NUR 201 Test 1
- Mechanical obstruction of the bowel can result from
Answer -Outside the bowel problem (such as ADHESIONS)
-In the bowel wall (such as CHRON'S Disease) -Or in the intestinal lumen (such as Tumors)
- Non-mechanical obstruction
Answer AKA Paralytic ileus/adynamic ileus.
-Does not involve a physical obstruction in or outside the intestine. Instead peristalsis is decreased or absent as a result of neuromuscular disturbance, resulting in a slowing of the movement or a backup of intestinal contents. (SHUTDOWN)
- With obstructions what is compromised?
Answer Elimination
- The type of complications from obstructions depend on....
Answer The location of the obstruction.
- If you have an obstruction that is high in the small intestine, which complication will you
have?
Answer Loss of acid due to vomiting, leading to Metabolic Alkalosis.
- If you have an obstruction below the duodenum/above the large intestine you will have....
Answer A loss of both ACID AND BASE 1 / 4
- If you have an obstruction towards the end of the small bowel/lower intestine you will
have a loss of....
Answer BASE-Leading you to Metabolic Acidosis. Remember losing a lot of stool will lead to acidosis.
- What is the complication of obstruction that may lead to acute kidney injury?
Answer Hypovolemia. Severe hypovolemia can result in AKI, or even death.
- what is peritonitis?
Answer acute inflammation of the peritoneum
- Why does bleeding occur in the intestines?
Answer Perforation or ruptured intestines . Remember this will lead to peritonitis.
- What are the causes of mechanical obstruction?
Answer -Scar tissue (adhesions) from surgeries/pathology
-Benign or malignant tumor -Hernias -Fecal impactions. (Especially in your older adults) due to decreased mobility, decreased GI motility, may not be eating enough or drinking enough.-Crohn's disease which is an inflammatory disease.-Volvulus-Twisting of the intestine
-Intussusception
Answer Telescoping of a segment within itself.
- Causes of non-mechanical obstruction 2 / 4
Answer -Post-op ileus
-Peritonitis -Intestinal ischemia.
- What will intestinal ischemia lead to?
Answer Bowel death, it NEVER comes back.
- Paralytic ileus is most commonly caused by
Answer Handling of the intestines during abdominal surgery. In post-op ileus patients functions is lost for a few hours to
several days. Electrolyte disturbances, especially HYPOKALEMIA, predispose the patient to this problem.
- Why does peritonitis cause an ileus?
Answer Because leakage of colonic contents causes severe irritation and triggers an inflammatory response and INFECTION.
- Assessment of the patient with a suspected obstruction?
Answer -A hx of GI disorders, surgeries, and treatment
-Recent N&V (especially color of emesis) -thorough pain assessment with particular attention to the onset, aggravating fac- tors, alleviating factors, and patterns or rhythms of the pain.-Do they have gas?-Character and consistency of the last BM. And WHEN?-Hiccups (common with all types of intestinal obstruction) -Ask about diet and family hx.-Ask about medications (don't forget HERBALS) 3 / 4
- Severe pain that then stops and changes to tenderness on palpation...
Answer -
May indicate perforation and must be reported promptly to the physician.
- Physical assessment of mechanical obstructions?
Answer -Generalized abdominal distention
-Possible, visible peristalic waves.-High pitched sounds (borborygmi) or absent sounds -Tender upon palpation. Minimal rigidity. May be able to feel inflated bowel.-Mild abdominal pain, cramping.
-If it is strangulation
Answer Pain is more localized and steady.
-Vomiting
-Obstipation
Answer No passage of stool
-Diarrhea with PARTIAL obstructions.
- Physical assessment of non-mechanical obstructions>
Answer -Abdominal disten- sion
-Decreased bowel sounds early; absent bowel sounds later.-Pain is associated with vascular insufficiency or infarct -Colicky pain/ cramping -OBSTIPATION- permanent loss of function which is worse than constipation.
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