OVERVIEW
Intestinal obstruction is one of the common acute abdominal diseases, which refers to the obstruction of intestinal contents through the intestinal lumen caused by any reason. Intestinal obstruction can not only cause anatomical and functional changes in the intestinal canal itself, but also lead to systemic physiological disorders, which are mainly manifested as abdominal pain, abdominal distension, vomiting, and cessation of anal defecation. Observation and nursing care of patients with intestinal obstruction is of great significance to the treatment of the disease.
Nursing assessment
1. Past history and family history
Dietary and defecation habits, especially whether there is a history of prolonged constipation, whether there is any recent infection, whether there is any malignant tumor, whether there is any history of abdominal surgery, whether there is any family history of intestinal tumor.
2. History of present illness and physical examination
The patient’s current symptoms, whether there is abdominal pain, abdominal distension, vomiting, stopping defecation from anal defecation, etc., as well as the severity and duration of the symptoms. Physical examination needs to focus on the patient’s abdominal auscultation of bowel sounds whether hypertonic, whether weakened, whether the abdomen has pressure pain rebound pain.
3. Auxiliary examination and treatment
Laboratory tests such as the three major routine (blood, urine, stool), C-reactive protein, blood electrolytes. The ancillary examinations that need to be emphasized are X-ray standing abdominal film, abdominal ultrasound examination, treatment received, efficacy and adverse reactions.
Major nursing problems
1. pain.
2. Abdominal distension.
3. nutritional disorders.
4. potential for electrolyte disturbances.
Nursing Measures
1.Psychological care
Patients with intestinal obstruction often have different degrees of tension, anxiety and other emotions. Therefore, we should give psychological guidance continuously and dynamically according to the psychological characteristics of the patients, communicate with them in time, and patiently explain the causes, treatment methods and prognosis of intestinal obstruction, so as to eliminate their fear and make them actively cooperate with the nursing and treatment.
2.Gastrointestinal decompression care
If the patient has nausea and vomiting, instruct him to fast according to the doctor’s instruction, and keep the gastrointestinal decompression tube to reduce the pressure of the upper part of the intestinal lumen. The drainage tube should be flushed regularly to keep it open and prevent blockage, and the negative pressure in the drainage bottle should be checked regularly, and the amount and color of the drainage fluid should be observed. Rehydration fluid should be given during the fasting period to ensure nutritional supplementation and maintain electrolyte balance. After the intestinal obstruction is relieved and the anus is exhausted, a small amount of fluid can be fed.
3.Positional care
Those with stable vital signs should take semi-recumbent position, which is conducive to the descent of diaphragm and reduce the impact of abdominal distension on the respiratory and circulatory systems. Serious patients lie flat, head turned to the side to prevent vomitus from being inhaled into the trachea, resulting in asphyxia and aspiration pneumonia. For postoperative patients, they should be encouraged to get out of bed early to promote the recovery of gastrointestinal function.
4. Observation of condition
Closely observe the patient’s abdominal pain, abdominal distension, vomiting and abdominal signs, and regularly measure and record the temperature, pulse, respiration, blood pressure, etc. If the patient’s symptoms and signs do not get better or aggravate, the possibility of intestinal strangulation should be considered. The clinical features of strangulated intestinal obstruction are: ① persistent severe pain or persistent pain during paroxysmal exacerbation, intestinal sounds may not be hyperactive; ② early, severe and frequent vomiting; ③ asymmetric abdominal distension, localized abdominal elevation or palpation of a mass with tenderness; ④ obvious signs of peritoneal irritation, elevated temperature, increased pulse rate, increased white blood cell count and neutrophil ratio; ⑤ vomitus, bloody fluid withdrawn by gastrointestinal decompression, bloody fluid discharged from the anus, or bloody fluid withdrawn by laparotomy; ⑥ no significant improvement in symptoms and signs after active non-surgical treatment. After confirmed diagnosis of strangulated intestinal obstruction, early surgical treatment should be performed.
5. Pain care
If there is no intestinal paralysis or intestinal strangulation, atropine anticholinergic drugs can be applied to relieve smooth muscle spasm of gastrointestinal tract as prescribed by doctor to relieve abdominal pain. If the patient is incomplete, spasmodic intestinal obstruction, appropriate clockwise gentle massage of the abdomen. Hot compresses can also be applied to the abdomen, and acupuncture and moxibustion can be applied to bilateral foot-sanli points to promote the recovery of intestinal peristalsis.
Health promotion
1. Adhere to the treatment as prescribed by the doctor and have regular checkups.
2. Take appropriate physical exercise to the extent that you do not feel fatigue.
3. Maintain good mood and avoid mental stress.
4. Gradually resume the diet as prescribed by the doctor, have small and frequent meals, and avoid overeating. 5. If abdominal pain and bloating persist without relief, and the anus stops defecation and bowel movement, consult the doctor in time.