6. Intestinal obstruction: blockage in movement of intestinal contents through small or large intestine.
   1. Pathophysiology:
      1. Mechanical causes-physical impediments to passage of intestinal contents, e.g., adhesions, hernias, neoplasms, inflammatory bowel disease, foreign bodies, fecal impactions, congenital or radiational strictures, intussusception, or volvulus.
      2. Paralytic causes-passageway remains open, but peristalsis ceases, e.g., after abdominal surgery, abdominal trauma, hypokalemia, myocardial infarction, pneumonia, spinal injuries, peritonitis, or vascular insufficiency.
   2. Assessment:
      1. Subjective data: pain related to
         1. Proximal loop obstruction: upper abdominal, sharp, cramping, intermittent pain.
         2. Distal loop obstruction: poorly localized, cramping pain.
      2. Objective data:
         1. Bowel sounds: initially loud, high pitched; then when smooth muscle atony occurs, bowel sound absent.
         2. Increased peristalsis above level of obstruction in attempt to move intestinal contents through the obstructed area.
         3. Obstipation (no passage of gas or stool through obstructed portion of bowel; no reabsorption of fluids).
         4. Distention.
         5. Vomiting:
            1. Proximal loop obstruction: profuse nonfecal vomiting.
            2. Distal loop obstruction: less frequent fecal-type vomiting.
         6. Urinary output: decreased.
         7. Temperature: elevated; tachycardia; hypotension —» shock if untreated.
         8. Dehydration, hemoconcentration, hypovolemia.
         9. Lab data:
            1. Leukocytosis.
            2. Decreased: sodium (<138), potassium (<3.5).
            3. Increased: bicarbonate (>26 mEq/L), BUN (>18 mg/dL).
            4. pH: If obstruction is at gastric outlet, pH will be elevated, indicating metabolic alkalosis; if obstruction is distal duodenal or proximal jejunal, the pH will drop and metabolic acidosis occurs.
   3. Analysis/nursing diagnosis:
      1. Fluid volume deficit related to vomiting.
      2. Pain related to increased peristalsis above the level of obstruction.
      3. Altered nutrition, less than body requirements, related to vomiting.
      4. Risk for trauma related to potential perforation.
   4. Nursing care plan/implementation:
      1. Goal: obtain and maintain fluid balance.
         1. Nursing care of patient with nasogastric tube.
            1. Miller-Abbott tube: dual lumen, balloon inflated with air after insertion. Caution: do not tape tube to face until tube reaches point of obstruction.
            2. Cantor tube: has mercury in distal sac, which helps move tube to point of obstruction. Caution: do not tape tube to face until tube reaches point of obstruction.
         2. Nothing by mouth, IV therapy, strict I&O.
         3. Take daily weights (early morning), monitor CVP for hydration status.
         4. Monitor abdominal girth for signs of distention and urinary output for signs of retention or shock.
      2. Goal: relieve pain and nausea.
         1. Medications as ordered:
            1. Analgesics, antiemetics.
            2. If problem is paralytic: medical treatment includes neostigmine to stimulate peristalsis.
         2. Observe for bowel sounds, flatus (tape intestinal tube to face once peristalsis begins).
         3. Skin and frequent mouth care.
      3. Goal: prevent respiratory complications.
         1. Encourage coughing and deep breathing.
         2. Semi-Fowler’s or position of comfort.
      4. Goal: postoperative nursing care (if treated surgically):
   5. Evaluation/outcome criteria:
      1. Fluid balance obtained and maintained.
      2. Shock prevented.
      3. Obstruction resolved.
      4. Pain decreased.
      5. Fluids tolerated by mouth.
      6. Complications such as perforation and peritonitis avoided.