SCHOOL OF NURSING SCIENCE AND RESEARCH SHARDA UNIVERSITY

Micro teaching
On
INTESTINAL OBSTRUCTION
SUBJECT: - NURSING EDUCATION

SUBMITTED TO: SUBMITTED BY:-

Ms. Ankita POOJA SAHU

Senior Tutor POST BASIC BSC NURSING 1ST YR

SNSR, SHARDA UNIVERSITY

SUBMITTED ON: 11/10/2019

Topic : Intestinal Obstruction

Subject : Nursing Education
Group of students : GNM students
Duration : 20 min
Venue : GNM Classroom
Time : 2:45 pm-3.30 pm
Date : 18/12/17
Method of teaching : Lecture cum discussion
Teaching learning material : Power points, charts
Name of presenter : Pooja Sahu
Name of the supervisor : Ms. Ankita
General objectives: - At the end of the lecture the student will acquire knowledge about Intestinal obstruction.
Specific objective: - At the end of seminar the student will able to:-

 Introduces to topic
 Define Intestinal obstruction.
 Enlists risk factor of Intestinal obstruction.
 Enlists the causes of Intestinal obstruction.
 Explain pathophysiology of Intestinal obstruction.
 List the symptom of Intestinal obstruction.
 Discuss the diagnosis of Intestinal obstruction.
 Explain the management of Intestinal obstruction.
 List the complication of Intestinal obstruction.
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2 min. To introduce INTRODUCTION Students listen
the topic. Digested food particles to the lecture
must travel through 30 and clears
feet or more of doubts
intestines as part of
normal digestion.
These digested wastes
are constantly in
motion. However,
intestinal obstruction
can put a stop to this.
An intestinal
obstruction occurs
when your small or
large intestine is
blocked. The blockage
can be partial or total,
and it prevents passage
of fluids and digested
food.
2 min. The students DEFINITION Teacher defines Students listen Define intestinal
will able to Bowel obstruction, also known intestinal obstruction. to the lecture obstruction?
define intestinal as intestinal obstruction, is a mechanical and clears
obstruction. or functional obstruction of doubts
the intestines which prevents the normal
movement of the products of digestion.
(Wikipedia)
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2 min. The students RISK FACTORS Teacher enlists the risk Students listen PPT Enlist the risk
will able to Diseases and conditions that can increase factor of intestinal to the lecture factor of
enlist the risk the risk of intestinal obstruction include: obstruction. and clears intestinal
factor of doubts obstruction?
intestinal  Abdominal or pelvic surgery,
obstruction.
which often causes adhesions a
common intestinal obstruction

 Crohn's disease, which can cause

the intestine's walls to thicken,
narrowing the passageway

 Cancer in the abdomen, especially

if you've had surgery to remove an
abdominal tumor or radiation
therapy.

5 min. The students Teacher list the causes Students listen PPT List the causes of
will able to list of intestinal to the lecture intestinal
the causes of CAUSES obstruction and clears obstruction?
intestinal doubts
obstruction.
SMALL BOWEL
OBSTRUCTION
Causes of small bowel obstruction include:

 Adhesions from previous
abdominal surgery (most common
cause)
 Barbed sutures.
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 Pseudoobstruction
 Hernias containing bowel
 Crohn's disease causing adhesions
or inflammatory strictures
 Neoplasms, benign or malignant
 Intussusception
 Volvulus
 Superior mesenteric artery
syndrome, a compression of
the duodenum by the superior
mesenteric artery and
the abdominal aorta
 Ischemic strictures
 Foreign
bodies (e.g. gallstones in gallstone
ileus, swallowed objects)
 Intestinal atresia

LARGE BOWEL
OBSTRUCTION
 Causes of large bowel obstruction
include:
 Neoplasms / cancer
 Diverticulitis / Diverticulosis
 Hernias
 Inflammatory bowel disease
 Colonic volvulus (sigmoid, caecal,
transverse colon)
 Adhesions
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 Constipation
 Fecal impaction
 Fecaloma
 Colon atresia
 Intestinal pseudoobstruction
 Endometriosis
 Narcotic induced (especially with
the large doses given to cancer or
palliative care patients)

OUTLET OBSTRUCTION
Outlet obstruction is a sub-type of large
bowel obstruction and refers to conditions
affecting the anorectal region that
obstruct defecation, specifically conditions
of the pelvic floor and anal sphincters.
Outlet obstruction can be classified into 4
groups.
Inefficient inhibition of the internal anal
sphincter
 Short-segment Hirschsprung's
disease
 Chagas disease
 Hereditary internal sphincter
myopathy
Inefficient relaxation of the striated pelvic
floor muscles
 Anismus (pelvic floor dyssynergia)
 Multiple sclerosis
 Spinal cord lesions
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Mechanical outlet obstruction
 Internal intussusception
 Enterocele

