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INTESTINAL OBSTRUCTION: A. INTESTINAL OBSTRUCTION= inability to poop a. Mechanical- due to disorders outside of the intestines b. Non-mechanical- A.K.

A PARALYTIC ILEUS- due to neuromuscular or vascular disorders i. Causes- hypokalemia, inflammatory response, peritonitis B. ETIOLOGY & PATHOPHYSIOLOGY a. Obstruction cause gas, fluid and intestinal contents to accumulate above obstructionmalabsorption of fluids & e-lytesdecreased blood volumehypotension & hypovolemic shock b. Small bowel obstructionmetabolic alkalosis; large bowel obstructionmetabolic acidosis C. SIGNS & SYMPTOMS: a. ABSOMINAL DISTENTION (hallmark) b. Borborygmi above obstruction c. Colicky cramp like painsmall bowel obstruction; dull cramping painlarge bowel obstruction d. Rapid onset N&V that is perfusefood particleswaterybile (small bowel) i. Large bowel rarely vomits, when doorange-brown w/ foul odour due to accumulation bacteria e. Obstipation f. Hiccups D. DIAGNOSTIC TESTS: a. Abdominal flat-panel x-ray- shows air (suggests peritonitis)and fluid (suggests abscess) b. CT scan c. Barium enema & Barium swallow -locate obstruction large & small bowel d. Upper & lower GI series endoscopy e. Sigmoidoscopy or colonoscopy (not if perforation) f. Guaiac stool g. CBC: WBC increase indicates perforation h. Serum e-ltyes Na, K+ Cli. j. HgB & HCT- increased=hemoconcentration, decrease = poss bleeding BUN & creatinine to ensure adequate fluid resuscitation levels

E. COLLABORATIVE: a. NPO b. NG (salem-sump, Levin) w/ sxn or intestinal tube (canto, miller abbott) i. Patency & position q4 ii. Ice chips iii. Oral & nasal hygiene- use water-soluble lube before taping iv. Abdominal girths c. IV fluid resuscitation w/ NS (add K+) or ringers lactate i. VS, UOP, skin turgor ii. I/O iii. Assess for edema and ascites iv. Daily weight v. TPN if ordered d. Pain Management i. Opiods when in diagnostic phase ii. Semi-fowlers e. Administer antibiotics f. Surgery i. Exploratory Laparotomy 1. Post-op same as per colorectal surgery