1

A CARE STUDY OF A FIFTY SIX YEAR OLD WOMAN WITH DIAGNOSIS OF

INTESTINAL OBSTRUCTION ADMITTED TO PLATEAU STATE SPECIALIST

HOSPITAL, JOS.

BY

OGUNSIJI PRAISE JESUFEMI

(FTN090620236276)

SUMMITED TO THE FACULTY HEALTH SCIENCE AND TECHNOLOGY,

DEPARTMENT OF NURSING SCIENCE, UNIVERSITY OF JOS, PLATEAU STATE.

IN PARTIAL FULFILMENT OF A REQUIREMENT OF NURSING AND MIDWIFERY

COUNCIL OF NIGERIA FOR THE AWARD OF

“LICENSED REGISTERED NURSE”CERTIFICATE

NOVEMBER, 2023

ii
 CERTIFICATION

This is to certify that this care study was carried out by OGUNSIJI PRAISE JESUFEMI

with the examination number NFTN/23/00519 under supervision.

____________________

Dr. OGUNYEWO A.O Signature & Date

Supervisor

_____________________ ______________

DR. OGUNYEWO A.O Signature & Date

HOD Nursing

_______________ __________________

Chief Examiner Signature & Date

iii | G A L L S T O N E S (CHOLELITHIASIS)
 DEDICATION

This care study is dedicated to my parent.

iv | G A L L S T O N E S (CHOLELITHIASIS)
 Acknowledgement

I wish to express my heartfelt gratitude to my supervisors, Dr. Ogunyewo, whose professional,

time and physical support were vital in the completion of this work.

Special thanks go to all staff Department of Nursing Science, university of Jos and all the

Nursing staffs of Plateau state specialist hospital, Jos, for their professionalism and critics which

have played a great deal to my present achievement.

To my beloved parents Mr. & Mrs. Ogunsiji Sunday Olatunji, who gave me their full support I

needed in my academic achievement.

I am glad to use this medium to express my appreciation to Mr.& Mrs. Agbonyin Micheal and

Dr. Faniran for their support and encouragement, which inspired me to work harder. Also, to a

friend like a Blood Brother, Ige Blessing Iyanuoluwa,, I really appreciate your presence in my

life. Not failing to remember my friends, Oladosu Taiwo Janet, Oderinde Stephen Olawale, who

assisted me with prayers and financial support throughout period of my studies.

Above all, to Almighty God who guided and protected me throughout my period of my studies.

v|GALLSTONES (CHOLELITHIASIS)
 TABLE OF CONTENT

vi | G A L L S T O N E S (CHOLELITHIASIS)
vii | G A L L S T O N E S (CHOLELITHIASIS)
 CHAPTER ONE

INTRODUCTON

1.0 Introduction to study

This is a case study of a 56 years old woman with the diagnosis of intestinal obstruction who was

managed at Plateau State Specialist Hospital, Jos in female medical ward 2 on 4th August, 2023.

Intestinal obstruction is significant mechanical impairment or complete arrest of the passage of

contents through the intestine. Symptoms include cramping pain, vomiting, constipation, and lack

of flatus. Diagnosis is clinical, confirmed by abdominal x-rays. Treatment is fluid resuscitation,

nasogastric suction, and, in most cases of complete obstruction, surgery.

According to Abubakar, B (2022), Bowel obstruction occurs when the normal flow of

intraluminal contents is interrupted. Obstruction can be functional (due to abnormal intestinal

physiology) or due to a mechanical obstruction, which can be acute or chronic. Advanced small

bowel obstruction leads to bowel dilation and retention of fluid within the lumen proximal to the

obstruction, while distal to the obstruction, as luminal contents pass, the bowel decompresses. If

bowel dilation is excessive, or strangulation occurs, perfusion to the intestine can be

compromised leading to necrosis or perforation, complications, which increase the mortality,

associated with small bowel obstruction.

The most common causes of mechanical small bowel obstruction are postoperative adhesions and

hernias. Other etiologies of small bowel obstruction include disease intrinsic to the wall of the

small intestine (erg, tumors, stricture, and intramural hematoma) and processes that cause

intraluminal obstruction (erg, intussusception, gallstones, and foreign bodies) (David, J &

Charles. P. D., (2021)

Acute, mechanical small bowel obstruction is a common surgical emergency. It is estimated that

over 300,000 laparotomies per year are performed in the United States for adhesion-related
obstructions. Ischemia, which complicates 7 to 42 percent of bowel obstructions, significantly

increases mortality associated with bowel obstruction. (Ogawa R, (2018)

The small bowel is involved in about 80 percent of cases of mechanical intestinal obstruction.

The incidence is similar for males and females. In one Polish study of adult patients, the average

age of patients with acute obstruction was 64 years, women comprised 60 percent of the group,

and the small bowel was affected in 76 percent. (Olabanji, J. K., & Oladele, A., (2020):

In addition, I have learned and gained new knowledge regarding on Intestinal obstruction. The in-

depth understanding of the etiology, pathophysiology, clinical manifestations, diagnosis,

treatment and prevention of this condition has yielded and enhanced my acquired knowledge. As

a student nurse, I also believed that actual interaction with the patient who has the condition

being studied can make it easier to understand. Also, to be able to learn completely, one must be

able to know how the concepts learned be applied into the actual clinical practice.

