Disorders of DISORDERS OF SMALL AND

AHN INTESTINE)
LARGE unit 1

INTESTINAL
OBSTRUCTION
By :
Marwan khan
Lecturer nursing
KMU
IHS
SWAT
 Objectives
At the end of this lecture students will be able to :
✘ Discuss the causes, pathophysiology and
manifestations of Intestinal obstruction.
✘ Discuss the diagnostic, medical and surgical
management of Intestinal obstruction.
✘ Apply nursing process with ADPIE Format of care to
clients with Intestinal obstruction.
✘ Develop a teaching plan for a client experiencing
disorder of Intestinal obstruction.
 Intestinal
obstruction
✘ A bowel obstruction is a partial or complete blockage of
small intestine or large intestine (bowels). The most
common causes include scar tissue forming after abdominal
surgery, hernias and colon cancer. A bowel obstruction is a
medical emergency that requires immediate care.
 Causes of Intestinal
Obstruction
1. Mechanical Obstruction (physical blockage)
• Adhesions (post-surgical fibrous bands)
• Hernias (intestinal loop trapped in the abdominal wall)
• Tumors (benign or malignant)
• Volvulus (twisting of the intestine)
• Intussusception (telescoping of one part of intestine into another,
common in children)
• Foreign bodies or impacted stool
• Strictures (e.g., from Crohn’s disease or radiation)
2. Functional Obstruction (Paralytic Ileus)
• Postoperative ileus (after abdominal surgery)
• Neuromuscular disorders (e.g., Parkinson’s disease)
• Infections (e.g., peritonitis)
• Electrolyte imbalances (e.g., hypokalemia)
• Medications (e.g., opioids, anticholinergics)
 Pathophysiology of Intestinal
Obstruction

1. Obstruction occurs → Blocks forward movement of intestinal contents.

2. Accumulation of contents proximal to obstruction → Gas, fluids, and
electrolytes build up.
3. Distension of bowel → Increases intraluminal pressure.
4. Decreased absorption and increased secretion → Worsens fluid
accumulation.
5. Compression of blood vessels → Leads to ischemia and possible
necrosis.
6. Bacterial overgrowth and translocation → Can lead to infection or
peritonitis.
7. Perforation risk → Due to increased pressure and wall damage.
8. Systemic effects → Hypovolemia, electrolyte imbalance, shock.
 Clinical Manifestations of
Intestinal Obstruction
1. Abdominal Pain
• Colicky (intermittent, crampy) pain is typical of mechanical
obstruction.
• Constant pain may indicate strangulation or ischemia of the bowel.
2. Abdominal Distension
• More pronounced in large bowel obstruction.
• May be mild in proximal small bowel obstruction but severe in distal
obstructions.
3. Vomiting
• Early and profuse in small bowel obstruction.
• May contain bile or fecal matter (late sign in large bowel obstruction).
• Causes dehydration and electrolyte imbalance.
4. Constipation and Obstipation
• Constipation: Inability to pass stool.
 CONT…
5. Bowel Sound Changes
• High-pitched, hyperactive bowel sounds (borborygmi) in early
mechanical obstruction.
• Absent or hypoactive bowel sounds in late obstruction or paralytic
ileus.
6. Signs of Dehydration
• Dry mucous membranes
• Decreased urine output
• Hypotension
• Tachycardia
7. Fever and Leukocytosis
• May indicate strangulation, bowel necrosis, or peritonitis.
8. Shock (Advanced Complication)
• Tachycardia, hypotension, cold/clammy skin — signs of hypovolemia or
 Diagnostic Management
Timely diagnosis of intestinal obstruction is essential to prevent
complications like bowel necrosis or perforation. The following steps are
typically involved:
History and Physical Examination
• Symptoms: Abdominal pain, distension, vomiting, constipation
• Examination: Distended abdomen, altered bowel sounds (hyperactive or
absent), tenderness, palpable mass (in some cases)
Laboratory Tests
• CBC: Leukocytosis may indicate infection or strangulation.
• Electrolytes: Detect imbalances (e.g., hypokalemia).
• Serum lactate: Elevated in bowel ischemia.
• Blood urea and creatinine: Assess hydration and renal function.
 Imaging Studies
Investigation Findings

Dilated bowel loops, multiple air-fluid levels, absence of gas

Abdominal X-ray (plain)
in distal colon

Useful in children (e.g., intussusception); can show dilated

Ultrasound (USG)
loops, free fluid

Most accurate; reveals location, cause (e.g., tumor,

CT scan (Abdomen & Pelvis)
volvulus), and complications (e.g., ischemia)

Contrast studies (Barium enema) Helpful in large bowel obstruction or suspected volvulus
 Medical Management

