Nursing Care Plan (NCP) for Bowel Obstruction

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Outline

Pathophysiology

A bowel obstruction is when there is an obstruction or blockage in the intestines. This blockage impedes the passage contents through the GI tract thus causing dehydration, nutrient deficiency, and other complications.  obstruction is a sudden or gradual blockage of the intestinal tract that prevents the normal passage of GI contents through the intestines.

Etiology

There are two ways a bowel obstruction can occur. Mechanical obstruction occurs when something is physically blocking the lumen of the intestine. This can come from hernia, fecal impaction, strangulation, or adhesions. Functional obstruction occurs when the intestine fails to move contents forward. This is most likely attributed to paralytic ileus. 

Desired Outcome

Patient will have normal fluid balance; patient will be free from infection; patient will have a normal elimination pattern.

Subjective Data

  • Abdominal Pain
  • Abdominal fullness
  • Nausea
  • Dehydration
  • Cramping
  • Constipation

Objective Data

  • Abdominal distention
  • ↑HR, ↓BP
  • Firm abdomen
  • ↓ Bowel sounds
  • Vomiting
  • Fever

Nursing Interventions

Intervention

Rationale

Assess abdomen

Note size and girth. The patient  will have a firm abdomen. Decreased bowel sounds may be auscultated. Abdomen will be distended.

Monitor fluid balance

Strict I&O; Monitor for signs of dehydration; IV fluids should be ordered as needed. Electrolytes may also need to be replaced.

NPO status

Patient should be placed on NPO status to avoid further complications. Patient may need to go to surgery for correction.

Place NG tube

Patient will need NG tube hooked to low intermittent suction. This will aid in decompressing the stomach and prevent recurring abdominal distention.

Education on care of colostomy

Patients who undergo surgery to repair resection may come back with a colostomy. It is important to teach how to care for colostomy. Once a patient learns how to properly care for and assess any issues, it should be demonstrated to exhibit competence.

Monitor vital signs closely

Elevations of temperature and pulse may indicate infection or necrosis.

Lesson Details

Writing a Nursing Care Plan (NCP) for Bowel Obstruction

A Nursing Care Plan (NCP) for Bowel Obstruction starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.

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Transcript

This is a nursing care plan for bowel obstruction. So the pathophysiology of bowel obstruction is when there is an obstruction in the intestine. The blockage impedes the passage to the GI tract, and it causes hydration and nutrition differences, and other complications of structure. It is a sudden or gradual blockage of the intestinal tract that prevents the normal passage of GI contents through the intestines. So what are some nursing considerations that we want to think of? Well, we want to do a really good abdominal assessment. We want to monitor those vital signs. We want to insert an NG tube in place on low intermittent suction. We want to maintain fluid balance and we want to educate on colostomy care. The desired outcome for this patient is that this patient will have a normal fluid balance. The patient is going to be free from infection and the patient will return to a normal elimination pattern. So what are some subjective data that we can gather from this patient? What are some things that you think that the patient is going to, come in and complain about? Well, they’re not going to be able to pass stool, so they are going to complain of some abdominal pain. They’re gonna also complain of a feeling of abdominal fullness. 

Bowel Obstruction xray nursing care plan
By James Heilman, MD – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15997133

They may complain of some nausea, some dehydration, cramping, stomach cramping, and constipation upon assessment of this patient. We’re going to be able to see some pretty clear objective data that we’ll be able to gather. First, we’ll notice that the abdomen is distended. So they’re going to have some abdominal distension. There also may have increased heart rate or some decreased blood pressure. The abdomen is going to be firm to the touch. When we all auscultate with the stethoscope, we’re going to also hear some diminished or absent bowel sounds. They’re going to have some vomiting and they may also present with a fever. So the nursing interventions, what are some things that we can do to intervene with these patients? Well, the very first thing that we want to do according to ADPIE is we want to assess; we’re going to assess that abdomen and look for some of the abnormalities that’s happening. 

We want to note the size and the girth of the abdomen. The patient is going to have a firm abdomen with decreased bowel sounds. The abdomen will be distended. So next, what are some things that we can do? Remember this patient is not able to get the full impact of the intestinal tract. So absorption of minerals in water is going to be impaired. So we want to monitor their fluid balance. That’s to monitor fluid balance. Okay. Remember, we want to have strict I’s and O’s we want to monitor for signs of dehydration. We want to make sure IV fluids are administered. And we want to check those electrolytes because they may also need to be replaced. Next, We want to make sure this patient is NPO, nothing by mouth. And the reason why is we don’t want to stimulate that GI tract any further. 

We want that GI tract to rest. So that way the thing we’re going to do to resolve it is the patient may need to go to surgery. So if this patient has to go to surgery, we want to make sure that there is nothing in the belly. So to reduce the risk of aspiration, the next thing we want to do is we want to make sure that this patient has a NG tube. And not only do we want to make sure they have an NG tube, but we want to place this NG tube to low suction. The reason why is because this is going to aid us in decompressing the abdomen and prevent recurring abdominal distension. Next, we want to give some good education on the care of the colostomy. Most of these patients will need to go to surgery. So we want them as well as their family members to know about colostomy care. 

If they go and they go to surgery for a resection, a bowel resection, they are going to come back with a colostomy. It’s very important to teach how to properly care for and assess any issues with the class. To me, it should be demonstrated to exhibit competence. So the final thing that we want to look at is just kind of ongoing is we want to look at those vital signs. So let’s monitor vital signs. Some of the vital signs that we want to look at is the temperature. Remember any elevation in temperature and heart rate may indicate infection or necrosis. We also want to look at the heart rate because a heart rate that’s up may also indicate pain. Remember decreased blood pressure is also possible. So decreasing BP is possible because this patient is not getting as much absorption of fluids as they’re able to get. 

So that may indicate hypovolemia here is the complete care plan. Let’s take a look at some of the key points. Remember the pathophysiology for a bowel obstruction is simply that there is an obstruction or blockage of the intestine. Some of the subjective data that these patients are going to tell us is they are going to complain of some abdominal pain, some nausea, some cramping, and some abdominal fullness. Some of the objective data that we’re going to be able to gather from this patient is that this abdomen is going to be distended. And first they may vomit their vital signs may show the elevated heart rate or elevated temperature. Remember that could indicate fever. They’re going to have some decreased BP that may indicate some dehydration. Some of the things that we want to do is we want to get that NG in place as soon as possible. The NG tube is key to making sure that we are decompressing that abdomen and keeping them from going further. We want to place it on low intermittent suction. And we want to make sure that this patient is NPO. We also want to teach colostomy care because this patient, if they go to surgery, is more than likely going to come back with a colostomy. So we want to educate on how to care for the colostomy. And we want to make sure that the patient teaches us back. We love you guys here at nursing.com. Go out and be your best self today. And, as always, happy nursing.

 

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