What is the nursing diagnosis of intestinal obstruction?
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Constipation is defined by NANDA-I as, “A decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool.”[1] Typically a patient is diagnosed with constipation if they have less than three bowel movements per week. Constipation can be caused by slowed peristalsis due to decreased activity, dehydration, lack of fiber, medications such as opioids, depression, or surgical procedures in the abdominal area. As the stool moves slowly through the large intestine, additional water is reabsorbed, resulting in the stool becoming hard, dry, and difficult to move through the lower intestines. See Figure 16.6[2] for the Bristol Stool Chart used to assess the characteristics of stools ranging from constipation to diarrhea.  The patient may experience associated symptoms such as rectal pressure, abdominal cramps, bloating, distension, and straining. can occur when stool accumulates in the rectum, usually due to the patient not feeling the presence of stool or not using the toilet when the urge is felt. Large balls of hard stool need to be digitally removed or treated with mineral oil enemas. InterventionsThe goal of interventions implemented to treat constipation is to establish what is considered a normal bowel pattern for each patient and to set an expected outcome of a bowel movement at least every 72 hours regardless of intake. Treatment typically includes a prescribed daily bowel regimen, such as oral stool softeners (e.g., docusate) and a mild stimulant laxative (e.g., sennosides). Stronger laxatives (e.g., Milk of Magnesia or bisacodyl), rectal suppositories, or enemas are implemented when oral medications are not effective. Patients should be educated about the importance of increased fluids, increased dietary fiber, and increased activity to prevent constipation. Some food sources, such as prune juice, prunes, and apricots, are helpful in preventing constipation. Over-the-counter medication, such as methylcellulose or psyllium, can be used to increase dietary fiber. When administering these medications, mix in a full 8-ounce glass of water to avoid the development of an intestinal obstruction. Read more about laxatives used to treat constipation in the “Gastrointestinal” chapter in Open RN Nursing Pharmacology. Intestinal Obstruction or Paralytic Ileusis a partial or complete blockage of the intestines so that contents of the intestine cannot pass through it. It can be caused by , a condition where peristalsis is not propelling the contents through the intestines, or by a mechanical cause, such as fecal impaction. Patients who have undergone abdominal surgery or received general anesthesia are at increased risk for paralytic ileus. Other risk factors include the chronic use of opioids, electrolyte imbalances, bacterial or viral infections of the intestines, decreased blood flow to the intestines, or kidney or liver disease. If an obstruction blocks the blood supply to the intestine, it can cause infection and tissue death (gangrene).[3] Symptoms of an intestinal obstruction or paralytic ileus include abdominal distention or a feeling of fullness, abdominal pain or cramping, inability to pass gas, vomiting, constipation, or diarrhea. Because of the common occurrence of paralytic ileus in postoperative patients, nurses routinely monitor for these symptoms, and diet orders are not upgraded until the patient is able to pass gas. Treatment may include insertion of an NG tube attached to suction to help relieve abdominal distention and vomiting until peristalsis returns. Obstructions may require surgery if the tube does not relieve the symptoms or if there are signs of tissue death.[4] Read more about NG tubes in “Enteral Tube Management” in Open RN Nursing Skills. Early identification results in a positive outcome.Takeaways:
Anna Smith* is a 56-year-old woman who arrives in a wheelchair to the emergency department (ED). She’s doubled over with her arms across her abdomen. Her husband reports that she’s had severe, sudden-onset, mid-abdominal pain for the past 6 hours. Ms. Smith doesn’t drink alcohol or smoke, and her only chronic condition is hypothyroidism. History and assessment hintsMs. Smith is unable to respond to the triage nurse’s questions because of her pain. She’s diaphoretic, tachypneic, and afebrile. Her pain severity is 8/10, and her blood pressure is stable at 145/90 mmHg. Ms. Smith’s husband reports that she’s unable to keep anything down and has been vomiting dark green bile. The nurse learns that Ms. Smith had abdominal surgery