Small bowel obstruction (SBO) is a condition characterized by a partial or complete blockage in the small intestine. This obstruction prevents the normal passage of intestinal contents, leading to a buildup of waste and fluids proximal to the blockage. Common causes of SBO include adhesions from previous surgeries, hernias, cancer, and inflammatory bowel diseases. Prompt identification and management are crucial in cases of SBO, as delayed treatment can lead to serious complications and increased mortality. Surgical intervention is often necessary for complete obstructions, while partial obstructions may sometimes resolve with conservative management.
Nurses play a vital role in the care of patients with SBO, particularly in the inpatient setting. Nursing care focuses on assessment, symptom management, and preventing complications. Depending on the severity of the obstruction, nursing interventions may include intravenous (IV) fluid administration to correct dehydration and electrolyte imbalances, nasogastric (NG) tube insertion for bowel decompression, pain and nausea management, and pre- and post-operative care. Patient education is also essential, covering risk factors, symptoms requiring medical attention, and long-term management strategies.
Nursing Assessment
The nursing assessment is the foundation of care for patients with small bowel obstruction. It involves a comprehensive collection of subjective and objective data to understand the patient’s condition and guide the development of an individualized care plan.
Review of Health History
A thorough health history provides crucial context for the patient’s current condition.
1. Identify General Symptoms. Common symptoms of small bowel obstruction include:
- Abdominal pain and cramping: Often intermittent and colicky in nature.
- Abdominal distension: Visible bloating of the abdomen due to gas and fluid accumulation.
- Bloating: Subjective feeling of fullness and pressure in the abdomen.
- Nausea: Feeling of unease in the stomach, often preceding vomiting.
- Vomiting: Expulsion of stomach contents, which may be bilious or fecal in SBO.
- Constipation: Infrequent or difficult bowel movements.
- Anorexia: Loss of appetite or desire to eat.
2. Detailed Abdominal Pain Assessment. Explore the characteristics of the abdominal pain:
- Onset, location, duration, character, alleviating and aggravating factors.
- Pain associated with SBO is typically described as intermittent, crampy, and colicky, often worsening and then easing in waves.
- Importantly, pain may temporarily improve after vomiting due to a reduction in pressure.
3. Bowel Habit Changes. Inquire about alterations in bowel movements:
- Constipation and obstipation (severe constipation or complete bowel obstruction) are common.
- Some patients may experience loose stools, particularly with partial obstructions or initially as the bowel attempts to clear itself.
- Document the presence or absence of flatus (passing gas), as this can indicate the degree of obstruction.
4. Risk Factor Identification. Determine potential predisposing factors for SBO:
- Postoperative adhesions: Scar tissue from previous abdominal surgeries is the most frequent cause.
- Hernias (incarcerated): Trapping of intestine within a hernia sac.
- Malignancy: Tumors within the bowel or pressing on it from outside.
- Inflammatory bowel disease (IBD): Conditions like Crohn’s disease can cause strictures and obstructions.
- Fecal impaction: Hardened stool blocking the bowel, more common in the elderly or those with chronic constipation.
- Foreign bodies: Ingested objects causing blockage.
- Volvulus: Twisting of the intestine, compromising blood supply and causing obstruction.
5. Pediatric-Specific Risk Factors. For children, consider common causes of SBO in this age group:
- Intussusception: Telescoping of one part of the intestine into another.
- Pyloric stenosis: Narrowing of the pyloric sphincter, more common in infants, but can lead to secondary SBO symptoms if severe.
- Congenital atresia: Birth defects where a portion of the intestine is absent or blocked.
6. Comprehensive Medical History Review. Obtain a detailed past medical history:
- Prior hernias and hernia repairs.
- History of inflammatory bowel disease (Crohn’s disease, ulcerative colitis).
- Cancer diagnosis and treatment, particularly abdominal or pelvic cancers.
- Previous abdominal surgeries (laparotomy, laparoscopy).
- Congenital conditions known to predispose to bowel obstruction, such as cystic fibrosis.
Physical Assessment
The physical examination provides objective signs and symptoms of small bowel obstruction.
1. Abdominal Examination. Perform a systematic abdominal assessment:
- Auscultation: Bowel sounds may be altered. In early obstruction, they may be high-pitched and hyperactive (“tinkling”) as the bowel attempts to overcome the blockage. In later stages or with complete obstruction, bowel sounds may be hypoactive or absent.
- Palpation: Assess for tenderness, distension, and masses. Tenderness can be localized or diffuse. Distension is a key sign. Palpate for any palpable masses, including hernias.
- Percussion: Tympany (drum-like sound) may be present due to increased gas.
- Rebound tenderness, guarding, and rigidity: These are signs of peritonitis, a serious complication indicating bowel perforation or ischemia and requiring immediate surgical evaluation.
2. Rectal Examination. Perform a digital rectal exam (DRE):
- Assess for stool in the rectal vault (absence may indicate obstruction).
- Check for gross or occult blood, which can suggest mucosal injury or ischemia.
- Palpate for rectal masses or hernias that could be contributing to the obstruction.
- Evaluate for fecal impaction as a potential cause, especially in elderly or debilitated patients.
Diagnostic Procedures
Diagnostic tests confirm the diagnosis of small bowel obstruction and identify the cause and location of the blockage.
1. Blood Sample Analysis. Laboratory tests provide supportive information:
- Complete Metabolic Profile (CMP): Electrolyte imbalances (hypokalemia, hyponatremia) and dehydration (increased BUN) are common due to vomiting and decreased oral intake. CMP can also assess renal function, important for pre-operative assessment.
- Blood Urea Nitrogen (BUN) and Creatinine: Elevated levels suggest dehydration and decreased kidney perfusion secondary to fluid volume deficit.
- Complete Blood Count (CBC): White blood cell (WBC) count may be elevated in cases of strangulated obstruction or peritonitis, indicating infection or inflammation. Hematocrit may be increased due to dehydration and hemoconcentration.
- Lactic Acid: Elevated lactic acid levels are a critical indicator of bowel ischemia or sepsis, suggesting compromised blood flow to the bowel and requiring urgent intervention.
2. Imaging Scans. Radiologic imaging is essential for visualizing the obstruction:
- CT Enterography or CT Enteroclysis: These are highly accurate CT scans specifically designed to evaluate the small bowel in detail. CT enterography is generally preferred and more accurate than standard CT scans for identifying the site, cause, and degree of obstruction, as well as complications like strangulation or ischemia.
- CT Scan of the Abdomen and Pelvis: The imaging modality of choice, particularly if sepsis or complications are suspected. CT scans can reveal abscesses, inflammatory processes, ischemia, and the level and nature of the obstruction.
- Magnetic Resonance Imaging (MRI): Less commonly used for initial SBO diagnosis compared to CT, but may be used in specific situations, such as in pregnant patients or when avoiding radiation is desired. It is slightly less sensitive than CT for detecting SBO.
- Plain Abdominal X-rays: Often the initial imaging study. X-rays can show dilated loops of small bowel and air-fluid levels, suggestive of obstruction. However, they have low sensitivity and specificity and cannot rule out SBO. They are useful for initial screening and identifying free air in cases of perforation.
- Ultrasound: Less expensive and non-invasive. Ultrasound can sometimes detect SBO and rule out other conditions, particularly in children (e.g., pyloric stenosis, intussusception). However, it is operator-dependent and less reliable than CT for comprehensive evaluation of SBO in adults and is not a replacement for CT scanning when SBO is suspected.
Nursing Interventions
Nursing interventions are crucial for managing patients with small bowel obstruction, focusing on addressing the underlying cause, alleviating symptoms, and preventing complications.
Treat According to the Etiology
The primary goal is to address the cause of the obstruction while providing supportive care.
1. Prepare for Immediate Surgical Consultation and Potential Surgery. Most cases of complete small bowel obstruction are surgical emergencies.
