MDC2 Final Exam Study Guide

Ch. 56 – Care of Patients with Noninflammatory Intestinal Disorders ● Nonmechanical (ileus) vs. mechanical obstruction (intussusception, volvulus, etc.) o Non-mechanical: results from neurological disturbances that affect the muscles. Can be primary or secondary (often based on anesthesia medications). Remember to assess the patient's bowel tones for complications from this! ▪ Paralytic Ileus: the bowel is not impacted by a physical obstruction, but because of a lack of peristalsis as a result of neuromuscular disturbance, causing backup of fecal contents and abdominal distention and potentially leakage of stool contents into the peritoneum space can occur, causing inflammation and infection, decreased electrolyte levels and reduced blood volume. o Mechanical: from a structural disturbance of the bowel. ▪ Adhesions: scar tissue from surgery that builds up and causes obstruction ▪ Benign or malignant tumors ▪ Appendicitis complications: if the appendix bursts, often the contents will cause disruptions in fecal matter flow. ▪ Hernia: protrusion of the bowel through an opening that should not be there, causing pain and blockages. ▪ Fecal impactions: from constipation ▪ Strictures: from crohns or radiation ▪ Intussusception: telescoping of the bowel into itself. ▪ Volvulus: twisting of the bowels, allowing nothing to go through. o Physical Assessment ▪ Obstipation: severe constipation that may last for days without any passage of stools. Diarrhea may be present in partial obstructions ▪ Failure to pass gas ▪ Vomiting that may be foul smelling or coffee ground like. ▪ Abdominal Distention: abdominal when assess will be firm, swollen, and painful ▪ Peristaltic waves: movement of the intestine, then stopping ▪ Borborygmi: high pitch gurgling bowel sounds o Diagnostics: ▪ Barium Swallow ▪ CT with contrast ▪ Ultrasound o Nursing Care: ▪ Monitor vitals ▪ Assess abdomen 2 times a day for bowel tones, distention, and passing for gas ▪ Monitor F/E,I/O, lab values for disturbances- may need to give IV fluid replacement due to potential loss of electrolytes such as NS ▪ Manage NG tube- often will be a salem sump tube ▪ Ensure tube patency ▪ Check initial tube placement with XRAY ▪ May need suction and decompression for the obstruction ● Metabolic alkalosis is a concern ▪ Check for tube placement (pH 0-4) ▪ Irrigate tube ▪ NPO status ▪ Perform mouth and nare care ▪ Place patient in a semi fowler's position ▪ Give pain medications ▪ Give alvimopan. o Surgery ▪ Exploratory laparotomy: will allow the provider to relieve and locate the obstruction. may be large or small incisions. ▪ The RN should teach the patient about what to expect after such as NG tube insertion and a clear liquid diet that will advance as tolerated. Potential N and V. o Patient Teaching ▪ Patients should eat high fiber foods, like raw fruits and veggies. ▪ Drink lots of water ▪ Do not use routine laxatives as they have a potential to become abused. and cause damage to the abdominal muscles. ▪ Daily exercise needed to promote gastric motility ▪ Take bulk forming products and a stool softener. ▪ Sit on the toilet or commode rather than the bedpan. ▪ Must report and abdominal pain, distention, N,V,constipation ▪ Teach about incision care ▪ Drug therapy will often include percocet, stool softener. ● Polyps o Small growths that are attached to the intestinal mucosa that are often benign but can become malignant. o Adenomatous: polyps that have the potential to become malignant ▪ Villious ▪ Tubular o Hyperplastic: little chance to become cancerous polyps o Malignant: those polyps that are cancerous when developed o Familial adenomatous polyposis and hereditary nonpolyposis are inherited that will eventually progress to colorectal cancer o Assessment: ▪ Asymptomatic and usually discovered on a routine colonoscopy screening ▪ May cause bleeding, obstruction or intussusception o Diagnostics: biopsy and will often be remov