Nursing Care Plan (NCP) for Bowel Obstruction
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Outline
Lesson Objective for Nursing Care Plan Bowel Obstruction
Upon completion of this nursing care plan for Bowel Obstruction, nursing students will be able to:
- Recognize Signs and Symptoms of Bowel Obstruction:
- Develop proficiency in recognizing the signs and symptoms associated with bowel obstruction, including abdominal pain, distension, altered bowel habits, and potential complications. Identify key assessment findings indicative of bowel obstruction.
- Understand the Pathophysiology of Bowel Obstruction:
- Gain a comprehensive understanding of the pathophysiology of bowel obstruction, including the mechanical and functional causes. Recognize the impact of obstruction on intestinal motility, fluid balance, and potential complications such as ischemia or perforation.
- Implement Effective Nursing Interventions:
- Demonstrate the ability to implement effective nursing interventions for individuals with bowel obstruction. This includes interventions to relieve symptoms, maintain fluid and electrolyte balance, and prevent complications such as bowel perforation.
- Collaborate in Diagnostic and Treatment Modalities:
- Develop collaboration skills to work with healthcare providers in the diagnostic process and treatment modalities for bowel obstruction. Participate in the interpretation of diagnostic tests and contribute to the development and implementation of treatment plans.
- Provide Patient and Family Education:
- Provide education to patients and their families on bowel obstruction, its causes, potential complications, and the importance of adherence to prescribed treatments. Empower individuals to recognize early signs and seek timely medical attention.
Pathophysiology of Bowel Obstruction:
- Mechanical Blockage:
- Bowel obstruction typically involves a physical blockage within the intestinal lumen, hindering the normal flow of gastrointestinal contents. Mechanical causes may include adhesions, hernias, tumors, or impacted fecal material.
- Impaired Intestinal Motility:
- The obstruction leads to impaired peristalsis and intestinal motility, preventing the smooth movement of contents through the affected segment of the bowel. Reduced or absent motility contributes to the accumulation of contents proximal to the obstruction.
- Distention and Increased Pressure:
- Accumulation of gas, fluid, and undigested material proximal to the obstruction causes distention of the bowel segment. Increased pressure within the obstructed area can lead to vascular compromise, compromising blood flow to the affected bowel.
- Fluid and Electrolyte Imbalance:
- Bowel obstruction can result in fluid and electrolyte imbalances due to vomiting, decreased oral intake, and the loss of fluids into the obstructed bowel. Electrolyte disturbances, especially potassium imbalances, may occur and contribute to systemic complications.
- Ischemia and Perforation Risk:
- Prolonged obstruction can lead to ischemia (reduced blood supply) of the bowel wall, increasing the risk of tissue necrosis and perforation. Bowel perforation is a severe complication that can result in peritonitis, sepsis, and a life-threatening emergency.
Etiology of Bowel Obstruction:
- Adhesions:
- Intra-abdominal adhesions, often formed as a result of previous abdominal surgeries or inflammatory processes, can cause abnormal connections between tissues and lead to bowel obstruction by constricting or compressing the intestines.
- Hernias:
- Hernias occur when a portion of the bowel protrudes through a weakened area of the abdominal wall. Incarceration or strangulation of the herniated bowel segment can result in bowel obstruction.
- Tumors:
- Benign or malignant tumors within the gastrointestinal tract or adjacent structures can obstruct the normal flow of intestinal contents. Tumors may cause a partial or complete blockage depending on their size and location.
- Intussusception:
- Intussusception occurs when one segment of the intestine telescopes into another, leading to obstruction. This condition is more common in infants and young children but can also occur in adults.
- Volvulus:
- Volvulus involves the twisting or torsion of a segment of the bowel around its mesentery. This rotational movement can lead to obstruction and compromise the blood supply to the affected bowel, resulting in ischemia and potential necrosis.
