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Vital signs
Temperature and pulsePatients with bowel
obstruction are usually normothermic, but pulse is
an excellent marker of physiological abnormality.
Patients with bowel obstruction can become
hypovolaemic due to vomiting, poor fluid intake
or the leaking of fluid into the bowel lumen that
is not re-absorbed. When combined with low
blood pressure, this can prevent the heart from
maintaining adequate cardiac output, leading to
tachycardia (Patel and Burnard 2009). Meanwhile,
excretion of urinary sodium and water is usually
reduced to maintain plasma volume, resulting in
oliguria (Macutkiewicz and Carlson 2005).
Oxygen saturationThis refers to the percentage
saturation of oxygen in haemoglobin rather than
thepartial pressure of oxygen in the blood (Docherty
2002). Measuring oxygen saturation with saturation
probes is less invasive and painful, is cheaper,
and involves less risk of infection than frequent
measuring of arterial blood gas samples (Department
of Health 2008).
HydrationThis is one of the first signs of
hypovolaemia (Kadlec et al 2008) and is indicated
bylack of skin turgor, dry tongue or, in extreme
cases, sunken eyes. To test patients hydration
status, nurses can ask them if they are thirsty.
Feature
term (Davis 2000). Patients with bowel obstruction
are given analgesia according to the World Health
Organizations (2011) pain ladder, originally devised
for pain from cancer. This means using paracetamol
if pain is mild and progressing through non-steroidal
anti-inflammatory drug and opiates as pain becomes
more severe. Analgesia is usually given in intravenous
(IV) form inpatients who are nil bymouth.
ConsciousnessIn patients with bowel obstruction,
Glasgow Coma Scale (GCS) parameters remain
unaltered. In patients with sepsis, perfusion of
the brain may be inadequate. This can lead to
perforation or shock, and affect patients mental
state (Gilkes and Whitfield 2009).
Interventions
Fluid managementFluid resuscitation is an essential
first step when managing intestinal obstruction.
After prolonged vomiting, patients fluids and
electrolytes can be seriously depleted (Burkitt and
Quick 2002) and there may be excessive fluid in the
EMERGENCY NURSE
Feature
upper gastrointestinal tract, so oral intake of fluids
should be discontinued and IV intake introduced.
The volume and type of fluid depends on patients
hydration status, the duration of the obstruction
and serum electrolyte abnormalities. Over a 24-hour
period, up to 8L of gastrointestinal secretions
from the stomach, pancreas, gall bladder and
small intestine can accumulate in the bowel due to
obstruction (Shelton 1999). Nasogastric tubes (NGTs)
drain the gastro-intestinal fluids, reducing fluid
accumulation at the site of obstruction and the risk
of perforation (Shelton 1999).
AntiemeticsManaging the symptoms of intestinal
obstruction is extremely important and the use
of appropriate antiemetics is essential. In surgical
settings, metoclopramide is commonly used in
patients who experience nausea and vomiting. It is
contraindicated in patients with bowel obstruction,
however, because it stimulates gastric emptying and
further distends the bowel, as stomach contents
pass into an area of the gut where there is no
possible outlet. Cyclizine and prochlorperazine,
which act centrally on the chemoreceptor trigger
zone and the vomiting centre, can be used instead
(Bader et al2009).
AnalgesiaChoice of analgesia is usually based on
each patients pain type, intensity, duration and
constancy. It is also based on each patients age,
Reflection
Emergency care staff see patients with a wide range
of medical, surgical, psychological, gynaecological
and traumatic conditions, and it is vital that they
are skilled to treat all such conditions effectively
andcompetently.
Reflection enables practitioners to explore,
understand and develop meaning and highlights
contradictions between theory and practice.
Byreflecting on the care given to patients it is
possible to learn what could have been done
differently and what to do if the situation
occursagain.
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This article has been subject
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Beatrice Harold is a
senior straff nurse at the
emergency department at
HillingdonHospital, London
References
Bader F, Schrder M, Kujath P et al (2009)
Diffuse postoperative peritonitis: value of
diagnostic parameters and impact of early
indication for relaparotomy. European Journal
of Medical Research. 14, 11, 491-496.
Burkitt H, Quick C (2002) Essential Surgery.
Third edition. Churchill Livingstone, London.
Chiu YH, Chen JD, Tiu CM et al (2009)
Reappraisal of radiographic signs of
pneumoperitoneum at emergency department.
American Journal of Emergency Medicine.
27,3,320-327.
Cole E, Lynch A, Cugnoni H (2006)
Assessment of the patient with acute abdominal
pain. Nursing Standard. 20,38,56-61.
Davis B (2000) Caring for People in Pain.
Routledge, London
Department of Health (2008) High Impact
Healthy Workplace Interventions: Case Studies
of Good Practice. DH, London.
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