Evidence Based Nursing Care Plan For Intestinal Obstruction

Nursing Care
Plan for Bowel

Obstruction
Introduction
Bowel obstruction refers to a complete or partial
blockage in the intestine. It can be caused by scar
tissue from a previous surgery, hernias, cancer, and
inflammatory bowel disorders.
Bowel Obstruction prevents contents from passing
through into the large intestine. This causes waste
products to build up above the portion of the
obstruction. Surgery is required for most instances
of Bowel Obstruction, except in cases of partial
obstructions. Bowel Obstruction must be identified
promptly, as mortality can be reduced when surgery
is performed within 24-36 hours.
Pathophysiology of Bowel
Obstruction
 Mechanical Blockage:
Mechanical causes may include adhesions, hernias, tumors, or
impacted fecal material.
 Impaired Intestinal Motility :
Reduced or absent motility contributes to the accumulation of
contents proximal to the obstruction.
 Distention and Increased Pressure:
Accumulation of gas, fluid, and undigested material proximal to the
obstruction causes distention of the bowel segment. Increased
pressure within the obstructed area can lead to vascular
compromise, compromising blood flow to the affected bowel.
 Fluid and Electrolyte
Imbalance:
Bowel obstruction can result in fluid and
electrolyte imbalances due to vomiting,
decreased oral intake, and the loss of
fluids into the obstructed bowel.
 Ischemia and Perforation Risk:
Prolonged obstruction can lead to
ischemia (reduced blood supply) of the
bowel wall, increasing the risk of tissue
necrosis and perforation, a life-
Etiology of Bowel
Obstruction
Adhesions:
Intra-abdominal adhesions, often formed as a
result of previous abdominal surgeries or
inflammatory processes lead to bowel
obstruction by constricting or compressing the
intestines.
 Hernias:
Incarceration or strangulation of the herniated
bowel segment can result in bowel obstruction.
 Tumors:
Benign or malignant tumors within the gastrointestinal
tract or adjacent structures can obstruct the normal flow
of intestinal contents.
 Intussusception:
Intussusception occurs when one segment of the intestine
telescopes into another, leading to obstruction.
 Volvulus:
Volvulus involves the twisting or torsion of a segment of
the bowel around its mesentery can lead to obstruction
Desired Outcomes for Nursing Care Plan:
 Relief of Symptoms:
Achieve relief of symptoms associated with bowel
obstruction, including abdominal pain, distension, nausea,
and vomiting. Improve the individual’s overall comfort and
well-being.
 Restoration of Intestinal Function:
Facilitate the restoration of normal intestinal function by
relieving the obstruction.
 Maintenance of Fluid and Electrolyte Balance:
Ensure maintenance of fluid and electrolyte balance through
appropriate interventions. Address dehydration, electrolyte
 Prevention of Complications:
Prevent complications associated with bowel
obstruction, such as ischemia, necrosis, and
perforation. Monitor for signs of deteriorating bowel
health and intervene promptly to minimize the risk of
severe complications.
 Patient Education and Follow-Up:
Provide education to the patient and their family on
the nature of bowel obstruction, potential causes, and
the importance of adherence to prescribed
treatments. Empower individuals to recognize early
signs of recurrence and seek timely medical attention.
Subjective Data
 Chief Complaint:
The patient reports severe abdominal pain.
 Pain Assessment:
Describes sharp pain in the lower back that worsens with movement.
 Present Illness:
Reports onset of nausea and vomiting yesterday, with worsening abdominal pain.
 Medication History:
States taking medication for high blood pressure every morning.
 Allergies:
Mentions being allergic to penicillin and experiencing a rash as a reaction.
Objective Data
 Vital Signs:
Decreased blood pressure if dehydrated or septic, increased heart rate if dehydrated or septic, elevated
temperature if infection is present
 Gastrointestinal assessment:
The abdomen is distended with tenderness on palpation, bowel sounds are absent, and the patient
winces when pressure is applied to the lower back. The patient is observed vomiting bile, and there is
no evidence of bowel movements during the examination.
Lab Results:
Elevated white blood cell count of 15,000/mm³, indicating potential infection.
Diagnostic Imaging:
Abdominal X-ray shows air-fluid levels and distended loops of the bowel.
Nursing Assessment for Bowel Obstruction:
 Abdominal Assessment:
Perform a thorough abdominal assessment, noting the location, intensity, and characteristics of
abdominal pain. Evaluate for distension, tenderness, and visible peristaltic waves, which may be
indicative of obstruction.
 Bowel Sounds:
Auscultate bowel sounds in all abdominal quadrants. Diminished or absent bowel sounds may
suggest decreased motility, while hyperactive sounds may be present in the early stages of
obstruction.
 Vomiting and Stool Assessment:
Assess the frequency and characteristics of vomiting, including the presence of bile or fecal
content. Note changes in stool patterns, such as constipation or the absence of bowel movements.
 Fluid and Electrolyte Status:
Monitor fluid and electrolyte status, assessing for signs of dehydration, electrolyte imbalances, and
potential shifts in fluid volume. Document input and output to gauge hydration status.
Vital Signs:
Monitor vital signs regularly, paying attention to changes in blood pressure, heart rate, and
respiratory rate. Elevated temperature may indicate inflammation or infection.
Abdominal Imaging:
Collaborate in obtaining and interpreting diagnostic imaging studies, such as abdominal X-rays
or CT scans, to visualize the location and extent of the obstruction. Evaluate for signs of bowel
distension or air-fluid levels.
Pain Assessment:
Use a pain scale to assess the intensity and location of abdominal pain. Document any radiation
of pain, and assess the effectiveness of pain management interventions.
Psychosocial Assessment:
Perform a psychosocial assessment, considering the individual’s emotional response to the
condition, coping mechanisms, and support systems. Recognize the potential impact of bowel
obstruction on mental well-being.
Nursing Interventions and Rationales for Bowel Obstruction:
 Initiate NPO Status:
Withholding oral intake helps rest the gastrointestinal tract, reduces stimulation of peristalsis, and
prevents the risk of aspiration if vomiting occurs.
 Insert Nasogastric (NG) Tube:
NG tube decompresses the stomach, relieving pressure caused by accumulated gastric contents
and preventing aspiration. It aids in assessing the volume and nature of gastric output.
 Administer Intravenous (IV) Fluids:
Maintaining hydration and electrolyte balance is crucial, especially when oral intake is restricted
due to vomiting or bowel obstruction. IV fluids provide essential support.
 Monitor Vital Signs and Abdominal Distension:
Regular monitoring helps identify changes in the patient’s condition, such as signs of dehydration,
shock, or increased abdominal distension, which may indicate worsening obstruction.
 Collaborate for Diagnostic Tests:
Collaborating with healthcare providers for diagnostic imaging (e.g., X-rays, CT scans) helps identify
the location and severity of the obstruction, guiding appropriate interventions.
 Administer Medications as Prescribed:
Rationale: Medications may include analgesics for pain relief, antiemetics to control nausea and
vomiting, and antibiotics if infection is suspected. Administering medications as prescribed
addresses specific symptoms and complications.
 Prepare for Surgery if Indicated:
Rationale: Surgical intervention may be necessary to correct the underlying cause of the
obstruction, such as removing adhesions, tumors, or repairing hernias. Preparing the patient for
surgery ensures timely intervention.
 Provide Emotional Support and Patient Education:
Rationale: Bowel obstruction can be distressing for patients. Offering emotional support and
providing education on the condition, treatment plan, and signs of recurrence empower the
patient to actively participate in their care.
Evaluation for Bowel Obstruction Nursing Care Management:
 Symptom Resolution:
Evaluate the resolution of symptoms, including abdominal pain, distension, and
vomiting. Assess whether the individual experiences relief from the presenting
symptoms and if there is a return to normal bowel function.
 Bowel Function Restoration:
Monitor the restoration of normal bowel function, including the return of bowel
sounds, passage of stool, and relief of obstructive signs. Assess for any ongoing issues
related to motility or recurrent obstructions.
 Fluid and Electrolyte Balance:
Assess the maintenance of fluid and electrolyte balance. Evaluate hydration status,
electrolyte levels, and the effectiveness of interventions in preventing or correcting
imbalances.
 Complication Prevention:
Evaluate the success of interventions in preventing complications such as bowel
ischemia, necrosis, or perforation. Monitor for any signs of deteriorating bowel
health and intervene promptly if complications are suspected.
Patient Education and Follow-Up:
Assess the understanding and implementation of patient education regarding
bowel obstruction, its causes, and the importance of follow-up care. Ensure
that the patient is equipped to recognize early signs of recurrence and seek
timely medical attention.
Thank
s
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Nursing Care

Plan for Bowel

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