Bowel perforation, Bowel obstruction

What is a bowel perforation?

Rupture of the bowel wall, leading to spilling of GI contents into the body cavities

What are the s/s of bowel perforation?

• Sudden onset of severe abdominal pain, cramping

  • pain may radiate to back/shoulders

• Rigid and distended abdomen

• bowel tones absent or decreased

• n/v

• weak pulse, tachycardia, fever, HPN

• Grey-turner’s sign

What are the nursing interventions for bowel perf?

• Assessment:

  • VS every 15-30mins

  • Assess for shock

• Implementation:

  • NG tube for decompression

  • IV fluids, blood transfusion

  • Administer Antibiotics

  • Keep NPO

What is a bowel obstruction?

A partial or complete blockage of the intestines, making intestinal contents unable to pass?

What is the difference between a mechanical and non-mechanical bowel obstruction?

• Mechanic obstruction means their is a physical cause

  • can be strictures, surgical adhesions, intussusception

• Non-mechanical means it is either an ileus or a vascular obstruction

What is the difference between a simple and strangulated obstruction?

• Simple obstructions have an intact blood supply

• Strangulated obstructions have an impaired blood supply

What is a pseudo-obstruction?

A GI motility disorder that mimics a mechanical obstruction

What are the RF for bowel obstruction?

• Surgery, general anesthesia

• Hernias, cancer

• immobility

• IBD, Constipation

• Foreign objects

• Ileus, vascular issues

What are the common s/s of bowel obstruction?

• N/V

• Distention, tenderness, rigidity

• High-pitched bowel sounds above obstruction

• absent bowel tones if paralytic ileus

• Dehydration

What are the s/s of proximal SBO?

• Pain that occurs at 4-5 min intervals

• Rapidly developing n/v, projectile vomiting, bile in vomit

  • provides temporary relief for abdominal pain

What are the s/s of distal SBO?

• Pain occurring less frequently than proximal

• Gradual onset n/v, fecal smelling vomit

What are the s/s of LBO?

• Gradual n/v

• Fecal/foul smelling with vomit

• Abdominal distention

• obstipation

• lack of flatus

• hypoactive bowel tones