Desired Outcomes for Bowel Obstruction Nursing Care Plan:
- Relief of Symptoms:
- Achieve relief of symptoms associated with bowel obstruction, including abdominal pain, distension, nausea, and vomiting. Improve the individual’s overall comfort and well-being.
- Restoration of Intestinal Function:
- Facilitate the restoration of normal intestinal function by relieving the obstruction. Promote the resumption of bowel motility and the passage of gastrointestinal contents through the affected area.
- Maintenance of Fluid and Electrolyte Balance:
- Ensure maintenance of fluid and electrolyte balance through appropriate interventions. Address dehydration, electrolyte imbalances, and nutritional deficits resulting from vomiting decreased oral intake, or fluid shifts.
- Prevention of Complications:
- Prevent complications associated with bowel obstruction, such as ischemia, necrosis, and perforation. Monitor for signs of deteriorating bowel health and intervene promptly to minimize the risk of severe complications.
- Patient Education and Follow-Up:
- Provide education to the patient and their family on the nature of bowel obstruction, potential causes, and the importance of adherence to prescribed treatments. Empower individuals to recognize early signs of recurrence and seek timely medical attention.
Subjective Data
- Chief Complaint:
- The patient reports severe abdominal pain.
- Pain Assessment:
- Describes sharp pain in the lower back that worsens with movement.
- Present Illness:
- Reports onset of nausea and vomiting yesterday, with worsening abdominal pain.
- Medication History:
- States taking medication for high blood pressure every morning.
- Allergies:
- Mentions being allergic to penicillin and experiencing a rash as a reaction.
Objective Data
- Vital Signs:
- Decreased blood pressure if dehydrated or septic, increased heart rate if dehydrated or septic, elevated temperature if infection is present
- Gastrointestinal assessment:
- The abdomen is distended with tenderness on palpation, bowel sounds are absent, and the patient winces when pressure is applied to the lower back. The patient is observed vomiting bile, and there is no evidence of bowel movements during the examination.
- Lab Results:
- Elevated white blood cell count of 15,000/mm³, indicating potential infection.
- Diagnostic Imaging:
- Abdominal X-ray shows air-fluid levels and distended loops of the bowel.
Nursing Assessment for Bowel Obstruction:
- Abdominal Assessment:
- Perform a thorough abdominal assessment, noting the location, intensity, and characteristics of abdominal pain. Evaluate for distension, tenderness, and visible peristaltic waves, which may be indicative of obstruction.
- Bowel Sounds:
- Auscultate bowel sounds in all abdominal quadrants. Diminished or absent bowel sounds may suggest decreased motility, while hyperactive sounds may be present in the early stages of obstruction.
- Vomiting and Stool Assessment:
- Assess the frequency and characteristics of vomiting, including the presence of bile or fecal content. Note changes in stool patterns, such as constipation or the absence of bowel movements.
- Fluid and Electrolyte Status:
- Monitor fluid and electrolyte status, assessing for signs of dehydration, electrolyte imbalances, and potential shifts in fluid volume. Document input and output to gauge hydration status.
- Vital Signs:
- Monitor vital signs regularly, paying attention to changes in blood pressure, heart rate, and respiratory rate. Elevated temperature may indicate inflammation or infection.
- Abdominal Imaging:
- Collaborate in obtaining and interpreting diagnostic imaging studies, such as abdominal X-rays or CT scans, to visualize the location and extent of the obstruction. Evaluate for signs of bowel distension or air-fluid levels.
- Pain Assessment:
- Use a pain scale to assess the intensity and location of abdominal pain. Document any radiation of pain, and assess the effectiveness of pain management interventions.
- Psychosocial Assessment:
- Perform a psychosocial assessment, considering the individual’s emotional response to the condition, coping mechanisms, and support systems. Recognize the potential impact of bowel obstruction on mental well-being.
Nursing Interventions and Rationales for Bowel Obstruction:
- Initiate NPO Status:
- Rationale: Withholding oral intake helps rest the gastrointestinal tract, reduces stimulation of peristalsis, and prevents the risk of aspiration if vomiting occurs.