The knowledge I acquired through this study will give me the opportunity to improve my

capability to deliver efficient and appropriate interventions and information to a variety of

population. The knowledge, skills and attitude that comprise an effective nurse will be of high

regard to promote a reduction in the morbidity and mortality rate.

1.1 Purpose of the study

The purpose of this study is to broaden my knowledge about the condition understand the signs

and symptoms, causes, medical and nursing management.

1.2 Objective of the Study

The objectives of the study are to:

1. To describe the Anatomy and Physiology, Causes and Sign and symptoms of Intestinal

Obstruction.
 2. To describe factually, the personal and pertinent family history of the patient and relate it

to the present condition.

3. To determine the predisposing and precipitating factors and the signs and symptoms and

relate to the disease process.

4. To List the preventive measure for the occurrence of Intestinal Obstruction.

1.3 Definition of terms

Intestine: Intestine is an important organ of digestive system that is responsible for breaking

food down, absorbing its nutrients and solidifying the waste.

Obstruction: A thing that impedes or prevents passage of something

 CHAPTER TWO

REVIEW OF THE LITERATURES

2.0 Anatomy and physiology of organs affected

The digestive system, sometimes called the gastrointestinal tract, alimentary tract, or gut, consists

of a long hollow tube which extends through the trunk of the body, and its accessory structures:

the salivary glands, liver, gallbladder, and pancreas. The digestive tract is divided into two

sections, the upper tract, consisting of the mouth, esophagus, and stomach, and the lower tract,

consisting of the intestines.

Inside this tube, ingested food and fluid, along with secretions from various glands, are efficiently

processed. First, they are broken down into their separate constituents; then the desired nutrients,

water, and electrolytes are absorbed into the blood for use by the cells, and waste elements are

eliminated from the body. Within this system, the liver can reassemble the component nutrients

into new materials as they are needed by the body. For example, the proteins in milk are digested

by enzymes in the digestive tract, producing the component amino acids, which are then absorbed

into the blood. The individual amino acids are used by the liver cells to produce new proteins,

such as albumin or prothrombin, or they may circulate as they are in the amino acid pool in the

blood to be taken up by individual cells as necessary.

The peritoneal cavity refers to the potential space between the parietal and visceral peritoneum. A

small amount of serous fluid is present in the cavity to facilitate the necessary movement of

structures such as the stomach. Numerous lymphatic channels drain excessive fluid from the

cavity.

Because serous membranes are normally thin, somewhat permeable, and highly vascular, the

peritoneal membranes are useful as an exchange site for blood during peritoneal dialysis in

patients with kidney failure. However, such an extensive membrane may also facilitate the spread
of infection or malignant tumor cells throughout the abdominal cavity or into the general

circulation.

The mesentery is a double layer of peritoneum that supports the intestines and conveys blood

vessels and nerves to supply the wall of the intestine. The mesentery attaches the jejunum and

ileum to the posterior (dorsal) abdominal wall. This arrangement provides a balance between the

need for support of the intestines and the need for considerable flexibility to accommodate

peristalsis and varying amounts of content.

The greater omentum is a layer of fatty peritoneum that hangs from the stomach like an apron

over the anterior surface of the transverse colon and the small intestine. The lesser omen-tum is

part of the peritoneum that suspends the stomach and duodenum from the liver. When

inflammation develops in the intestinal wall, the greater omentum, with its many lymph nodes,

tends to adhere to the site, walling off the inflammation and temporarily localizing the source of

the problem. Inflammation of the omentum and peritoneum may lead to scar tissue and the

formation of adhesions between structures in the abdominal cavity, such as loops of intestine,

restricting motility and perhaps leading to obstruction.

2.1.1 The Colon

The colon is the last part of the digestive system in most vertebrates; it extracts water and salt

from solid wastes before they are eliminated from the body, and is the site in which flora-aided

(largely bacteria) fermentation of unabsorbed material occurs. Unlike the small intestine, the

colon does not play a major role in absorption of foods and nutrients. However, the colon does

absorb water, potassium and some fat-soluble vitamins.

In mammals, the colon consists of four sections: the ascending colon, the transverse colon, the

descending colon, and the sigmoid colon (the proximal colon usually refers to the ascending

colon and transverse colon). The colon, cecum, and rectum make up the large intestine.
The location of the parts of the colon are either in the abdominal cavity or behind it in the

retroperitoneum. The colon in those areas is fixed in location.

Arterial supply to the colon comes from branches of the superior mesenteric artery (SMA) and

inferior mesenteric artery (IMA). Flow between these two systems communicates via a "marginal

artery" that runs parallel to the colon for its entire length. Historically, it has been believed that

the arc of Riolan, or the meandering mesenteric artery (of Moskowitz), is a variable vessel

connecting the proximal SMA to the proximal IMA that can be extremely important if either

vessel is occluded. However, recent studies conducted with improved imaging technology have

questioned the actual existence of this vessel, with some experts calling for the abolition of the

terms from future medical literature.

Venous drainage usually mirrors colonic arterial supply, with the inferior mesenteric vein

draining into the splenic vein, and the superior mesenteric vein joining the splenic vein to form

the hepatic portal vein that then enters the liver.

