Bowel obstruction is a critical condition that occurs when there is a blockage in the intestines, either in the small or large bowel. This blockage can be mechanical (due to a physical obstruction) or functional (due to impaired muscle activity in the bowel).
Mechanical obstructions are often caused by conditions such as tumors, hernias, adhesions, or volvulus, while functional obstructions can be due to factors like paralytic ileus.
What is Bowel Obstruction?
Bowel obstruction is a partial or complete blockage of the small or large intestine, which impedes the normal flow of digestive contents through the gastrointestinal tract. This can cause symptoms such as abdominal pain, vomiting, bloating, and the inability to pass gas or stool.
Obstruction can be categorized into:
- Mechanical Obstruction: This includes causes such as adhesions, tumors, volvulus (twisting of the bowel), or intussusception (telescoping of one part of the intestine into another).
- Functional Obstruction: Also known as paralytic ileus, this occurs when the muscles of the intestines are unable to propel contents forward, even without a physical blockage.
Without appropriate intervention, bowel obstruction can lead to serious complications, including bowel perforation, necrosis, peritonitis, and systemic infection (sepsis).
Nursing Assessment for Bowel Obstruction
When assessing a patient with suspected bowel obstruction, the nurse should be vigilant for the following signs and symptoms:
- Severe abdominal pain, often crampy or colicky in nature
- Nausea and vomiting, which may contain bile or fecal matter in severe cases
- Abdominal distension
- Inability to pass stool or flatus
- Hyperactive bowel sounds initially, followed by absent or hypoactive bowel sounds in late stages
- Dehydration due to vomiting and reduced oral intake
- Electrolyte imbalances
Early identification and intervention are essential to prevent worsening of the condition and to optimize patient outcomes.
Nursing Diagnoses for Bowel Obstruction
- Acute Pain related to bowel distention and increased peristalsis secondary to obstruction.
- Imbalanced Nutrition: Less than Body Requirements related to reduced nutrient absorption and intake secondary to obstruction.
- Risk for Deficient Fluid Volume related to vomiting and decreased fluid intake secondary to obstruction.
- Risk for Infection related to potential bowel perforation and sepsis secondary to prolonged obstruction.
- Impaired Gas Exchange related to abdominal distension affecting respiratory effort.
Each nursing diagnosis should be managed through an individualized care plan tailored to the patient’s specific needs and conditions. Below are the nursing care plans associated with these diagnoses.
Nursing Care Plan 1: Acute Pain
Nursing Diagnosis:
Acute Pain related to bowel distention and increased peristalsis secondary to bowel obstruction.
Expected Outcomes:
- The patient will report reduced pain levels within 30 minutes of interventions.
- The patient will display signs of comfort, such as reduced guarding, less restlessness, and improved ability to rest.
Nursing Interventions:
- Assess the patient’s pain: Use a pain scale to regularly monitor the intensity, location, and quality of the pain.
- Administer pain medication as prescribed: Provide opioids or non-opioid analgesics based on the severity of the pain.
- Position the patient comfortably: Elevate the head of the bed to a semi-Fowler’s position to reduce abdominal pressure and improve comfort.
- Apply non-pharmacological measures: Utilize heat packs, relaxation techniques, and other non-pharmacological methods to reduce discomfort.
Rationale:
Pain relief is a priority for patients with bowel obstruction, as it not only improves comfort but also reduces the risk of further complications such as increased intra-abdominal pressure and respiratory compromise.
Nursing Care Plan 2: Imbalanced Nutrition: Less than Body Requirements
Nursing Diagnosis:
Imbalanced Nutrition: Less than Body Requirements related to reduced nutrient absorption and intake secondary to bowel obstruction.
Expected Outcomes:
- The patient will maintain or improve body weight during hospitalization.
- Nutritional deficiencies, such as protein or electrolyte imbalances, will be corrected within 48 hours.