- Insert Nasogastric (NG) Tube:
- Rationale: NG tube decompresses the stomach, relieving pressure caused by accumulated gastric contents and preventing aspiration. It aids in assessing the volume and nature of gastric output.
- Administer Intravenous (IV) Fluids:
- Rationale: Maintaining hydration and electrolyte balance is crucial, especially when oral intake is restricted due to vomiting or bowel obstruction. IV fluids provide essential support.
- Monitor Vital Signs and Abdominal Distension:
- Rationale: Regular monitoring helps identify changes in the patient’s condition, such as signs of dehydration, shock, or increased abdominal distension, which may indicate worsening obstruction.
- Collaborate for Diagnostic Tests:
- Rationale: Collaborating with healthcare providers for diagnostic imaging (e.g., X-rays, CT scans) helps identify the location and severity of the obstruction, guiding appropriate interventions.
- Administer Medications as Prescribed:
- Rationale: Medications may include analgesics for pain relief, antiemetics to control nausea and vomiting, and antibiotics if infection is suspected. Administering medications as prescribed addresses specific symptoms and complications.
- Prepare for Surgery if Indicated:
- Rationale: Surgical intervention may be necessary to correct the underlying cause of the obstruction, such as removing adhesions, tumors, or repairing hernias. Preparing the patient for surgery ensures timely intervention.
- Provide Emotional Support and Patient Education:
- Rationale: Bowel obstruction can be distressing for patients. Offering emotional support and providing education on the condition, treatment plan, and signs of recurrence empower the patient to actively participate in their care.
Evaluation for Bowel Obstruction Nursing Care Management:
- Symptom Resolution:
- Evaluate the resolution of symptoms, including abdominal pain, distension, and vomiting. Assess whether the individual experiences relief from the presenting symptoms and if there is a return to normal bowel function.
- Bowel Function Restoration:
- Monitor the restoration of normal bowel function, including the return of bowel sounds, passage of stool, and relief of obstructive signs. Assess for any ongoing issues related to motility or recurrent obstructions.
- Fluid and Electrolyte Balance:
- Assess the maintenance of fluid and electrolyte balance. Evaluate hydration status, electrolyte levels, and the effectiveness of interventions in preventing or correcting imbalances.
- Complication Prevention:
- Evaluate the success of interventions in preventing complications such as bowel ischemia, necrosis, or perforation. Monitor for any signs of deteriorating bowel health and intervene promptly if complications are suspected.
- Patient Education and Follow-Up:
- Assess the understanding and implementation of patient education regarding bowel obstruction, its causes, and the importance of follow-up care. Ensure that the patient is equipped to recognize early signs of recurrence and seek timely medical attention.
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Example Nursing Diagnosis For Nursing Care Plan (NCP) for Bowel Obstruction
- Constipation: This diagnosis directly addresses the issue of constipation, including its causes, contributing factors, and interventions to promote regular bowel movements.
- Risk for Impaction: Chronic constipation can lead to fecal impaction. This diagnosis highlights the risk and the need for preventive measures.
- Deficient Knowledge: Some patients may lack knowledge about healthy bowel habits and factors contributing to constipation. This diagnosis addresses the educational needs of the patient.
Transcript
This is a nursing care plan for bowel obstruction. So the pathophysiology of bowel obstruction is when there is an obstruction in the intestine. The blockage impedes the passage to the GI tract, and it causes hydration and nutrition differences, and other complications of structure. It is a sudden or gradual blockage of the intestinal tract that prevents the normal passage of GI contents through the intestines. So what are some nursing considerations that we want to think of? Well, we want to do a really good abdominal assessment. We want to monitor those vital signs. We want to insert an NG tube in place on low intermittent suction. We want to maintain fluid balance and we want to educate on colostomy care. The desired outcome for this patient is that this patient will have a normal fluid balance. The patient is going to be free from infection and the patient will return to a normal elimination pattern. So what are some subjective data that we can gather from this patient? What are some things that you think that the patient is going to, come in and complain about? Well, they’re not going to be able to pass stool, so they are going to complain of some abdominal pain. They’re gonna also complain of a feeling of abdominal fullness.
