Assessment

HISTORY. Establish any predisposing factors: surgery, especially abdominal surgery; radiation therapy; gallstones; Crohn's disease; diverticular disease; ulcerative colitis; or a family history of colorectal cancer. Ask if the patient has had hiccups, which is often a symptom of intestinal obstruction.

To establish the diagnosis of small bowel obstruction, ask about vomiting fecal contents, wavelike abdominal pain, or abdominal distension. Elicit a history of intense thirst, generalized malaise, or aching. A paralytic ileus usually causes a distended abdomen, with or without pain, but usually without cramping. To establish the diagnosis of large bowel obstruction, which has a slower onset of symptoms, ask about recent constipation with a history of spasmodic abdominal pain several days afterward. Establish a history of hypogastric pain and nausea. Ask if the patient has been vomiting. To establish neurogenic obstruction, ask about abdominal pain. Neurogenic obstruction characteristically produces diffuse abdominal discomfort rather than colicky pain. Establish a history of vomiting; ask the patient to describe the vomitus, which may consist of gastric and bile contents but rarely fecal contents.

PHYSICAL EXAMINATION. Inspect the patient's abdomen for distension. Observe the patient's abdomen for signs of visible peristalsis or loops of large bowel. Measure the patient's abdominal girth every 4 hours to observe the progress of an obstruction. Auscultate the patient's abdomen for bowel sounds in all four quadrants; you may hear rushes or borboryg-mus (rumbling noises in the bowels). Always auscultate the abdomen for up to 5 minutes for bowel sounds before palpation. Lack of bowel sounds can indicate a paralytic ileus. High-pitched tingling sounds with rushes can indicate a mechanical obstruction. Palpate all four quadrants of the abdomen to determine areas of localized tenderness, guarding, and rebound tenderness.

Assess the patient for tachycardia, a narrowed pulse pressure, urine output less than 30 mL/hr, and delayed capillary blanching—all indicators of severe hypovolemia and impending shock. Assess for fever, which may indicate peritonitis. Inspect the patient's skin for loss of turgor and mucous membranes for dryness.

PSYCHOSOCIAL. The patient with an intestinal obstruction is acutely ill and may need emergency intervention. Assess the patient's level of anxiety and fear. Assess the patient's coping skills, support system, and the significant others' response to the illness.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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