognize the symptoms, rapid onset, projectile vomiting and the higher the obstruction the more intense the pain. |
| What kind of an onset does Large Intestine Mechanical Obstruction have? | It has an incidious onset. Quiet and it just creeps up on you. |
| By the time you know the patient has large intestine mechanical obstruction, their abdomen is | Distended almost like ascites or pregnancy. |
| The vomit of a patient with large intestine mechanical obstruction will have what in it? | Fecal matter and this is a late sign. |
| How do you verify placement of an NG tube? | Listening for air two fingers below the xyphoid. Listen for a swish. |
| Would the patient with large intestine mechanical obstruction have an odor to their breath? | Yes, they could have a very strong fecal odor. |
| A mechanical blockage is an actual | Physical blockage. |
| What is a volvulus? | A twisting of the colon. |
| Why could a baby have a volvulus? | Because they have weak abdominal walls. |
| What would you assess on the newborns abdomen? | Bowel sounds, soft, non tender abdomen, paten anus, passing meconium? |
| Later in life you would see a volvulus from what? | Adhesions |
| What is intussusception? | Telescoping of the colon into itself. |
| What would the stool of a patient with intussusception look like? | It would look like red currant jelly. |
| You can see intussusception not only due to weakness of muscle wall of the bowel but also due to: | Malignancies of a variety of causes. |
| You can have this when patients have alot of adhesions, like if they have had prior surgery, inflammation, infection, or trauma to the abdomen and scar tissue develops. | Volvulus |
| What is a functional bowel obstruction? | A decrease or absence of peristalsis, often called palytic ileus. |
| One of the functions of the intestine besides absorption is to propel the waste products through, so when there is a decrease of peristalsis, the function is decreased, this called what? | An ileus. |
| Causes of functional bowel obstructions. | Medications, Inactivity or immobility, post-op, bowel manipulating surgery, trauma to the abdomen, decreased electrolytes, pancreatitis, sepsis, neuromuscular,and dehydration. |
| What types of medications can cause functional bowel obstructions? | Opioids, anesthetic medications, and neuromuscular blocking agents. |
| Why could anesthetic medication cause a functional obstruction. | Anticholinergic cause decreased secretions. |
| Why could neuromuscular blocking agents cause functional obstructions. | Because it may take a little while for peristalsis to return. |
| The more bowel manipulation, the longer it takes for peristalsis to return. If a patient has intestinal surgery, how long can it take to hear the faintest little gurgle? | up to 48 hours |
| Anytime there is trauma to the tisse, the tissues will release what? | Potassium |
| This can make you constipated, but it should not cause a functional bowel obstruction. | diet |
| Describe mechanical obstruction bowel sounds. | Above the obstruction, or proximal to the obstruction you would hear hyperactive bowel sounds. Below, absent or faint bowel sounds. |
| Describe functional bowel sounds. | There will be an absence or none at all. |
| What is a flat plate x-ray of the abdomen? | No preparation, the patient doesn't have to be NPO and no contrast medium is needed. Regular x-ray of abdomen. |
| What findings on a flat plate x-ray would be consisten with a bowel obstruction? | Dilated loops of the bowel. |
| If you have a functional bowel obstruction and there is no peristalsis wuld you have dilated loops of the bowel? | Of course the gas is still going to be blocked. |
| When diagnosing an obstruction of the bowel, what do we look for in our CBC? | Increases in WBC's. |
| What will happen to the electrolytes when a patient has a bowel obstruction? | Sodium and potassium will decrease. |
| What will amylase levels be like if a patient has a bowel obstruction? | It will be elevated because it is secreted into your duodenum by the pancreas and it can't get through wso it will elevate in the system. |
| What is an x-ray obstructive series? | It is used to determine if and where a bowel obstruction is. Barium is ingestied and a series of x-rays are taken. |
| Why would a full body CT be done in a patient who has a functional obstruction. | If the patient has cancer, they can determine if there is any metastasis that could be causing the obstruction. |
| What is one of the first things we will want to do for the patient with an obstruction? | We need to provide decompression with an NG tube. |
| A functional bowel obstruction will usually resolve in: | 24-72 hours with conservative treatment. |
| What is considered conservative treatment for a functional bowel obstruction? | NG tube, treat precipitating factors such as electrolye imbalances,stimulating motility. |
| Increased activity will stimulate: | Peristalsis |
| A mechanical usually won't: | Resolve on its own. |
| For the most part this type of obstruction has to be corrected by surgery. | Mechanical obstruction |
| Why would a patient have acolon resectio with a stoma? | If there is a very large area of involvement they may remove a significant section of the colon. |
| What will removing 1-2 cm of th terminal ileum cause. | You will have to be on B-12 for the rest of your life. |
| What is the purpose of a conservative Intestinal resection? | They want to take out the smallest amount of intestine possible for absorption surface. |
| What causes short bowel syndrome? | If too much of the intestine is removed, patients can develop this. The less intestine they have, the more absorption problems they have. |
| This procedure used to be called a reversal. | A colostomy takedown. |
| When is a resectoscope used? | In colostomy takedowns. It helps to connec the ends of the colon back together and staple it from the inside. |
| The stoma that is draining fecal matter or affluentit is called: | The functioning or proximal stoma. |
| The stoma that is closest to the rectum is called: | The distal stoma or mucous fistula. |
| How soon do we need to get the patient up after colon surgery and how often. | We need to have the patient up 2-3 times withing the first 24 hours. The 2nd and 3rd post op days they need to get up 4 times a day. |
| What is peritonitis? | Bacterial or chemical inflammation of the colon. |
| Anytime there is anything internally that ruptures of perforates, of it you have anything that breaks the integrity of the abdominal wall, the patient can develop: | Peritonitis |
| What are the symptoms of peritonitis? | Abdominal pain, rebound tenderness, guarding and rigidity, tachcardia, orthostatic hypotension, diaphoresis, pallor, weakness, oliguria, fever and chills, nausea and vomiting, abnormal bowel sounds, constipation, parilytic ileus, and abdominal distention. |
| With peritonitis you will start to see the signs and symptoms of hypovolemia which are: | tachycardia, BP drops, orthostatic hypotension, diaphoresis, pallor weakness, oliguria. |
| Patients with peritonitis can go into hypovolemic shock because of what? | Fluid shifts. |
| As a nurse what do we do for the patient with peritonitis? | Monitor BP, O2, telemetry, SpO2, large bore IV, NG tube, Indwelling catheter, antibiotics and pain meds. |
| Why do we want to start a large bore IV when our patient with peritonitis is admitted? | In case we need to give blood products, or for rapid fluid replacements. |
| Why is it not a good idea to wait until a patient crashes to put in the 18 gauge IV? | Because the blood vessels get flat and then you won't be able to start the IV. |
| Whenever there is a perforation in peritonitis they will have to instill a lot of: | Antibiotic solution. |
| Any time there is a perforation, you can end up with: | peritonitis |
| What would the benefits of a paracentisit be with peritonitis. | Anytime there is an issure with the belly and we don't know what it is, we can use this to determin if we have fecal matter or blood or pus. |
| How do we treat pertonitis? | Identify the cause and adminsiter antibiotic, IV fluids and decrease abdominal distention. |
| When the patient gets hypovolemic, and you will see fluid shifts as a result of this, what happens to the HR and BP? | The HR goes up and the BP goes down. |
| We need to monitor the patient with peritonitis for s/s of: | Hypovolemia or dehydration. |
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