INTESTINAL OBSTRUCTION ppt [Autosaved].pptx

presented by- Gaurav Karanjekar

1. INTESTINAL OBSTRUCTION INTESTINAL OBSTRUCTION PRESENTED BY, GAURAV KARANJEKAR

2. ANATOMY AND PHYSIOLOGY OF INTESTINE

3. 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.

4. definition “Intestinal obstruction is a significant or mechanical blockage of intestine that occur when food or stool can not move through the intestine.”

5. TYPES OF INTESTINAL OBSTRUCTION

6. TYPES OF INTESTINAL OBSTRUCTION 1. Simple Intestinal Obstruction

7. TYPES OF INTESTINAL OBSTRUCTION 2. Strangulated Intestinal Obstruction

8. TYPES OF INTESTINAL OBSTRUCTION 3. Closed-Loop Intestinal Obstruction

9. ETIOLOGICAL FACTOR

10. 1. Mechanical Obstruction: A physical block to passage of intestinal contents

11. Cont …. Volvulus Intussusception Adhesion

12. Cont …. Hernia Atresia Hirschsprung’s disease

13. 2. FUNCTIONAL OBSTRUCTION Paralytic ileus Neurologic disorders ( Parkinson's disease )

14. 3. Vascular Obstruction A vascular obstruction occurs in the large intestine when an atherosclerotic narrowing interrupts the blood supply to the bowel. This narrowing inhibits peristalsis and can lead to life-threatening intestinal ischemia.

15. PATHOPHYSIOLOGY

16. PATHOPHYSIOLOGY

17. SIGN & SYMPTOMS

18. SIGN & SYMPTOMS Nausea/vomiting Unable to defecate A bdomen distended Fever 1. 2. 3. 4.

19. SIGN & SYMPTOMS Generalized malaise and aching Tachycardia Anorexia Hiccups 5. 6. 7. 8.

20. SIGN & SYMPTOMS Reverse peristalsis movements Scar tissue on small intestine H igh pitch Bowel sound Shock 9. 10. 11. 12.

21. DIAGNOSTIC EVALUATION

22. MANAGEMENT

23. MEDICAL MANAGEMENT Place intravenous line or IV line into a vein in the arm Putting a nasogastric or NG tube through the nose and into the stomach Placing a flexible catheter into bladder in order to drain urine as well as collect it for testing A rectal tube may be inserted to decompress an area that is lower in the bowel

24. Cont … MEDICATION Opioids – Astramorph , 0.2 to 1 mg, OD , MS Contin- 15 mg tablets orally Q8H OR Q12H Duramorph - IV: initially 2–10mg/70kg of body wt , OD Anti-emetics – Metoclopramide ( adult dose is 10mg, taken up to 3 times a day) Antibiotics - Metronidazole (Flagyl) 400 MG Antimuscarinic / Anticholinergic- e.g. atropine, scopolamine

25. SURGICAL MANAGEMENT Lysis of adhesions : The process of removing these bands of scar tissue is called lysis.

26. CONT.. Hernia repair .

27. CONT… Resection with end-to-end anastomosis : "Resection" means to remove part or all of a tissue or structure. Resection of the small or large intestine,

28. CONT…. Resection with ileostomy or colostomy : obstruction and diseased tissue is removed, an ileostomy or colostomy is created.

29. NURSING MANAGEMENT PRE-OPERATIVE CARE Assess the patient's level of anxiety and fear. Administer perioperative antibiotics. Keep the patient in semi Fowler's position as much as possible.   Prepare patient by explaining surgical procedure Prepare the patient and his family for the possibility of surgery

30. CONT… POST-OPERATIVE CARE Relieving Pain Maintaining Fluid & Electrolyte Balance Maintaining Tissue Perfusion Maintaining Skin Integrity Improving Nutritional Status Providing knowledge

31. COLOSTOMY CARE Observe stoma for colour, swelling, trauma & healing. Stoma should be moist & pink. Cover the stoma with a gauze piece. Clean peristomal region gently with warm tap water using gauze pad. Don't scrub the skin, dry by patting the skin. Remove gauze & clean stoma with gauze

32. NURSING DIAGNOSIS Pre-operative Nursing Diagnosis Acute pain related to distention/ edema and ischemia of intestinal issue, straining to pass motion due to constipation as evidenced by restlessness 2. Impaired bowel elimination related to presence of obstruction/changes in peristalsis as evidenced by changes in frequency and consistency hard stool) or absence of stock, alterations in bowel sounds, presence of pain, and cramping   3. Imbalanced nutritional status less then body requirements related to less intake of food, as evidenced by constipation, weight loss 4. Anxiety related to disease prognosis; follow up as evidenced by depression, fear. 5. Activity intolerance related to pain while sitting as evidenced by decreased activity level.

33. CONT… Post operative Nursing Diagnosis   1. Acute pain related to surgical incision as evidenced by restlessness, verbal reports, guarding/distraction behaviours, narrowed focus and autonomic responses (changes in vital signs).   2. Fluid volume deficit related to increased intestinal losses (vomiting and diarrhoea), and decreased intake, rectal bleeding as evidenced by dehydration. 3. Ineffective tissue perfusion: Gl related to hypovolemia caused by intestinal obstruction as evidenced by stabilized vital signs, warm skin, palpable peripheral pulses, ABGs within client norms, adequate urine output. 4. Impaired skin integrity related to surgery, presence of drains, bed rest altered nutritional state (obesity)/metabolic state as evidenced by disruption of skin/subcutaneous tissues.     5. Impaired physical mobility related to surgery as evidenced by pain in the surgical wound

34. NURSING CARE PLAN

35. PREVENTION

36. SUMMERY At last in this topic I would like to say intestinal obstruction is a digestive system disorder that may affect the intestinal which are responsible for movement of digestive food particles, faeces , gases. Ifthey are not passed it will strangulate in intestine and cause many problem. It may also cause intestinal perforation that is life threatening condition and if not treated it will cause death.

37. SUMMERY