5 Nursing Care Plans For Bowel Obstruction with Examples

Introduction

Bowel obstruction is a serious problem that happens when something blocks the bowels, either the large or small intestine. It’s also known as an intestinal obstruction. If the digestive system comes to a grinding halt, a person can’t have a bowel movement or pass gas. A person might also notice stomach pain and a swollen belly.

A common type of blockage is called fecal impaction. This is when a large, hard mass of poop gets stuck in the digestive tract and can’t get pushed out the usual way. But when the bowel is blocked by something other than hard stool, doctors call it a bowel obstruction.

This blog post discusses what bowel obstruction is, its symptoms, nursing care plans and interventions with some examples .As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Types of Bowel Obstruction

A bowel obstruction may be a partial blockage or a complete blockage. A person can also have what’s called pseudo-obstruction. This is when a person has symptoms of bowel obstruction, but nothing is physically blocking it. It can happen because of problems with the gastrointestinal muscles or with the nerves that control them.

Pseudo-obstruction

Intestinal pseudo-obstruction (paralytic ileus) can cause signs and symptoms of intestinal obstruction, but it doesn’t involve a physical blockage. In paralytic ileus, muscle or nerve problems disrupt the normal coordinated muscle contractions of the intestines, slowing or stopping the movement of food and fluid through the digestive system.

Paralytic ileus can affect any part of the intestine. Causes can include:

• Abdominal or pelvic surgery
• Infection
• Certain medications that affect muscles and nerves, including antidepressants and opioids
• Muscle and nerve disorders, such as Parkinson’s disease

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Bowel Obstruction Symptoms

Signs of intestinal blockage will depend on how severe the obstruction is. But it almost always comes with belly pain, usually around your belly button and cramping. Other signs include:

• Constipation
• Can’t pass gas
• Lack of appetite
• Nausea or vomiting
• A hard, swollen belly
• Diarrhea (with a partial blockage)

Many people with bowel obstructions are older and may have other serious illnesses, so a bowel obstruction may be life-threatening.

Causes of Bowel Obstruction

The bowel could become blocked in several ways:

1. Part of the bowel may get twisted, which can close it off and keep anything from passing through.
2. It can get inflamed and swell up.
3. Part of the intestine can slide into another part like a telescope (intussusception).
4. Scar tissue or a hernia could make the bowel too narrow for anything to pass through.
5. A tumor or other type of growth inside the bowel could block it.
6. Damaged blood vessels leading to the bowel can cause some bowel tissue to die.
7. Inflammation, surgeries, or cancer can cause bowel obstruction in many cases. It’s more likely to happen in older people.

Risk Factors for Bowel Obstruction

Bowel obstructions can happen in your small or large intestine, but they’re more likely to be in the small intestine. A person might be at higher risk if they have:

• Crohn’s disease
• Diverticulitis
• Hernia
• Colon cancer
• Stomach cancer
• Ovarian cancer
• Scar tissue from surgery
• Radiation to the belly
• Lung cancer, breast cancer, or melanoma that’s spread to the bowel

Bowel Obstruction Diagnosis

A doctor will ask about the patient’s medical history, including whether they have been constipated, if they have had cancer, and what new symptoms they have had. The doctor may also:

1. Do a physical exam to see if a patient has pain in the belly, if he/she can be able to pass gas, or if they can feel a lump in the belly
2. Order blood tests
3. Order urine tests
4. Order a CT scan or an X-ray to look for a blockage
5. Give a barium enema. They’ll put a special liquid that contains barium (a whitish-silver metal) into the rectum. It will spread into the bowels and show on an X-ray as a bright area. If there’s a blockage, the barium may show it.

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Bowel Obstruction Treatment

A doctor may give medicine and fluids through a vein (intravenous or IV). They may also run a thin tube through the nose and into the stomach. This is called a nasogastric (NG) tube. It lets out fluids and gas to ease the symptoms.

Most partial blockages get better on their own. A doctor may give a special diet that’s easier on the intestines.

Enemas of air or fluid can help clear blockages by raising the pressure inside the bowels.

A mesh tube called a stent is a safe option for people who are too sick for surgery. A doctor puts it in the intestine to force the bowel open. Some people may not need anything more than a stent. Others may need surgery after they become stable.

Surgery is usually the best treatment for a totally blocked intestine when the bowel is damaged. A doctor can treat the cause of the obstruction or take out the blocked area and any damaged tissue.

If a patient has surgery, they may need a colostomy or ileostomy. After a doctor takes out the damaged part of the intestine, they sew the rest to an opening in the skin. The poop exits the body through this opening and goes into a disposable bag. In some cases, the intestines can be reattached after the patient gets better.

