1.Disease Introduction
Obstruction is caused by a variety of causes of intestinal contents can not run normally and smoothly through the intestinal lumen. It is mainly due to strangulation of the intestinal lumen, intestinal tube compression, intestinal wall lesions or intestinal spasm or intestinal paralysis. According to the cause, it can be divided into mechanical, dynamic and hemodynamic intestinal obstruction; according to the presence or absence of blood circulation disorders in the intestinal canal, it can be divided into simple and strangulated intestinal obstruction. Patients have abdominal pain, vomiting, anal cessation of defecation and cessation of exhaustion as the main symptoms.
2.Psychological guidance
Careful and considerate patients, patiently listen to their fears and concerns caused by the disease, explain the treatment plan, eliminate their nervousness and fear of psychological pressure, and actively cooperate with the medical staff in various treatments and care.
3.Dietary guidance
(1) In the acute stage and those who need surgery, fasting is required. After the symptoms of intestinal obstruction are relieved (i.e. abdominal pain is relieved, abdominal distension disappears, anal venting, defecation and bowel sounds return to normal), a small amount of warm water or liquid can be eaten. With the improvement of the disease gradually into semi-liquid, general food, it is appropriate to eat less and more meals, early to less residue food.
(2) In the early postoperative period, we should cooperate with gastrointestinal decompression to suck out the fluid and gas from the gastrointestinal tract to reduce abdominal distension and facilitate wound healing. One to two days after surgery, gastrointestinal function is restored and there is anal venting, the gastric tube can be removed and food can be eaten, and the principle is the same as above.
4.Guidance on work and rest
(1) Preoperative guidance For those with stable blood pressure, take a semi-recumbent position, which is conducive to drainage of fluid in the gastrointestinal cavity and flow of inflammatory exudate in the abdominal cavity to the pelvis to prevent subdiaphragmatic abscess; it can also relax the abdominal muscles and lower the diaphragm, which is conducive to breathing. After the symptoms of intestinal obstruction are relieved, we can start to assist to leave the bed for 5 min twice a day, and increase 10 min day by day.
(2) Postoperative guidance After the blood pressure stabilized 6h after surgery, take a semi-recumbent position to facilitate adequate drainage of the abdominal cavity, assist in turning, patting the back, encouraging deep breathing and assisting in moving the limbs every 2h, 3 times a day. In the first postoperative day, the activity can be 10min per day; the second postoperative day can be increased to 15min; the third postoperative day can be assisted to leave the bed twice a day, 5min each time, increasing to 10min day by day. pay attention to the combination of work and rest.
5.Medication guidance
(1) Preoperative guidance
Antibiotic application: generally, cephalosporins and methotrexate can be used.
Application of antispasmodics: after determining the absence of intestinal strangulation, atropine, scopolamine (654-2) and other anticholinergic drugs can be applied to release the spasm of smooth muscle of gastrointestinal tract and inhibit the secretion of gastrointestinal glands, so that the patient’s abdominal pain can be relieved.
Correct water, electrolyte and acid-base imbalance. Nutritional support if necessary.
(2) Postoperative guidance
Anti-infection; give expectorant and anti-inflammatory drugs for nebulized inhalation; supplement intravenous nutrition during fasting; during the infusion process, follow the infusion rate controlled by the medical staff, and do not speed up the infusion rate at will.
6.Special instruction
(1) Gastrointestinal decompression: through gastrointestinal decompression, gas and liquid in the gastrointestinal tract are sucked out, which can reduce abdominal distension, lower the pressure in the intestinal cavity, reduce bacteria and toxins in the abdominal cavity, improve blood circulation in the intestinal wall, and help improve local lesions and systemic conditions.
(2) Indwelling gastric tube: fix the gastric tube properly, prevent dislodgement, maintain effective gastrointestinal decompression, and pay attention to the amount and color change of gastric fluid. If bloody fluid is found, it should be treated in time to prevent the occurrence of intestinal strangulation. Before drug injection in the gastric tube, aspirate gastric fluid to avoid discomfort caused by overdose. Clamp the tube for 1~2h after instillation to prevent reflux of medicine and affect the efficacy of the medicine.
(3) Keep the mouth clean: insist on rinsing the mouth twice a day, and vomiting patients should rinse the mouth with warm boiled water after each vomiting. Because after fasting, the secretions in the mouth are reduced, bacteria invade and multiply, and stomatitis and mumps are likely to occur.
(4) Avoid the spread of inflammation: Do not use hot compresses when abdominal pain and distension are present to avoid causing the spread of inflammation.
(5) Complications of intestinal fistula: If you feel abdominal distension and hyperthermia, redness and swelling of the abdominal wall incision, and fecal odor fluid flow from the abdominal wound 1 week after surgery, you should notify the medical staff; keep the skin around the fistula clean and dry, often wipe the surrounding dirt with warm water, apply zinc oxide ointment to protect the local skin to prevent dermatitis and keep the drainage unobstructed.
(6) Wound drainage to keep the drainage unobstructed, properly fixed drainage tube, do not fold, twist, dislodge, with the record of the color, quality and amount of drainage fluid. If you see abdominal drainage with cesspool-like fluid outflow, suggesting intestinal fistula, should promptly report to the medical staff.
7, condition observation guidance
(1) Pre-operative regular cooperation in measuring body temperature, pulse, respiration and blood pressure. If the following clinical features appear, the possibility of intestinal strangulation should be considered and the medical staff should be informed promptly and dealt with.
Continuous severe abdominal pain, vomiting is severe and frequent. Rapid progression of the disease with early onset of shock and no significant improvement after anti-shock treatment.
There are obvious signs of peritoneal irritation, rising body temperature, increased pulse rate, and elevated white blood cell count.
There is asymmetric abdominal distention with localized abdominal bulging or palpable masses with pressure pain.
Vomitus, gastrointestinal decompression aspirate, and anal discharge are bloody. No significant improvement in symptoms with aggressive non-surgical treatment. Isolated, protruding distended intestinal collaterals, or pseudotumor-like shadows are seen on abdominal X-ray; or the intestinal gap is widened. Should actively cooperate with the preoperative preparation while anti-shock and anti-infection.
(2) Closely observe the changes of vital signs, abdominal pain, abdominal distension, vomiting and anal venting after surgery, and also pay attention to the color, quality and quantity of drainage. If you feel abdominal distension, persistent fever, increased white blood cell count, redness and swelling at the abdominal wall incision, followed by more fluid flow with fecal odor, suggesting intestinal fistula, you should promptly inform the medical staff and cooperate with active treatment.
8.Discharge instruction
(1) Pay attention to dietary hygiene and prevent intestinal infections.
(2) Eat foods with high fiber, drink more water, and keep the stool open.
(3) Avoid overeating and irritating food.
(4) Avoid strenuous activities after meals to prevent intestinal torsion.
(5) Seek medical attention promptly if severe vomiting, abdominal distension, abdominal pain, wasting, or change in bowel habits occur.