Small Bowel Obstruction Nursing Care Plan

What is a Small Bowel Obstruction Nursing Care Plan Template?

A small bowel obstruction (SBO) occurs when there is a blockage in the small intestine, impeding the normal flow of contents through the digestive system. This obstruction can result from various causes, including adhesions from prior surgeries, hernias, tumors, or inflammatory bowel diseases like Crohn's disease. It's characterized by symptoms such as severe abdominal pain, bloating, nausea, vomiting, constipation, and a lack of appetite. 

This condition can affect individuals of any age but is more commonly observed in those who've had abdominal surgeries or possess conditions predisposing them to bowel obstructions. SBO poses significant risks if not promptly addressed, leading to complications like bowel perforation, tissue death due to reduced blood flow (ischemia), peritonitis, and potentially life-threatening infections.

Developing a comprehensive care plan for SBO treatment is paramount due to the urgency and severity of the condition. Well-made and instigated nursing care plans encompass timely interventions to resolve the obstruction, manage symptoms, prevent complications, and guide postoperative recovery. Immediate surgical intervention is often necessary to alleviate the blockage, prevent tissue damage, and avert life-threatening complications. Additionally, fluid resuscitation helps restore electrolyte balance and manage dehydration, a common consequence of SBO.

Effective care plans for SBO treatment also involve diligent monitoring for signs of complications like bowel perforation or ischemia, as these can rapidly escalate and necessitate urgent medical attention. Effective pain management and prophylactic antibiotics are integral to alleviating discomfort and reducing the risk of infection before or after surgical intervention. 

A well-structured care plan for small bowel obstruction is indispensable for timely interventions, effective symptom management, prevention of complications, and patient education. It is pivotal in optimizing treatment outcomes, reducing morbidity and mortality rates, and ensuring patients receive the comprehensive care necessary to navigate this potentially critical condition.

If you like a care plan template that provides a structured and customizable approach for various medical conditions, ensuring comprehensive care and optimal outcomes, you can explore our comprehensive guide. Our templates are designed to support healthcare professionals in creating effective, individualized care plans that address the unique needs of each patient.

How does it work?

Step One: Gather your resources

Small bowel obstruction nursing care plans are a valuable resource and essential to keep on hand. Make sure that you have a copy of the free printable PDF when the need arises by either clicking the “Download Template” or “Use Template” button or by searching “small bowel obstruction nursing care plan” on Carepatron’s template library’s search bar on the website or app.

Step Two: Collate essential information

Once the patient has been diagnosed and assessed for a bowel obstruction, utilizing the small bowel obstruction nursing care plan template to ensure all goals of care are met is both seamless and easily accessible to relevant parties via Carepatron's centralized workspace. Assessment, symptom management, and interventions can be collated within the single care plan and safely stored on a single database. The care plan allows for individualized treatment options. It acts as a scaffolding to ensure goals of care are met, and the next steps are recorded for future reference or for distribution to other healthcare specialists who are part of the patient's care team.

Step Three: Store the chart securely

After reviewing the small bowel obstruction nursing care plan and creating a viable and individualized plan for the patient, you need to secure the plan so that access is only granted to relevant parties.

Ensure this through Carepatrons HIPAA-compliant free patient records software. Here, all relevant medical records can be safely stored and collated for ease and security.

When would you use this template?

An SBO nursing care plan is employed when a patient presents with signs and symptoms suggestive of a partial or complete blockage in the small intestine. Nurses may utilize this care plan in various situations, including:

Emergency department admissions

Patients arriving with abdominal pain, distension, vomiting, and constipation may indicate a possible SBO. Nurses in the emergency department initiate assessments, pain management, and interventions while preparing for further diagnostic tests.

Inpatient hospital care

Patients diagnosed with or suspected of having an SBO require comprehensive nursing care. Nurses monitor the patient's vital signs, assess abdominal symptoms, manage pain, and provide support before and after interventions like nasogastric tube insertion or surgery.

Postoperative care

Patients recovering from abdominal surgery, particularly those involving the intestines, are at risk of developing an SBO. Nurses monitor for signs of obstruction and provide postoperative care, including pain management, wound care, and monitoring bowel function.

Patients with a history of abdominal adhesions or hernias

Individuals with a history of abdominal surgeries, adhesions, or hernias are at higher risk for SBO. Nurses provide ongoing monitoring and educate these patients about signs and symptoms to report promptly.

Telemetry or step-down units

Patients recovering from an SBO or undergoing conservative management might be placed in telemetry or step-down units. Nurses continue to monitor their condition, manage pain, assess for complications, and provide support during recovery.

Patient education and discharge planning

Nurses are vital in educating patients and their families about SBO symptoms, dietary modifications, follow-up care, and when to seek medical attention after discharge.

What do the results mean?

Assessment

The nursing assessment for small bowel obstruction involves comprehensive data collection encompassing both subjective and objective aspects.

Review of Health History:

• Evaluate general symptoms such as abdominal pain, cramps, distension, bloating, nausea, vomiting, constipation, and lack of appetite.
• Probe further into the nature of abdominal pain, bowel habits, and potential risk factors like previous surgeries, hernias, inflammatory bowel diseases, cancer, or congenital conditions.
• Specifically assess risk factors in pediatric patients, including conditions like intussusception or congenital atresia.

