Nursing care plan intestinal obstruction

Intestinal Obstruction

Intestinal (bowel) obstruction is a condition in which the intestinal contents fail to move through the bowel. The obstruction can be partial or complete and can develop slowly or rapidly. It can occur as a result of any factor that narrows the lumen of the intestine or interferes with peristalsis. Narrowing of the lumen results in a mechanical obstruction and can be caused by factors such as adhesions, tumors, inflammatory bowel disease, hernias, fecal impaction, intussusception, a volvulus, and strictures. In a nonmechanical obstruction, the bowel lumen remains open but the intestinal contents are not propelled forward. Factors that can cause this paralytic (adynamic) ileus include abdominal surgery, effects of anesthesia and some medications (e.g., narcotic [opioid] analgesics, some antiemetics, anticholinergics, antidiarrheals), electrolyte imbalances such as hypokalemia, decreased blood flow to the intestine (can occur with conditions such as hypovolemia or blockage of mesenteric vessels as a result of an embolus, thrombus, or arteriosclerosis), spinal cord injury, and peritonitis.

Signs and symptoms of intestinal obstruction vary depending on the location, cause, and degree of the obstruction. Common clinical manifestations include abdominal pain and distention, nausea, and vomiting. Hyperactive, high-pitched bowel sounds are present early in the development of a mechanical obstruction. Bowel sounds are absent or hypoactive in nonmechanical obstruction and as mechanical obstruction worsens.

Treatment of intestinal obstruction is directed toward relieving symptoms, managing fluid and electrolyte imbalances, preventing complications, and determining and treating the cause of the obstruction. Most cases of nonmechanical obstruction do not necessitate surgery. Some mechanical obstructions can be treated nonsurgically (e.g., enemas and laxatives to remove fecal impaction, dilatation of obstructed portion of bowel via endoscopy, radiation or chemotherapy to reduce tumor size, gentle instillation of barium to resolve an intussusception or reverse a sigmoid volvulus). Surgical intervention (intestinal resection with reanastomosis or creation of an ileostomy or colostomy) is indicated when it is necessary to remove an obstruction that persists despite conservative management or to remove a segment of bowel that is strangulated or necrotic.

Imbalanced fluid and electrolytes
deficient fluid volume, hypokalemia, hypochloremia, and metabolic alkalosis
Acute pain: abdominal
Potential complications
intestinal necrosis
Deficient knowledge, Ineffective therapeutic regimen management, or Ineffective health maintenance

Additional Diagnoses
Imbalanced nutrition: less than body requirements
Impaired oral mucous membrane: dryness
Ineffective breathing pattern
Fear and anxiety

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