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MedSurg Chapter 60:2

Noninflammatory Intestinal Disorders-2

QuestionAnswer
Intestinal Obstruction Can be partial or complete
Intestinal Obstruction Mechanical- bowel is physically obstructed by disorders outside the intestine
Intestinal Obstruction Nonmechanical- result of neuromuscular distrubance- does not involve a physical obstruction in or outside the intestinePeristalsis is decreased or absent- resulting in slowing in the movement or backup of intestinal contents
Intestinal Obstruction Obstruction high in the small intestine causes a loss of gastric hydrochloride- METABOLIC ALKALOSIS
Intestinal Obstruction Obstruction a the end of the small intestine and lower in the intestinal tract causes loss of alkaline fluid- METABOLIC ACIDOSIS
Strangulated Obstruction Obstruction with compromised blood flow
Mechanical Obstruction Result from adhesionsTumorsHerniasFecal Impaction(Older Adults)Strictures due to Crohn's disease or radiationIntussusceptionVolvulus- twisting of the intestineFibrosis due to disorders such as endometriosisVascular Disorder
Mechanical Obstruction-Manifestations Mild abdominal pain or cramping Vomit may contain bile and mucus or be orange-brown and foul smellingVisible peristaltic waves Obstipation- no passage of stool
Mechanical Obstruction-Manifestations High pitched bowel sounds (borborygmi)- associated with cramping early in the obstructive process as intestine tries to push the mechanical obstruction forwardIn later stage, bowel sounds are absent Abdominal tenderness and rigidity are minimal
Nonmechanical Obstruction Paralytic or adynamic, ileusCaused by physiologic, neurogenic, or chemical imbalances associated with decreased peristalsis from trauma or the effect of a toxin on autonomic intestinal controlCaused by MI, rib fracture, and pneumonia
Nonmechanical Obstruction Adynamic ileus- occurs to some degree following abdominal surgery or traumaParalytic ileus can be caused by handling of the intestines during abdominal surgery; intestinal function is lost for a few hours to several days
Nonmechanical Obstruction-Manifestations Pain is constant, diffuse, discomfortNO COLICKY PAINAbdominal distention is PRESENTDecreased bowel sounds in early obstructionAbsent bowel sounds in later stages
Nonsurgical Management- NG Tubes Assess for proper placement of the tube, tube patency, and output at least every 4 hours and irrigate with 30mL of NS *Assess for peristalsis by auscultating for bowel sounds with the suction DISCONNECTED (suction masks peristaltic sounds)
Pain Management Report any pain that increases or changes from a colicky, intermittent type to a constant discomfortOpioid analgesics are withheld in the diagnostic period-may mask other thingsComfortable Position-Semi-Fowlers
Created by: keisha12_18
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