Lecture Notes: Gastrointestinal System - Bowel Obstructions

Introduction

• Focus on the GI system in relation to bowel obstructions.
• Importance of active learning and understanding for patient care.
• Encourage reflection on prior knowledge and experiences.
• Learning objectives should be clearly understood and met.

Types of Bowel Obstructions

1. Partial vs. Complete Obstructions

   • Partial: Allows some fluid and gas passage; often resolved without surgery.
   • Complete: Usually requires surgical treatment.

2. Simple vs. Strangulated Obstructions

   • Simple: Blood supply intact.
   • Strangulated: Blood supply cut off, leading to ischemia and necrosis.

3. Mechanical vs. Non-Mechanical Obstructions

   • Mechanical: Physical blockage.
     • Causes: Adhesions, hernias, tumors, strictures, intussusception.
   • Non-Mechanical: Lack of peristalsis.
     • Common causes: Paralytic ileus, peritonitis, pancreatitis, appendicitis, electrolyte imbalances, spinal fractures.

Symptoms of Bowel Obstructions

• Abdominal distension.
• Nausea and vomiting; can be projectile with certain obstructions.
• Pain: Colicky, crampy, off-and-on pain.
• Constipation and changes in bowel sounds.
• Dehydration signs: Tachycardia, dry mucous membranes, hypotension.
• Acid-base and electrolyte imbalances: Metabolic alkalosis, hypokalemia.

Assessment and Diagnosis

• Thorough patient assessment including symptom onset, pain assessment, and emesis evaluation.
• Diagnostic imaging: X-ray, CT, MRI.
• Bowel sound assessment: Listen to each quadrant for five minutes.

Treatment and Management

• NPO and Bowel Rest: Especially for complete obstructions.
• NG Tube: Decompress stomach, symptom management, not for clearing obstructions.
• Medications: Steroids, IV fluids, antibiotics, antiemetics, pain management.
• Surgical Interventions: Required in cases of strangulation or perforation.
• Cardiac Monitoring: For electrolyte imbalance-induced dysrhythmias.

Nursing Interventions

• Understand rationale for each intervention.
• Educate patients on procedures, expected outcomes, and self-care.
• Monitor for complications like perforation and peritonitis.
• Provide psychosocial support, particularly with ostomies and body image concerns.

Educational and Psychosocial Considerations

• Teach patients about obstruction causes, location, and type.
• Explain diagnostic processes and symptom management.
• Address lifestyle changes, including ostomy care and potential sexual health impacts.
• Encourage patient support groups and long-term planning if applicable.

Review and Self-Assessment

• Review content and test understanding against learning objectives.
• Identify knowledge gaps and seek further information to ensure mastery.