4. Mechanical Causes of Intestinal
Obstruction
A. Intussusceptions: The prolapse
of the intestine into the lumen
of the immediate adjacent part
B. Volvulus: Torsion of a loop of
intestine causing an
obstruction (may also have
strangulation)
C. Hernia: An abnormal
protrusion through the
abdominal wall
5. Functional Causes of Bowel
Obstruction
Ileus, paralytic ileus, adynamic)
musculature can’t propel bowel contents usually
accompanied by peritonitis
Symptoms include abdominal pain and distention,
vomiting and constipation. Potential complications
include dehydration and shock.
Treatment : Decompression with a tube at the site of
the obstruction
6. Small Bowell Obstruction
Pathophysiology
Obstruction
Effluent and flatus collect above abdominal distention
Distention and fluid retention absorp & stimulate
prod of more fluids
distention intraluminal press venous and
art cap press
edema, congestion, necrosis, rupture
7. Signs and SXs of Small Bowel
Obstruction
Crampy abdominal pain that is wavelike and colicky
Pass blood and mucus but no feces or flatus
Vomiting
In severe cases reverse peristalsis
8. Example of an x ray showing a small
bowel obstruction
9. Large Bowel Obstruction
Pathophysiology
Obstruction build up of effluent & gas above site
severe distention and perforation
Often undramatic (unlike sbo)
Strangulation and necrosis are life threatening
Adenocarcinoid tumors account for the majority of
large bowel obstructions
10. Signs & SXs of Large Bowel
Obstruction
Constipation (may be the only sx for months)
Alteration in the shape of stool
Weakness, anorexia and weight loss
May develop iron deficiency anemia
Distended abdomen showing the outline of the large
bowel
11. Treatment Options for LBO
Monitor symptoms, provide sx relief
Surgical resection of bowel and formation of
ostomy (temp or permanent) if condition worsens
Nursing Care
Monitor for improvement, deterioration
Fluid and electrolyte balance
Pre- & post-op care
12. Bowel Obstruction
Clinical Signs & SXs Small Intestine Large Intestine
Onset Rapid Gradual
Vomiting Frequent & Copious Rare
Pain Colicky, cramp like, Low grade, crampy
intermittent
Bowel Movements Feces for a short duration Absolute constipation
Abdominal Distention Minimally increased Greatly increased
13. Colorectal Cancer
Risk Factors (cause unknown):
Over 40
Blood in stool
History of rectal polyps
Family history
History of inflammatory bowel disease
High fat, protein, beef diet; low fiber
The third most common cause of U.S. cancer deaths
Risk factors: see Chart 38-8
Importance of screening procedures
Manifestations include change in bowel habits; blood in stool—occult, tarry,
bleeding; tenesmus; symptoms of obstruction; pain, either abdominal or rectal;
feeling of incomplete evacuation
Treatment depends upon the stage of the disease
14. Patho-physiology of Colorectal
Cancer
Predominantly adenocarcinoma (arising from the
epithelial cells of the intestine
Symptoms •Rectal
Right side •Tenesmus
•Pain
Dull pain
•Felling of
Melena incomplete
Left side evacuation
•Bloody stools
Pain/cramping
Narrowing stools
Constipation
Bright blood
15. Colon Cancer
Diagnosis
Abdominal and rectal exam
Fecal occult blood testing
Barium enema
Colonoscopy / sigmoidoscopy with biopsy & cytology
smears
Carcinoembryonic antigen (CEA) (dx and recurrence)
16. Nursing Process—Assessment of the Patient
With Cancer of the Colon or Rectum
Health history
Fatigue and weakness
Abdominal or rectal pain
Nutritional status and dietary habits
Elimination patterns
Abdominal assessment
Characteristics of stool
17. Nursing Diagnosis
Anxiety
Pain
Altered nutrition, less than
High risk for fluid volume deficit
High risk for infection
Knowledge deficit
Impaired skin integrity
Disturbed body image
Ineffective sexuality patterns
18. Potential Complications of Colon or
Rectal Cancer
Intraperitoneal infection
Complete large bowel obstruction
GI bleeding
Bowel perforation
Peritonitis, abscess, and sepsis
20. Placement of
Permanent Colostomies
A. Sigmoid
Feces are
solid
B. Descending
Feces are
semi-mushy
C. Transverse
Feces are
mushy
D. Ascending
Feces are
fluid
23. Managing Nasogastric Tubes
Feeding vs.
Decompression
Placement
Verification
Guidelines for
Flushing
Patient Positioning
24. Nasogastric Tubes
Decompress
Lavage
Diagnose GI motility and other disorders
Administer medications and feedings
Treat an obstruction
Compress a bleeding site
Aspirate gastric contents for analysis
25. Care of the Patient with a G-Tube
Check institution’s policy
for management
Monitor GI function and
tube insertion site at least
once per shift
Assess gastric drainage for
amount and characteristics
each shift
26. Care of the Patient with an NG or
G-Tube
Irrigate q 4 hours.
Flush a tube used for feeding with 30ml
Replace irrigation equipment per protocol.
Reposition as needed
Clean nares, apply water soluble lubricant and retape
daily or prn.
Oral hygiene
Clean new abdominal tube site
27. Medication Administration by NG
or G-Tube
Assess for placement and flush with 30 ml water.
When gastric suction prescribed, clamp tube for 20 minutes after
instillation of medications to allow for absorption.
Avoid crushing sustained release, enteric coated products, or drugs in a
chewable or sublingual form.
Administer crushed medications separately; do not mix together in
water.
Flush with about 15 ml between each medication.
Some medications, for example Dilantin, are rendered less potent when
given with tube feedings. For these medications, it is important to turn
the feeding off for 30-45 minutes following medication administration.
Check your institution’s policy for specifics.
28. Enteral Feeding
Verify placement
Verify formula, amount, and method of
administration upon initiation of feeding
and minimally once per shift there after
Confirm placement
Monitor for vomiting, diarrhea, changes in
aspirates, abdominal characteristics,
change in bowel sounds, onset of
respiratory distress, hypotension, fever or
significant change in UO.
Monitor labs (especially glucose levels).
Assess weight.
Elevate HOB 30 degrees – when and why?
Aspirate for residual