Abdominal paracentesis and culture of fluid ct scan

Abdominal paracentesis and culture of fluid
 CT scan or ultrasound
 Peritoneoscopy (Lewis pg.974-975)
Intestinal Obstruction
- Clinical manifestations
o Higher level of obstruction S/S:
 Rapid onset
 Profuse, projectile vomiting with bile
 Vomit usually relieves the abdominal pain
 Colicky, crampy
 Intermittent pain
 Hyperactive bowel sounds above the obstruction
 Hypoactive/absent bowel sounds below the obstruction
o Distal small bowel: Gradual onset, Orange-brown , foul smelling vomitus

o Large bowel obstruction: May not have vomiting, May eventually vomit fecal
material, Vague, diffused, constant pain, Significant abdominal distention
 Mechanical obstructions
 Types of Mechanical obstructions=
 Intussusception= telescoping of bowel, most common in children 1-2 years
 Fecal impaction= constipation
 Encirclement or compression of intestine by adhesions, tumors, fibrosis, or
strictures
Mechanical obstructions:
 Accounts for 90% of all obstructions
 Usually requires surgery
 Most intestinal obstructions are small bowel (adhesions are the most common
cause)
 Most often in the ileum
 Pain comes and goes in waves due to? Peristalsis
 Most common cause of large bowel obstruction? Cancer, tumor in colon; colon
cancer
 Carcinoma followed by volvulus and diverticular disease
S/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 Pancreatitis
 Appendicitis
 Electrolyte imbalance (hypokalemia)
 Inflammatory responses (peritonitis or sepsis)
 Constant generalized discomfort
- Nursing diagnoses for Intestinal Obstruction
o Pain: location, duration, intensity, frequency, tenderness/rigidity,
o N/V: onset, frequency, color, odor, and amount
o Inspection: peristaltic waves=small bowel obstruction. Significant bowel
distension= large bowel obstruction
o Auscultation= above obstruction= hyperactive, high-pitched bowel sounds ,
below obstruction= hypoactive/absent
o Percussion= if bowel has a lot of air in it then it sounds like tympany
o Palpation= 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 Obstruction
o History & Physical
o Laboratory tests
 CBC – Inflammation or Infection
 Elevated WBC = Strangulation, Perforation

 Elevated H&H = Dehydration (blood is more consolidated)
 Amylase – ? check for pancreatitis
 BUN – Fluid status
 Stool – Occult Blood
 Acid-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)
o Electrolytes – Fluid status
 ↓ Na, K, CL with small bowel obstructions(related to losses)
CT Scan!!