Complex Care of Patient with Bowel Obstruction

3319 Words14 Pages
Developing proficiency in Nursing Practice
UoB: 11006491

This paper will examine the key pathological and psychological processes of a patient with a small bowel obstruction focusing particularly upon the hydration status of the patient; these will be critically debated in relation to the complex care of the patient. The paper will justify and critically evaluate the Nursing assessment and care strategies for this patient. It will analyse the clinical course of a small bowel obstruction and justify the Nursing interventions which were required to meet the hydration needs of the patient and identify how these needs were met holistically. In accordance with the Nursing Midwifery Council, to insure patient confidentiality (NMC 2008) and for the purpose of this paper the patient will be referred to as Bob.
65-75% of small bowel obstructions are caused by adhesions (Royal Marsden 2011). Adhesions are loops of the intestine which adhere to scar tissue in the abdomen following abdominal surgery (Smeltzer 2010). When the small bowel becomes completely obstructed, the oral intake of fluid as well as saliva, gastric, biliary and pancreatic fluid accumulate above the obstruction (Royal Marsden 2011) the passage of all bowel contents also become impeded. This accumulation results in vomiting which in turn results in fluid loss and therefore an electrolyte imbalance, the secretion of sodium and potassium also increases (Doerr 2001). Peristalsis will initially continue, which as a result moves the contents of the intestine towards the obstruction; the peristalsis is what initially causes severe pain in the abdomen (Royal Marsden 2011). As the obstruction progresses the intestinal and bowel wall become oedematous and distended, this causes the leaking of proteins, these proteins along with electrolytes accumulate in the peritoneal cavity changing the fluid from clear to

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