Nursing Care Plans for Bowel Obstruction Based on Diagnosis

Nursing Care Plan 1: Diagnosis – Acute Pain (Abdominal)

Acute pain related to bowel obstruction as evidenced by reports of cramping abdominal pain and restlessness

Desired Outcome

The patient will be able to have reduced pain levels of less than 3 to 4 on a rating scale of 0 to 10 with improved patient baseline vital signs and mood.

Nursing Interventions	Rationale
Anticipate occurrence by providing measures to relieve pain, especially before it becomes severe.	Anticipating occurrence and episodes of severe pain will provide continued relief to the patient. Timely pain assessment ensures that the patient has controlled pain levels and the continuity of daily living activities.
Provide cognitive-behavioral therapy of the patient’s pain through the following:   Distraction such as watching TV, reading, etc.     Eliciting the relaxation response such as directed meditation, deep breathing, etc.     Guided imagery	Providing cognitive-behavioral therapy provides comfort by changing the patient’s perception of pain.    Distraction techniques help with pain control by lessening the patient’s perception of pain.     Increased stress levels are related to the increase in pain levels. Invoking the relaxation response may decrease the effects of stress on pain.   Guided imagery such as using mental pictures or relaxing events will help the patient to be distracted from the pain.
Offer cutaneous stimulation or physical interventions through the following:   Heat and cold applications           Contralateral stimulation         Transcutaneous Electrical Nerve Stimulation (TENS)	Cutaneous stimulation may provide temporary pain relief through tactile stimulation.   Cold is effective in reducing pain by decreasing the release of pain-inducing chemicals, while heat is helpful by improving blood flow and reduction of pain impulses.   This technique is used when touching the painful area and is done by stimulating the skin opposite the painful area.    This method may be used to apply low-volt electricity over painful areas and thereby temporarily the pain pathways, thereby providing pain relief.
Provide pharmacologic pain treatment as indicated and ordered.	Adequate and timely administration of pain medications ensures continued and effective pain relief to the patient. Compliance with the prescribed treatment regimen ensures that effectivity levels are maintained to provide analgesia to the patient.
Perform nursing care at the peak levels of pain medications.	Careful scheduling of tasks during peaks of effectivity of pain medications ensures optimal client comfort and compliance to care.

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Nursing Care Plan 2: Diagnosis – Constipation

Constipation related to bowel obstruction as evidenced by abdominal distention, the infrequent passage of stools, and associated pain with defecation.

Desired Outcome

The patient will be able to verbalize relief from the discomfort of constipation and maintain passage of soft and formed stools in regular intervals, normal to the patient.

Nursing Interventions	Rationale
Check and assess the patient’s usual bowel movement pattern to include frequency and consistency.	Establishing baseline data of the bowel patterns of the patient ensures the accurate and timely recognition of deviations, specifically manifestations of constipation.
Consider the patient’s laxative and enema usage, including the type and frequency.	Laxative abuse plays a big role in the development of constipation. Laxative dependency can cause the muscles and innervations of the intestine to produce the urge to defecate inadequately. Because of this, the colon will not respond normally to the presence of stool and therefore inhibit elimination.
Investigate the patient’s usual dietary habits, including eating habits, schedule, and fluid intake.	Interruption to usual meal schedules, the type of food taken, and inadequate fluid intake can cause constipation.
Assess the patient’s activities of daily living.	A sedentary lifestyle consisting of an inadequate exercise regimen and prolonged bed rest can contribute to constipation development.
Take note of the patient’s current medications.	Various medications can alter the normal peristalsis or intestinal movement and thereby cause constipation. Drugs such as opioids, antidepressants, antihypertensives, and anticholinergics are some examples that may affect the gut.
Assess for fear of pain with bowel elimination	Certain conditions such as hemorrhoids and other anorectal disorders are painful and may cause the patient to withhold defecating. Over time, this results in a dilated rectum that no longer is triggered by stool presence for bowel elimination.

Nursing Care Plan 3: Diagnosis – Imbalanced Nutrition: Less Than Body Requirements

Imbalanced Nutrition: Less Than Body Requirements related to bowel obstruction as evidenced by changes in bowel functions and imbalances in nutritional studies.

Desired Outcome

The patient will be able to recover appropriate and normal laboratory results with no further observed signs of malnutrition.

