Disorders of the Gastrointestinal System, 2nd Edition
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other symptoms become apparent by day five. Colicky abdominal pain may develop quite swiftly, producing frequent spasms. There is significant abdominal distention. Eventually, vomiting occurs. The vomitus may contain fecal matter. Continuous ab- dominal pain develops, and peritonitis may occur. If the obstruction is partial, these symptoms can occur but will like- ly present in a less severe form. Bowel sounds are often absent or quiet when auscultated (Yeh & Bordeinabou, 2021). In addition to findings from a history and physical, lab studies may show de- creased sodium, chloride, and potassi- um levels because of vomiting and an elevated WBC caused by infection, for example, peritonitis. It should be noted that WBC levels are often increased, even in mild forms of constipation (Yeh & Bor - deinabou, 2021). In severe cases, a lac- tate level should be assessed for sepsis or impending septic shock (Smith et al., 2022). Diagnostic tests such as CT scans; barium enema; upper GI; small-bowel series, if tolerated; and abdominal films may be conducted. Small bowel obstruc- tion findings include alternating dilat - ed and collapsed portions of the bowel, sometimes referred to as a “stepladder” pattern (Bordeianou & Yeh, 2021). Large bowel obstruction findings in - clude a distended, air-filled colon (Yeh & Bordeinabou, 2021). Immediate treatment includes fluid resuscitation, treatment of underlying diseases or conditions, cor- rection of electrolyte imbalances, and ad- ministration of analgesics and antiemet- ics as indicated. Bowel decompression is accomplished by inserting a nasogastric tube to suction GI contents and avoid aspiration. Antibiotics effective against gram-negative and anaerobic organisms are prescribed if ischemia or infection is
suspected (Smith et al., 2022). Patients must be monitored closely for evidence of shock indicated by pallor, tachycardia, and hypotension. Surgery is necessary if the patient’s condition does not improve or deteriorate (Yeh & Bordeinabou, 2021). Surgical interventions may include the re- moval of tumors and other masses, hernia repair, or bowel resection. In cases where ischemia and tissue damage are exten- sive, surgical resection with anastomosis, colostomy, or ileostomy may be neces- sary (Yeh & Bordeinabou, 2021). Nursing considerations for bowel ob- struction include the following: ● Monitor patients closely for signs and symptoms of metabolic alkalosis, such as changes in levels of consciousness, tetany, twitching, shallow respirations, cardiac arrhythmias, and confusion (Thomas, 2022). ● Monitor patients closely for signs and symptoms of metabolic acidosis, including malaise, hyperpnea (abnormal long and deep breathing), hypotension, anorexia, and stupor (Penn Medicine, 2023). ● Monitor intake and output meticulously, especially if peritonitis, perforation, and/or sepsis is suspected. Record the amount and color of nasogastric (NG) tube drainage and urine output (Yeh & Bordeinabou, 2021). ● Monitor for signs of dehydration: Dry oral mucous membranes, dark or absent urine output, dizziness, tachycardia, tachypnea, and poor skin turgor (Stoppler, 2019). ● Monitor for signs of sepsis and shock. Perforation and peritonitis can occur, so vital signs, physiological responses, and level of consciousness should be monitored (Yeh & Bordeinabou, 2021).
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