- Prompt surgical intervention (within 24-36 hours) significantly reduces mortality.
- Delay in surgical management can lead to bowel ischemia, perforation, sepsis, and death.
- Partial bowel obstructions may be initially managed conservatively, but close monitoring and surgical consultation are still necessary. If partial obstructions do not resolve within a few days, surgical intervention may be required.
2. Initiate Aggressive Fluid Resuscitation. Address fluid and electrolyte deficits resulting from vomiting, third-spacing of fluids, and decreased oral intake.
- Administer IV fluids: Isotonic solutions like normal saline or lactated Ringer’s solution are used to restore intravascular volume and correct dehydration.
- Correct electrolyte imbalances: Monitor and replace potassium, sodium, and other electrolytes as indicated by lab results.
- Fluid resuscitation aims to improve hemodynamic stability, renal perfusion, and overall patient status in preparation for surgery or conservative management.
3. Monitor Fluid Output Closely. Accurate monitoring of urine output and overall fluid balance is essential.
- Insert a Foley catheter to monitor hourly urine output, reflecting renal perfusion and the effectiveness of fluid resuscitation.
- In some cases, central venous or Swan-Ganz catheters may be necessary for advanced hemodynamic monitoring, particularly in patients with comorbidities or severe fluid imbalances.
4. Decompress the Bowel with Nasogastric (NG) Tube. NG tube insertion is a key intervention for bowel decompression.
- An NG tube connected to intermittent suction removes fluid and air from the stomach and proximal small bowel, reducing abdominal distension, relieving nausea and vomiting, and preventing aspiration.
- Bowel decompression helps to reduce intraluminal pressure, improve bowel wall perfusion, and promote bowel rest.
- In partial obstructions, NG decompression and conservative management may be sufficient to resolve the obstruction.
5. Prepare Patient for Surgery. If surgical intervention is necessary:
- Pre-operative preparation includes ensuring patient is NPO, continuing fluid and electrolyte resuscitation, administering pre-operative antibiotics as ordered, and providing patient education and emotional support.
- Laparoscopic surgery may be feasible in some cases, offering minimally invasive approach. Open laparotomy may be necessary for complex obstructions or when laparoscopy is contraindicated.
- Surgical procedures may include lysis of adhesions, hernia repair, bowel resection with anastomosis (removal of the diseased bowel segment and reconnection of healthy ends), or ostomy creation in severe cases.
Manage Pain and Nausea
Symptom control is vital to patient comfort and recovery.
1. Pain Management. Address abdominal pain effectively.
- Administer analgesics as prescribed. Morphine sulfate is often the preferred opioid analgesic for SBO pain due to its efficacy, safety, and reversibility with naloxone if needed.
- Regular pain assessment is crucial to evaluate pain intensity and response to medication.
- Consider non-pharmacological pain management strategies, such as positioning, relaxation techniques, and distraction, as adjuncts to medication.
2. Nausea and Vomiting Management. Control nausea and vomiting to improve comfort and prevent complications.
- Administer antiemetics as ordered. Common antiemetics include ondansetron (5-HT3 receptor antagonist) and promethazine (dopamine antagonist).
- Nausea and vomiting can be exacerbated by the obstruction itself and by NG tube placement.
- Monitor and manage potential side effects of antiemetics, such as sedation or extrapyramidal symptoms.
3. Preoperative Antibiotic Administration. Prophylactic antibiotics are typically administered before surgery.
- Broad-spectrum antibiotics are used to cover gram-negative bacteria and anaerobic organisms, which are commonly found in the bowel flora.
- Antibiotics aim to reduce the risk of surgical site infection and sepsis, particularly if bowel perforation or strangulation is suspected.
4. Encourage Ambulation and Repositioning. Promote mobility as tolerated.
- Early ambulation and frequent position changes, especially postoperatively, help to stimulate bowel motility, reduce abdominal distension and gas buildup, and prevent respiratory complications.
- Encourage deep breathing and coughing exercises to prevent pneumonia.
