NURSING CARE OF PATIENT WITH

INTESTINAL OBSTRUCTION

AND COLON CANCER

INTESTINAL OBSTRUCTION

DEFINITION
Intestinal obstructions occur when the flow of intestinal contents is blocked. There are two types of intestinal obstruction, mechanical and paralytic, both of which can be either partial or complete.
.

Mechanical obstruction occurs when a blockage occurs within the intestine from conditions causing pressure on the intestinal walls such as adhesions(stick to something), twisting of the bowel or strangulated hernia.

Paralytic obstruction occurs when peristalsis is impaired and the intestinal contents cannot be propelled(push something forward) through the bowel.

Pathophysiology of intestinal obstruction

1.Mechanical obstruction Adhession/Bands of scar tissue

*Hernia

-Incarcerated Hernia
-Strangulated Hernia

*Volvolus

*Tumor

*Intussuception

2. FUNCTIONAL OBSTRUCTION

*Paralytic ileus

Etiology
Small bowel obstruction
Adhesion or bands of scar tissue are the most common cause of small bowel obstruction and are usually acquired from previous abdominal surgery or inflammation. Hernias(protrusion 'bonjolan' of an organ or part of it through a defect in the wall surrounding) and neoplasms(tumor or new cell growth) are the next most common causes followed by inflammatory bowel disease, strictures(sekatan), volvulus and intussusception.

Large bowel obstruction

Most large bowel obstruction occur in the sigmoid colon and are caused by carcinoma, inflammatory, bowel disease, diverticulitis, or benign tumor(tumor yang tidak berbahaya). Impaction of stool may also cause obstruction.

Clinical manifestation
Small bowel obstruction vomiting Abdominal pain

Flatus and feces that are low in the bowel and blood and mucus may be passed

Clinical manifestation
Large bowel obstruction
@ Crampy lower abdominal pain @ Diarrhea @ Constipation @ High - pitch bowel sound

TREATMENT AND MANAGEMENT

SMALL BOWEL OBSTRUCTION * NPO * Bowel decompress using Nasogastrictube * IV solution which electrolyte * IV antibiotic

* Surgical

Large bowel obstruction * radiological examination * Surgical ( complete mechanical obstruction) * temporary colostomy

Medication
1.Antibiotic a) cefoxiton (Mefoxin) b) cefoteton (Cefotan) c) cefuroxime ( ceftin,kefurox,zinacef)

2.Antiemetic a) promethazine b) ondansetron (zofran) 3.Analgesic a) morphine sulphate (astramorph, oramorph )

Health Education
Increase dietary fibre intake - to prevent constipation Maintain fluid balance - easy to absorption of food Prevent constipation - to prevent excessive tonicity of intestinal wall - to prevent weakness muscle of colon and rectum Stress management - to control disease become more chronic Exercise daily - to perform activity of muscle

COLON CANCER

Definition

Colon cancer is one of the most common types of internal cancer.people with a family history of colon cancer or ulcerative colitis are at higher risk of developing it themselves

Pathophysiology
Nearly all colorectal cancers are adenocarcinomas that begin as adenomatous polyps. Most tumor develop in the rectum and sigmoid colon although any portion of the colon may be affected. The tumor typically grows undetected, producing fews manifestation. By the time manifestation occur, the disease may have spread into deeper by direct extensions to involve the entire bowel circumference, the submucosa, and outer bowel wall layers.

Neighbouring structures such as the pancreas, spleen, genitourinary tract, and abdominal wall also may be involved by direct extension. Metastasis to regional lymp nodes is the most common form of tumor spread. This is not always an orderly process, distal nodes may contain cancer cell while regional nodes remain normal. Cancerous cell from the primary tumor may also spread by way of the lymphatic system or circulatory system to secondary sites such as the liver, lungs, brain, bones and kidneys. seeding af the tumor or other areas of the peritoneal cavity can occur when the tumor extends through the serosa or during surgical resection.

Etiology
1. people with a personal; or family history of ulcerative colitis, colon cancer or polyps of the rectum or large intestine are at higher risk for developing cancer. 2. Colon cancer has been linked with previous gallbladder removal and dietary carcinogens. 3. bacterial flora is believed to be altered by excess fat, which converts steroids into compounds having carcinogenic properties.

Clinical manifestation

abdominal pain change in bowel habit blood or mucus in stool

Treatment and management

Small localized tumor may be excised and treated during endoscopy or laparoscopy Radiation theraphy and chemotheraphy

MEDICATION

CHEMOTHERAPHY AGENT TO TREAT COLON CANCER:

* Erbitux Indication- treatment of patient with epidermal growth factor receptor. Adverse reaction disorders of the skin, subcutenous tissue, eye, respiratory and immune system

*Eloxatin
Indication- treatment of metastatic colorectal cancer. Contraindication known allergy to platinum derivatives, pregnancy, lactation bone marrow depression before first cycle of treatment. Adverse reaction infection, allergic reaction: blood and lymphatic system disorder, sensory disturbance, diarrhea , vomiting, back pain, fatigue, fever

Health education

Avoid smoking

- to reduce more effect of cancer

Avoid alcohol

- to prevent chronic cancer

Increase dietary fiber intake

- to prevent constipation

Encourage to take vitamin c

- integrity of intercellular cement in may tissue

Prevent constipation

- to prevent injuries or weakness muscle of colon and rectum

NURSING DIAGNOSIS OF INTESTINAL OBSTRUCTION AND COLON CANCER

@pain related to obstruction , distention and strangulation . *administer prescribed analgesics

*NG tube to assist with discomfort

*To relive air fluid lock syndrome turn the patient from supine to prone position every 10 minutes until enough flatus is passed to decompress the abdomen . A rectal tube may be indicated .

@Acute pain related to tissue compression from the tumor

* Have patient identify pain using a rating scale to identify pain level consistently . *Postoperatively , administer analgesics as prescribed to relive pain .

@Anxiety related to diagnosis of cancer

*Set aside time to allow the patient who so desires to talk , cry , or ask questions about the diagnosis and planned surgery . * Provide a quiet , relaxing atmosphere to help alleviate ate anxiety . *Answer questions accurately to provide a trusting relationship.

@Imbalanced nutrition : Less than body requirements related to nausea and anorexia *Give antiemetics as ordered to relive nausea *Identify foods patients like and provide them to stimulate appetite . *Give total parenteral nutrition as ordered to provide depleted vitamins , minerals , and nutrients if the patient has been anorexic for any length of time or has had a significant weight loss *Provide the patient with a high-protien , high-calorie diet , as ordered, that is low in residue to decrease excessive peritalsis and minimize cramping

@Acute pain related to abdominal distention *Assess pain level using rating scale to consistently communicate patient level *Give medication for pain as ordered. Opioids are given cautiously because they may mask symptoms of perforation and decrease intestinal motility. *Position patient in semi-Fowlers position to reduce tension on the abdomen. *Maintain oral/nasogastric tube on low intermittent suction as ordered to relieve discomfort from distention

*Maintain NPO status to rest the bowel and promote comfort

*Provide frequent mouth care to promote

@Deficient fluid volume relate to vomiting *Accurately monitor intake and output to identify fluid deficit

*Maintain fluid replacement as ordered to prevent dehydration

*Give ice chips sparingly if ordered by the physician . When melted ice mixed with electrolytes and hydrochloric acid is removed from the stomach by suction , electrolyte imbalance and metabolic alkalosis occur.

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