Large bowel obstruction

Define:
Large bowel obstruction is a blockage of large colon
that prevent food and fluid from passing through.
Large bowel obstruction can be causes many
condition including fibrous bands of tissue in the
abdomen (Adhesion) or tumors.

Cause:
 Inflammatory bowel disease .
 Colonic volvulus (twisting of the colon)
 Cont..
 Adhesion
 Constipation.
 Fecal impaction.
 Colon Artesia.
 Diverticular
 Benign strictures.
 Endometriosis.
• Paralytic ileus ( Intestine donot function properly).
 Abdominal surgery.
 Pelvic surgery.
 Pathology
The prevalence of mechanical large bowel obstruction
increase with age as does it main cause ,colon cancer,
diverticulitis, sigmoid volvulus are also potential cause
this disorder. Mechanical obstruction of the large bowel
cause bowel dilation above the obstruction. This cause
mucosal edema and impaired venous or arterial blood
flow to bowel . Bowel edema and ischemia increase the
mucosal permeability of the bowel which can lead to
bacterial translocation, system toxicity, dehydration. That
bowel ischemia can lead to perforation which result from
decrease para symphatic tone.
 Cause cont..
 Infection .
 Certain medication.
 Muscle and nerve disorder.

Signs and symptoms:

 Abdominal pain .
 Abdominal distension.
 Vomiting .
 Fecal vomiting.
 Constipation
 Cont..
 Bloating.
 Diarrhea.
 Ischemia .
 Perforation.
 Infection.
 Inability bowel movement or pass gas.

Diagnosis :
 Stool test .
 Blood test.
 X-ray abdomen.
 Cont..
 CT or MRI.
 Colonoscopy.
 Endoscopy.
 Laparoscopy.

Treatment & Management:

 Start I/V .
 Keep N.P.O.
 Insertion of nasogastric tube for aspiration.
 Cont..
 Administered opioid pain relievers and antiemetic for
control vomiting.
 Perform surgical resection to removed obstructing
lesion.
 A temporary or permanent colostomy may be
perform if needed because removal of the entire
large bowel.
 Teach about how to change colostomy bag and
support.
 Nursing intervention according to
nursing process
Assessment:
 First history taking .
 Take subjective and objective information.
 Perform physical examination.
 Collect dada from medical record.
Analysis all data and information and prioritize the
problem .
 Nursing diagnosis & set goal
 Altered elimination due to decrease intestine
motility.
 Deficit fluid volume due to vomiting and NGT
drainage , inadequate oral intake.
 Pain due to abdominal discomfort constipation &
abdominal distention .
 Alter nutrition due to decrease desire ability to eat
nausea.
 Nursing care plan/ intervention as
related to nsg diagnosis and goals:
 Assess patient abdomen for tenderness, auscultation
for bowel sound in all 4 quadrants palpate for
distention and inquire patient is passing flatus or see
bowel movement.
 Instruct patient to report any instance of abdominal
cramping , nausea or vomiting.
 Instruct patient to intake oral fluid to prevent
dehydration and electrolyte imbalance.
 Monitor and record patient intake & output .noting
color and consistency of stool.
 Cont..
 Encourage patient to ambulate around the unit at
least 3 time per shift .
 Teach about disease ,treatment ,care, and follow up
visit.

On going evaluation related nursing goals:

Example:-
 Patient’s abdomen will be assessed and ausculated
,palpated for the presence of bowel sound, passed
flatus or bowel movement.
 Cont..
 Increase oral intake .
 Intake out put will be balance.

Thank – You