Conservative (Non- Surgical Management:

surgical): •Indicated in:
• NPO (nothing by mouth) • Complete obstruction
• Nasogastric (NG) tube • Strangulation
insertion for • Ischemia
decompression •Procedures:
• IV fluids to correct • Resection of necrotic
dehydration bowel
• Electrolyte correction • Removal of
• Antibiotics (if infection tumor/adhesions
suspected) • Colostomy (if required)
• Monitoring of vital signs
and output
 Nursing Management in ADPIE
Format

A – Assessment
• Monitor vital signs: BP, HR, temperature (signs of infection or shock)
• Assess for:
• Abdominal pain (location, character, and duration)
• Abdominal distension
• Bowel sounds (hyperactive early, absent late)
• Nausea, vomiting, especially fecal-smelling
• Inability to pass stool or flatus
• Monitor fluid and electrolyte balance
• Observe for signs of dehydration: dry mucous membranes, decreased
skin turgor, low urine output
 D – Nursing Diagnoses
1. Deficient fluid volume related to vomiting and NG suction
2. Acute pain related to bowel distension
3. Imbalanced nutrition: less than body requirements related to NPO
status and GI losses
4. Risk for infection related to possible perforation or surgical
intervention
5. Anxiety related to hospitalization and uncertain outcome
 P – Planning
(Goals/Objectives)
• The patient will maintain adequate fluid and electrolyte balance
• The patient will report relief from abdominal pain
• The patient will demonstrate improved bowel function
• The patient will remain free from infection
• The patient will verbalize reduced anxiety
 I – Implementation
• Maintain NPO status as ordered
• Insert and manage NG tube for gastric decompression
• Administer IV fluids and electrolytes as prescribed
• Provide pain management (as prescribed and per protocol)
• Monitor and record intake/output accurately
• Assist with ambulation to stimulate peristalsis if allowed
• Provide mouth care for comfort during NPO status
• Prepare the patient for surgical intervention if needed
• Provide emotional support and explain all procedures to reduce
anxiety
• Monitor for signs of complications (e.g., fever, increased pain, rigidity
of abdomen)
 E – Evaluation
• The patient maintains stable vital signs and adequate hydration
• Pain is relieved or controlled
• Bowel sounds and movements return to normal
• No signs of infection or complications
• The patient expresses understanding and reduced anxiety
 Teaching Plan for Intestinal
Obstruction

Objectives of the Teaching Plan:

• Patient will understand the nature and management of intestinal
obstruction.
• Patient will follow dietary and fluid instructions.
• Patient will comply with medications and follow-up.
• Patient will recognize and report complications early.
• Patient will demonstrate proper hygiene and self-care.
 Domain Content Method of Teaching Evaluation

Definition, causes, and types (mechanical vs. non- Verbal explanation, chart
1. Knowledge Patient explains condition in own word
mechanical) of intestinal obstruction display

Importance of NPO status initially; gradual reintroduction Patient lists appropriate post-
2. Diet Verbal instruction, diet chart
of fluids and soft diet post-treatment obstruction diet

3. Fluid Importance of IV fluids and signs of dehydration (dry Demonstration, verbal

Patient recognizes signs of dehydratio
Balance mouth, low urine output) explanation

4. NG Tube Patient/caregiver demonstrates

Purpose and care of nasogastric tube Demonstration with model
Care understanding

Importance of taking prescribed medications (antibiotics, Patient states name, purpose, and
5. Medication Verbal instruction
pain relievers, antiemetics) timing of medication

Importance of early ambulation post-surgery to promote

6. Activity Verbal instruction Patient agrees to mobilize as instructe
bowel function

7. Warning When to seek help: fever, worsening pain, no bowel

Verbal discussion, pamphlet Patient verbalizes 3 warning signs
Signs movement, vomiting

Importance of follow-up visits for monitoring recovery and Patient states date and purpose of
8. Follow-Up Verbal instruction
preventing recurrence follow-up

Patient correctly performs hand

9. Hygiene Handwashing to prevent infection post-surgery Demonstration
hygiene
 References
✘ P.K. Panwar
Medical-Surgical Nursing, Latest Edition
– Published by AITBS Publishers
✘ Brunner & Suddarth’s Textbook of Medical-Surgical Nursing
✘ Wong’s Essentials of Pediatric Nursing (for reference when gastritis
occurs in pediatric clients).
✘ https://my.clevelandclinic.org/health/diseases/10349-gastritis
✘ https://www.mayoclinic.org/diseases-conditions/gastritis/symptoms-caus
es/syc-20355807
✘ https://nurseslabs.com/gastroenteritis-nursing-care-plans/