Nursing Interventions:
- Monitor the patient’s nutritional intake: Keep track of all oral intake, including fluids and solid food, if allowed. Collaborate with a dietitian for the best nutritional support.
- Administer parenteral or enteral nutrition: If the obstruction precludes oral intake, provide parenteral nutrition (TPN) or nasogastric tube feeding to ensure adequate nutrient delivery.
- Monitor lab values: Regularly assess serum albumin, prealbumin, and electrolyte levels to detect malnutrition or deficiencies.
Rationale:
Bowel obstruction severely limits the patient’s ability to absorb nutrients, which can lead to malnutrition and further compromise healing. Ensuring adequate nutritional support is crucial for recovery.
Nursing Care Plan 3: Risk for Deficient Fluid Volume
Nursing Diagnosis:
Risk for Deficient Fluid Volume related to vomiting and decreased fluid intake secondary to bowel obstruction.
Expected Outcomes:
- The patient will maintain normal fluid and electrolyte balance, as evidenced by stable blood pressure, heart rate, and urine output.
- The patient will have no signs of dehydration (e.g., dry mucous membranes, skin turgor, hypotension).
Nursing Interventions:
- Monitor fluid balance: Measure and record all intake and output, paying special attention to signs of dehydration or fluid overload.
- Administer IV fluids: Provide isotonic intravenous fluids as prescribed to prevent hypovolemia and maintain electrolyte balance.
- Monitor for signs of dehydration: Check for dry mucous membranes, decreased skin turgor, and hypotension, which are common indicators of fluid depletion.
Rationale:
Fluid imbalances can occur rapidly in patients with bowel obstruction due to vomiting, nasogastric suctioning, and reduced oral intake. Close monitoring and timely interventions are essential to prevent complications such as hypovolemic shock.
Nursing Care Plan 4: Risk for Infection
Nursing Diagnosis:
Risk for Infection related to potential bowel perforation and sepsis secondary to prolonged bowel obstruction.
Expected Outcomes:
- The patient will remain afebrile with no signs of infection during the hospital stay.
- Laboratory results (e.g., WBC count) will remain within normal limits, indicating no active infection.
Nursing Interventions:
- Monitor for signs of infection: Regularly assess the patient for fever, chills, increased WBC count, and signs of sepsis (e.g., hypotension, tachycardia).
- Maintain aseptic technique: Use sterile techniques during procedures such as inserting a nasogastric tube or managing intravenous lines to prevent infection.
- Administer prophylactic antibiotics if prescribed: Prevent bacterial translocation and reduce the risk of infection, particularly in cases of suspected bowel perforation.
Rationale:
Patients with prolonged bowel obstruction are at risk of perforation, which can lead to peritonitis and sepsis. Early detection and prevention strategies are critical to minimizing this risk.
Nursing Care Plan 5: Impaired Gas Exchange
Nursing Diagnosis:
Impaired Gas Exchange related to abdominal distension affecting respiratory effort.
Expected Outcomes:
- The patient will maintain oxygen saturation levels above 95% throughout hospitalization.
- The patient will report improved breathing and reduced shortness of breath.
Nursing Interventions:
- Monitor respiratory status: Regularly assess the patient’s respiratory rate, depth, and oxygen saturation.
- Position the patient in a semi-Fowler’s position: This helps relieve pressure from the diaphragm, making breathing easier.
- Administer oxygen therapy as needed: Provide supplemental oxygen if the patient’s oxygen saturation falls below 92%.
Rationale:
Abdominal distension from bowel obstruction can increase pressure on the diaphragm, impairing lung expansion and gas exchange. Prompt interventions help maintain adequate respiratory function.
References
- Moore, K. L., & Dalley, A. F. (2018). Clinically Oriented Anatomy (8th ed.). Lippincott Williams & Wilkins.
- King, B. R., & Baker, C. J. (2021). “Management of Small and Large Bowel Obstruction in Adults,” American Journal of Surgery, 221(2), 293-298.