Intestinal obstruction is the mechanical or physical blockage of the intestine which prevents

normal movements of the products of digestion.

Mechanical obstruction occurs when there is physical blockage in the intestine while functional

obstruction occur when there is ineffective motility without physical blockage due to something

interrupting coordinated system of small and large intestine leading to slowing or stopping the

movement of intestinal contents through digestive system. However, intestinal obstruction

occur either in small intestine or large intestine and the blockage can be complete or partial.

A complete obstruction occurs when the lumen is totally blocked and does not allow any

intestinal content to pass through it, while partial intestinal obstruction occurs when the lumen is

narrowed but it can allow some contents to pass through it

Causes of intestinal obstruction include;

 Twisting of the intestine (vulvulus)

 Cancer that grow within the intestine

 Presence of worms

 Foreign bodies such as gallstones or swallowed object

 Fecal impaction

 Hernia

 When two parts of intestine connect each other by bands(adhesion)

The following are the symptoms of intestinal obstruction:

a. Abdominal distention due to accumulation of gas and fluids

b. Pain around umbilicus in small bowel obstruction and lower abdomen in large bowel

obstruction

c. Vomiting

d. Constipation

e. Inability to have bowel movement or gas

Intestinal obstruction can be diagnosed through history taking, performing physical exam and

abdominal ultrasound

Management of intestinal obstruction depends on location and severity of obstruction. If it is

partial obstruction non operative management such as inserting a nasogastric tube to the patient

for decompression, administering antibiotics and intravenous fluids can be used. However if it is

complete obstruction with failure in conservative management surgical procedure to remove the

obstruction as well as any section of the intestine that as died is needed.

Nursing care plan for a patient with intestinal obstruction

s/ Nursing diagnosis Expected outcome interventions

1 Electrolyte imbalance The patient will i. Assessing the patient for the signs of

. related to diseased maintain normal dehydration such as dry mouth and

condition as evidenced electrolytes at a decreased urine output.

by vomiting functional level ii. monitoring patient input and output

iii. administration of antiemetic as prescribed

iv. Administering intravenous fluids as

prescribed.

2 Pain related to pressure To relieve patient i. assessing patient pain level

created by gas and fluid pain ii. administering ant pain as prescribed

accumulations against the

obstruction as evidenced

by patient complain or

facial expression.

3 High body temperature The patient will i. Assessing patient dehydration signs such as

. related to dehydration as maintain normal dry mouth and low concentrated urine.

evidenced by patient body temperature ii. maintaining adequate patient fluid intake

body temperature above within the iii. Administration of antipyretics as prescribed.

the normal range expected range and

exhibit stable vital

sign and
 demonstrate

appropriate

hydration status

4 Fluid volume deficit The patient will i. monitoring patient vital sign

related to diseased maintain fluid ii. monitoring patient intake and output

condition as evidenced volume at a iii. administration of intevenous fluids as

by vomiting, decreased functional level prescribed

urine output,

concentrated urine.

5 Shock related to The patient will be i. Assessing possible cause of shock

. hypovolemia as free from shock ii. Monitoring patient vital signs

evidenced by iii. Administering intravenous fluid as

hypotension,tachycardia prescribed

cool and pale skin, iv. Elevating patient leg to increase blood

decreased urine output return to the heart.

v. Administering supplemental oxygen and

medications as prescribed.

6 Risk of aspiration related The patient will be i. Positioning

. to vomiting of gastric free aspiration and ii. provide moth care to patient when necessary

contents its effects iii. Inserting nasogastric tube for

decompression.
Antenatal care refers to attention given to woman during pregnancy and before

labor. The aim of antenatal care is;

-to prevent, detect and manage factors that will affect health of a mother and baby

-to provide advice, reassurance, education and support for woman and her family

-to provide general health screening

As a nurse during the first antenatal care contact for a teenager girl aged(12-17

years) and an elderly primegravida female my role will be ;to provide

comprehensive ,personalized and age appropriate care

Specific actions that can be taken to a teenager girl (12-17) years old

i. Creating a safe and non judgmental environment for a girl to feel

comfortable discussing her concerns and any sensitive issues.

ii. Performing health assessment to ensure normal progress of pregnancy, this

will facilitate early detection and special care for complication, chronic

conditions and other potential problems that can affect the mother and

newborn.

iii. Providing health messages and counseling on complication readiness

planning and birth preparedness.

iv. Addressing social and emotional challenges such as concerns for family

support and mental health problems and connect her with appropriate social

worker or counselors if needed.

v. Follow organization protocol to report the situation to the appropriate

authorities if there is indication of abuse.

Specific actions that can be taken to elderly primegravida include;

i. Performing health assessment to ensure normal progress of pregnancy, this

will facilitate early detection and special care for complication, chronic

conditions and other potential problems that can affect the mother and

newborn.

ii. Providing health messages and counseling on complication readiness

planning and birth preparedness.

iii. Address age-related concerns: recognize and discuss potential health or

complications associated with pregnancy at advanced age.

iv. Providing individualized care to help maintaining normal progress of

pregnancy such as preventive measures.

v. Arrange appropriate tests and screening to ensure necessary prenatal tests

and screening are scheduled.

The following are the complications of pregnancy at young age, between 12-17

years;

i. Postpartum hemorrhage, due to over distention of the uterus and vaginal tear

ii. Low birth weight babies

iii. Preterm birth

iv. Maternal death

 Cesarean delivery is recommended for elderly primegravida due to increased

risk of labor complications such as prolonged labor or difficulty pushing the

baby through birth canal.

 Complications that can arise in elderly primegravida include;

i. Pregnancy induced hypertension; older women have an increased risk of

developing high blood pressure during pregnancy which can lead to pre-

eclampsia or eclampsia.

ii. Placenta praevia, older women have a higher risk of placenta praevia, a

condition where the placenta partially or completely cover the cervix,

leading to bleeding during pregnancy.

iii. Chromosomal abnormalities that can lead to Down syndrome baby.

iv. Abruption placenta.

 Management of complications that can arise in elderly primegravida

a. Management of placenta praevia includes;

-hospitalization for bed rest

-Blood transfusion

-monitoring of fetal and maternal condition

b. Management of abruptio placenta includes;

-Get help

-oxygen therapy

-insert 2 intravenous access for active fluid resuscitation

-blood transfusion

-stabilize vital sign and insert a foley catheter

-if fetus is at term and alive c-section is the best route of delivery,

However vaginal delivery is used when the fetus is dead and the

mother is stable.

c. Management of pre –eclampsia with severe features and eclampsia

-administration of corticosteroids to accelerate fetal lung maturity

-delivery is the only cure for pre

-maintaining patent airway, and keeping upper respiratory tract clear

-protect patient tongue from biting.

-administration of magnesium sulfate

 REFERENCES

 Bennet V Ruth and Brown Linda K Myles textbook for midwives 7th

edition Churchill Livingstone Edinburgh

 MoHSW (2010) Basic basic obstetric and newborn care (BEmONC)

participant’s handbook

 USAID,Archieving results in antenatal care:Improving maternal and

newborn outcomes through integration of

services.Baltimore,Maryland:JHPIEGO,ACCESS program,2008

 Miller G,Boman J,Shrier I,Gordon PH.Etiology of Small bowel obstruction

 Gore RM,Silver RI ,Thakrar KH,et al.Bowel obstruction.Radiol Clin N

Am.2015