Description of Intestinal Obstruction: Pathophysiology, Etiology & Risk Factors
Intestinal obstruction is characterized by a blockage in the intestine. Such blockages subsequently result in solids, gas, and fluid building up in the proximal intestine, causing severe abdominal pain, increased tension in the wall of the intestine, and increased tension in the intestine. This tension can also be accompanied by impairment of the blood supply of the intestine associated with the external pressure and twisting. In nearly 25% of small bowel obstruction, the blood flow is extremely compromised (Ansari & Hofstra, 2017). This type of obstruction is usually linked to intussusception, hernia, and volvulus. It is important to mention that strangulating obstruction of the intestine can develop into further complications such as gangrene or infection in a very short space of time (around six hours). First, venous obstruction takes place and is then followed by arterial occlusion, which subsequently results in the bowel wall ischemia.
Perforation and gangrene of the intestine can develop because of the ischemic bowel becoming edematous and later experiencing an infarct (Ansari & Hofstra, 2017). With regards to obstruction of the large-bowel, the process of strangulation rarely occurs, with the exception of volvulus. There are a range of symptoms of intestinal obstruction, depending on the severity of the condition; nausea and vomiting, constipation or diarrhea, severe pain in the abdomen and bloating, cramps, bloating, and swelling are the most common symptoms. In some cases, patients can also experience dehydration, dizziness, and fever when they have experienced intestinal obstruction for a long period of time without treatment. For instance, early stages of the condition are characterized by vomiting while later stages, such as complete obstruction, are accompanied by the patients’ inability to pass stools (constipation) and gas, which can also lead to inflammation and infection if untreated.
The etiology of intestinal obstruction includes several causes, the most common of which is the cancer of the colon. Another is intestinal adhesions, which are characterized by bands of fiber-like tissue that can form after a patient has undergone pelvic or abdominal surgery. When it comes to intestinal obstruction among children, the most common reason for the condition’s development is intussusception. Other reasons for the condition can include the presence of other inflammatory bowel diseases (e.g., Crohn’s disease), hernias, volvulus or colon twisting, diverticulitis, as well as impacted feces. If left untreated, intestinal obstruction can lead to more serious complications as tissue death and infections. In the case of tissue death, the lack of blood in the organ causes its tissue to die; the subsequent perforations in the walls of the intestine result in infection.
When peritonitis develops in the abdominal cavity, the infection can be an extremely life-threatening condition that needs immediate medical attention, and possibly surgery. Overall, when it comes to intestinal obstruction, it is essential to consider its etiological causes and control the possible risk factors for decreasing mortality and morbidity (Ojo et al., 2014). Risk factors for diagnosing intestinal obstruction are associated with the additional complications of being able to differentiate between actual mechanical obstruction and other causes that may have the same symptoms (Jackson & Raiji, 2011). Tachycardia and hypotension can indicate dehydration, which is a risk factor in itself that can cause further complications. In patients with proximal or early intestinal obstruction, the usual symptoms of a tympanitic abdomen may not be present, which makes for an even more complicated diagnosis of the condition.
Nursing Diagnosis and Interventions
A patient is likely to have intestinal obstruction because he/she has deficient volumes of fluid associated with severe vomiting and nausea, which are accompanied by diaphoresis and fever. Interventions targeted at the management of the diagnosis will have the objective of meeting fluid requirements, normalizing vital signs, and balancing input and output. The first intervention should address the problem of dehydration because the patient’s nausea and vomiting will have contributed to the poor fluid intake. Hypodermoclysis is a viable intervention that is less invasive than intravenous infusion and can be efficiently performed even by low-skilled personnel. The rationale for this is the following: when implemented correctly, this balances the fluid volumes in the body, and an accurate intake and output can be achieved. The second intervention is associated with the administration of analgesics or antibiotics to relieve pain and eliminate fever for balancing the patient’s vital signs. The rationale for this intervention is associated with relieving the discomfort that the patient experiences in order to proceed with further management. The third possible intervention that can be implemented in the patient’s case is to protect the patient’s airway due to the high risks of vomiting leading to aspirations. This intervention is explained by the fact that when caring for the patient, a nurse should place the patient’s head in a position in which the mouth would be lower than the vocal cord to avoid aspiration. The last intervention should be targeted at relieving distension in the bowel. Nasogastric intubation is a rational strategy for doing so because it can remove gastrointestinal secretion, as well as swallowed air, to subsequently decrease the distension.
References
Ansari, P., & Hofstra, N. (2017). Intestinal obstruction. MSD manual professional version. Web.
Jackson, P., & Raiji, M. (2011). Evaluation and management of intestinal obstruction. American Family Physician, 83(2), 159-165.
Ojo, E., Ihezue, C., Sule, A., Ismaila, O., Dauda, A., & Adejumo, A. (2014). Etiology, clinical pattern and outcome of adult intestinal obstruction in Jos, North Central Nigeria. African Journal or Medicine and Medical Sciences, 43(1), 29-36.