JMJ Marist Brothers Notre Dame of Dadiangas University College of Nursing

A Case Presentation on Intestinal Obstruction

In Partial Fulfillment of The Requirements in NCM B 102

Presented by: James Lyndel L. Mandal, SN Angiela Marie N. Lopez, SN Katherine L. Laud, SN Selma R. Lang, SN BSN 3A

Presented to: Shirley L. Gellor, RN Clinical Instructor

January 21, 2010

ABSTRACT

Intestinal obstruction is a significant mechanical impairment or complete arrest of the passage of contents through the intestine. Intestinal obstructions account for 20% of all acute surgical admissions. Mortality and morbidity are dependent on the early recognition and correct diagnosis of obstruction. If untreated, strangulated obstructions cause death in 100% of patients. However, the mortality rate decreases to 8% with prompt surgical intervention (Vicky P. Kent, RN, PhD, CNE, 2009). Nanay Ganda, 84 years old, was admitted last December 8, 2010 at General Santos Doctors Hospital under the care of Dr. Albano, had complaints of inability to defecate by about 4 days. A background of one year history of intermittent abdominal pain with bloating was claimed by the patient. The impression to the result of the ultrasound of her whole abdomen is to consider ileus; partial obstruction and fecal stasis. Dr. Albano believed that the symptoms being manifested were results of a disorder she has in a long time. Since they werent able to have that checked and it wasnt figured out earlier, the signs become more evident now. Its also because these manifestations develop and progresses relatively slowly. It was then that the physician decided to let the patient undergo exploratory lap to detect what really had cause the obstruction. It was December 13, 2010 when the surgeon discovered a tumor at the site of the obstruction particularly at the descending colon and immediately removed it. The found tumor was then subjected for biopsy.

ACKNOWLEDGEMENT

The student nurses would like to extend their heartfelt gratitude to the following: To the parents of the student nurses, for the moral and financial support, as well as to the love theyve always shown them; To their beloved Clinical Instructors and consultants especially Ms. Shirley L. Gellor, for giving them the chance to experience this Case Presentation making and for sharing her expertise in the field of case study; To their friends, for helping them in their hardships and trials in life; To their school, Notre Dame of Dadiangas University, Nursing Department, for giving them the quality education and teaching them the moral values to the formation of persons in all levels of learning as Christian leaders, competent professionals, community-oriented citizens, and culture-

sensitive individuals in active participation of building a peaceful and progressive nation. Above all, the Almighty God, for the wisdom, knowledge, guidance, good health and unconditional love He had given them.

Table of Contents

Page Title Page Abstract Acknowledgement Chapter

1 2 3 4

i ii iii

Introduction Purpose of the Study Patients Database Nursing History History of Present Illness Past Medical History Immunization and Childhood Illness Compliance to Health Management Menarche Family History Activities of Daily Living

1 4 6

8 8 9 9 9

Hospitalization Nursing Physical Assessment

5 6 7

11 12 24 47

Anatomy and Physiology Pathophysiology Medical and Nursing Management Ideal Diagnostic Tests Ideal Medical Management Ideal Nursing Management Actual Diagnostic Tests Actual Medical Management Surgery Actual Nursing Management Actual Pharmacological Management Prognosis Discharge Planning

51 52 53 54 66 75 75 77 102 104 107 135

8 9

Gordons Functional Health Pattern Nursing Care Plan

Bibliography

144