OBSTRUCTIVE ILEUS(Group 2)

By: Group 2Lilis Nur Aida (1301100002)Genta Mahendra (1301100003)Kevian Septian Adi (1301100016)Nurul Qomariah (1301100045)Dyah Ayu Rachmawati (1301100059)

TOPICS

1. Background of obstructive ileus2. Definiton of obstructive ileus3. Etiology of obstructive ileus4. Pathophysiology of obstructive ileus5. Clinic manifestation of obstructive ileus6. Diagnostic examination of obstructive ileus7. Medical management of obstructive ileus8. Nursing care plan of obstructive ileus

BACKGROUND

• Obstructive ileus is a mechanical blockage of the intestine where the blockage completely closes or disrupt the way of intestinal contents. Approximately 20% of patients come to the hospital with complaints of acute abdomen due to obstruction of the gastrointestinal tract, 80% occurred in intestine tenue obstruction.• In Indonesia recorded 7,059 cases of paralytic ileus and obstructive

without hernia who are hospitalized and 7,024 outpatients

DEFINITION OFOBSTRUCTIVE ILEUS

Obstructive ileus is breakdown or disappearance the passage of intestinal contents caused by mechanical obstruction. Barriers in the way of intestinal contents will lead to obstructed intestinal contents and buried in the proximal part of the blockage so that the proximal region will occur or dilated bowel distension.

ETIOLOGY OF OBSTRUCTIVE ILEUS

Abnormality cause of obstruction include:1. Intestinal adhesion

Existence of fibrous tissue in the intestines were found at birth (congenital). However, fibrous tissue is most common after abdominal surgery. Small intestine adhesions are experiencing as a result of this fibrous tissue will blockage the way of food and fluids2. Incarcerated hernia

When it happened narrowing of the intestine can lead to intestinal obstruction

ETIOLOGY OF OBSTRUCTIVE ILEUS

3. Tumors (primary, metastatic):Can lead to obstruction to the entrance of food and fluids

4. Intussusception (entry of the proximal to the distal intestinal)

5. Volvulus (twisted intestinal).

PATHOPHYSIOLOGY OF OBSTRUCTIVE ILEUS

Obstructive Ileus

any mechanical power affects the intestinal

wall

narrowing / blockage of the

bowel lumen

passage disturbed

intestinal lumen

collecting the contents of the

intestinal lumen in the form of gas and

liquid in the proximal

stimulation of the digestive

gland hypersecretion

intestinal distension of

the entire colon at the proximal

occlusion

This blockage causes increased

intestinal movements (hyper

peristalsis) as a natural attempt

CLINICAL MANIFESTATION

OF OBSTRUCTIVE ILEUS

1. Pain on abdomen2. Vomit3. Difficult to defecation4. Feel nauseous5. There’s blood6. Filled with air7. Can’t flatus8. Hyperperistaltik

DIAGNOSTIC EXAMINATION OF OBSTRUCTIVE ILEUS

There are diagnostic examination can do:1. X-ray on thorax: diaphragm will go high because of abdomen

distention2. X-ray on abdomen when the patient lay on bed: to find causes3. X-ray: to see the gas or water in abdomen4. Laboratory examination: like a examination to the blood and

electrolit, it can show if the patient is dehydration, or maybe loss of plasma, or there’s infection

5. Radiogram examination is important to make a diagnostic

MEDICAL MANAGEMENT OF OBSTRUCTIVE ILEUS

Basic treatment of intestinal obstruction are:1. Treatment2. Pharmacology3. Paracentesis4. Surgical actions, which include:

- Colostomy- Stents: surgery for intestinal obstruction

depends on the cause of the obstruction. The most common cause of obstruction such as hernia and adhesions. The surgical action is herniotomy.

NURSING CARE PLAN OF OBSTRUCTIVE ILEUS

• Assessmenta. Identityb. History of present illnessc. Past medical historyd. Family history

e. Activity Daily Lifea) nutritionb) eliminationc) Activityd) Personal Hygiene.

f. Examination a) General condition b) Physical Examination

Nursing Diagnosis

1. Impaired sense of comfort (pain) associated with increased intraluminal pressure

2. Disorders of fluid and electrolyte balance associated with excess fluid loss

3. Nutrition less than body requirements relate to nausea, vomiting

4. The risk of infection associated with peritonitis complications of septicemia

Nursing Intervention

Diagnose 11. Observation level of pain2. Monitor the status of the abdomen every 4 hours3. Encourage early ambulation and avoid sitting long4. Maintain client in semi-Fowler's position5. Maintain fasting until bowel sounds return, reduced abdominal

distension and flatus out6. Teach relaxasi and distraction techniques7. Collaboration: Give analgesics as an indication and evaluation of its

effectiveness

Diagnose 21. Monitor vital sign2. Assess skin turgor and humidity mucous membrane3. Observation intake and output4. Give extra fluids intravenously as indicated5. Collaboration: Parenteral fluids distribution and blood

transfusion

Diagnose 31. Encourage restriction on activities during the acute phase2. Improve oral diet, either a liquid diet or low residu diet3. Consultation with a nutritionist4. Collaboration: Give a drug as indicated

Diagnose 41. Monitor the quality and intensity of pain2. Monitor abdominal distension3. Observation of vital signs4. Prepare patients for surgery if planned5. Collaboration: Give antibiotics as indicated

CONCLUSION

1. Obstruction ileus is damage or loss of the passage of intestinal contents caused by mechanical obstruction.

2. Clinical manifestations in ileus tenderness in the abdomen, vomiting, constipation, abdominal distension, Chapter blood and mucus but no feces and flatus.

3. Diagnostic tests include: X-ray of the thorax, abdomen X-rays, x-rays, laboratory tests), abdominal radiogram examination is essential for diagnosis of intestinal obstruction.