Prevent Complications
Preventing and monitoring for complications is a critical aspect of nursing care.
1. Monitor for Signs and Symptoms of Complications. Be vigilant for signs of serious complications:
- Bowel Perforation:
- Sudden worsening abdominal pain and tenderness.
- Changes in vital signs (tachycardia, hypotension, fever).
- Fever and chills.
- Increased white blood cell count.
- Bowel Ischemia (Strangulation):
- Severe, unrelenting abdominal pain.
- Abdominal bloating and distension.
- Blood in the stool (hematochezia or melena).
- Nausea and persistent vomiting.
- Peritonitis:
- Abdominal rigidity and guarding.
- Rebound tenderness.
- Signs of systemic infection (fever, tachycardia, sepsis).
2. Patient and Family Education on Recurrence. Small bowel obstructions have a significant recurrence rate.
- Educate patients and families about the signs and symptoms of bowel obstruction recurrence.
- Emphasize the importance of seeking immediate medical attention if symptoms develop, as delayed treatment increases the risk of complications and mortality.
- Provide written discharge instructions outlining warning signs and when to seek medical help.
Nursing Care Plans
Nursing care plans for small bowel obstruction are organized around common nursing diagnoses. These plans guide nursing interventions and help achieve desired patient outcomes.
Acute Pain
Patients with SBO frequently experience acute pain related to the obstruction and associated inflammation.
Nursing Diagnosis: Acute Pain
Related to:
- Inflammation and distension of the bowel
- Bowel obstruction and cramping
- Surgical incision (if applicable)
As evidenced by:
- Patient reports of abdominal pain, cramping, or discomfort
- Pain score greater than 3 on a 0-10 scale
- Guarding behaviors, restlessness
- Facial grimacing, moaning
- Changes in vital signs (increased heart rate, blood pressure)
Expected outcomes:
- Patient will report a pain level of 3 or less on a 0-10 scale within 2 hours of intervention.
- Patient will demonstrate relaxed body posture and decreased guarding.
- Patient will verbalize relief of pain and cramping.
Assessment:
1. Pain Assessment. Conduct a comprehensive pain assessment:
- Characterize pain (location, quality, intensity, onset, duration, aggravating/alleviating factors).
- Use a pain scale (numerical rating scale, visual analog scale) to quantify pain intensity.
- Assess pain at regular intervals and before and after pain interventions.
2. Nonverbal Pain Cues. Observe for nonverbal indicators of pain:
- Facial expressions (grimacing, furrowed brow).
- Body posture (guarding, fetal position).
- Restlessness, agitation, or reluctance to move.
- Changes in vital signs (tachycardia, hypertension, increased respiratory rate).
3. Vital Sign Monitoring. Assess vital signs in relation to pain:
- Monitor heart rate, blood pressure, and respiratory rate.
- Note if vital signs are elevated in conjunction with reports of pain.
- Recognize that vital signs may not always correlate with pain intensity, particularly in chronic pain or in debilitated patients.
Interventions:
1. Administer Analgesics. Provide pain medication as prescribed and ordered:
- Administer pain medications promptly and regularly, especially IV medications given NPO status.
- Consider patient-controlled analgesia (PCA) if appropriate for postoperative pain management.
- Monitor for effectiveness of pain medication and adjust dosage or frequency as needed in collaboration with the physician.
2. Implement Comfort Measures. Utilize non-pharmacological pain relief strategies:
- Provide comfortable positioning (semi-Fowler’s, side-lying with knees flexed).
- Offer back massage, gentle abdominal massage (if not contraindicated).
- Encourage relaxation techniques (deep breathing exercises, guided imagery).
- Provide a quiet and restful environment.
- Apply warm compresses to the abdomen (if not contraindicated).
3. Cluster Nursing Care. Coordinate nursing activities to maximize pain relief:
- Schedule nursing procedures and activities when pain medication is at peak effectiveness.
- Allow for rest periods to minimize pain exacerbation.
- Anticipate patient needs to reduce unnecessary movement and discomfort.