Physical Assessment:

• Conduct a thorough abdominal examination, noting changes in bowel sounds, tenderness, rebound tenderness, guarding, rigidity, and the presence of hernias, scars, or masses.
• Perform a rectal examination to identify potential causes like fecal impaction, hernias, masses, or signs of bleeding.

Interventions

Nursing interventions for small bowel obstruction aim to address the condition's underlying causes, manage symptoms, prevent complications, and educate patients and families about recurrence signs.

Treat According to the Etiology:

• Immediate surgical scheduling is crucial in most cases to avert potentially fatal complications.
• Initiate fluid resuscitation through IV administration to correct electrolyte imbalances and manage dehydration or shock.
• Monitor fluid balance and urine output using Foley or central venous catheters.
• Decompress the bowel using a nasogastric tube to relieve stomach pressure, particularly in partial obstructions.
• Prepare for surgery, especially in complete blockages, employing laparoscopic techniques or bowel resection.

Manage Pain, Nausea, and Antibiotics:

• Control pain with morphine sulfate and manage nausea with medications like ondansetron or promethazine.
• Administer prophylactic antibiotics preoperatively to counter gram-negative and anaerobic bacteria.

Promote Mobility and Prevent Complications:

• Encourage early ambulation and position changes post-surgery to reduce abdominal pressure and enhance breathing.
• Vigilantly monitor for signs of potential complications like bowel perforation, ischemia, and peritonitis.
• Educate patients and families on recognizing recurrence signs and seek immediate treatment to prevent delayed surgeries and associated risks.

Research & evidence

Small bowel obstruction represents a prevalent surgical emergency characterized by a mechanical blockage within the bowel. Numerous pathological factors can trigger this condition, with intra-abdominal adhesions ranking as the primary cause in developed nations. These obstructions can manifest as partial or complete and may present as non-strangled or strangulated cases (Grigsby et al., 2017).

Small bowel obstructions are prominently accounted for through postsurgical adhesions, followed by incarcerated hernias as the second most frequent etiology. Other prevalent causes include but aren’t limited to malignancies, Crohn's disease (inflammatory bowel disease), stool impaction, foreign bodies, and volvulus. Concerning the pediatric demographic, common triggers include congenital atresia, pyloric stenosis, various congenital anomalies, and intussusception (Bower et al., 2018).

In the United States, over 300,000 laparotomies are estimated to be performed annually to address small bowel obstruction, with approximately 80% of bowel obstructions attributed to the small bowel. Both males and females exhibit a similar incidence rate, though a higher occurrence is associated with advancing age and an increased history of intra-abdominal procedures (Wessels et al., 2019).

Over the past decade, there has been a significant shift in the approach to treating SBO in individuals with prior abdominal surgeries. Presently, the predominant method for managing most SBO cases involves non-operative strategies, encompassing bowel decompression, the use of water-soluble contrast agents, and administering fluid for rehydration. Non-operative management has proven to be both safe and effective, demonstrating success in around 70% of SBOs induced by adhesions (ASBO) (ten Broek et al., 2018). 

However, several authors contend that in instances of SBO occurring in a virgin abdomen (SBO-VA), where there hasn't been previous abdominal surgery, surgical exploration remains essential (Zielinski & Bannon, 2011). This perspective is based on the belief that SBO-VA is typically caused by factors other than adhesions, such as malignancies, internal hernias, and bezoars, which are considered the primary triggers (McCloy et al., 1998).

References

Bower, K. L., Lollar, D. I., Williams, S. L., Adkins, F. C., Luyimbazi, D. T., & Bower, C. E. (2018). Small Bowel Obstruction. Surgical Clinics of North America, 98(5), 945–971. https://doi.org/10.1016/j.suc.2018.05.007

Grigsby, C. K., Falkenstrom, K. L., & Merchen, T. D. (2017). Small Bowel Obstruction from a 3-cm Gallstone in the Setting of Child-Pugh C Liver Cirrhosis. The American Surgeon, 83(12), e480-481. https://pubmed.ncbi.nlm.nih.gov/29336742/

McCloy, C., Brown, T. C., Bolton, J. S., Bowen, J. C., & Fuhrman, G. M. (1998). The etiology of intestinal obstruction in patients without prior laparotomy or hernia. The American Surgeon, 64(1), 19–22; discussion 22-23. https://pubmed.ncbi.nlm.nih.gov/9457032/

ten Broek, R. P. G., Krielen, P., Di Saverio, S., Coccolini, F., Biffl, W. L., Ansaloni, L., Velmahos, G. C., Sartelli, M., Fraga, G. P., Kelly, M. D., Moore, F. A., Peitzman, A. B., Leppaniemi, A., Moore, E. E., Jeekel, J., Kluger, Y., Sugrue, M., Balogh, Z. J., Bendinelli, C., & Civil, I. (2018). Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World Journal of Emergency Surgery, 13(1). https://doi.org/10.1186/s13017-018-0185-2

Wessels, L. E., Calvo, R. Y., Dunne, C. E., Bowie, J. M., Butler, W. J., Bansal, V., Beth Sise, C., & Sise, M. J. (2019). Outcomes in adhesive small bowel obstruction from a large statewide database: What to expect after nonoperative management. Journal of Trauma and Acute Care Surgery, 86(4), 651–657. https://doi.org/10.1097/ta.0000000000002196

Zielinski, M. D., & Bannon, M. P. (2011). Current Management of Small Bowel Obstruction. Advances in Surgery, 45(1), 1–29. https://doi.org/10.1016/j.yasu.2011.03.017