Lymphatic drainage from the entire colon and proximal two-thirds of the rectum is to the

paraaortic lymph nodes that then drain into the cisterna chyli. The lymph from the remaining

rectum and anus can either follow the same route, or drain to the internal iliac and superficial

inguinal nodes. The pectinate line only roughly marks this transition.

2.1.2 The Ascending colon

The ascending colon, on the right side of the abdomen, is about 25 cm long in humans. It is the

part of the colon from the cecum to the hepatic flexure (the turn of the colon by the liver). It is

secondarily retroperitoneal in most humans. In ruminant grazing animals, the cecum empties into

the spiral colon.

Anteriorly it is related to the coils of small intestine, the right edge of the greater omentum, and

the anterior abdominal wall. Posteriorly, it is related to the iliacus, the iliolumbar ligament, the
quadratuslumborum, the transverse abdominis, the diaphragm at the tip of the last rib; the lateral

cutaneous, ilioinguinal, and iliohypogastric nerves; the iliac branches of the iliolumbar vessels,

the fourth lumbar artery, and the right kidney. The ascending colon is supplied by

parasympathetic fibers of the vagus nerve (CN X).

Arterial supply of the ascending colon comes from the ileocolic artery and right colic artery, both

branches of the SMA. While the ileocolic artery is almost always present, the right colic may be

absent in 5–15% of individuals.

2.1.3 The Transverse colon

The transverse colon is the part of the colon from the hepatic flexure to the splenic flexure (the

turn of the colon by the spleen). The transverse colon hangs off the stomach, attached to it by a

wide band of tissue called the greater omentum. On the posterior side, the transverse colon is

connected to the posterior abdominal wall by a mesentery known as the transverse mesocolon.

The transverse colon is encased in peritoneum, and is therefore mobile (unlike the parts of the

colon immediately before and after it). Cancers form more frequently further along the large

intestine as the contents become more solid (water is removed) in order to form feces.

The proximal two-thirds of the transverse colon is perfused by the middle colic artery, a branch

of SMA, while the latter third is supplied by branches of the IMA. The "watershed" area between

these two blood supplies, which represents the embryologic division between the midgut and

hindgut, is an area sensitive to ischemia.

2.1.4 The Descending colon

The descending colon is the part of the colon from the splenic flexure to the beginning of the

sigmoid colon. The function of the descending colon in the digestive system is to store food that

will be emptied into the rectum. It is retroperitoneal in two-thirds of humans. In the other third, it

has a (usually short) mesentery. The arterial supply comes via the left colic artery.
2.1.5 The Sigmoid colon

The sigmoid colon is the part of the large intestine after the descending colon and before the

rectum. The name sigmoid means S-shaped (see sigmoid). The walls of the sigmoid colon are

muscular, and contract to increase the pressure inside the colon, causing the stool to move into

the rectum.

The sigmoid colon is supplied with blood from several branches (usually between 2 and 6) of the

sigmoid arteries, a branch of the IMA. The IMA terminates as the superior rectal artery.

Sigmoidoscopy is a common diagnostic technique used to examine the sigmoid colon.

2.1.6 The Redundant colon

One variation on the normal anatomy of the colon occurs when extra loops form, resulting in a

longer than normal organ. This condition, referred to as redundant colon, typically has no direct

major health consequences, though rarely volvulus occurs resulting in obstruction and requiring

immediate medical attention. A significant indirect health consequence is that use of a standard

adult colonoscope is difficult and in some cases impossible when a redundant colon is present,

though specialized variants on the instrument (including the pediatric variant) are useful in

overcoming this problem.

2.1.7 Standing gradient osmosis

Water absorption at the colon typically proceeds against a transmucosal osmotic pressure

gradient. The standing gradient osmosis is a term used to describe the reabsorption of water

against the osmotic gradient in the intestines. This hypertonic fluid creates an osmotic pressure

that drives water into the lateral intercellular spaces by osmosis via tight junctions and adjacent

cells, which then in turn moves across the basement membrane and into the capillaries.

2.2 Functions of the Colon

There are differences in the large intestine between different organisms, the large intestine is

mainly responsible for storing waste, reclaiming water, maintaining the water balance, absorbing

some vitamins, such as vitamin K, and providing a location for flora-aided fermentation. Vitamin

K is essential as a coagulation factor. By the time the chyme has reached this tube, most nutrients

and 90% of the water have been absorbed by the body. At this point some electrolytes like

sodium, magnesium, and chloride are left as well as indigestible parts of ingested food (e.g., a

large part of ingested amylose, protein which has been shielded from digestion heretofore, and

dietary fiber, which is largely indigestible carbohydrate in either soluble or insoluble form). As

the chyme moves through the large intestine, most of the remaining water is removed, while the

chyme is mixed with mucus and bacteria (known as gut flora), and becomes feces. The ascending

colon receives fecal material as a liquid. The muscles of the colon then move the watery waste

material forward and slowly absorb all the excess water. The stools get to become semi solid as

they move along into the descending colon. The bacteria break down some of the fiber for their

own nourishment and create acetate, propionate, and butyrate as waste products, which in turn are

used by the cell lining of the colon for nourishment. No protein is made available. In humans,

perhaps 10% of the undigested carbohydrate thus becomes available; in other animals, including

other apes and primates, who have proportionally larger colons, more is made available, thus

permitting a higher portion of plant material in the diet. This is an example of a symbiotic

relationship and provides about one hundred calories a day to the body. The large intestine

produces no digestive enzymes chemical digestion is completed in the small intestine before the

chyme reaches the large intestine. The pH in the colon varies between 5.5 and 7 (slightly acidic to

neutral).

