Bowel obstruction is a serious condition where the normal passage of intestinal contents is blocked, either partially or completely. This comprehensive guide focuses on nursing diagnoses and care plans for managing patients with bowel obstruction, essential knowledge for nurses providing care in acute care settings.
Understanding Bowel Obstruction
Bowel obstruction occurs when the small or large intestine is blocked, preventing the normal passage of digestive contents. This blockage can be mechanical (physical obstruction) or functional (related to bowel motility). Common causes include:
- Adhesions from previous surgeries
- Hernias
- Tumors or masses
- Volvulus (twisting of the intestine)
- Intussusception (telescoping of the intestine)
- Inflammatory bowel disease
- Fecal impaction
Clinical Manifestations
Nurses should be alert to the following common signs and symptoms:
- Severe abdominal pain (colicky or constant)
- Abdominal distention
- Nausea and vomiting
- Obstipation (complete absence of bowel movements)
- Decreased or absent bowel sounds
- Dehydration
- Fever (if complications present)
- Tachycardia
- Oliguria
Nursing Assessment
Subjective Assessment
Pain Assessment
- Character and intensity of pain
- Location and radiation
- Aggravating and alleviating factors
- Duration and frequency
Gastrointestinal History
- Changes in bowel habits
- Last bowel movement
- Presence of flatus
- Dietary changes
- Previous surgeries
- History of similar episodes
Objective Assessment
Physical Examination
- Vital signs monitoring
- Abdominal assessment
- Bowel sound evaluation
- Assessment for signs of dehydration
- Evaluation of skin turgor and mucous membranes
Diagnostic Results Review
- Complete blood count
- Comprehensive metabolic panel
- Serum electrolytes
- Imaging studies (X-rays, CT scans)
- Lactic acid levels
Nursing Care Plans
1. Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to increased intraluminal pressure and bowel distention evidenced by verbal reports of pain, guarding behavior, and facial grimacing.
Related Factors:
- Bowel distention
- Increased peristalsis
- Inflammation
- Tissue ischemia
Nursing Interventions and Rationales:
Assess pain characteristics regularly
- Enables evaluation of intervention effectiveness
- It helps identify potential complications
Administer prescribed analgesics
- Provides pain relief
- It helps prevent complications from pain-induced stress
Position patient for comfort
- Reduces pressure on the abdomen
- Promotes muscle relaxation
Monitor vital signs
- It helps identify pain-related physiological responses
- Enables early detection of complications
Desired Outcomes:
- The patient reports decreased pain levels
- The patient demonstrates improved comfort
- The patient maintains stable vital signs
2. Risk for Deficient Fluid Volume
Nursing Diagnosis Statement:
Risk for Deficient Fluid Volume related to vomiting, decreased oral intake, and third-spacing of fluids.
Related Factors:
- Excessive vomiting
- Decreased oral intake
- Third-spacing of fluids
- Nasogastric drainage
Nursing Interventions and Rationales:
Monitor intake and output strictly
- Enables accurate fluid balance assessment
- Guides replacement therapy
Assess for signs of dehydration
- Enables early intervention
- Prevents complications
Administer IV fluids as ordered
- Maintains fluid balance
- Prevents electrolyte imbalances
Monitor laboratory values
- Guides fluid replacement
- Identifies electrolyte imbalances
Desired Outcomes:
- The patient maintains adequate hydration
- The patient demonstrates stable vital signs
- The patient maintains normal laboratory values
3. Risk for Impaired Tissue Integrity
Nursing Diagnosis Statement:
Risk for Impaired Tissue Integrity related to bowel distention and compromised blood flow.
Related Factors:
- Increased intra-abdominal pressure
- Compromised circulation
- Tissue hypoxia
- Mechanical factors
Nursing Interventions and Rationales:
Monitor bowel sounds and abdominal distention
- Enables early detection of complications
- Guides intervention timing
Assess skin color and temperature
- Identifies circulatory compromise
- Enables early intervention
Maintain nasogastric decompression
- Reduces bowel distention
- Prevents further tissue compromise
Position patient appropriately
- Promotes tissue perfusion
- Reduces pressure on distended areas
Desired Outcomes:
- Patient maintains tissue integrity
- The patient shows no signs of tissue compromise
- The patient maintains adequate perfusion
4. Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less Than Body Requirements related to inability to absorb nutrients and decreased oral intake.
Related Factors:
- NPO status
- Malabsorption
- Decreased appetite
- Nausea and vomiting
Nursing Interventions and Rationales:
Monitor nutritional status
- Enables assessment of nutritional needs
- Guides intervention planning
Maintain accurate intake and output records
- Enables nutrition planning
- Guides supplementation needs
Collaborate with dietary services
- Ensures appropriate nutrition planning
- Promotes optimal nutrition delivery
Monitor weight changes
- Enables assessment of nutritional status
- Guides intervention effectiveness
Desired Outcomes:
- The patient maintains stable weight
- The patient demonstrates improved nutritional status
- Patient tolerates appropriate diet advancement
5. Anxiety
Nursing Diagnosis Statement:
Anxiety related to acute illness and uncertain prognosis evidenced by expressed concerns and restlessness.
Related Factors:
- Acute illness
- Uncertain prognosis
- Hospitalization
- Pain and discomfort
Nursing Interventions and Rationales:
Provide clear information about the condition and treatment
- Reduces anxiety through understanding
- Promotes cooperation with treatment
Encourage expression of concerns
- Enables identification of specific anxiety triggers
- Guides targeted interventions
Maintain calm environment
- Reduces stress
- Promotes rest and healing
Include family in care planning
- Provides support system
- Reduces isolation
Desired Outcomes:
- The patient verbalizes decreased anxiety
- The patient demonstrates improved coping
- The patient participates in care planning
Patient Education
Provide comprehensive education on:
- Signs and symptoms requiring immediate medical attention
- Dietary modifications
- Activity restrictions
- Medication management
- Follow-up care requirements
- Prevention strategies
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Klingbeil KD, Wu JX, Osuna-Garcia A, Livingston EH. Management of small bowel obstruction and systematic review of treatment without nasogastric tube decompression. Surg Open Sci. 2022 Nov 7;12:62-67. doi: 10.1016/j.sopen.2022.10.002. PMID: 36992798; PMCID: PMC10040372.
- Masoomi H, Kang CY, Chaudhry O, Pigazzi A, Mills S, Carmichael JC, Stamos MJ. Predictive factors of early bowel obstruction in colon and rectal surgery: data from the Nationwide Inpatient Sample, 2006-2008. J Am Coll Surg. 2012 May;214(5):831-7. doi: 10.1016/j.jamcollsurg.2012.01.044. Epub 2012 Mar 28. PMID: 22464661.
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