Aberos, Marithe Joi A.

Group 1- 4BSN1

Partial Gut Obstruction

DESCRIPTION

 A condition involving the intestinal tract (small bowel and large bowel)

 Characterized by the partial obstruction in the passage of stool through bowels.

 Most bowel obstruction occur in the small intestine

 About 15% of intestinal obstructions occur in the large bowl

SIGNS AND SYMPTOMS

 FOR SMALL BOWEL OBSTRUCTION

 Crampy pain

 Diarrhea

 Vomiting

 FOR LARGE BOWEL OBSTRUCTION

 Constipation
 Abdomen becomes distended
 Crampy lower abdominal pain
 Shock
 Vomiting

RISK FACTORS

MODIFIABLE – age

NON-MODIFIABLE – age, sigmoid volvulus, hernia, colon mass, cecal volvulus.

LABORATORY AND DIAGNOSTIC TESTS

CT scan

 Shows detailed images of any part of the body, including the bones, muscles, fat,
organs, and blood vessels.
 Used to visualize placement of needles during biopsies of abdominal organs or tumors
or during aspiration (withdrawal) of fluid from the abdomen.

Abdominal X-ray

 Shows abnormal quantities of gas, fluid, or both in the bowel.

Complete blood count (CBC) and Electrolyte studies

 detect a variety of diseases and conditions, such as infections, anemia and leukemia.

 Reveal a picture of dehydration, loss of plasma, and possible infection.

MEDICAL MANAGEMENT

SMALL BOWEL OBSTRUCTION

o Decompression of the bowel through a nasogastric or small bowel tube is successful in most
cases.
o Before surgery, intravenous therapy is necessary to replace the depleted water, sodium,
chloride, and potassium.
o The surgical treatment of intestinal obstruction depends largely on the cause of the obstruction.
In the most common causes of obstruction, such as hernia and adhesions, the surgical
procedure involves repairing the hernia or dividing the adhesion to which the intestine is
attached. In some instances, the portion of affected bowel may be removed, and an
anastomosis performed. The complexity of the surgical procedure for intestinal obstruction
depends on the duration of the obstruction and the condition of the intestine

LARGE BOWEL MANAGEMENT

o A colonoscopy may be performed to untwist and decompress the bowel.

o Cecostomy, in which a surgical opening is made into the cecum, may be performed for patients
who are poor surgical risks and urgently need relief from the obstruction.
o A temporary or permanent colostomy may be necessary.
o Ileoanal anastomosis may be performed if it is necessary to remove the entire large colon.
NURSING MANAGEMENT

SMALL BOWEL MANAGEMENT

o Maintaining the function of the nasogastric tube, assessing, and measuring the nasogastric
output.
o Assessing for fluid and electrolyte imbalance, monitoring nutritional status, and assessing
improvement (e.g., return of normal bowel sounds, decreased abdominal distention, subjective
improvement in abdominal pain and tenderness, passage of flatus or stool).
o Reports discrepancies in intake and output, worsening of pain or abdominal distention, and
increased nasogastric output.
o If the patient’s condition does not improve, the nurse prepares him or her for surgery.

LARGE BOWEL MOVEMENT

o Monitor the patient for symptoms that indicate that the intestinal obstruction is worsening and
to provide emotional support and comfort.
o Administers intravenous fluids and electrolytes as prescribed.
o If the patient’s condition does not respond to nonsurgical treatment, the nurse prepares the
patient for surgery.
o Preoperative teaching as the patient’s condition indicates.
o After surgery, general abdominal wound care and routine postoperative nursing care are
provided.
 Mechanism of
Drug Name Indication Contraindication Side effect Adverse effect Nursing responsibility
action
Generic name: -Reduces gastric Duodenal ulcer, Hypersensitivity to Headache. CNS: dizziness, -Evaluate for therapeutic
acid secretion and gastric ulcer, other proton pump Occasional headache, asthenia response (relief of GI symptoms).
Omeprazole
increases gastric hypersecretory inhibitors. (3%–2%): Diarrhea, GI: nausea, vomiting, Question if GI discomfort, nausea,
  mucus and conditions, H. abdominal pain, diarrhea, constipation, diarrhea occurs.
Brand Name: bicarbonate pylori nausea. abdominal pain -Tell patient to take 30 to 60
production, eradication,
Prilosec minutes before a meal, preferably
creating GERD, erosive Rare (2%): Dizziness, Metabolic:
in morning.
  protective coating asthenia (loss of hypomagnesemia
esophagitis strength, energy),
Patient dose: on gastric mucosa Musculoskeletal: back - Instruct patient to swallow
vomiting,
and easing pain; fractures of hip, capsules or tablets whole and not
40 mg IV OD discomfort from constipation, upper wrist, spine (with long- to chew or crush them. If he can’t
  excess gastric acid respiratory tract swallow capsule, tell him he may
term daily use)
infection, back pain, open it, carefully sprinkle and mix
Drug   Respiratory: cough,
rash, cough. entire contents into 1 tbsp of cool
Classification: upper respiratory tract applesauce, and swallow
-Proton pump infection immediately with glass of water
Inhibitor. Skin: rash -Report headache, onset of black,
tarry stools, diarrhea, abdominal
 
pain.
-Avoid alcohol. 
-Swallow capsules whole; do not
chew, crush, dissolve, or divide.
- Take before eating.
 Mechanism of
Drug Name Indication Contraindication Side effect Adverse effect Nursing responsibility
action

Generic name: Centrally acting Management of Hypersensitivity to Dizziness, vertigo, fatigue,  Monitor vital signs
opiate receptor moderate to tramadol or other headache, headache, and assess for
Tramadol
agonist that inhibits moderately severe opioid analgesics; somnolence, restlessness orthostatic
Drowsiness,
  the uptake of pain. patients on MAO , seizures, vomiting, hypotension or signs
nausea, vomiting,
Brand name: norepinephrine and inhibitors; patients xerostomia, dyspepsia, of CNS depression.
constipation,
serotonin, acutely intoxicated diarrhea, abdominal pain,  Assess bowel and
Ultram lack of energy,
suggesting both with alcohol, anorexia bladder function;
  opioid and hypnotics, centrally sweating, dry report urinary
nonopioid acting analgesics, mouth, frequency or
 
mechanisms of pain opioids, or itching retention.
Dosage: relief. psychotropic drugs;  Discontinue drug
50mg tab substance abuse; and notify physician
patients on obstetric if S&S of
 
preoperative hypersensitivity
Route: medication; abrupt occur.
Oral discontinuation;
alcohol intoxication;
 
pregnancy (category
Drug Classification: C); lactation;
Analgesic children <16 y.
 Nursing
Drug Name Mechanism of action Indication Contraindication Side effect Adverse effect
responsibility
Generic name: Synthetic compound preoperative Blood dyscrasias; loss of appetite, Hypersensitivity, Assess for any
with direct prophylaxis in active CNS disease; diarrhea, trouble fever, fleeting joint sensitivity to
Metronidazole
trichomonacidal and colorectal surgery, first trimester of sleeping, headache, pains, overgrowth antibiotics.
  amebicidal activity as elective hysterectomy pregnancy (category dizziness, stomach of Candida. 
 
Brand name: Flagyl well as antibacterial or vaginal repair, and B), lactation. upset, weakness; ·
CNS: restlessness,
activity against emergency nausea, vomiting, Report to physician
  weakness, fatigue,
anaerobic bacteria appendectomy. IV any sign of adverse
  and some gram- metronidazole is used GI: Nausea, vomiting, reaction
negative bacteria. for the treatment of anorexia, epigastric
Dosage:  
serious infections distress, abdominal
500mg TIV OD cramps, diarrhea, Discontinue therapy
caused by susceptible
constipation, dry immediately if
  anaerobic bacteria in
mouth symptoms of CNS
intraabdominal
Drug Classification: toxicity develop.
infections, skin
Antibiotic infections,  
gynecologic Monitor especially for
infections, seizures and
septicemia, and for peripheral
both pre- and neuropathy
postoperative
prophylaxis, bacterial  
vaginosis.
ASSESSMEN DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
T
SUBJECTIVE Problem: Acute pain SHORT TERM GOAL: INDEPENDENT: 1. To create an SHORT TERM
: related to Within 3 hours of nursing intervention that client GOAL:
Having postoperative surgical interventions the patient 1. Assess for referred pain, as will be able to tolerate After 3 hours of nursing
radiating pain in incision as evidence will be able to report that appropriate. interventions the patient
the incision site by verbal reports of pain is relieved or 2. Provides information is able to report that pain
as verbalized by pain controlled. 2. Ask the client about the about need for or is relieved or controlled.
the client. severity of pain. effectiveness of
LONG TERM GOAL: interventions LONG TERM GOAL:
OBJECTIVE: Within 2 to 3 days of 3. Monitor Vital signs After 2 to 3 days of
-Guarded nursing intervention 3. Alteration on vital nursing intervention
behavior on the patients will be able to 4. Assist the patient into a signs could indicate the patients have appear
post-op sit appear relaxed, able to semi-fowler's position with a client is in pain. Such as relaxed, able to
-Facial Grimace rest/sleep and participate few pillows under the head and elevated temperature.. rest/sleep and participate
in activities appropriately. one under the knees for in activities
-Pain scale 7/10 support. 4. Prevents stress on the appropriately.
suture line and reduces
5. Promote bed rest. muscle tension. Goal met.

