bewols-121202092803-phpapp02 جميل
TRANSCRIPT
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Acute abdomen
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DefinitionFailure of intestinal contents to
move through the bowel lumen .
most common site is small
intestine
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Types;
Mechanical
functional /Paralytic/ a
dynamic
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Causes of mechanical obstruction;
Adhesions;the most common cause of small
bowel obstruction.
Intussusceptions;
One part of the intestine slips into
another part located below it.
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Intussusceptions
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Volvulus
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Strangulation hernia
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Tumor;
-a tumor that exists within the
wall of the intestine or a tumor
outside the intestine causespressure on the wall of the
intestine.
Impaction of stool
Foreign bodies;
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paralytic/Funct ionalobst ruct ion:
Failure ofperistalsis
to move intestinalcontents: due to neurologic or
muscular impairment.
in which The intestinal muscles
cannot propel(push) the contents
along the bowel.
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Causes;
Abdominal surgery and trauma.Spinal injuries
PeritonitisVascular insufficiency
muscular dystrophy,
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Intestinal obstruction
can be:partial
complete/ acute
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Most bowel obstructions occur
in the small intestine.About 15% of intestinal
obstructions occur in the largebowel; most of these are found
in the sigmoidcolon.
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Pathophysiology
Intestinal contents, fluid, and gas
accumulateabovethe obstruction.Resulting in abdominal distention and
retention of fluid.
With increasing distention, pressurewithin the lumen increases, causingadecreasein venous and arteriolar
capillary pressure.This causesedema, congestion,
necrosis, and perforation of the
intestinal wall.
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Complications
Hypovolemia and hypovolemic
shock can result in multiple organdysfunction.
Strangulated bowel can result
in;-Perforation peritonitis septicshock
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ClinicalManifestat ions:-
depend on level & type of
obstruction.The patient initially complains of
wavelikeabdominalpain
abdominal distention.
vomiting.
The patient may pass blood andmucus, but no fecal no f latus.
Signs of dehydration
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in complete obstruction ,peristaltic waves reverse,propelling the intestinal contents
toward the mouth, leading tofecalvomiting.
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Peristaltic waves may be visible in a
thin person. In mechanical obstructions, high-
pitched, bowel sounds are heard
proximalto the obstruction and areabsent distalto it.
If the obstruction is nonmechanical,
there is an absence of bowel sounds.
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Assessment and Diagnos t ic Find ings;
Diagnosis is based on the history.
Physical examination
x-ray; show abnormal quantities
of gas, fluid, or both in the bowel.
Laboratory studies (ie, electrolyte
studies).
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In most cases the patient is keptNPO.
NGtube to decompressed , which
relieves symptoms and may resolvethe obstruction.
I.V solution with electrolytes is
initiated to correct the fluid andelectrolyte imbalance.
Sometimes IV antibiotics are begun.
MedicalTreatment
Surgical treatment;
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Surgicaltreatment;
Required in Complete mechanical
obstruction. Preoperativecare;
1.Insertion of NG tube to relieve
vomiting, abdominal distention, and toprevent aspiration of intestinalcontents.
2.Restore fluid and electrolyte balance;correct acid and alkaline imbalances.
.
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3.Laparotomy: inspection of
intestine and removal of infractedor gangrenous tissue.
4.Removal of cause of obstruction,
gangrenous portion of intestinesand anastomosisor creation ofcolostomydepending on
individual case
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Nurs ing Process ASSESSMENT.
Assess pain
assessment of Abdomen byauscultationof bowel for 5 minutes .Palpationfor distention, firmness,and tenderness.
assess the vomiting .
Assess S/S of dehydration.
Vital signs are assessed.
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IMPL;NGT is maintained on lowintermittent suction to relievediscomfort from distention.
NPO to rest the bowel
The patient is placed in semi-Fowlersposition to reduce tension on the
abdomen. pain killers as ordered.
Opioidsare given cautiously because
they may mask symptoms ofperforation and decrease intestinalmotility.
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deficient fluid volume R/T collection of
fluid in the intestine and vomiting.
Goal; prevention of dehydration and
electrolyte imbalance.
IMPL;- assess fluid status
Ineffective Breathing Pattern R/T
abdominal distention.
Knowledge deficit about disease,
surgery
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G
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