CASE PRESENTATION on Intestinal Obstruction.pptx

Presented By- Gaurav Karankekar

1. CASE PRESENTATION ON INTESTINAL OBSTRUCTION PRESENTED BY, MR. GAURAV KARANJEKAR

2. BIOGRAPHICAL INFORMATION Patient Name : Mr. Pramod B hopat Father name : M r. Jayram B hopat Age : 62 yrs Sex : male Address : sector 9, near N avi M umbai Religion : Hindu Education : 12th Marital status : Married Occupation : shopkeeper Name of hospital : D Y P atil Hospital Ward : medicine intensive care unit 2 Bed no. : 09 Date of admission : 13-04-2024 U.M.R. No. : 3840015 DIAGNOSIS : Intestinal Obstruction

3. CHIEF COMPLAINTS Mr. Pramod , 62yrs got admitted to D.Y.Patil Hospital with complaints of……….. Fever. Abdominal pain since 2 days Abdominal distension since 2 days Constipation

4. Present Medical History Mr Pramod , 62yrs old got admitted to D. Y. Patil Hospital on 13-04-2024 with Abdominal pain and discomfort . pain was severe 7 in pain scale, and associated with abdominal fullness, weakness and headache and reduces with rest and medication. Patients were relatively, Asymptomatic before 2 days. he develop high grad Fever since 2 days abdominal distention, Patient was a relatively a symptomatic before 12 hours he develop abdominal distention ,which was sudden ,the abdominal pain since 6 hours which was dull achy and non radiating in nature Constipation since 2 days, No flatus pass since 2 days, He was stopped food , Then patient developed abdominal pain since 6 hours. Which was dull, Achy and none radiating in nature.

5. PAST MEDICAL HISTORY My Patient Never Suffered With Any Type Of Major And Chronic Illness. Minor Ailment Like Fever, Vomiting, Nausea ,Headache etc. Were Treated In The Nearer Clinic Only, So Patient Have No Any Experience Of Long Term Hospitalization. Also not suffer any type of eye problem like injury. SURGICAL HISTORY Present Surgical History My patient has undergone with exploratory laparotomy surgery. Stoma is present with colostomy bag. Past Surgical History Prakash not underwent any surgical interventions in the past.

6. FAMILY HISTORY S.N. FAMILY MEMBER SEX AGE RELATION WITH PATIENT EDUCATION OCCUPATION HEALTH STATUS 1 Pramod bhopat Male 62 year Self 12 th Shopkeeper Unhealthy 2 Sunanda bhopat Female 56 year Wife 12 th Shopkeeper Healthy 3 Sarika bhopat Female 28 year Doughter I.T.I. - Healthy 4 Amit bhopat male 25 year Son B.Sc. - Healthy

7. SOCIO-ECONOMIC HISTORY: Mr. Promod has self owned house in Navi Mumbai, with toilet facilities. Water supply was continuous . Proper lightening and ventilation is present. He is Shopkeeper in Navi Mumbai , He is earns upto 20 k monthly. He earning a moderate income that covers the family's basic needs but leaves little for savings. NUTRITIONAL HISTORY: Diet pattern: Vegetarian, Patient Nutritional Status Is Very Poor Because Of disease condition. PERSONAL HISTORY: Personal Hygiene : Oral Hygiene : poor Bath : he is taking bath daily. , Sleep And Rest : Adequate Elimination : Bowel Per Day : Regular 1 Times Per Day, Urine Frequency : 1000ml/ Day

8. Physical examination General appearance :   Alert and responsive   G.I. Function :   Altered appetite due to disease condition.   Vital Signs : Temperature : 96 F Pulse :72 / minute Respiration Rate: 18/minute Blood pressure: 110/70 mm of Hg. Abdomen       Inspection Palpation Percussion Auscultation Right Upper Quadrant : Soft Right Lower Quadrant : Soft Left Upper Quadrant : Soft Left Lower Quadrant : Soft Transverse colostomy done, one drainage present. Abdominal mildly distended ,umbilical centered , Distention present ,No visible lump Tenderness +,No rigidity. Reflexes present Stool Present.

9. investigation S.N. Biochemical Test Patents value Normal Value Remark 1 HB 7 gm 12-16 gm Decrease 2 ESR 18 mm 12 mm Increase 3 Sr. K+ 3.4 mEq /L 3.5 – 5.5 mEq /L Decrease 4. Platelets 1. lakh 1.5 -5 lakh Decrease 5. X-RAY Both rotate lung field sander vision normal, Right CP angle is clear, Cardiac size is within present limit, Boney thorax under vision appears normal, Air fluid level noted normal, Ryle’s tube noted. 6. U.S.G. Abdomen   Liver appear normal, Portal vein appears normal., Spleen appears normal in size and echo texture Pancreas and Para aortic region. Normal, Both kidneys appears in normal size Urinary bladder full normal, Moderate free fluid seen in peritoneal cavity There is cells inflamed terminal ileum ascending colon transverse and Descending colon.