for a hernia a few months ago and had been recovering well. On physical examination, Ms. Smith’s abdomen is distended and tender to palpation with hypoactive bowel sounds. She says she’s been constipated for the past few days and is unable to pass gas. The nurse notes that her mucous membranes are dry. Taking actionThe nurse recognizes that Ms. Smith has the classic symptoms of a bowel obstruction, including a positive history for recent abdominal surgery, and takes her to a room for a provider examination. The provider assesses Ms. Smith’s distended abdomen and performs a digital rectal exam to check for fecal impaction. Lab results are unremarkable for severe or systemic infection. After chest and abdominal radiographs rule out a complete obstruction, a computed tomography (CT) scan with oral contrast (Gastrografin) is ordered. The scan reveals a small bowel obstruction without necrosis or perforation. Ms. Smith is given pain and nausea medication, as well as I.V. fluids for hydration, and a nasogastric (NG) tube is inserted. The ED nurse educates Ms. Smith and her husband about the purpose of the NG tube, which will help remove excess stomach fluid. She understands that she shouldn’t eat or drink with the tube in place. OutcomeAfter 3 days in the hospital, Ms. Smith reports significant improvement in her pain. Her abdomen is no longer distended and she says that she can pass gas, a good sign for small bowel obstruction recovery. Ms. Smith continues I.V. fluids. After she has a bowel movement, the NG tube is removed. Her laboratory tests indicate that she’s adequately hydrated and she reports that her pain is 1/10, with only mild cramping. Education and follow upWhen Ms. Smith is feeling better and no longer receiving opioid pain medication, she asks the provider and nurse about her condition. The provider explains that the hernia surgery created adhesions around the bowel that caused the obstruction, which could recur. The nurse explains that the bowel could have been unhealthy or even dead, requiring immediate surgical intervention. The nurse also talks to Ms. Smith about the importance of staying hydrated with sips of clear liquids and eating a modified diet of small, bland meals to avoid recurrence of the obstruction. *Name is fictitious. Access references at myamericannurse.com/?p=73275. Jessica Dzubak is director of nursing practice at the Ohio Nurses Association in Hilliard. ReferencesBaiu I, Hawn MT. Small bowel obstruction. JAMA. 2018;319(20):2146. doi:10.1001/jama.2018.5834 Catena F, Di Saverio S, Coccolini F, et al. Adhesive small bowel adhesions obstruction: Evolutions in diagnosis, management and prevention. World J Gastrointest Surg. 2016;8(3):222-31. doi:10.4240/wjgs.v8.i3.222 Hill AG, Sammour T. Gastrografin for adhesive small bowel obstruction. UpToDate. November 19, 2019. uptodate.com/contents/gastrografin-for-adhesive-small-bowel-obstruction Long S, Emigh B, Wolf JS, Byrne C, Coopwood TB, Aydelotte J. This too shall pass: Standardized Gastrografin protocol for partial small bowel obstruction. Am J Surg. 2019;217(6):1016-8. doi:10.1016/j.amjsurg.2018.12.063 Medline Plus. Intestinal or bowel obstruction—discharge. September 2018. medlineplus.gov/ency/patientinstructions/000150.htm National Institute of Diabetes and Digestive and Kidney Diseases. Abdominal adhesions. June 2019. niddk.nih.gov/health-information/digestive-diseases/abdominal-adhesions What is the diagnosis of intestinal obstruction?To confirm a diagnosis of intestinal obstruction, your doctor may recommend an abdominal X-ray. However, some intestinal obstructions can't be seen using standard X-rays. Computerized tomography (CT). A CT scan combines a series of X-ray images taken from different angles to produce cross-sectional images.
What is a nursing diagnosis for bowel obstruction?Small bowel obstruction (SBO) refers to a complete or partial blockage in the small intestine. It can be caused by scar tissue from a previous surgery, hernias, cancer, and inflammatory bowel disorders.
What are 5 nursing diagnosis?The five stages of the nursing process are assessment, diagnosing, planning, implementation, and evaluation. All steps in the nursing process require critical thinking by the nurse.
What are the 4 nursing diagnosis?NANDA-I recognizes four categories of nursing diagnoses: problem focused diagnosis, risk diagnosis, health promotion diagnosis, and syndrome. Problem focused diagnoses, also known as actual diagnoses, are patient issues or problems that are present and observable during the assessment phase.
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