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NCP Nursing Care Plans for Intestinal Obstruction. Intestinal obstruction is the partial or complete blockage of the lumen of the small or large bowel. Intestinal obstruction occurs when a blockage obstructs the normal flow of contents through the intestinal tract. It’s commonly a medical emergency. Complete obstruction in any part of the bowel, if untreated, can cause death within hours from shock and vascular collapse. Intestinal obstruction is most likely after abdominal surgery or in people with congenital bowel deformities.
Causes for Intestinal Obstruction
The two major types of intestinal obstruction are mechanical and neurogenic or nonmechanical.
Intestinal obstruction results from mechanical or nonmechanical (neurogenic) blockage of the lumen.
  • Mechanical obstruction include adhesions and strangulated hernias (Mechanical obstruction usually associated with small-bowel obstruction) chronic, severe constipation or fecal impaction, carcinomas (usually associated with large-bowel obstruction) foreign bodies, such as fruit pits, gallstones, and worms; compression of the bowel wall from stenosis; intussusception; volvulus of the sigmoid or cecum, tumors and atresia.
  • Nonmechanical obstruction usually results from paralytic ileus, the most common of all intestinal obstructions. Paralytic ileus is a physiological form of intestinal obstruction that usually develops in the small bowel after abdominal surgery. Other nonmechanical causes of obstruction include electrolyte imbalances, toxicity, such as that associated with uremia or generalized infection; neurogenic abnormalities such as spinal cord lesions; and thrombosis or embolism of mesenteric vessels.
Complications for Intestinal Obstruction
Intestinal obstruction can lead to perforation, peritonitis, septicemia, secondary infection, metabolic alkalosis or acidosis, hypovolemia or septic shock and, if untreated, death.
Nursing Assessment Nursing Care Plans for Intestinal Obstruction
Investigation of the patient’s history often reveals predisposing factors, such as surgery (especially abdominal surgery), radiation therapy, and gallstones. The history may also disclose certain illnesses that can lead to obstruction, such as Crohn’s disease, diverticular disease, and ulcerative colitis. Family history may reveal colorectal cancer in one or more relatives. Hiccups are a common complaint in all types of bowel obstruction. Other specific assessment findings depend on the cause of obstruction mechanical or nonmechanical and its location in the bowel
Diagnostic tests for Intestinal Obstruction
Various tests help to establish the diagnosis and pinpoint complications. For example,
  • Abdominal X-rays.
  • Barium enema In large-bowel obstruction reveals a distended, air-filled colon or a closed loop of sigmoid with extreme distention
  • Serum sodium, chloride, and potassium levels may decrease because of vomiting.
  • White blood cell counts may be normal or slightly elevated if necrosis, peritonitis, or strangulation occurs. Serum amylase level may increase, possibly from irritation of the pancreas by a bowel loop.
  • Hemoglobin concentration and hematocrit may increase, indicating dehydration.
  • Sigmoidoscopy, colonoscopy, or a barium enema may be used to help determine the cause of obstruction.
Nursing diagnosis Nursing Care Plans for Intestinal Obstruction
  • Acute pain
  • Constipation
  • Deficient fluid volume
  • Imbalanced nutrition: Less than body requirements
  • Ineffective tissue perfusion: GI
Nursing Key outcomes Nursing Care Plans for Intestinal Obstruction
  • The patient will express feelings of comfort, Report pain is relieved/controlled, Verbalize methods that provide relief.
  • The patient’s bowel function will return to normal, Participate in bowel program as indicated.
  • The patient’s fluid volume will remain within normal parameters, Maintain fluid volume at a functional level as evidenced by individually adequate urinary output, stable vital signs, moist mucous membranes, good skin turgor.
  • The patient will maintain adequate caloric intake. Demonstrate behaviors, lifestyle changes to regain and/or maintain appropriate weight.
  • The patient will exhibit signs of adequate GI perfusion.
Nursing interventions Nursing Care Plans for Intestinal Obstruction
  •  Pain Management Alleviation of pain or a reduction in pain to a level of comfort that is acceptable to the patient. Analgesic Administration Use of pharmacologic agents to reduce or eliminate pain. Environmental Comfort Management Manipulation of the patient’s surroundings for promotion of optimal comfort
  • Constipation/Impaction Management: Prevention and alleviation of constipation/impaction. Bowel Management: Establishment and maintenance of a regular pattern of bowel elimination
  • Fluid Management Promotion of fluid balance and prevention of complications resulting from abnormal or undesired fluid levels. Hypovolemia Management: Reduction in extracellular and/or intracellular fluid volume and prevention of complications in a patient who is fluid overloaded. Shock Management: Volume: Promotion of adequate tissue perfusion for a patient with severely compromised intravascular volume.
  • Nutrition Management Assisting with or providing a balanced dietary intake of foods and fluids. Weight Gain Assistance Facilitating gain of body weight.
  • Fluid/Electrolyte Management Promotion of fluid/electrolyte balance and prevention of complications resulting from abnormal or undesired fluid/serum electrolyte levels. Gastrointestinal Intubation: Insertion of a tube into the gastrointestinal tract

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