Nursing Interventions	Rationale
Ensure measuring of the patient’s daily calorie intake.	Utilizing a record of the patient’s food intake will help the healthcare providers in assessing patient needs, deficiencies, and other nutritional patterns that are crucial for the management of the patient’s malnutrition.
Weigh daily or as ordered. Make sure to take note of weight history and skinfold measurements.	Although daily patient weighing is limited in assessing for malnutrition, it is still necessary to allow for proper assessment. Skinfold measurement ensures for proper assessment of latent fat reserves of the patient and in determining muscle or fat wasting.
Encourage patients to eat small, frequent meals as tolerated.	Because of the manifestations of bowel obstruction (e.g., abdominal pain, bloatedness), eating for the patient could be difficult. Having the patient eat small, frequent meals guarantee the patient continuous nutritional intake.
Monitor laboratory studies, especially serum albumin, transferrin, WBC, and RBC counts serum electrolytes.	Laboratory tests assist in determining the patient’s medical status. Monitoring for decreasing levels of albumin (below 3.8 g/dl) may suggest protein reduction in the body. Depressed WBC and RBC counts also may indicate malnutrition and reduced infection resistance and anemia. Elevated serum potassium and decreased sodium levels may also indicate malnutrition.
Look for physical manifestations of poor intake.	The patient with nutritional deficiencies will appear fatigued and will have sluggish responses. The patient may also have pale and dry skin, decreased attention span, and swollen and red mucus membranes. Tachycardia and hypertension may be present for patients with malnutrition.

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Nursing Care Plan4: Diagnosis – Ineffective Coping

Ineffective Coping related to unpredictable nature of disease process secondary to bowel obstruction as evidenced by verbalization of inability to cope and poor self-esteem.

Desired Outcome

The patient will be able to identify, acknowledge and utilize applicable coping mechanisms with regards to his current condition.

Nursing Interventions	Rationale
Assess the patient and significant others’ knowledge and understanding of the disease.	Establishing a baseline assessment of the expectations and understanding of the patient and his family will help the healthcare provider to address problems realistically. Anxiety and any misconceptions may hinder health teaching and learning for the patient.
Determine the external stressors of the patient. (Social environment, relationships, etc.)	Stress can directly affect the immune system of the patient and their response to the treatment regimen. External stressors are powerful enough to hinder the patient’s treatment goals and should be addressed accordingly.
Consider opportunities for the patient to discuss other aspects of their life (e.g., sexual needs) that are hindered by the disease.	Stress brought about by illness can affect all aspects of a person’s life. Allowing for patient verbalization of concerns ensures the patient that they are heard and can be assisted with.
Assist the patient in identifying personal and effective coping skills.	Using previously successful coping skills can help the patient handle and manage their current situation and strategize for future issues.
Ensure that the patient has adequate and uninterrupted sleep and rest.	Illness can be exhausting for the patient. Interruptions with established rest and sleep patterns may further aggravate the patient’s coping abilities.
Encourage the use of relaxation techniques, deep-breathing exercises, etc.	These methods assist in refocusing the patient’s attention, thereby inducing relaxation and coping with the disease.

Nursing Care Plan 5: Diagnosis – Deficient Knowledge

Deficient Knowledge related to information misinterpretation of the disease secondary to bowel obstruction as evidenced by statements of misconceptions and development of preventable complications.

Desired Outcome

The patient will be able to verbalize understanding of the disease and its associated complications and effectively participate in the treatment regimen.

Nursing Interventions	Rationale
Ascertain the patient’s perception of the disease.	This ensures the healthcare provider of a baseline assessment and insight into the educational and coping needs of the patient.
Look at the disease process, cause and effect that reduce or aggravate the patients’ symptoms. Encourage the patient to verbalize concerns.	Precipitating factors vary for every patient. Allowing the patient to realize factors that may reduce or worsen their symptoms enables them to have accurate knowledge of the disease. With these, the patient is empowered to make sound decisions when it comes to their care.
Review the patient’s medication regimen, including the indication, frequency, and dosage. Also, take note of the associated side effects of the drugs administered.	Explaining this to the patient promotes understanding, thereby gaining their trust and cooperation with the treatment regimen.
Highlight the importance of proper handwashing techniques and perineal care.	Good skincare ensures the reduction of latent bacteria flora and reduces the risk of skin irritation and breakdown that can develop into infections.
Recommend smoking cessation	Smoking may worsen current symptoms and may be contraindicated for the patient’s treatment regimen.
Highlight the need for periodic follow-ups and long-term reevaluation of the condition.	Some causes of bowel obstruction predispose a patient to other conditions, such as the increased risk for colon cancer. Regular check-ups with a healthcare provider can ensure early prevention and detection of developing the disease.

Nursing Care Plans for Lung Cancer-References

• ncbi.gov
• scholar.google.com