Chapter 60-Pt. 2
Terms
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- Intestinal Obstruction
- Can be partial or complete Mechanical- bowel is physically obstructed by disorders outside the intestine Nonmechanical- result of neuromuscular distrubance- does not involve a physical obstruction in or outside the intestine Peristalsis is decreased or absent- resulting in slowing in the movement or backup of intestinal contents Obstruction high in the small intestine causes a loss of gastric hydrochloride- METABOLIC ALKALOSIS Obstruction a the end of the small intestine and lower in the intestinal tract causes loss of alkaline fluid- METABOLIC ACIDOSIS
- Mechanical Obstruction
- Result from adhesions Tumors Hernias Fecal Impaction(Older Adults) Strictures dut to Crohn's disease or radiation Intussusception Volvulus- twisting of the intestine Fibrosis due to disorders such as endometriosis Vascular Disorder
- Nonmechanical Obstruction
- Paralytic or adynamic, ileus Caused by physiologic, neurogenic, or chemical imbalances associated with decreased peristalsis from trauma or the effect of a toxin on autonomic intestinal control Adynamic ileus- occurs to some degree following abdominal surgery or trauma Paralytic ileus can be caused by handling of the intestines during abdominal surgery; intestinal function is lost for a few hours to several days- Caused by myocardial infarction, rib fracture, and pneumonia
- Mechanical Obstruction-Manifestations
- Mild abdominal pain or cramping Vomit may contain bile and mucus or be orange-brown and foul smelling Visible peristaltic waves High pitched bowel sounds (borborygmi)- associated with cramping early in the obstructive process as intestine tries to push the mechanical obstruction forward In later stage, bowel sounds are absent Abdominal tenderness and rigidity are minimal
- Nonmechanical Obstruction-Manifestations
- Pain is constant, diffuse, discomfort NO COLICKY PAIN Abdominal distention is PRESENT Decreased bowel sounds in early obstruction Absent bowel sounds in later stages
- Nonsurgical Management
- Nasogastric Tube- Assess for proper placement of the tube, tube patency, and output at least every 4 hours and irrigate with 30mL of NS Assess for peristalsis by auscultating for bowel sounds with the suction DISCONNECTED (suction masks peristaltic sounds)