They may complain of some nausea, some dehydration, cramping, stomach cramping, and constipation upon assessment of this patient. We’re going to be able to see some pretty clear objective data that we’ll be able to gather. First, we’ll notice that the abdomen is distended. So they’re going to have some abdominal distension. There also may have increased heart rate or some decreased blood pressure. The abdomen is going to be firm to the touch. When we all auscultate with the stethoscope, we’re going to also hear some diminished or absent bowel sounds. They’re going to have some vomiting and they may also present with a fever. So the nursing interventions, what are some things that we can do to intervene with these patients? Well, the very first thing that we want to do according to ADPIE is we want to assess; we’re going to assess that abdomen and look for some of the abnormalities that’s happening.
We want to note the size and the girth of the abdomen. The patient is going to have a firm abdomen with decreased bowel sounds. The abdomen will be distended. So next, what are some things that we can do? Remember this patient is not able to get the full impact of the intestinal tract. So absorption of minerals in water is going to be impaired. So we want to monitor their fluid balance. That’s to monitor fluid balance. Okay. Remember, we want to have strict I’s and O’s we want to monitor for signs of dehydration. We want to make sure IV fluids are administered. And we want to check those electrolytes because they may also need to be replaced. Next, We want to make sure this patient is NPO, nothing by mouth. And the reason why is we don’t want to stimulate that GI tract any further.
We want that GI tract to rest. So that way the thing we’re going to do to resolve it is the patient may need to go to surgery. So if this patient has to go to surgery, we want to make sure that there is nothing in the belly. So to reduce the risk of aspiration, the next thing we want to do is we want to make sure that this patient has a NG tube. And not only do we want to make sure they have an NG tube, but we want to place this NG tube to low suction. The reason why is because this is going to aid us in decompressing the abdomen and prevent recurring abdominal distension. Next, we want to give some good education on the care of the colostomy. Most of these patients will need to go to surgery. So we want them as well as their family members to know about colostomy care.
If they go and they go to surgery for a resection, a bowel resection, they are going to come back with a colostomy. It’s very important to teach how to properly care for and assess any issues with the class. To me, it should be demonstrated to exhibit competence. So the final thing that we want to look at is just kind of ongoing is we want to look at those vital signs. So let’s monitor vital signs. Some of the vital signs that we want to look at is the temperature. Remember any elevation in temperature and heart rate may indicate infection or necrosis. We also want to look at the heart rate because a heart rate that’s up may also indicate pain. Remember decreased blood pressure is also possible. So decreasing BP is possible because this patient is not getting as much absorption of fluids as they’re able to get.
So that may indicate hypovolemia here is the complete care plan. Let’s take a look at some of the key points. Remember the pathophysiology for a bowel obstruction is simply that there is an obstruction or blockage of the intestine. Some of the subjective data that these patients are going to tell us is they are going to complain of some abdominal pain, some nausea, some cramping, and some abdominal fullness. Some of the objective data that we’re going to be able to gather from this patient is that this abdomen is going to be distended. And first they may vomit their vital signs may show the elevated heart rate or elevated temperature. Remember that could indicate fever. They’re going to have some decreased BP that may indicate some dehydration. Some of the things that we want to do is we want to get that NG in place as soon as possible. The NG tube is key to making sure that we are decompressing that abdomen and keeping them from going further. We want to place it on low intermittent suction. And we want to make sure that this patient is NPO. We also want to teach colostomy care because this patient, if they go to surgery, is more than likely going to come back with a colostomy. So we want to educate on how to care for the colostomy. And we want to make sure that the patient teaches us back. We love you guys here at nursing.com. Go out and be your best self today. And, as always, happy nursing.
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