2.3 Disease theory

Intestinal obstruction refers to a lack of movement of the intestinal contents through the intestine.

Because of its smaller lumen, obstructions are more common and occur more rapidly in the small

intestine, but they can occur in the large intestine as well. Depending on the cause and location,

obstruction may manifest as an acute problem or a gradually developing situation. For example,

twisting of the intestine could cause sudden total obstruction, whereas a tumor leads to

progressive obstruction. A, sigmoid colostomy-a surgically created opening into the colon

through the abdominal wall. B, the stoma is the new opening on the abdomen. It is always red

and moist, is not painful, but may bleed easily. C, A plastic pouch to collect stools is attached to

the stoma. (Courtesy of Hollister Incorporated, Patient Education Series.)

Intestinal obstruction occurs in two forms. Mechanical obstructions are those resulting from

tumor, adhesions, hernias, or other tangible obstructions. Functional, or adynamic, obstructions

result from neurologic impairment, such as spinal cord injury or lack of propulsion in the

intestine, and are often referred to as paralytic ileus. While the end result can be the same, these

types manifest somewhat differently and require different treatment.

2.4 Causes of intestinal obstruction

1. Intestinal adhesion: Bands of fibrous tissues in the abdominal cavity that can form after

abdominal or pelvic surgery

2. Hernias: Portion of intestines that protrude into another part of the body

3. Cancer of the colon

4. Intussusception
2.5 Pathophysiology of Intestinal obstruction

Risk Factors for Intestinal obstruction

 Crohn’s disease – narrows intestinal

passageways due to thickening
 Abdominal Cancer

2 types of obstructions

Mechanical:
(+) Physical obstruction
or increased pressure
from walls creating a
blockage
Functional:
Intestinal muscles
cannot propel the
contents along the
bowel

(+) Increased fluid and gas Increased pressure on

intestinal wall causes
more fluid to enter
intestine
(+) Severe vomiting &
pain
Decreased blood
pressure &
hypovolemic shock
(+) Dehydration &
Electrolyte Imbalance

(+) Increased peristalsis
attempts to force contents past
obstruction
Continued pressure on
intestinal wall causes
edema, ischemia and
decreased peristalsis

Prolonged ischemia causes

(+) Abdominal distention
(+) mass in the small
intestine
increased permeability and
necrosis of wall. Intestinal
bacteria & toxins leak into
blood.
2.6 Signs and Symptoms of Intestinal Obstruction

1. A change in bowel habits.

2. Blood (either bright red or very dark) in the stool.

3. Diarrhea, constipation, or feeling that the bowel does not empty completely.

4. Stools that is narrower than usual.

5. Frequent gas pains, bloating, fullness, or cramps

6. Weight loss for no known reason

7. Feeling very tired

8. Vomiting

2.7 Risk Factors of Intestinal Obstruction

Risk factors include the following:

1. Age 50 or older.

2. A family history of carcinoma of the colon or rectum.

3. A personal history of carcinoma of the colon, rectum, ovary, endometrium, or breast.

4. A history of polyps in the colon.

2.8 Complications of Intestinal Obstruction

1. Pain

2. Constipation

3. Inability to keep food or fluid down

4. Fever

5. Infection

6. Tear (Perforation) of the intestine

2.9 Laboratory investigations

1. Complete Blood Count: CBC is a screening test, used to diagnose and manage numerous

diseases. The results can reflect problems with fluid or loss of blood.

2. Hemoglobin: Hemoglobin determines the RBC that carries oxygen and carbon dioxide

throughout the body

 Normal range: (115-175 g/L)

 Patient result: 125g/L

Interpretation: The hemoglobin level is normal. This indicates that RBC is capable of

carrying O2 and CO2 throughout the body.

3. Hematocrit: Hematocrit determines the concentration of RBC within the blood volume

An RBC count is a blood test that measures how many red blood cells (RBCs) you have.

 Normal Value: 0.40-0.52

 Patient Result: 0.44

 Interpretation: The result indicates there is normal concentration of RBC within the

blood volume.

4. White blood cells: White blood cells (WBCs), also called leukocytes, are an important part of

the immune system. These cells help fight infections by attacking bacteria, viruses, and germs

that invade the body. White blood cells originate in the bone marrow, but circulate throughout

the bloodstream.

 Normal range: N: 5-10x 109/L

 Patient result: 13.0

 Interpretation: WBC is high which indicates that there is infection presented in the body
5. Red blood cells: RBCs contain hemoglobin, which carries oxygen. How much oxygen

your body tissues get depends on how many RBCs you have and how well they work.

 Patients result: RBC: 4.93

 Normal range: 4.5-6.2

 Interpretation: The result is within normal range which indicates that the body's

RBCs containing hemoglobin, carrying oxygen to the body's tissues are functioning

normally

6. Urinalysis: Urinalysis yields a large amount of information about possible disorders of

the kidney and lower urinary tract, and systemic disorders that alter urine composition.

Patient results: Color: Yellow, Transparency: Slightly turbid, SP Gravity: 1.020, Sugar:

negative, Protein: +2, RBC: 2.5, Pus cells: 1-3, Epithelial cells: few, Mucus threads: few.

Interpretation: The result is normal

7. Abdominopelvic scan: a pelvic ultrasound is an imaging exam that creates picture of the

abdominal and pelvic organ. It is use to diagnose the cause of pain and bleeding.
2.10 Medical management

1. IV: Dextrose 5% in lactated ringers’ solution

Indication: For daily maintenance of body fluids and nutrition, and for rehydration, Treatment

for persons needing extra calories who cannot tolerate fluid overload, Treatment of shock.

Client’s response: The patient willingly accepted treatment and is kept hydrated as evidenced by

continuous infusion, improvement in his condition and good skin turgor. There were no negative

effects noted.

2. Drug: OMEPRAZOLE 40 mg TIV O.D

Mechanism of action: Inhibits proton pump activity by binding to hydrogen-potassium

adenosine triphosphatase, located at secretory surface of gastric parietal cells, to suppress gastric

acid secretion.

Indication: It is use to decrease the amount of acid produced in the stomach

Clients’ response: The patient did not experience any adverse effect

3. CEFUROXIME

Indication: Serious lower respiratory tract infection, UTI, skin or skin-structure infections, bone

of joint infection, septicemia, meningitis and gonorrhea, Pharyngitis and tonsillitis, Early Lyme

disease.

Clients Response: The patient did not manifest adverse reactions or any signs of hypersensitivity

to the drug.

4. Metronidazole

Mechanism of action: Direct acting trichomonicide and amebicide that works inside and outside

the intestines. It's thought to enter the cells of microorganisms that contain nitroreductase.

Forming unstable compounds that binds to DNA and inhibit synthesis, causing cell death.

Indication: Amebic Liver abscess, Intestinal amebiasis, Trichomoniasis

Clients’ response: The patient did not manifest adverse reactions or any signs of hypersensitivity

to the drug.

2.11 Nursing management of intestinal obstruction

1. Admission: The patient should be admitted to ward for adequate and proper management

of intestinal obstruction.

2. 2. Position: Place the patient in a comfortable position.

3. 3. Assessment: The nurse will assess the obstruction site to know the level and severity of

the intestinal obstruction.

8. Reassurance: The nurse will reassure the patient by helping her allay fear and anxiety.

9. Observation: (i) Monitor the alertness and consciousness of the patient. (ii) Monitor vital

signs closely.
10. Encourage rest: Rest should be encouraged to enhance patient and nursing care was

planned to prevent interruption in rest period.

5. Physical Care: The nurse should provide physical care such as oral care, bathing and

maintain personal hygiene during admission.

6. Drugs: patient relative was encouraged to provide the prescribed drug and are serve when

due. The patient was monitored closely for any side effect of the drugs.

7. Psychological Care: Patient was reassured psychologically and good nurse relationship is

established.

8. Health Education: The patient and relatives should be health educated on prevention of

intestinal obstruction to prevent the reoccurrence of the condition.

9. Follow Up: Patient is advised to come for follow up a week after the surgery to dress the

surgery site and to prevent infection.

 CHAPTER THREE

GENERAL INFORMATION OF THE PATIENT

3.1 Selected case:

NAME Mrs. L.N

DATE OF BIRTH 30/04/1967

AGE 56 years

SEX Female

OCCUPATION Hew

MARITAL STATUS Married

STATE OF ORIGIN Plateau state

RELIGION Christianity

NATIONALITY Nigerian

TRIBE Taroh

HOSPITAL Plateau State specialist Hospital, jos

DIAGNOSIS Intestinal obstruction

WARD Female medical Ward 2

DATE OF ADMISSION 04/08/2023

DATE OF DISCHARGE 17/08/2023

ADDRESS Malaram Rayfield, Jos, plateau state.

NEXT OF KIN Mrs V.N

RELATIONSHIP Son

CONSULTANT-IN-CHARGE Dr. Okoli

FOLLOW UP 07/09/2023

PHONE NUMBER 09050601367

3.2 Brief History of the Disease

a. Past Medical History: The patient has been to the hospital before and was treated for malaria

b. Present Medical History: The patient was in the hospital via out-patient department with a

complain abdominal pain and discomfort, restless. The patient vital signs on admission read

thus:

A. Temperature-36.4 degree

B. Pulse-89b/m

C. Respiration-26c/m

D. Blood pressure-125/80mmhg

II. Nutritional /metabolic pattern: Patient can tolerate food.

III. Elimination pattern: Patient excretory function in related to bowel and bladder is normal.

IV. Activity and exercise pattern: Patient is active and she can engage in passive exercise.

V. Sleep and rest pattern: Patient sleep and rest is normal. She slept 8hours or more in a day.

VI. Cognitive and perceptual pattern: Patient was fully conscious, alert and time oriented. Her

five senses organ (sense of touch, taste, hearing, smell and sight were intact and function

normal.

VII. Self-perception and self-concept pattern: Patient feel comfortable during her stay in the

hospital.

