Bowel Obstruction Concept Map

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Nursing Concept Map Template (Cheatsheet)

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Outline

Overview

Concept maps
1. Many types, variations, layouts
2. Primary diagnosis
  1. Typically in center of maps
  2. Connects to
    1. Contributing factors
    2. Medications
    3. Labwork
    4. Patient education
    5. Nursing diagnoses
      1. Interventions
      2. Evaluations

Nursing Points

General

Nursing diagnosis
1. Risk for deficient fluid volume
  1. Observe for bleeding/test occult blood
    1. No occult blood in stool
  2. Administer parenteral fluids
    1. Normal electrolyte values, CBC, vital signs
  3. Monitor I&O and daily weights
    1. Appropriate urine concentration, electrolytes, skin turgor
2. Imbalanced nutrition less than body requirements
  1. Assess nutritional needs of patient
    1. Established nutritional needs of patient
  2. Encourage activity restrictions
    1. Patient limits activity
  3. Administer parenteral nutrition
    1. Stable weight of patient
3. Acute pain
  1. Encourage patient to report pain
    1. Patient reports pain and level
  2. Encourage positions of comfort
    1. Increased patient comfort
  3. Administer analgesics
    1. Patient reports pain reduction

Assessment

Contributing factors
1. Bowel adhesions
2. Cancer (colon)
3. Inflammatory bowel diseases
  1. Crohn’s
4. Hernias
5. Diverticulitis
6. Impacted feces
7. Tumor

Therapeutic Management

Labwork
1. Complete blood count
  1. Dehydration
  2. Loss of electrolytes
2. Other diagnostic testing
  1. Abdominal x-ray
  2. Abdominal physical assessment
Medications
1. Antibiotics
  1. Cefazolin 1-2 g IV
2. Antiemetics
  1. Promethazine 12.5-25 mg IV prn
3. Analgesics
  1. Morphine 1-4 mg IV prn

Nursing Concepts

Clinical judgement
Functional ability
Elimination

Patient Education

Patient education
1. If surgery
  1. Limit exercise/strenuous activity
  2. Teach ileostomy/colostomy care
2. Eat small, spaced meals
3. Take sips of clear fluid
4. Report
  1. Vomiting
  2. Diarrhea
  3. Fever/chills
  4. No or little gas
  5. No or bloody stool

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Transcript

Hey guys! Today we are going to take a look at a concept map for bowel obstruction!

So in this lesson we will take a look at the components of a concept map including contributing factors, medications, lab work and the significance, patient education, and associated nursing diagnoses with interventions and evaluations!

Ok so here is a basic example of a concept map, guys there are many different variations and this is just one example. First, we start with the primary diagnosis typically in the center of the concept map which leads to nursing diagnoses and interventions and also contributing factors, medications, labwork, and patient education which are associated with the primary diagnosis. Lets jump in! Lets start with contributing factors in this upper corner. Contributing factors for a bowel obstruction or in other words your patient may have had a recent surgery which can cause adhesions, cancer specifically colon cancer, inflammatory bowel disease like Crohns, a hernia, tumor, or even impacted feces.

In this next circle right here we might see medications associated with a bowel obstruction. Often times your patient will be given antibiotics for prophylaxis of surgical intervention, which is a realistic end result for a patient with a bowel obstruction to cover gram-negative and anaerobic organisms like Cefazolin (1-2 g IV) which works by inhibiting bacterial growth. Antiemetics like promethazine (12.5-25 mg IV q4-6 hours prn) are super common because your patient is probably experiencing nausea and vomiting with this issue. Promethazine works by blocking postsynaptic mesolimbic dopaminergic receptors in the brain which reduces stimuli that results in nausea and vomiting. Finally, your patient is most likely experiencing pain and analgesics help with this discomfort. Morphine (1-4 mg IV prn) could be a dose given as it acts on the central nervous system being a full opioid agonist.

Ok additional information included in a concept map is commonly patient education and significant labwork. So in this circle here lets add important patient education information which might be different for each patient depending on if they required surgery or were only treated medically. If your patient had surgery teach them to limit exercise or strenuous activity for the amount of time ordered by the provider and if an ileostomy or colostomy was created you would teach them how to care for this. Teach all bowel obstruction patients to each small meals that are spaced out, add new foods back into the diet slowly, take sips of clear fluids throughout the day. Also teach your patient to avoid foods that cause gas, loose stools, or constipation to give the bowel a rest. Finally, teach the patient to report vomiting, nausea, diarrhea that does not go away, fever, chills, little or no gas or no stool, or bloody stool. What about labwork or the ways that bowel obstruction is diagnosed? A complete blood count will be done to check for dehydration or loss of electrolytes. It is important to mention that a physical examine and x-ray of the abdomen will be completed for diagnosis.

Finally, in the three circles that are left we will add nursing diagnoses with interventions and evaluations for bowel obstruction. One appropriate nursing diagnosis would be risk for deficient fluid volume. One intervention is to observe for overt bleeding and test for occult blood daily which will be evaluated by the absence of blood in the stool. Next, administer parenteral fluids and blood transfusions as necessary as the bowel will require rest so alternative fluid replacement can replace the lost fluids and anemia. This will be evaluated by normal electrolyte values, CBC, and vital signs. Finally, monitor your patient’s intake and output and daily weights which will give you information on over fluid balance and will be evaluated by the urine of normal concentration as well as appropriate electrolyte values, skin turgor, and mucous membranes.

Another nursing diagnosis could be imbalanced nutrition less than body requirements. Interventions which are appropriate include assessing the nutritional needs of your patient which will be evaluated by established nutritional needs of the patient and encouraging activity restrictions to decrease metabolic needs evaluated by limited activity of the patient. Finally give parenteral nutritional if the patient is not allowed to eat which will be evaluated by stable weight.

Although there are many nursing diagnoses for bowel obstruction one last one that we will talk about here is acute pain which a patient with a bowel obstruction will most likely have. Interventions appropriate include encourage the client to report pain evaluated by the patient evaluated pain, encourage the patient to assume a position of comfort (knees flexed) which will be evaluated by increased patient comfort. Finally, administer appropriate analgesics as ordered to decrease acute pain evaluated by reduction in pain level.

Here is a look at the completed concept map for bowel obstruction!

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