Primary Nursing Diagnosis

Fluid volume deficit related to abnormal loss of gastrointestinal fluids

OUTCOMES. Fluid balance; Hydration; Nutritional status: Food and fluid intake; Bowel elimination; Knowledge: Disease process

INTERVENTIONS. Fluid management; Intravenous insertion and therapy; Surveillance; Venous access devices maintenance; Vital signs monitoring

H PLANNING AND IMPLEMENTATION Collaborative

SURGICAL. Surgery is often indicated for a complete mechanical obstruction. The operative procedure varies with the location and type of obstruction. A strangulated bowel constitutes a surgical emergency. A bowel resection may be necessary in some obstructions.

Postoperative care includes monitoring the patient's cardiopulmonary response and identifying surgical complications. The highest priority is maintaining airway, breathing, and circulation. The patient may require endotracheal intubation and mechanical ventilation temporarily to manage airway and breathing. The circulation may need support from parenteral fluids, and total parenteral nutrition may be prescribed if the patient has protein deficits. Care for the surgical site, and notify the physician if you observe any signs of poor wound healing, bleeding, or infection.

MEDICAL. Medical management with intravenous fluids, electrolytes, and administration of blood or plasma may be required for patients whose obstruction is caused by infection or inflammation or by a partial obstruction. Insertion of a nasogastric (NG) tube, often ordered by the physician to rest and decompress the bowel, greatly decreases the abdominal distension and the patient's discomfort.

Analgesic medication may be ordered after the cause of the obstruction is known, but it may be withheld until the diagnosis of intestinal obstruction is confirmed so as to not mask pain, which is an important clinical indicator. Explore nonpharmacologic methods of pain relief. The physician may order oxygen. Usually, until the patient is stabilized, her or his condition precludes any oral intake.

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