VIII. Role and Relationship pattern: Patient relate well with family, children and relatives.

IX. Sexuality and Reproductive pattern: Patient sexuality pattern was satisfactory and her

reproductive pattern was good. She’s married.

X. Coping and stress pattern: Patient coping and stress pattern is normal.

XI. Value and belief pattern: Patient value and belief pattern is normal.
3.3 Signs and Symptoms presented by the patient

1. Pains.

2. Bloating

3. Discomfort.

4. Constipation

5. Vomiting

3.4 Investigations and Results

On admission patient was awake, conscious, and alert. History taking from patient and physical

examination was done

Patient diagnostic test include:

1. Physical Examination.

2. Full blood count reveal elevated in white blood cell.

3. Urinalysis

4. Abdominopelvic scan.

3.5 Nursing diagnosis

1. Acute pain related to inflammatory process as evidenced by patient verbalization.

2. Ineffective breathing pattern related to the disease condition evidence by dyspnea.

3. Risk for deficient fluid volume related to patient placed on nil per oral (NPO).

4. Risk for infection related to surgical procedure.

5. Self-care deficit related to immobility evidence by inability to carry out activity daily

living (ADL).

6. Risk for impaired skin integrity related to immobility.

7. Functional urinary incontinence related to surgical procedure evidence by urinary catheter

in situation
 3.6 Nursing Care Plans

NURSING CARE PLAN OF MRS. L.N DIAGNOSED WITH INTESTINAL OBSTRUCTION

S/ NURSING DIAGNOSIS OBJECTIVE INTERVENTION SCIENTIFIC EVALUATION

N RATIONALE

1 Ineffective breathing pattern Patient will breathe with 1. Assess the respiratory 1. Serve as a baseline. Patient breathes with

related to the disease ease at a rate of 18-22b/m rate of the patient. 2. Aid air entrance ease at the rate of 18-

condition within 1hr of 2. Position the patient in a and promotes lung 22b/m within 1hr of

Evidence by dyspnea. nursing intervention. semi-fowlers position. ventilation. nursing intervention.

3. Administer oxygen as 3. To improve

prescribed. oxyhaemoglobin

4. Encourage patient to take level.

deep breathe. 4. To aid

lung expansion and

ventilation.

2 Acute pain related to Patient will verbalize 1. Assess level of pain. 1. To serve as further Patient verbalizes less
 inflammatory less or no pain within 10- nursing management pain within

process as evidenced by 20 minutes of Nursing 2. Encourage the patient to 2. To improve the 15minutes of Nursing

patient verbalization. intervention. obtain a comfortable comfortability of the intervention.

position. patient.

3. Provide a diversional 3. This promotes

therapy e.g. watching of relaxation and

favourite program on TV. distraction from pain.

4. Administer 4. To reduce pain.

prescribed analgesicse.g. IM

Pentazocine.

3 Risk for deficient fluid Patients willdemonstrate 1. Assess level of 1. Serve as a baseline. Patient shows no sign

volume related to patient no signs and symptoms of dehydration. 2. To determine the and symptoms of

placed on nil per oral (NPO). dehydration within 2. Monitor input and output. level of fluid and dehydration within

24hours of nursing 3. Administer IV fluid as electrolyte in the 24hours of nursing

intervention. prescribed e.g. IV0.9% body. intervention.

Normal saline. 3. To replace lost

fluid and prevent

 4. Monitor the weight of the dehydration.

patient. 4. To prevent fluid

overload.

4 Risk for infection related to Patient will show no sign 1. Monitor vital signs. 1. Increase in vital Patient was free from

surgical procedure. of infection throughout the 2. Ensure strict aseptic signs signifies infection throughout the

period of hospitalization. technique. infection. period

3. Maintain personal and 2. Reduce the chance of hospitalization.

environmental hygiene. of getting infected.

4. Give high protein diet. 3. To prevent

5. Administer antibiotics as infection.

prescribe e.g IV cefuroxime 4. High protein diet

boosts immunity.

5. To combat

infection.

5. Functional urinary Patient will be able to 1. Ensure urinary catheter is 1. For elimination of Patient was able to
 incontinence related to eliminate urine with the passed. urine. eliminate urine with the

surgical procedure evidence use of Foley catheter 2. Assess color, odour and 2. Provides use of foley catheter

by urinary catheter within 24 hours of nursing component of the urine. information about within 24hours of

in situation intervention. 3. Monitor input and output adequacy of urine nursing intervention.

chart. output.

4. Ensure catheter is not 3. To determine the

kink. fluid and electrolyte

5. Ensure aseptic technique in the body.

in providing care to the 4. Kinking can

catheter. prevent urine flow.

5. Reduces risk for

infection.

6 Self-care deficit related to Patient will be able to 1. Asses ability to carry out 1. Serve as a baseline. Patient was able to

immobility evidence by perform self-care task with ADL. 2. To avoid exposing perform self care task

inability to carry out activity the assistant of the nurse 2. Maintain privacy during the patient / breaches with the assistance of

daily living (ADL). within 24hrs of nursing bathing as appropriate. in privacy. the nurse within 24hrs

intervention 3. Provide frequent 3. To reduce energy

 assistance in ADL. expenditure. of nursing intervention.

