Simple blockage in one spot closed loop blocked in

This preview shows page 20 - 23 out of 29 pages.

Simple – blockage in one spot Closed loop – blocked in two different spots Strangulation and gangrene are likely to develop if not treated immediately Colicky and spasmodic, borborygmi (hyperactive bowel sounds), visible peristaltic waves, paralytic ileus & tender to touch Shock (tachycardia, fever, tachypnea, hypotension), renal (METABOLIC ALKALOSIS), and pulmonary Perforation Sigmoid colon Cancer cause Close loop obstruction - blocked in two different spots Gangrene and perforation Constipation & low grade constant colicky pain – ischemia, and abdominal distention. ****Analgesic medications are really not used bc they decrease the GI mptaility, which further compromises the bowel----Demerol may be given in small amounts
GI Surgery Pre-op Post-op Postoperative Complications Check Dr order NG placement (when?) wait until surgery to alleviate discomfort Check ID, consent signed? Void prior Teaching about procedure and what to expect Check patency of NG – x-ray, aspiration (tells you if the food is being tolerated), auscultation TCDB Assess drainage Expected to be bright red @ first, with gradual darkening w/n the first 24 hours Color changes to yellow-green w/n 36-48 hours IV fluid Meds, bowel sounds, diet, increase ambulation to stimulate peristalsis, VS q4h Discharge planning Set suction tube to green area 80-120 ; red/yellow – run the risk of perforation, increased pressure sucks secretion and when gone suctions the lining of the stomach Do not take out too much secretions at one time - excess secretions removed all at one time can lead to **shock ↓BP, ↑HR**, can also causes alkalosis Dumping syndrome – food goes into small intestine faster than normal Occurs within 5-30 minutes after meals S&S - N/V, epigastric pain, cramping & borborygmi, hypovolemia, reflux, parasympathetic stimulation Avoid drinking fluids with meals and lying down after eating Self limiting last 6-12 months (body has adapted) Nursing Management Nursing Interventions Radiation & chemotherapy Complications Anemia, pernicious, & wt loss Assess NG tube, suction or clamp Turn off suction, crush and give meds, wait 30 mins before turning the suction back on Thorough abdominal assessment
Medication Anticholinergics - ↓ stimulation of HCl and ↓ gastric motility Sedatives Antispasmodics Assess contour of abdomen Auscultation – (use bell) search for present of bruits, should not be there b/c means there is an anuryesm Sterile dressing changes 4x4 pad Do not cut gauze WHY? Do not cut b/c of loose fibers can cause an infection Irrigate with 30-50cc sterile water Oral care Mouth dries out and secretions becomes crusty (can inhibit breathing) Lemon glycerin swab Milk of Magnesia with mineral oil will remove crust Teach patient how to take care of tube and administer feedings What is a JP drain? Fluid will come out thru drain and it doesn’t put pressure on the suture line and won’t cause evisceration and dehiscence; looks like a little grenade, depress and squeeze all the air out, quickly place the top on, as it fills with fluid it expand to accommodate fluid from

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture