Week 5 - Bowel obstruction

Question 1

What are the symptoms of Small bowel obstruction? (SBO)

Answer 1

-Rapid onset
-Frequent copious vomiting that is projectile - dehydration
-Colicky intermittent ABD pain
-BM for a short time
-Mild/moderate ABD distension

Question 2

What are the symptoms of Large bowel obstruction? (LBO)

Answer 2

-Gradual onset
-Vomiting in late stages
-Low grade cramping ABD pain
-Constipation
-Significant Abd distension

Question 3

What 2 tests are used to diagnose SBO or LBO?

Answer 3

abdominal xray
CT

Question 4

What is likely the first order we will see for someone with bowel obstruction?

Answer 4

decompress stomach
-NG tube with intermittent suction

Question 5

What nursing care do we need to do for someone with SBO or LBO?

Answer 5

-Abd assessment often- measure
-PAIN control- important
-N/G care - esp around the nose and flushing q4-6hrs
-Nutrition/Fluid/Lytes replacement
-Prepare for Surgery if not resolved
-*Monitor for perforation d/t pressure of obstruction

Question 6

Does SBO or LBO cause severe dehydration and why?

Answer 6

SBO d/t projectile vomiting

LBO takes a while to cause an issue so vomiting occurs later on

Question 7

What are the risk factors of colorectal cancer?

Answer 7

Age >50,
alcohol,
smoking,
Hx IBD,
colorectal polyps,
family hx,
Crohn’s or UC
obesity,
increased red meat,
low fruits and veggies,
low fibre

Question 8

Do we see clinical manifestations early in colorectal cancer or later on?

Answer 8

later on

Question 9

What are the 3 main clinical manifestations of colorectal cancer?

Answer 9

1. change in elimination habits (ribbon like stool)
2. Gas pains
3. blood in stool

Question 10

What diagnostic tests are used for colorectal cancer?

Answer 10

*Family history- red flag- early testing
*Colonoscopy- best test to visualize and remove polyups
DRE
FOBT - blood in stool ?
CEA - carcinoembryonic antigen (cancer marker)
CT,
Ultrasound

Question 11

What is the number one red flag to monitor for someone regarding colorectal cancer and why?

Answer 11

Family history - because it presents in late stages so early testing is key through colonoscopy

Question 12

How often do we screen for colorectal cancer in Canada?

Answer 12

Q 1-2 yrs >age 50

Question 13

Is colorectal bowel cancer curative?

Answer 13

Yes- if the patient can handle surgery and hasn’t spread
No- if they are not healthy enough for surgery - then chemo and radiation are used in a palliative approach

Question 14

When is Abdominal Peritoneal (AP) Resection surgery performed?

Answer 14

when cancer is within 5 cm of the anus

Question 15

What is removed with an Abdominal Peritoneal (AP) Resection ?

Answer 15

Distal sigmoid colon
rectum
anus

Question 16

What does the patient need to live with and care for post Abdominal Peritoneal (AP) Resection?

Answer 16

A colostomy in LLQ

Question 17

What are 2 potential complications of Abdominal Peritoneal (AP) Resection and why?

Answer 17

-Delay wound healing and
Infections d/t location (bacteria)
-Urinary incontinence and sexual
dysfunction d/t location of surgery

Question 18

What two wounds do we need to care for post AP?

Answer 18

Abdominal incision (colostomy)
perineal incision - irrigate with NS

Question 19

What is most important to remember in terms of positioning post AP?

Answer 19

• NO PRESSURE ON PERINEUM*
• side to side sitting
• pillow for perineum (roho cushion) later on

Question 20

How do we care for an ostomy post surgery?

Answer 20

1. Assess q8 hrs
2. very vascular so small amount of bleeding is normal
3. 24-48 hours - not much drainage
4. > 48 hours we should see gas & stool starting

Question 21

What do we teach a patient post ostomy surgery?

Answer 21

1. Check skin & inspect stoma
2. empty pouch when 1/3 full or inflated with gas
3. Deodorants as needed
4. Avoid food that cause odor gas, diarrhea or obstruction
   -Initially low residue diet then increase gradually
5. Increase fluid intake and observe for S&S of dehydration
6. Assess stool consistency (liquid for ileostomy, formed for sigmoidoscopy)
7. Support groups for emotional adjustment
8. Follow up care
   -Report S&S of Fever, diarrhea, constipation, other stoma problems

Question 22

What is the best non-medical way to help people manage their pain post GI surgery?

Answer 22

Walk to release gas!

Question 23

What is a big risk factor for GI patients post surgery that we need to be on top of?

Answer 23

Dehydration!
I&O