Dissipation of force vector

 rectocele
 Descending perineum
 Rectal prolapse
Impaired rectal sensitivity
 Megarectum
 Rectal hyposensitivity
5 min. The students Students listen PPT Explain the
will able to Teacher explains the to the lecture pathopysiology
explain the pathopysiology of and clears of intestinal
PATHO PHYSIOLOGY intestinal obstruction.
pathopysiology Proximal bowel dilated and develops doubts obstruction?
of intestinal altered motility→dilate →reduce
obstruction. peristalsis strength →flaccidity and
paralysis (previous vascular damage due to
intra luminal pressure)

Distal to obstruction bowel exhibits

normal peristalsis and obstruction →
become empty→ contract and become
immobile

Distension is by gas and fluid

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gas: aerobic and anaerobic growth
fluid: digestive juices and retarded
absorption

dehydration and electrolytes loss: reduced

oral intake, defective intestinal
obstruction, loses from vomiting and
5 min. The students sequestration in bowel of lumen Students listen Chart Enlist the
will able to Teacher enlists the to the lecture symptoms of
enlist the symptoms of intestinal and clears intestinal
symptoms of SYMPTOMS obstruction. doubts obstruction?
intestinal Intestinal obstruction causes a wide range
obstruction. of uncomfortable symptoms, including:

 severe bloating
 abdominal pain
 decreased appetite
 nausea
 vomiting
 inability to pass gas or stool
 constipation
 diarrhea
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5 min. The students  severe abdominal cramps Teacher explains the Students listen PPT Explain the
will able to diagnosis of intestinal to the lecture diagnosis of
explain the  abdominal swelling obstruction. and clears intestinal
diagnosis of doubts obstruction?
intestinal
obstruction.

DIAGNOSIS
Tests and procedures used to diagnose
intestinal obstruction include:
History collection
Physical exam.  Doctor will ask about the
medical history and the symptoms. Doctor
also does a physical exam to assess the
situation. The doctor may suspect
intestinal obstruction if the abdomen is
swollen or tender or if there's a lump in the
abdomen. He or she may listen for bowel
sounds with a stethoscope.

X-ray. To confirm a diagnosis of intestinal

obstruction, doctor may recommend an
abdominal X-ray. However, some
intestinal obstructions can't be seen using
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standard X-rays.

Computerized tomography (CT). A CT

scan combines a series of X-ray images
taken from different angles to produce
cross-sectional images. These images are
more detailed than a standard X-ray, and
are more likely to show an intestinal
obstruction.

Ultrasound. When an intestinal
obstruction occurs in children, ultrasound
is often the preferred type of imaging. In
youngsters with an intussusception, an
ultrasound will typically show a "bull's-
eye," representing the intestine coiled
within the intestine.

Air or barium enema. An air or barium

enema is basically enhanced imaging of
the colon that may be done for certain
suspected causes of obstruction. During
the procedure, the doctor will insert air or
liquid barium into the colon through the
rectum. For intussusception in children, an
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5 min. The students Teacher explains the Students listen PPT Explain the
will able to air or barium enema can actually fix the management of to the lecture mana of
explain the intestinal obstruction. and clears intestinal
problem most of the time, and no further
management of doubts obstruction?
intestinal treatment is needed.
obstruction.

MANAGEMENT
General management
When patient arrive at the hospital, the
doctors will first work to stabilized, so that
you can undergo treatment. This process
may include:

 Placing an intravenous (IV) line

into a vein in the arm so that fluids
can be given.

 Putting a nasogastric tube through

the nose and into the stomach to
suck out air and fluid and relieve
abdominal swelling.
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 Placing a thin, flexible tube
(catheter) into the bladder to drain
urine and collect it for testing.

Medical management
Opioids and anti-emetics (usually
dopamine antagonists, e.g. haloperidol)
can be administered (IV or SQ) to relieve
pain and nausea.

Antimuscarinic/anticholinergic drugs
(e.g. atropine, scopolamine) are used to
manage colicky pain due to smooth
muscle spasm and bowel wall distension.

Prokinetic drugs (e.g. metoclopramide)

may be beneficial if there is a partial
obstruction. However, if there is total
obstruction prokinetic agents should be
discontinued as they may exacerbate
symptoms.

Corticosteroids have been recommended

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to decrease the inflammatory response and
resultant edema, as well as relieve nausea,
through both central and peripheral
antiemetic effects. 

Surgical management
The type of surgical procedure required
will depend upon cause of obstruction –
1. If adhesion – Adhesiolysis
2. Excision
3. Bypass
4. Proximal decompression

Adhesiolysis
Although multiple adhesions may be
found only one may be causative
 This should be divided and the
remaining adhesions left in-situ
unless severe angulation is present
as division of these adhesions will
only cause further adhesion
formation
 When obstruction is caused by an
area of multiple adhesions, the
adhesions should be freed by sharp
dissection
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 To prevent recurrence, the bare
area should be covered with
omental grafts
 After the release of band
obstruction, the construction site
that have suffered direct
compression should be carefully
assessed for viability

Excision
Small bowel resection is surgery to
remove part or the entire bowel. It is done
when part of the small bowel is blocked or
diseased.