4. Nasogastric Tube Management. Ensure proper NG tube function:
- Verify NG tube patency and correct positioning.
- Monitor NG drainage for color, amount, and consistency.
- Provide oral and nasal care to enhance comfort for patients with NG tubes.
- Explain the purpose of the NG tube to the patient to reduce anxiety.
Constipation
Although counterintuitive, constipation is a significant nursing diagnosis in bowel obstruction, reflecting the altered bowel function.
Nursing Diagnosis: Constipation
Related to:
- Mechanical obstruction of the bowel
- Decreased bowel motility
- Dehydration
- Pain medication side effects
As evidenced by:
- Absence of bowel movements or decreased frequency
- Abdominal distension, bloating
- Reports of straining with defecation
- Hard, infrequent stools (if any)
- Decreased bowel sounds
Expected outcomes:
- Patient will report passage of stool or flatus within 24-48 hours (if partial obstruction).
- Patient will report decreased abdominal distension and bloating.
- Patient will verbalize understanding of strategies to manage constipation post-discharge.
Assessment:
1. Bowel Pattern History. Assess usual bowel habits:
- Inquire about normal frequency, consistency, and ease of bowel movements.
- Identify any recent changes in bowel habits.
- Determine patient’s perception of “normal” bowel function.
2. Dietary and Fluid Assessment. Evaluate factors influencing bowel function:
- Assess usual dietary fiber intake and fluid consumption.
- Identify any dietary changes related to illness or hospitalization.
- Assess for potential dietary factors contributing to constipation.
3. Defecation Assessment. Evaluate current bowel status:
- Inquire about pain or difficulty with defecation, straining, or incomplete evacuation.
- Assess for hemorrhoids, which can exacerbate discomfort and constipation.
- Document characteristics of any stool passed (amount, consistency, color).
Interventions:
1. Sitz Baths. Provide comfort measures:
- Offer warm sitz baths as appropriate, especially if hemorrhoids are present, to relieve discomfort and promote relaxation of rectal muscles.
2. Hydration Encouragement. Promote adequate fluid intake (when oral intake is resumed):
- Encourage oral fluids as soon as medically appropriate.
- Recommend water, clear broths, and diluted juices.
- Discourage dehydrating beverages like alcohol and caffeinated drinks.
- Monitor IV fluid administration as prescribed.
3. Dietary Fiber Education. Provide dietary guidance (post-obstruction resolution):
- When diet is advanced, educate on the importance of a high-fiber diet to promote bowel regularity.
- Recommend gradual increase in fiber intake to avoid abdominal discomfort or gas.
- Discuss fiber-rich foods (fruits, vegetables, whole grains).
4. Activity Promotion. Encourage physical activity:
- Promote ambulation as tolerated, both during hospitalization and post-discharge.
- Explain the benefits of physical activity in stimulating bowel motility.
- Encourage regular exercise routines once recovered.
Dysfunctional Gastrointestinal Motility
Dysfunctional gastrointestinal motility is a direct consequence of bowel obstruction.
Nursing Diagnosis: Dysfunctional Gastrointestinal Motility
Related to:
- Mechanical obstruction (partial or complete)
- Inflammatory process in the bowel
- Effects of surgery
- Ileus
As evidenced by:
- Abdominal distension and bloating
- Abdominal cramping or pain
- Altered bowel sounds (hyperactive, hypoactive, absent)
- Nausea and vomiting
- Absence of flatus or bowel movements
- Anorexia, early satiety
Expected outcomes:
- Patient will exhibit return of normal bowel sounds within 2-3 days.
- Patient will pass flatus and stool after obstruction is relieved.
- Patient will report reduction in abdominal distension and discomfort.
- Patient will tolerate oral intake without nausea or vomiting.
Assessment:
1. Bowel Sound Assessment. Auscultate and document bowel sounds:
- Assess frequency, character, and location of bowel sounds in all four quadrants.
- Note hyperactive, hypoactive, or absent bowel sounds.
