Intestinal Obstruction: Types, Causes, Nursing Care & Management

 Definition

Intestinal obstruction occurs when the normal flow of intestinal contents is blocked. This blockage can happen in the small intestine or the large intestine. It can be partial or complete.

2. Types of Obstruction

Mechanical Obstruction: There is a physical blockage like a tumor, adhesions (scar tissue), or hernia.

Functional (Non-Mechanical) Obstruction: Also called Paralytic Ileus. This happens when the muscles of the intestine stop moving (peristalsis stops), often after surgery or due to electrolyte imbalance.

3. Common Causes

Adhesions: Scar tissue from previous abdominal surgeries (Most common cause).

Hernias: Part of the intestine gets trapped in a weak spot of the abdominal wall.

Volvulus: Twisting of the bowel.

Intussusception: One part of the intestine slides into another (like a telescope).

Tumors: Cancerous growths blocking the path.

4. Clinical Manifestations (Signs & Symptoms)

Abdominal Pain: Usually crampy and comes in waves.

Vomiting: Especially if the blockage is high in the small intestine. The vomit may smell like feces in late stages.

Abdominal Distension: The stomach looks swollen or bloated.

Constipation/Obstipation: Failure to pass gas or stool.

High-pitched Bowel Sounds: Heard initially above the blockage, then sounds disappear (silent abdomen).

5. Diagnostic Evaluation

X-Ray (Abdomen): To see "air-fluid levels" and distended bowel loops.

CT Scan: To find the exact location and cause of the blockage.

Blood Tests: To check for dehydration and electrolyte levels (like Potassium).

6. Medical & Surgical Management

Decompression: Using a Nasogastric (NG) Tube to remove air and fluid from the stomach.

IV Fluids: To treat dehydration.

Surgery: If the blockage is complete or there is a risk of tissue death (Gangrene), surgery like Resection and Anastomosis is performed.

7. Nursing Care (Important for Nurses)

NPO Status: Strictly nothing by mouth to rest the bowel.

NG Tube Care: Ensure the tube is patent and monitor the amount/color of drainage.

Monitor Vitals: Watch for signs of shock (low BP, high pulse) which could mean the bowel has perforated (burst).

Fowler’s Position: Keep the head of the bed elevated to help the patient breathe easier despite the bloated abdomen.

Pain Management: Avoid giving opioids (like Morphine) initially as they can slow down the bowel even more.

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