10. Name of the drug Action USES   Side Effects Nurse’s Responsibility Injection LEVOFLOX 100 mg OD Bactericidal action by cell wall Synthesis Bacterimia , septicemia , Endocarditic, Bone and joint infection , Genitourenary,obstretic and gyenic and intraabdominal Infection Pain at injection site if injection given by i /m route, g i upset, renal impairment Instruct patients to take the medication exactly as prescribed, with or without food, and to complete the full course even if they feel better to prevent antibiotic resistance.   Inform patients about possible side effects, including the importance of reporting symptoms like severe diarrhea, Inj.Taxim 1000 mg 8 hourly Bactericidal by cell wall synthesis Bacterimia , septicemia , Endocarditic, Bone and joint infection, Genitourinary, obstetric and gyenic and intraabdominal infection, soft tissue injury, Use as a prevent infection in post oper . Renal failure , Leucopenia , Eosiniphelia , Pain at injection Site Administer the precise dosage as prescribed by the healthcare provider, taking into account the patient's age, weight, and renal function   Maintain aseptic technique throughout the preparation and administration process to prevent contamination and infection. Inj Ranitidine 50 mg BD Inhibits gastric acid by blocking the hydrogen potasiumATP enzyme system in gastric parietal Cells Zollinger Ellison syndrome, hyperacidity disorders, chronic episodic dyspepsia Rare ,but some time blood pressure of patient is fall Down Nurses must accurately calculate and administer the appropriate dose of ranitidine.   Nurses should ensure that ranaitidine is administered via the correct route, typically intramuscular (IM) or intravenous (IV). Tab B-plex fort It prevent pernicious anaemia, use as a nerve tonics a supportive therapy Vita b-complex deficiency, stomatitis ,Polyneuropathy, cervical lumber syndrome, Gastritis , nausea, digestive Disturbance Nurses should explain to patients the purpose of taking B-plex Forte, which includes supporting nerve function, energy production, and overall health. Nurses must instruct patients on the correct dosage and the importance of adhering to the prescribed schedule to ensure optimal effectiveness.   DRUG STUDY

11. INTESTINAL OBSTRUCTION INTESTINAL OBSTRUCTION

12. INTRODUCTION Intestinal obstruction is significant mechanical impairment which blockage in intestine that results in the failure of the passage of intestinal contents through is partial or complete the intestine. This is a potentially serious condition that requires urgent medical care.

13. TYPES OF INTESTINAL OBSTRUCTION Simple Intestinal Obstruction Strangulated Intestinal Obstruction Closed-Loop Intestinal Obstruction

14. CAUSES BOOK PICTURE PATIENT PICTURE Intussusception (Telescoping of the intestine) Tumors and neoplasms Volvulus Foreign bodies Inflammatory bowel diseases Strictures or Stenosis Adhesions in the intestines Hernias Abscesses Atresia Diverticulitis     Volvulus  

15. PATHOPHYSIOLOGY

16. BOOK PICTURE PATIENT PICTURE   nausea, vomiting, and intermittent, crampy abdominal pain. abdomen distended. constipation. Vomiting fever, Tachycardia (heart rate over 100), high-pitched bowel sounds. Scar tissue on small intestine Absolute constipation Diarrhea Hiccups Inability to pass gas Problem with bowel movement Swelling Anorexia and weight loss Reverse peristalsis movements Generalized malaise aching Shock       The abdomen appear distended constipation.   fever,           Inability to pass gas Problem with bowel movement Anorexia CLINICAL MANIFESTATION

17. DIAGNOSTIC EVALUATION BOOK PICTURE PATIENT PICTURE Physical exam.    Laboratory finding. CBC KFT ABG   X-ray.  Computerized tomography (CT).  Ultrasound.  Air or barium enema.  Colonoscopy   Physical exam.    Laboratory finding. CBC – increase in WBC. Low hb level KFT- increase creatinine. ABG – metabolic alkalosis and respiratory acidosis.   X-ray.    USG

18. MANAGEMENT MEDICAL MANAGEMENT Place intravenous line or IV line into a vein in the arm so that fluids may be given to replace the depleted water, sodium, chloride, and potassium Putting a nasogastric or NG tube through the nose and into the stomach to suck out fluid as well as air to release swelling in the abdomen Placing a flexible catheter into bladder in order to drain urine as well as collect it for testing A colonoscopy may be performed to untwist and decompress the bowel A rectal tube may be inserted to decompress an area that is lower in the bowel Opioids and anti-emetics can be administered to relieve pain and nausea. Administer antibiotics to treat bacterial growth. Antimuscarinic / anticholinergic drugs are used to manage colicky pain due to smooth muscle spasm and bowel wall distension  SURGICAL MANAGEMENT Lysis of adhesions :   Hernia repair .   Resection with end-to-end anastomosis : "  Resection with ileostomy or colostomy

19. Nursing diagnosis Fluid Volume Deficit R/T vomiting, decreased intestinal re-absorption of fluid, and decreased intestinal secretions Acute pain related to distention/ edema and ischemia of intestinal issue, straining to pass motion due to constipation as evidenced by restlessness, anxicon . Impaired bowel elimination related to presence of obstruction/changes in peristalais as evidenced by changes in frequency and consistency hard stool) or absence of stock, alterations in bowel sounds, presence of pain, and cramping Imbalanced nutrition, less than body requirement related to avoidance of food, nausea/ vomiting, intestinal dysfunction and metabolic abnormalities, increased metabolic needs. High risk for infection related to surgical wound, inadequate primary and secondary defenses and invasive procedures as evidenced by lake of awareness  Impaired physical mobility related to surgery as evidenced by pain in the surgical wound Knowledge deficit related to surgical procedure, post-operative care, condition, prognosis, treatment, self-care, and discharge needs.

20. CONCLUSION After completion of the one week posting ,I learn lots of from this patient how to give the immediate post operative nursing care to the patient and practically I, learn about the colostomy care and which type of diet prefer to the patient with colostomy. This patient is require complete nursing care regarding the maintain electrolyte balance and fluid maintenance. I teach to the patient and relative about rehabilitates to the patient and self care of the stoma .

21. THANK YOU