Diagnostic Studies for Bowel Obstruction

Diagnostic Studies for Bowel Obstruction

• Assessment: Thorough history and physical exam are crucial
• Imaging: X-rays, CT scans, or contrast enemas can identify and guide surgical decisions.
• Direct Visualization: Sigmoidoscopy or colonoscopy directly visualize the obstruction (LBO).
• Blood Tests: Complete blood count (CBC) and blood chemistries are essential.
  • High WBC: Suggests strangulation or perforation
  • Increased Hematocrit: May indicate hemoconcentration
  • Decreased Hemoglobin/Hematocrit: Suggests bleeding (cancer) or strangulation with necrosis
  • Electrolytes, BUN, and Creatinine: Monitored for dehydration assessment, including metabolic alkalosis (vomiting)

Interprofessional Care for Bowel Obstruction

• Goal: Restore intestinal patency and resolve the obstruction. Treatment varies according to the cause.
• Emergency Surgery: Required for strangulation, perforation, or severe cases.
• Potential Nonsurgical Resolution: Some obstructions (surgical adhesions) may resolve without surgery.
• Decompression: Nasogastric (NG) tube may be used for decompression.
• Nutritional Support: Parenteral nutrition (PN) may be necessary for bowel rest and improved nutrition before surgery.
• Stents: Endoscopic or fluoroscopic stents can be used palliatively or as a "bridge to surgery" to avoid emergency surgery.
• Corticosteroids: Often used with stent placement due to antiemetic and anti-inflammatory properties, that reduce edema.
• Surgical Intervention: May involve resection of the obstructed segment and anastomosis (reconnection). Partial or total colectomy, colostomy, or ileostomy may be needed in extensive cases.
• Nonsurgical Removal: Colonoscopy can remove polyps, dilate strictures, and destroy tumors (laser).

Nursing Management of Bowel Obstruction

• Assessment Focus: Preventing fluid/electrolyte imbalances & early recognition of deterioration.
• History: Location, duration, intensity, and frequency of abdominal pain are assessed. Restlessness and frequent position changes are observed
• Vomiting Assessment: Onset, frequency, color, odor, and amount are recorded.
• Bowel Function: Passage of flatus and bowel sounds (character & location) are assessed.
• Abdominal Assessment: Scars, masses, distention, tenderness, rigidity, and signs of peritoneal irritation (guarding, rebound pain) are observed.
• Regular Assessment: Important if the obstruction is expected to resolve on its own
• Vital signs & changes bowel sounds, urine output, abdominal distention, and pain are all reported to the HCP.
• Intake and Output: Strict monitoring of fluid intake, output and emesis and tube drainage. Hourly monitoring of urine output is critical. Low urine output (<0.5 mL/kg/hr body weight) indicates potential for kidney injury. Rising BUN & creatinine levels further indicate kidney injury.
• Monitoring of Other Parameters: Laboratory values and arterial blood gas values are crucial (metabolic imbalances).

Clinical Problems

• Pain
• Impaired GI function
• Fluid imbalance

Planning

• Goals: Relief of obstruction, normal bowel function, minimal discomfort, and normal fluid/electrolytes/acid-base balance.