 Welcome to Nursing School Explained and this video on bowel obstruction. Now, bowel obstruction can occur at any part of the small or the large intestine and it can be partial or complete. And we really have to distinguish between two types of bowel obstructions which are mechanical and non-mechanical obstructions. So the mechanical ones are the more common ones and that's an actual physical barrier that prevents the digestive contents to continue moving on further for excretion. And the most common site is the small intestine and it happens because of surgical adhesions. Adhesions are basically scar tissue that form after the patient had had previous surgery. Now the scar tissue affects the small intestine and then basically just kind of clamps down on it and creates that physical barrier, that physical obstruction. But mechanical obstructions can also occur because of hernias and strictures from Crohn's disease. If you recall Crohn's disease can cause all kinds of inflammation throughout the GI tract and then can cause mechanical obstructions as well as interceception. Now in the colon mechanical obstructions can also occur from cancer, diverticular or a barbless. And basically those are again the same thing. Something mechanically now is obstructing the flow of the digestive tract and this can be cancer or diverticular, those little polyps or barbless where the intestine just kind of collapses on itself. And then non-mechanical obstructions occur because of decreased peristalsis and the most common one here is paralytic ileus that occurs after abdominal surgery or it can be due to peritonitis. And decreased peristalsis after paralytic ileus happens because of several factors. Now one of them is that the anesthesia itself kind of slows everything down plus the patient has been NPO, there has now been some interference with the intestinal system whether it's a small or large intestine. And so now it's not quite working and the ileus is basically means that the digestive system is paralyzed. It's just not moving. So the peristalsis, the moving forward, the propulsion of the food is not working the way it's supposed to. But it can also be due to neuromuscular or vascular causes and so neuromuscular, remember that we need neuromuscular control and we have neuromuscular control and innervation of the digestive tract and if there is a spine, a fracture in the T or the L spine that has something to do now with blocking the impulses of the neuromuscular system on the intestine it can cause a non-mechanical obstruction as well as electrolyte imbalances. Remember that potassium has a lot to do with muscle contraction. We usually just think about the heart when we think about potassium but hypokalemia can also cause neuromuscular causes of non-mechanical bowel obstruction. So now the patient doesn't have enough potassium for the intestine to move and it gets very sluggish and then causes the obstruction. And then vascular causes, so this is anything that can cause atherosclerosis in the arteries and the blood vessels that supply the blood to the patient's digestive system and now there is a clot, no clot, no blood flow ischemia causes non-mechanical bowel obstruction. But again most common one here is the paralytic ills and the adhesions in the small intestine. The symptoms of any type of bowel obstruction will be abdominal pain and the patient will certainly be tender to palpation. They might be vomiting and depending on where the obstruction is, if it's higher or lower it will depend on what the vomit will look like. So if it's a very low obstruction close in the colon you have to think about that everything is blocked from a certain degree. So let's say it's in the descending colon over here on the left side so the obstruction is occurring here and nothing is flowing down. So everything else in the digestive tract is backing up and so the more distilled the obstruction is the more kind of foul smelling and stool-like and digestive content the vomit will be because it's nothing can move down so everything is going to back up and the patient is going to vomit that up. But it can't be anything from maybe even hematomosis or just stomach contents. And then there will be abdominal distension again because the patient is very bloated as the digestive contents just back up and cause the distension and it can also lead to rigidity. The patient certainly will be constipated because there is no movement downwards or no bowel movement occurs the natural way, no elimination occurs the natural way, everything is backing up and then most likely the patient will be vomiting. And then certainly bowel sounds will be affected and most likely they will be increased above the level of the obstruction so there will be lots of gurgling hyperactive bowel sounds and then below the obstruction there might be absent or certainly hypoactive bowel sounds are very common with this. So then let's look at diagnostic tests. Those include anything from a basic X-ray, abdominal X-ray to a TAT scan to really identify where the obstruction is occurring and then maybe even identify those adhesions or any kind of neoplasm, diverticular that could be causing this. And then we want to look at the patients CBC as always but mostly we want to look at here A is their infection in the white count and B might there be a drop in the hemoglobin and hematocrit from a possible bleeding especially if the patient has hematomesis or if there's been a report of blood in the stool that might have happened before or if there is a history of Crohn's disease or diverticulitis. And then certainly we want to look at their CMP to check the electrolytes because we know that hypokalemia can cause bowel obstruction as well and if we think about that the patient is vomiting a lot, think about acids. The patient will be losing lots of acids so this can lead to metabolic alkalosis. Now the nursing care and treatment usually kind of go hand in hand because that's what we're there for. But it always depends on the cause whether it's mechanical, non-mechanical and of course if it's let's say hypokalemia we want to treat that but definitely the patient will need to be in PO because we know that nothing is moving downward the regular digestive tract so we don't want to feed anything else into the patient's system. And they will need an NG tube for decompression because even if you don't feed the patient everything is backing up and all this digestive content has to have somewhere to go so rather than the patient being nauseous and distendent and constantly throwing up or just putting NG tube down, first of all it helps to get any of those contents out. And secondly the stomach still continues to produce stomach acids so we want to decompress that and make sure that we maintain that NG tube properly. The patient will need IV fluids because they're in PO and certainly electrolyte placement is not unheard of because we know we have to keep a close eye on their electrolyte status. So that also includes monitoring their labs for H&H drops that we're concerned with and their electrolytes. We want to assess their abdominal area frequently to see if there are any changes in the bowel sounds and certainly if you have a patient coming back from any kind of abdominal surgery knowing that paralytic ills is a very common cause of bowel obstruction which would really be paying close attention to the patients abdominal assessment to identify these hypoagulobal sounds, the constipation, the distension, vomiting, all these signs and symptoms that the patient might exhibit. Now ambulation is very important to think about. We always say that ambulation encourages bowel activity and encourages bowel movements. So if there is now maybe a partial obstruction we want to encourage the patient to move because it will get the digestive system moving and flowing and many times if it's a partial obstruction and not a surgical cause just by the presence of the NG tube and the ambulation many times the bowel obstruction will resolve itself. So the treatment can just be as simple as the NG tube along of course with all these other things here that we just talked about. Many times surgery is not required but if there is a complete obstruction or cancer or some adhesions that really clamp down on the lumen of the intestine the patient might need surgery so most likely for adhesions, cancer or if there's a strangulation due to any cause and then surgery might need in an ileostomy or colostomy. So this is now can be temporary or it can be permanent so most definitely we will need to educate the patient beforehand as to what to expect and then certainly how to care for the ileostomy and the colostomy in case they have one of those and then emotional support is super important here because it has a lot to do with body image any kind of abdominal surgery but then imagine that there is any kind of osteomy there how it can be taken an emotional toll on the patient and we might even want to collaborate with the wound and osteomy nerves and maybe even the social worker to get the patient in a support group or any of those groups that might help them recover from this better. Thank you for watching this video on bowel obstruction. Please also watch my other videos on the risk factors such as peritonitis, diverticulitis, Crohn's disease. I'll put those up in the follow-up videos for you as well. 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