DEPENDENT 5. Bed rest in reduces

6. Administer medications as
indicated.
COLLABORATIVE
7.Provide for individualized
physical therapy/exercise
program
that can be continued by the
intra-abdominal
pressure.
6. To promote the
healing process and to
reduce pain that the
patient had.
7. To promote wellness.
 client when discharged.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

OBJECTIVE: Risk for SHORT TERM INDEPENDENT: 1. Increased body temperature SHORT TERM GOAL:
-Client has an infection GOAL: indicates fever as evidenced by After 1 to 3 hrs of Nursing
incision from related to Within 1 to 3 hrs infection. intervention Client
surgical 1. Monitor client vital signs.
surgery. client will be able Such as increase in body verbalized understanding
incision to identify temperature 2. To help the patient identify the of individual causative/
interventions to present risk factors that may add up risk factor and identify
prevent/reduce risk to the infection interventions to prevent
of infection. 2. Inspect and note risk factors /reduce risk for infection
for occurrence of infection
( skin integrity, environ-mental 3. To evaluate if the character,
LONG TERM exposure) presence and condition of the present LONG TERM GOAL:
GOAL: infection. After 1 to 2 days of
Within 1 to 2 days Nursing Intervention client
of nursing Demonstrate techniques,
intervention client 3. Observe for localized signs 4.Technique decreases the chances of lifestyle changes to
will be able to of infection at insertion sites, transmitting or spreading pathogens
to or between patients. Interrupting promote safe environment
demonstrate sutures, and surgical and achieve timely wound
techniques, incision/wounds. the chain of infection and it is an
lifestyle changes effective way to prevent the spread of healing; be free from
infection. purulent drainage or
to promote safe erythema; be afebrile.
environment and 4. Maintain strict asepsis for
achieve timely dressing changes, wound care
wound healing; be 5. Wet area can be lodge area of
bacteria Goal met.
free from purulent
drainage or 5. Keep wound area clean and
erythema; be dry
6.Discontinuation of treatment when
afebrile.
client begins to feel well may result
6. Encourage to take full in return of infection.
course of antibiotics

7. Knowledge of ways to prevent

7. Educate clients and SO cross contamination or reduce the
(significant other) about Proper germs transmission.
hand washing and disinfecting,
and sterilizing items.
8. To promote relaxation and reduce
stress to the client
8. Promote quiet and safe
environment.

DEPENDENT:

9. This medication was tend for

9. Administer medication as
ordered such as
Analgesic (paracetamol,
Tramadol ) and Antibiotic
(Ceftriazone,Metronidazole
and Meropenem)
COLLABORATIVE:
10. Cooperate with laboratory
team and report to the
physician about abnormal
treatment such as Analgesic for
fever or pain or for moderate to
severe pain. Antibiotic is antibacterial
as treatment for infection
10.Immediate identification of type
of infective organism by Gram stain
allows prompt treatment, while more
specific identification by cultures can
be obtained in hours or days And
lower WBC indication of infection .
 changes in WBC.

FDAR

Focus Progress Note

Pain D: “Ang sakit ng tahi ko nurse” as verbalized by the patient. Pain scale 7/10
A: Administered Tramadol 50mg orally as prescribed
Promote bed rest
R: Patient verbalized, “Mas okay na, hindi na siya sobrang sakit”. Pain scale 2/10