- Correlate bowel sound findings with other clinical manifestations.
2. Diagnostic Study Review. Review results of diagnostic imaging:
- Examine CT scan, X-ray, or ultrasound reports for confirmation of obstruction and location.
- Note any findings of complications (strangulation, perforation).
- Integrate imaging findings with clinical assessment.
3. Gastrointestinal Motility Signs and Symptoms. Monitor for indicators of impaired motility:
- Assess for nausea, vomiting, abdominal distension, bloating, pain, and changes in bowel habits.
- Inquire about appetite and tolerance of oral intake.
- Document frequency and characteristics of vomiting or NG drainage.
Interventions:
1. Nasogastric Tube Insertion and Management. Implement bowel decompression:
- Insert and maintain NG tube as prescribed to decompress the stomach and proximal bowel.
- Ensure proper suction and patency of the NG tube.
- Monitor NG drainage and document characteristics.
- Provide regular oral and nasal care.
2. Surgical Preparation and Assistance. Prepare for potential surgical intervention:
- Ensure patient is NPO and IV fluids are infusing as ordered.
- Administer preoperative antibiotics and other medications as prescribed.
- Provide pre-operative education and emotional support.
- Assist with pre-operative procedures and documentation.
3. NPO Status Maintenance. Enforce bowel rest:
- Maintain strict NPO status as ordered to allow bowel rest and reduce stimulation of GI motility.
- Provide patient education regarding the rationale for NPO status.
- Address patient’s thirst and hunger while NPO.
4. Postoperative Ambulation. Promote early mobilization after surgery:
- Encourage ambulation as soon as medically stable postoperatively.
- Assist patient with ambulation and provide support as needed.
- Explain the benefits of ambulation in stimulating bowel motility and preventing complications.
Imbalanced Nutrition: Less Than Body Requirements
Nutritional deficits can occur rapidly in SBO due to impaired absorption and restricted oral intake.
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements
Related to:
- Impaired absorption of nutrients due to obstruction
- NPO status for bowel rest
- Vomiting and potential diarrhea
- Anorexia and decreased oral intake
As evidenced by:
- Weight loss or difficulty maintaining weight
- Decreased appetite or anorexia
- Electrolyte imbalances (hypokalemia, hyponatremia)
- Abnormal laboratory values (decreased albumin, prealbumin)
- Muscle weakness, fatigue
Expected outcomes:
- Patient will maintain stable weight during hospitalization.
- Patient will demonstrate electrolyte and nutritional lab values within normal limits.
- Patient will report improved appetite and energy levels as oral intake resumes.
- Patient will tolerate gradual advancement of diet without nausea, vomiting, or abdominal distress.
Assessment:
1. Laboratory Value Monitoring. Assess nutritional status objectively:
- Monitor serum albumin, prealbumin, and total protein levels as indicators of protein status.
- Review electrolyte levels (sodium, potassium, magnesium, phosphate) for imbalances.
- Track complete blood count for signs of anemia or infection.
2. Intake and Output Monitoring. Track fluid and nutrient balance:
- Accurately record all oral, IV, and NG tube intake.
- Document all output sources (vomitus, NG drainage, urine, stool).
- Calculate daily fluid balance.
3. Nutritional History. Assess dietary habits and preferences:
- Inquire about usual dietary intake, food preferences, and cultural or religious dietary restrictions.
- Identify any food allergies or intolerances.
- Determine patient’s appetite and any factors affecting food intake.
Interventions:
1. Maintain NPO Status. Support bowel rest initially:
- Reinforce NPO status as prescribed to reduce bowel stimulation and vomiting.
- Provide meticulous oral hygiene to maintain comfort while NPO.
- Explain the rationale for NPO status to the patient and family.
2. Daily Weight Monitoring. Track weight changes:
- Weigh patient daily at the same time, using the same scale and clothing, to monitor for weight loss or gain.
- Document weight changes and report significant fluctuations to the physician.