Bypass
Is a tube-like organ located in the digestive
tract between the stomach and the large
intestine? As food passes through the
small intestine, nutrients and minerals are
absorbed and the body becomes nourished.
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Proximal decompression
The treatment for acute mechanical
intestinal obstruction is a timely operation.
The technique of tube appendicostomy for
proximal decompression of anastomosis at
the anus and colon without complications
and allows for decompression of gas and
liquid stool in the immediate postoperative
period.

Treating intussusception
A barium or air enema is used both as a
diagnostic procedure and a treatment for
children with intussusception. If an enema
works, further treatment is usually not
necessary.

Treatment for partial obstruction

If patient have an obstruction in which
some food and fluid can still get through
(partial obstruction), patient may not need
further treatment after you've been
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stabilized. Doctor may recommend a
special low-fiber diet that is easier for
partially blocked intestine to process. If
the obstruction does not clear on its own,
patient may need surgery to relieve the
obstruction.

Treatment for complete

obstruction
If nothing is able to pass through the
intestine, patient usually needs surgery to
relieve the blockage. The procedure you
have will depend on what's causing the
obstruction and which part of the intestine
is affected. Surgery typically involves
removing the obstruction, as well as any
section of the intestine that has died or is
damaged.

Alternatively, doctor may recommend

treating the obstruction with a self-
expanding metal stent. The wire mesh tube
is inserted into the colon via an endoscope
passed through the mouth or colon. It
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forces open the colon so that the
obstruction can clear.

Stents are generally used to treat people

with colon cancer or to provide temporary
relief in people for whom emergency
surgery is too risky. Patient may still need
surgery, once your condition is stable.

Treatment for pseudo-obstruction

If the doctor determines that the signs and
symptoms are caused by pseudo-
obstruction (paralytic ileus), patient may
monitor the condition for a day or two in
the hospital, and treat the cause if it's
known. Paralytic ileus can get better on its
own. In the meantime, patient likely be
given food through a nasal tube or an IV to
prevent malnutrition.

If paralytic ileus doesn't improve on its

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own, doctor may prescribe medication that
causes muscle contractions, which can
help move food and fluids through the
intestines. If paralytic ileus is caused by an
2 min. The student Teacher list the Students listen PPT List the
illness or medication, the doctor will treat
teacher will to complication of to the lecture complication of
list the the underlying illness or stop the Intestinal obstruction. and clears Intestinal
complication of medication. Rarely, surgery may be doubts obstruction?
Intestinal needed to remove part of the intestine.
obstruction.
In cases where the colon is enlarged, a
treatment called decompression may
provide relief. Decompression can be done
with colonoscopy, a procedure in which a
thin tube is inserted into the anus and
guided into the colon. Decompression can
also be done through surgery.

COMPLICATIONS:
It is important to note that if the
obstruction stops or impedes blood supply
to the intestines, infection or gangrene
(death of tissue may result).
Other complications can include:
 Dehydration
 Perforation of the intestinal wall
 Infection
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 Jaundice
 Electrolyte imbalances

NURSING DIAGNOSIS
1. Acute pain related to distention and
rigidity as evidenced by patient rates
pain at 8/10 on pain scale and states
abdominal cramping and tenderness
in abdomen.
Intervention
 Assess level of pain using
appropriate pain scale. Assess pain
30 minutes before and after pain
medication is given
 Provide fowler’s position
 Have patient maintain limited bed
rest and activity
 Incorporate no pharmacologic
measures to assist with control of
pain.
 Administer pain medications as
prescribed and indicated.

2. Risk for Infection related to

development of inflammatory
process or worsening bowel
obstruction.

Interventions:
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 Assess vital signs including
temperature every 4 hours and as
needed. Report any abnormal
findings to the healthcare provider.
 Assess mental status and level of
consciousnesses every 4-6 hours.
 Report and note any abnormal
laboratory values (i.e. elevated
WBC count) to the healthcare
provider.

3. Ineffective Breathing Pattern related

to abdominal distension and or
rigidity.

 Assess the breathing pattern.

 Provide sitting position.
 Avoid pressure on abdomen
 Educate about breathing exercise
 Medication as prescribed by the
doctors.

CONCLUSION
Intestinal obstruction is a blockage that keeps food or liquid from passing through the small intestine or large intestine (colon). Causes
of intestinal obstruction may include fibrous bands of tissue (adhesions) in the abdomen that form after surgery, an inflamed intestine
(Crohn's disease), infected pouches in your intestine (diverticulitis), hernias and colon cancer.

BIBLIOGRAPHY
 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 12th Edition. Philadelphia: Lippincott Williams and
Wilkins. Page no.-1097-1098
 Lewis text book of medical surgical nursing 7th edition printed in 2009, published by Elsevier page no.-1617- 1620
 Williams. L. S. & Hopper, P. D. (2011). Understanding Medical- Surgical Nursing. 5th Edition. Philadelphia: F. A. Davis
Company3.
 www.medscape.com
 www.emedicinehealth.com
 www.wikipedia.com.