Intestinal Obstruction( treatment , Diagnoses , Nursing Interventions )

 Treatment of Intestinal Obstruction

* There is two types of treatment :

                                                        

        👉      Nonsurgical Management                           👉          Surgery

1/ Nonsurgical Management:

• Correction of fluid and electrolyte imbalances with normal saline or Ringer's solution with potassium as required.

• NG suction to decompress bowel.

• TPN may be necessary to correct protein deficiency from chronic obstruction, paralytic ileus, or infection.

• Analgesics and sedatives, avoiding opiates due to GI motility inhibition.

• Antibiotics to prevent or treat infection.

• Ambulation for patients with paralytic ileus to encourage return of peristalsis.

2/ Surgery :

*Consists of relieving obstruction. Options include:

• Closed bowel procedures: lysis of adhesions, reduction of volvulus, intussusception, or incarcerated hernia Enterotomy for removal of foreign bodies.

• Resection of bowel for obstructing lesions, or strangulated bowel with end to-end anastomosis Intestinal bypass around obstruction Temporary ostomy may be indicated.

Nursing Diagnoses

• Acute Pain related to obstruction, distention, and strangulation.

• Risk for Deficient Fluid Volume related to impaired fluid intake, vomiting, and diarrhea from intestinal obstruction.

• Diarrhea related to obstruction.

• Ineffective Breathing Pattern related to abdominal distention, interfering with normal lung expansion.

• Risk for Injury related to complications and severity of illness.

• Fear related to life-threatening symptoms of intestinal obstruction.

Nursing Interventions

Achieving Pain Relief:

1. Administer prescribed analgesics.
2. Provide supportive care during NG intubation to assist with discomfort.
3. To relieve air-fluid lock syndrome, turn the patient from supine to prone position every 10 minutes until enough flatus is passed to decompress the abdomen.   A rectal tube may be indicated

Maintaining Electrolyte and Fluid Balance:

1. Measure and record all intake and output.
2. Administer I.V. fluids and parenteral nutrition as prescribed.
3. Monitor electrolytes, urine analysis, hemoglobin, and blood cell counts, and report any abnormalities.
4. Monitor urine output to assess renal function and to detect urine retention due to bladder compressions by the distended intestine.
5. Monitor vital signs; a drop in BP may indicate decreased circulatory volume due to blood loss from strangulated hernia.

Maintaining Normal Bowel Elimination:

1. Collect stool samples to test for occult blood if ordered.
2. Maintain adequate fluid balance.
3. Record amount and consistency of stools.
4. Maintain NG tube as prescribed to decompress bowel.

Maintaining Proper Lung Ventilation:

1. Keep the patient in Fowler's position to promote ventilation and relieve abdominal distention.
2. Monitor ABG levels for oxygenation levels if ordered.

Preventing Injury Due to Complications:

1. Prevent infarction by carefully assessing the patient's status; pain that increases in intensity or becomes localized or continuous may herald strangulation.
2. Detect early signs of peritonitis to minimize this complication.
3. Avoid enemas, which may distort an X-ray or make a partial obstruction worse.
4. Observe for signs of shock.
5. Watch for signs of (metabolic alkalosis and metabolic acidosis ).