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What is Bowel obstruction in Pregnancy and Its Assessment: Nursing Case Study

Monday, 7 April 2014

Small or large intestine bowel obstruction in the neonate may be categorized as mechanical, nonmechanical (ileus), or congenital in origin. Obstructions can also be partial or complete. The implications and treatment of the obstruction vary with the cause.

Pathophysiology
Neonates most commonly have intestinal obstructions from meconium ileus, volvulus, intussusception, or intestinal stenosis. Meconium ileus occurs when thick, stringy meconium fails to mix with mucus and be expelled rectally. Volvulus and intussusception both involve abnormalities in the shape of the bowel, volvulus by twisting and intussusception by telescoping of the tubelike organ. If severe, either may cause total obstruction and may cut off the blood supply, leading to tissue death. Stenosis means narrowing, and may cause a partial obstruction in any segment of the intestine.

Congenital imperforate anus is the imperfect fusion of the anal area. The rectum may or may not pass through the puborectalis muscle, and fistulas to the vagina in girls or urethra in boys may occur. Congenital weakness or incomplete closure of the inguinal ring at 32 weeks' gestation or later may result in an inguinal hernia discovered during the neonatal period. A portion of the intestine may prolapse through the inguinal ring and become incarcerated, causing complete obstruction and tissue death from decreased perfusion.

Complications
■ Gangrene of the bowel
■ Allergy to anesthesia
■ Sepsis

Assessment
Health perception and management

■ Parents report infant as being sickly or unhealthy

Nutrition and metabolism
■ Poor feeding habits
■ Weight loss

Elimination

■ Lack of stool passage or ribbonlike stools
■ Urine mixed in stools passing from one area

Sleep and rest
■ Fussy
■ Colicky behavior
■ Poor sleep habits

Physical EXAMINATION
General appearance and nutrition
■ Usually appears normal at birth
■ Weight loss
■ Feeding difficulties

Mental status and behavior
■ Irritability
■ Fussiness
■ Severe crying with abdominal distention

Integumentary
■ Jaundice appears 2 to 3 weeks after birth
■ Bruising

Cardiovascular
■ Facial flushing

Gastrointestinal
■ Bile‑stained vomitus (early occurrence coincides with higher obstruction; later occurrence, with lower obstruction)
■ Abdominal distention or palpable mass
■ Closed anal area or only a small aperture, making the insertion of a rectal thermometer impossible
■ Anal dimple may be present (imperforate anus)
■ Diminished stools or failure to pass meconium stools

Renal and urinary
■ Urine may be present in the stools or may pass mixed from the urinary meatus

Hematologic and immune
■ Abnormal electrolyte levels on metabolic panel
■ Prolonged bleeding time or reduced clotting time
■ Elevated bilirubin levels

Diagnostic studies
■ X‑ray studies of bowel reveal pattern of double bubble from distended duodenum or dilated loops of bowel.
■ Upper GI and small bowel series shows degree and location of obstruction.
■ Barium enema determines obstruction by inguinal hernia strangulation.
■ Computed tomography (CT) of abdomen and pelvis reveals congenital abnormality, mechanical obstruction, or nonmechanical obstruction location and degree.

Teaching checklist
Teach parents:
■ Basic neonatal care, feeding, and hand washing
■ Signs and symptoms of complications associated with bowel obstruction
■ Reporting changes in neonate's status, such as weight loss, fever, feeding difficulties
■ Incision care and dressing changes as needed
■ Care of gastrostomy or colostomy if required
■ How to reach the health care provider after hours
■ Importance of follow-up appointments and immunizations
■ Self-care and stress management

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