Nursing in intestinal obstruction

Clinical features

Abdominal colic

Marked abdominal tenderness

Abdominal distension

Increased bowel sounds

Nausea and vomiting (may be absent in lower obstruction)

Constipation with absence of flatus

Fever

Toxicity

Blood tests - leucocytosis, C-reactive protein, renal function, group and save

Electrolyte disturbance

Shock

X rays show distended loops of bowel before the obstruction

Fluid levels on an erect film

Nursing assessments

Nature and location of pain, consider obstruction, distention, strangulation

Observation for distention, flatus, defecation, emesis

Listen for bowel sounds

Vital signs, oxygen saturations

Respirations may be inhibited

Management

NG suction to decompress upper tract (suck).

Fluid and electrolyte resuscitation (drip).

Analgesia, but caution with opiates.

Antiemetics but not metoclopramide.

Intravenous antibiotics.

Exploratory laparotomy and decompression.

Resection of any necrotic bowel segments.

Colorectal stents may be used for large bowel carcinoma, followed be elective surgery.

Volvulus of the sigmoid may be corrected with a flexible sigmoidoscope.

Obstruction in Crohn`s may respond to conservative management.

Pseudo-obstruction may occur after intrabdominal trauma, postoperatively, with intra-abdominal sepsis, in pneumonia, with metabolic disturbance or with opiates. This may respond to neostigmine.

Nursing interventions

Air fluid lock syndrome may be relieved with supine to prone position changes very 10 minutes.

Maintain fluid balance records; observe urine output for possible oliguria or retention.

Nature and volume of NG aspirate.

Stool specimen for occult blood.

Nurse in Fowler’s position with the body at about 45`.

Observe for perforation.

Observe for metabolic alkalosis or acidosis.

Nursing in colorectal cancer

Risk factors

Refined western diet

Fat and meat consumption

Familial adenomatous polyposis

Protective factors

Fruit and vegetable consumption

Fibre

Exercise

Aspirin and other NSAIDs

HRT

Clinical features

Alteration in bowel habit in left sided tumours

Blood mixed with stool in rectal and sigmoid and rectal tumours

Right sided tumours often present as iron deficiency anaemia

Elderly often present as bowel obstruction.

Faecal incontinence

Anorexia and weight loss

Passing PR mucus

Tenesmus – ineffectual spasms of the rectum with the desire to pass stool

Occult blood

Diagnosis

Possible mass

Possible hepatomegaly from metastases

Digital examination

Rigid sigmoidoscopy

Blood tests including carcinoembryonic antigen

Colonoscopy

CT MMR PET

Management

Correction of anaemia, possible blood transfusion

Surgical resection

Chemotherapy

Radiation therapy

Preoperative preparation for colectomy

Good nutrition before surgery

Fluid balance, possible diarrhoea, constipation, vomiting

IV therapy as required

Correct anaemia, correct fluid and electrolyte deficiencies

Assess and treat pain

Mechanical bowel preparation, oral laxatives, whole gut irrigation, enema/colonic irrigation

Antibiotic chemoprophylaxis

Thromboembolism prophylaxis

Procedures

Right or left hemicolectomy

Upper or mid rectal – anterior resection of rectum

Lower rectum – abdominoperineal resection of rectum and anus

Anastomosis or stoma formation

Postoperative complications of colectomy and rectal excision

Haemorrhage

Ureteric damage, leakage or stricture

Damage to bladder function, acute retention, urinary incontinence

Damage to sexual function

Damage to duodenum after right hemicolectomy

Damage to spleen after left hemicolectomy

Anastomotic complications, stenosis, leakage

Complications of stoma, parastomal hernia, prolapse, electrolyte imbalance, ischaemia, stenosis

Diarrhoea, constipation