4. Encourage patient to be 4. To be able to carry

independent. out ADL.

7 Risk for impaired skin Patient will demonstrate 1. Assess the skin integrity. 1. Serve as a baseline. Patient demonstrate skin

integrity related to skin integrity free of 2. Change patient position 2. To prevent skin integrity free of pressure

immobility. pressure ulcer at least every 2hours. breakdown and ulcer throughout period

throughout period of 3. Prevent pressure against promote circulation. of hospitalization

hospitalization. any other part of the body 3. Pressure constricts

with the use a pillow. vessels and hence

4. Slightly massage with impedes blood

lotion or gel. supply.

5. Encourage ambulation 4. Massaging promote

when the patient is fit. circulation.

5. Ambulation

reduces pressure on

the skin from

immobility hence
preventing skin

breakdown.
 3.6 DAILY NURSING CARE FOR MRS I.N

DAY 1 (04/08/2023)

1. At 11:50am, Mrs L.N was brought in accident & emergency conscious and alert accompanied

by relatives.

2. Vital signs on admission was; Temperatuer-36.4 degree Celsius, Pulse rate-89b/m, Respiratory

rate-26c/m, Blood Pressure-125/80mmHg.

3. Patient is on oxygen therapy via nasal prong nursed in fowler’s position.

4. Patient is on NPO till further notice.

5. Nasogatric tube was inserted to hasten return of bowel function and relieving gastrointestinal

discomfort.

6. Patient was placed on IVF Normal saline alternate with 5%Dextrose saline 1L 8hourly, IM

Pentazocine 30mg 6hourly, IV Flagyl 500mg 8hourly,IV cefuroxime 1g 12hourly, IV

Omeprazole 40mg daily.

DAY 2 (05/08/2023)

1. Personal and environmental hygiene were maintained.

2. Bed pan was served as desired.

3. Vital signs monitored, and read; Temperature-36.2 degrees Celsius, Pulse rate- 98b/m,

Respiratory rate- 20c/m, Blood pressure- 120/78mmHg.

4. He had IV Flagyl 500mg 8hourly, IM Pentazocine 30mg 6hourly, IV Omeprazole 40mg, IVF

Normal saline and IVF 5%Dextrose saline.

5. Patient nursed in fowler’s position and on oxygen therapy via nasal prongs.

6. Patient is on closed bag drainage, draining concentrated urine.

7. Intake and output monitored; 4600/3500mls

DAY 3 (06/08/2023)

1. Personal and environmental hygiene were maintained and Bed pan was served as desired.

2. Vital signs monitored, prescribed medication was administered.

3. Patient is closely monitored and still on oxygen therapy via nasal prongs.

4. Patient still on nil per oral (NPO).

5. Intake and output monitored; 1200/560mls

6. Patient still on nasogastric tube draining greenish effluent.

DAY 4 (07/08/2023)

1. Personal and environmental hygiene maintained.

2. Vital signs monitored and charted.

3. Oxygen therapy still in progress via nasal prongs with respiratory rate of 20c/m.

4. Prescribed medication administered at due time.

5. Patient still on nasogastric tube draining greenish effluent.

6. Intake and output monitored.

7. Daily wound dressing was done to reduce risk for infection and promote healing.

8. Patient is on closed bag drainage, draining clear urine.

DAY 5 (08/08/2023)

1. Personal and environmental hygiene maintained.

2. Vital signs monitored and charted; Temperature-36.4degree Celsius, Pulse- 88c/m, Blood

pressure- 120/80mmHg.
3. Oxygen therapy still in progress via nasal prongs with respiratory rate of 22c/m.

4. Patient was nursed in fowler’s position.

5. Daily wound dressing done.

6. Prescribed medication administered at due time.

7. Intake and output monitored.

DAY 6 (09/08/2023)

1. Personal and environmental hygiene maintained.

2. Vital signs monitored and charted.

3. Oxygen therapy still in progress via nasal prongs with respiratory rate of 20c/m.

4. Prescribed medication administered at due time.

5. Patient still on nil per oral (NPO).

6. Intake and output monitored; 3000/2390mls.

7. Daily wound dressing done.

8. Patient is on closed bag drainage, draining clear urine.

DAY 7 (10/08/2023)

1. Personal and environmental hygiene maintained.

2. Vital signs monitored and charted.

3. Oxygen therapy discontinued and patient maintain respiratory rate of 22c/m.

4. Prescribed medication administered at due time.

5. Bladder training commenced.

6. Nasogastric tube was disconnected.

7. Oral sip of water only was commenced.

8. Intake and output monitored; 3250/2370mls.

DAY 8 (11/08/2023)

1. Personal and environmental hygiene maintained.

2. Vital signs monitored and charted; Temperature- 36.5 degree Celsius, Respiratory rate- 20c/m,

Pulse rate- 94b/m, Blood pressure- 120/68mmHg.

3. Prescribed medication administered at due time.

4. Patient was nursed in semi-fowler’s position.

5. Intake and output monitored.

6. Daily wound dressing.

7. Water was given and well tolerated.

8. Patient was ambulated

DAY 9 (12/08/2023)

1. Personal and environmental hygiene maintained.

2. Vital signs monitored and charted; Temperature- 36.5 degree Celsius, Respiratory rate- 20c/m,

Pulse rate- 92b/m, Blood pressure- 116/60mmHg.

