Bowel Perforation for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Bowel Perforation for Certified Emergency Nursing (CEN)
Outline
Bowel Perforation
Definition/Etiology:
Perforation is a full-thickness injury of the bowel wall; however, partial-thickness bowel injury can progress over time to become a full-thickness injury or perforation, subsequently releasing gastrointestinal contents.
Pathophysiology:
Bowel obstruction can cause ischemia of the bowel wall and then necrosis.
Gastric contents have pH 1-2, and are very erosive and painful in the peritoneum.
Mechanisms:
- Instrumentation (endoscopy, contrast instillation, electrocautery during surgery, NG/OG)
- Trauma (blunt or penetrating)
- Bowel obstruction
- Cancer or other tumor
- Peptic ulcer disease
- Medication erosion (aspirin, NSAIDs)
- Diverticulitis
- Esophageal dilatation
- Foreign object (toothpick, fishbone, battery)
- Vomiting
- Crohn’s
- Appendicitis
- Mesenteric ischemia
- Bicycle/motorcycle handlebars
- Stabbing / gunshot wound
- Pelvic fracture
- Seatbelt
Clinical Presentation:
- Abdominal / chest / neck pain
- Curled up, unable to lay flat
- Toxic, septic
- Crepitus on palpation of mediastinum if esophageal perf
Collaborative Management:
Labs:
- CBC, CMP, amylase, lipase, CRP
- Blood cultures, lactate
- Type and cross
Imaging:
- FAST exam
- Abdominal x-rays, multiple views
- Neck x-rays (subq emphysema?)
- Abdominal CT (gas under the diaphragm, abscess?)
Management:
- IV fluids
- Broad spectrum IV antibiotics
- NPO
- Surgical consult
Evaluation | Patient Monitoring | Education:
Monitor for shock:
- Hypovolemic if bleeding or if third-spacing
- Septic
- Neurogenic if multi-trauma
Linchpins: (Key Points)
- Prevent septic shock.
- Early antibiotics and fluids.
- Understand third spacing.
- Treat pain.
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Benjamin, E. (2022, April 26). Traumatic gastrointestinal injury in the adult patient. UpToDate. https://www.uptodate.com/contents/traumatic-gastrointestinal-injury-in-the-adult-patient
- Odom, S. R. (2021, May 20). Overview of gastrointestinal tract perforation. UpToDate. https://www.uptodate.com/contents/overview-of-gastrointestinal-tract-perforation
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System