Discharge And Home Healthcare Guidelines

Teach the patient signs and symptoms of infection: poor wound healing, wound drainage, continued incisional pain, incisional swelling and redness, cough, fever, and mucus production. Explain the importance of completion of all antibiotics. Explain the mechanism of action, side effects, and dosage recommendations of all analgesics. Caution the patient against lifting and straining. Explain that he or she can resume normal activities 2 to 4 weeks after surgery.

524 Intestinal Obstruction

Intestinal Obstruction

DRG Category: 180 Mean LOS: 5.2 days Description: MEDICAL: Gastrointestinal Obstruction with CC DRG Category: 148 Mean LOS: 12.2 days Description: SURGICAL: Major Small and Large Bowel Procedure with CC

I ntestinal obstruction occurs when a blockage obstructs the normal flow of contents through the intestinal tract. Obstruction of the intestine causes the bowel to become vulnerable to ischemia. The intestinal mucosal barrier can be damaged, thus allowing intestinal bacteria to invade the intestinal wall and causing fluid exudation, which leads to hypovolemia and dehydration. About 7 L of fluid per day is secreted into the small intestine and stomach and usually reabsorbed. During obstruction, however, fluid accumulates, causing abdominal distension and pressure on the mucosal wall, which can lead to peritonitis and perforation. Obstructions can be partial or complete. The most common type of intestinal obstruction is one of the small intestine from fibrous adhesions.

The patient's mortality depends on the type of lesion causing the small bowel obstruction (closed-loop or strangulated), and the time until diagnosis and treatment; when an early diagnosis is made, mortality is low, but if more than 75% of the small bowel is necrotic at the time of surgery, the mortality rate is 65%. Complications of intestinal obstruction include bacteremia, secondary infection, or metabolic alkalosis or acidosis. If it is left untreated, a complete intestinal obstruction can cause death within a few hours from hypovolemic or septic shock and vascular collapse.

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