3. Prescribed medication administered and charted.

4. Patient was nursed in semi-fowler’s position.

5. Intake and output monitored; 2620/2820mls.

6. Daily wound dressing.

7. Pap was commenced and well tolerated.

DAY 10 (13/08/2023)
1. Personal and environmental hygiene maintained.

2. Vital signs monitored and charted.

3. Prescribed medication administered and charted.

4. Patient was nursed in semi-fowler’s position.

5. Intake and output monitored; 1500/800mls

6. Nutritious diet encouraged.

DAY 11 (14/08/2023)

1. Personal and environmental hygiene maintained.

2. Patient condition was improving.

3. Vital signs monitored and charted.

4. Prescribed medication administered and charted.

5. Patient still being managed conservatively

6. Intake and output monitored.

7. Nutritious diet encouraged

DAY 12 (15/08/2023)

1. Personal and environmental hygiene maintained.

2. Vital signs monitored and charted.

3. Prescribed medication administered and charted.

4. Patient still being managed conservatively

5. Intake and output monitored.

6. Nutritious diet encouraged.

 DAY 13 (16/08/2023)

1. Personal and environmental hygiene maintained.

2. Vital signs monitored and charted.

3. Prescribed medication administered and charted.

4. Patient still being managed conservatively

5. Intake and output monitored.

6. Nutritious diet encouraged.

7. Patient is being work up for discharge.

DAY 14 (17/08/2023)

1. Patient’s condition greatly improved.

2. Wound dressing was done.

3. Vital signs was checked and documented; Temperature- 36.5 degree Celsius, Pulse rate- 92b/m,

Respiratory rate- 20c/m, Blood pressure- 120/64mmHg.

4. Doctor saw and reported that his condition is satisfactory and was consequently discharged
CHAPTER FOUR

SUMMARY, CONCLUSION AND RECOMMENDATION

SUMMARY

This study was written on Mrs. L.N a 56 year old woman who was admitted via outpatient

department (OPD) with the diagnosis of intestinal obstruction on the 4th Aug, 2023.

This case study was written in 4 chapters in which chapter one deal with the introduction of the

case study, objectives of the study, purpose of the study and definition of terms.

Chapter two of the study was on the literature review of the affected organ, the definition,

etiology, pathophysiology, clinical manifestations, predisposing factor, the Diagnostic

investigation, general treatment, prevention and the management of intestinal obstruction.

Also chapter three of this study contains general information of the patient, past and present

history of the patient, and the investigations done on the patient, nursing diagnosis and nursing

care plan.

In chapter four of this case study is the summary, conclusion and recommendations

CONCLUSION

Mrs. L.N responded to intestinal obstruction treatment quickly, with this we have convinced that

prompt management and treatment of intestinal obstruction will bring about good prognosis.

Although there are other factors causing intestinal obstruction other than Age 50 or older.

Management Of intestinal obstruction include giving health talk on diet, prevention and

complications of Intestinal obstruction

Surgical site was dressed twice every day and there was no complication in wound healing

process, sutures were removed after 7 days.

He was discharged on the on the 17 th august 2023 on antibiotics and analgesics and was

recommended to come back for follow up at the general outpatient department (GOPD) in one

week time.

RECOMMENDATION

Recovery and management recommendations for someone who has suffered from intestinal

obstruction typically depend on the severity of their condition and whether they have undergone

treatment like surgery. Here are some general recommendations:

1. Dietary Modifications:

 Follow a low-fat diet to minimize the risk of digestive discomfort and diarrhea, especially

in the early postoperative period.

 Consume smaller, more frequent meals to aid digestion.

2. Hydration: Stay well-hydrated by drinking plenty of water throughout the day.

3. Pain Management: If patient experience post-surgical discomfort, follow the healthcare

provider's recommendations for pain relief medications.

4. Physical Activity: Engage in regular physical activity as advised by healthcare provider. It

promotes overall health and helps with digestion.

5. Medications: If prescribed bile acid sequestrates or other medications to manage bile flow

post-surgery, adhere to the prescribed regimen.

6. Follow-Up Appointments: Attend scheduled follow-up appointments with healthcare

provider to monitor your recovery and discuss any concerns or complications.

7. Lifestyle Changes: Maintain a healthy lifestyle by adopting a balanced diet and regular

exercise to prevent post-surgery weight gain and promote overall well-being.

 References

Abubakar, B (2022): Prevalence of intestinal obstruction in Nigeria.

David, J & Charles. P. D., (2021): Medical definition and historical background of intestinal

obstruction. https//emedicine.medscape.com

Ogawa R, (2018): Epidemiology of intestinal obstruction among Africans and Nigerian

population-based cross-sectional survey. https//www.researchgate.net

Olabanji, J. K., & Oladele, A., (2020): Clinical pattern and management of intestinal obstruction

in Africa. https//:www.njcponline.com

Olaitan P.B, (2019): Recruitment of Yoruba families from Nigeria for genetic research:

experience from intestinal obstruction study. https://bmcmedethics.biomedcentral.com

Waugh Anne and Grant Allison (2022). Ross and Wilson Anatomy and Physiology in health and

illness 14th edition Churcill living stone Elsevier