3. Diet Advancement as Tolerated. Gradually reintroduce oral intake:
- When ordered, advance diet slowly, starting with clear liquids and progressing to full liquids, soft diet, and regular diet as tolerated.
- Monitor patient’s tolerance to diet advancements (nausea, vomiting, abdominal pain, distension).
- Consult with a dietitian for nutritional assessment and recommendations.
4. Patient Involvement in Meal Planning. Encourage patient participation:
- Involve patient in food selections when diet is advanced.
- Offer preferred foods within dietary restrictions.
- Create a pleasant and supportive mealtime environment.
- Provide encouragement and positive reinforcement for oral intake.
Ineffective Tissue Perfusion
Compromised blood flow to the bowel is a serious complication of SBO, leading to ischemia and potential necrosis.
Nursing Diagnosis: Ineffective Tissue Perfusion (Gastrointestinal)
Related to:
- Mechanical obstruction of blood vessels
- Bowel distension and increased intraluminal pressure
- Inflammatory process
- Potential for strangulation or volvulus
As evidenced by:
- Severe abdominal pain, sudden onset or worsening
- Abdominal rigidity and rebound tenderness
- Abdominal distension, bloating
- Nausea and vomiting (especially bilious or fecal)
- Blood in stool (hematochezia, melena, occult blood)
- Altered vital signs (tachycardia, hypotension, fever)
- Changes in bowel sounds (absent or markedly diminished)
- Elevated lactic acid levels
Expected outcomes:
- Patient will maintain stable vital signs within normal limits.
- Patient will exhibit laboratory values (CBC, lactic acid) within acceptable ranges.
- Patient will report absence of sudden worsening abdominal pain or rigidity.
- Patient will demonstrate resolution of signs of gastrointestinal bleeding.
Assessment:
1. Signs and Symptoms of Decreased Perfusion. Monitor for indicators of ischemia:
- Assess for sudden onset or worsening of abdominal pain, especially if it becomes constant and severe.
- Evaluate for abdominal rigidity, rebound tenderness, and increasing distension.
- Observe for nausea, vomiting (especially bilious or fecal emesis), and changes in bowel sounds.
- Assess for signs of gastrointestinal bleeding (hematochezia, melena, or positive fecal occult blood test).
2. Laboratory Value Monitoring. Review labs for perfusion indicators:
- Monitor complete blood count (CBC) for changes in hemoglobin, hematocrit, and white blood cell count.
- Assess serum lactic acid levels as an indicator of tissue hypoxia and ischemia.
- Review electrolyte levels for imbalances related to fluid shifts and dehydration.
3. Abdominal Assessment for Complications. Assess for signs of peritonitis and ischemia:
- Palpate abdomen for rigidity, guarding, and rebound tenderness, indicating peritonitis.
- Auscultate bowel sounds for marked reduction or absence, suggesting ischemia or ileus.
- Assess for abdominal distension and measure abdominal girth if indicated.
Interventions:
1. Fluid and Electrolyte Replacement. Optimize hemodynamic status:
- Administer IV fluids as prescribed to correct dehydration and improve intravascular volume.
- Replace electrolyte deficits based on laboratory results.
- Monitor fluid balance closely, including intake and output.
2. Oxygen Therapy Administration. Ensure adequate oxygenation:
- Administer supplemental oxygen as prescribed to maintain adequate oxygen saturation and support tissue perfusion.
- Monitor oxygen saturation continuously or intermittently.
3. Diagnostic Study Review and Preparation. Facilitate timely diagnosis and intervention:
- Review results of diagnostic imaging (CT scan, X-ray) to assess for obstruction and complications.
- Prepare patient for further diagnostic procedures or surgical interventions as indicated.
- Ensure timely communication of assessment findings and lab results to the physician.
4. Surgical Intervention Preparation. Prepare for potential surgery to restore perfusion:
- Ensure patient is NPO and IV access is maintained.
- Administer preoperative antibiotics and other medications as ordered.
- Provide pre-operative education and emotional support to the patient and family.
- Assist with pre-operative procedures and documentation to expedite surgical intervention.
