intestinal obstruction ncp

House Authors

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09-12-2024

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Intestinal Obstruction: Nursing Care Plan & Management

Intestinal obstruction, a serious condition, occurs when the flow of intestinal contents is blocked. This blockage can be caused by various factors, leading to a build-up of gas and fluid within the intestines. Prompt diagnosis and management are crucial to prevent serious complications. This article will outline a comprehensive nursing care plan for patients experiencing intestinal obstruction.

I. Assessment & Diagnosis

A. Identifying the Type of Obstruction:

The first step is accurately determining the type of obstruction – mechanical or paralytic (ileus).

• Mechanical Obstruction: Caused by a physical blockage (e.g., adhesions, tumors, hernias, intussusception, volvulus). Symptoms often include severe, cramping abdominal pain, vomiting, and distension. The location of the obstruction influences the specific symptoms.
• Paralytic Ileus: Caused by a lack of intestinal motility, often resulting from surgery, infection, or electrolyte imbalances. Symptoms may be less severe than mechanical obstruction, possibly including mild abdominal distension and decreased bowel sounds.

B. Gathering Subjective Data:

Thoroughly assess the patient's history, including:

• Pain: Character, location, onset, duration, and severity (using a pain scale).
• Nausea and Vomiting: Frequency, character (bilious, fecal), and amount.
• Bowel Habits: Frequency, consistency, and any changes.
• Past Medical History: Previous surgeries, abdominal conditions, or medications.
• Allergies: To medications or contrast media.

C. Gathering Objective Data:

Perform a physical assessment focusing on:

• Abdominal Assessment: Inspect for distension, auscultate for bowel sounds (hyperactive, hypoactive, or absent), palpate for tenderness, rigidity, or masses.
• Vital Signs: Monitor heart rate, blood pressure, respiratory rate, temperature, and oxygen saturation. Changes can indicate complications.
• Fluid and Electrolyte Status: Assess hydration status (skin turgor, mucous membranes), and monitor electrolyte levels (sodium, potassium).
• Bowel Sounds: Document the presence, frequency, and character of bowel sounds.
• Abdominal Distension: Measure abdominal girth to track progression.

II. Nursing Diagnoses

Based on the assessment, several nursing diagnoses may be applicable:

• Acute Pain related to intestinal distention and inflammation: This is a primary concern, requiring effective pain management strategies.
• Fluid Volume Deficit related to vomiting and decreased oral intake: Dehydration is a significant risk, demanding careful fluid balance monitoring and replacement.
• Risk for Electrolyte Imbalance related to vomiting and nasogastric suction: Electrolyte shifts can be life-threatening, requiring close monitoring and correction.
• Impaired Bowel Elimination related to intestinal obstruction: This is a direct consequence of the obstruction and requires appropriate interventions.
• Anxiety related to illness severity and uncertainty of outcome: The patient’s emotional state needs to be addressed.

III. Planning & Interventions

A. Pain Management:

• Administer analgesics as prescribed (opioids may be used cautiously, considering the risk of paralytic ileus).
• Implement non-pharmacological pain relief methods (e.g., repositioning, relaxation techniques).

B. Fluid and Electrolyte Balance:

• Monitor intake and output meticulously.
• Administer intravenous fluids as prescribed to correct dehydration and electrolyte imbalances.
• Monitor serum electrolyte levels regularly.

C. Nasogastric (NG) Suction:

• Maintain NG suction as ordered to decompress the bowel and reduce distension.
• Monitor NG output frequently and document its character.

D. Bowel Rest:

• NPO (nothing by mouth) status is usually implemented to allow the bowel to rest.

E. Surgical Intervention:

• Provide pre-operative care if surgery is indicated. This may involve preparing the bowel, administering antibiotics, and providing emotional support.
• Provide post-operative care, including monitoring vital signs, incision site care, pain management, and bowel function assessment.

F. Monitoring for Complications:

• Observe for signs of peritonitis (abdominal rigidity, fever, tachycardia).
• Monitor for signs of sepsis (fever, hypotension, altered mental status).
• Monitor for signs of bowel perforation (sudden worsening of pain, rebound tenderness).

G. Patient Education:

• Explain the nature of the condition and the treatment plan.
• Instruct the patient and family on post-discharge care, including medication regimen, dietary restrictions, and signs and symptoms to report.

IV. Evaluation

The effectiveness of the nursing care plan is evaluated by assessing the patient's response to interventions:

• Reduction in pain levels.
• Improved fluid and electrolyte balance.
• Resolution of nausea and vomiting.
• Return of bowel function.
• Absence of complications.
• Decreased anxiety levels.

Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with a healthcare professional for diagnosis and treatment of medical conditions. The specific nursing interventions will vary depending on the individual patient's condition and the type of obstruction.