Abdominal paracentesis and culture of fluidCT scan or ultrasoundPeritoneoscopy (Lewis pg.974-975)Intestinal Obstruction -Clinical manifestationsoHigher level of obstruction S/S:Rapid onsetProfuse, projectile vomiting with bileVomit usually relieves the abdominal painColicky, crampyIntermittent painHyperactive bowel sounds above the obstructionHypoactive/absent bowel sounds below the obstructionoDistal small bowel: Gradual onset, Orange-brown , foul smelling vomitus
oLarge bowel obstruction: May not have vomiting, May eventually vomit fecal material, Vague, diffused, constant pain, Significant abdominal distentionMechanical obstructionsTypes of Mechanical obstructions= Intussusception= telescoping of bowel, most common in children 1-2 yearsFecal impaction= constipationEncirclement or compression of intestine by adhesions, tumors, fibrosis, or stricturesMechanical obstructions:Accounts for 90% of all obstructionsUsually requires surgeryMost intestinal obstructions are small bowel (adhesions are the most common cause)Most often in the ileumPain comes and goes in waves due to? PeristalsisMost common cause of large bowel obstruction? Cancer, tumor in colon; colon cancerCarcinoma followed by volvulus and diverticular diseaseS/S of nonmechanical obstruction:Nonmechanical obstructions (paralytic ileus)Result of decreased peristalsis from:Neurogenic disorders (surgery & spinal cord injury)Vascular disorders (insufficiency & mesenteric emboli)Acute PancreatitisAppendicitis Electrolyte imbalance (hypokalemia)Inflammatory responses (peritonitis or sepsis)Constant generalized discomfort -Nursing diagnoses for Intestinal ObstructionoPain: location, duration, intensity, frequency, tenderness/rigidity,oN/V: onset, frequency, color, odor, and amountoInspection: peristaltic waves=small bowel obstruction. Significant bowel distension= large bowel obstructionoAuscultation= above obstruction= hyperactive, high-pitched bowel sounds, below obstruction= hypoactive/absentoPercussion= if bowel has a lot of air in it then it sounds like tympany oPalpation= tender, guarding?-Acute pain r/t abdominal distention -Fluid volume deficit r/t decreased intestinal fluid absorption and vomiting-Imbalanced Nutrition: less than required r/t obstruction and vomiting-Diagnostic studies for Intestinal ObstructionoHistory & PhysicaloLaboratory testsCBC – Inflammation or InfectionElevated WBC = Strangulation, Perforation
Elevated H&H = Dehydration (blood is more consolidated)Amylase – ? check for pancreatitisBUN – Fluid statusStool – Occult BloodAcid-base balance assessment:Metabolic alkalosis with high obstruction (from high obstructions from loss of gastric hydrochloride and r/t vomiting)Metabolic acidosis with low obstruction (from lower levels of obstruction as alkaline fluids are not absorbed) oElectrolytes – Fluid status↓ Na, K, CL with small bowel obstructions(related to losses)CT Scan!!