Lecture Notes on Gastrointestinal System and Bowel Obstructions

Introduction

• Focus: GI system related to bowel obstructions.
• Importance of preparing beyond exams for real-life nursing scenarios.
• Encourages self-reflection on prior knowledge, experiences, knowledge gaps.

Learning Objectives

• Understand partial vs. complete obstructions.
• Differentiate between simple and strangulated obstructions.
• Identify mechanical and non-mechanical causes.

Types of Bowel Obstructions

Partial vs. Complete

• Partial: Some fluid and gas can pass; often resolves without surgery.
• Complete: Generally requires surgical intervention.

Simple vs. Strangulated

• Simple: Blood supply intact.
• Strangulated: Ischemia and necrosis due to lack of blood supply.

Mechanical vs. Non-Mechanical Obstructions

• Mechanical: Physical blockage.
  • Small bowel causes: Adhesions, hernias, tumors, intussusception.
  • Large bowel causes: Colorectal cancer, ischemia, volvulus, Crohn's disease.
• Non-Mechanical: Lack of peristalsis.
  • Common cause: Paralytic ileus (post-surgery, anesthesia effects).
  • Other causes: Peritonitis, pancreatitis, appendicitis, electrolyte imbalances, spinal fractures.

Pathophysiology

• Approx. 9 liters of GI tract secretions daily.
• Obstruction leads to fluid and gas build-up, causing symptoms:
  • Abdominal distention
  • Nausea and vomiting
  • Pain and cramping
  • Constipation
  • Changes in bowel sounds (high pitched or absent)

Clinical Assessment and Diagnosis

• Thorough patient assessment:
  • Onset, symptoms, aspiration risk, hydration status, pain details.
  • Vomitus characteristics and abdominal girth measurement.
• Imaging and diagnostics:
  • X-rays, CT, MRI, GI scopes.
• Blood work, NPO status, and potential surgery.

Nursing Interventions

• NG Tube: Common for decompression.
  • Ensure proper function, educate patient on its purpose.
• Monitoring: Cardiac monitor for electrolyte imbalances.
• Medications: Steroids, IV fluids, antibiotics, anti-emetics, pain management.

Potential Complications

• Perforation, peritonitis.
• Fluid and electrolyte/acid-base imbalances.
  • Common issues include metabolic alkalosis and hypokalemia.

Patient Education and Psychosocial Considerations

• Explain cause, location, and type of obstruction.
• Discuss diagnostic procedures and symptom management.
• Educate on post-surgical care (incentive spirometer, diet, ostomy care).
• Address psychosocial issues (body image, intimate relationships).

Reflection and Application

• Consider how various conditions (e.g., adhesions, volvulus) lead to obstructions.
• Understand the rationale for interventions.
• Approach patient education on sensitive topics like sexual health with preparation.

Conclusion

• Reinforce learning objectives through reviews and self-testing.
• Identify and fill knowledge gaps as necessary.