Overview
This lecture covers the causes, symptoms, management, and nursing care for intestinal bowel obstruction (both mechanical and non-mechanical) and diverticular disease, including diverticulosis and diverticulitis.
Intestinal Bowel Obstruction
- Obstruction can be partial or complete and classified as mechanical (physical blockage) or non-mechanical (paralytic ileus).
- Mechanical causes include adhesions, tumors, Crohn's disease, hernias, strictures, and impacted feces.
- Non-mechanical obstruction is often due to surgery-induced loss of peristalsis (paralytic ileus).
- Symptoms: abdominal distension, lack of bowel sounds, nausea, vomiting, inability to pass flatus or stool.
- Prevention of paralytic ileus: early ambulation, adequate pain control, fluid/electrolyte balance, avoidance of opioids, use of prokinetic drugs, minimal handling during surgery.
- Complications: hypoalbuminemia, electrolyte imbalances, peritonitis, septic shock, gangrene if blood flow is compromised.
- Diagnosis: abdominal CT, MRI, ultrasound, endoscopic procedures (except with perforation/complete obstruction).
- Labs: elevated hemoglobin, hematocrit, BUN (dehydration); low sodium, chloride, potassium; elevated amylase if strangulation.
- Key signs: obstipation (no stool/flatus) with complete obstruction; ribbon-like stools or blood with partial obstruction.
Nursing & Collaborative Management
- Monitor vital signs, especially fluid status; assess abdomen regularly.
- Manage fluid/electrolyte balance; maintain IV therapy.
- Use NG tube for decompression, monitor and maintain tube, document output.
- Analgesics and medications such as alvimopan may be used (watch for contraindications).
- Most obstructions require hospitalization; surgery is indicated for certain cases.
- Patient education: prevention of constipation, recognizing symptoms of recurrence, care for surgical sites or colostomies.
Diverticular Disease
- Diverticulosis: presence of multiple pouches (diverticula) in the intestinal wall, especially sigmoid colon.
- Diverticulitis: inflammation or infection of diverticula, often due to trapped food/bacteria.
- Symptoms of diverticulitis: left lower quadrant pain, low-grade fever, nausea, abdominal tenderness, possible rectal bleeding.
- Complications: perforation, peritonitis, abscess, bowel obstruction, fistula, bleeding.
- Management: broad-spectrum antibiotics, rest, nutrition therapy (low fiber during inflammation, high fiber when resolved), avoid laxatives/enemas, observe for drug side effects in older adults.
- Surgery may be needed for complications (colon resection, possible colostomy).
- Education: high-fiber diet when stable, avoid alcohol and seeds/indigestibles, importance of fluid intake, proper wound and ostomy care if needed.
Key Terms & Definitions
- Mechanical Obstruction — Blockage of the bowel due to a physical cause.
- Non-mechanical Obstruction (Paralytic Ileus) — Loss of bowel motility without physical blockage.
- Obstipation — Absence of stool and flatus passage.
- Diverticulosis — Multiple pouch-like herniations in the intestinal wall.
- Diverticulitis — Inflammation or infection of diverticula.
Action Items / Next Steps
- Review features of small vs. large bowel obstruction for the exam.
- Create drug cards for alvimopan, docusate, and major antibiotics used in diverticulitis.
- Teach patients appropriate dietary and activity modifications.
- Arrange home health referrals for patients with surgery or colostomy care needs.