Pathophysiology of Small Bowel Obstruction and Nursing Interventions Applied to Nursing Practice - Essay Example

? Pathophysiology of small bowel obstruction and nursing interventions applied to nursing practice October 2, 2013 Pathophysiology of small bowel obstruction and nursing interventions applied to nursing practice Executive summary Small bowel obstruction occurs when small intestines are blocked, partially or totally, and this identifies its significance to physiology of the bowel. This paper reviews secondary resources to develop knowledge on the scope of irritable bowel syndrome, its epidemiology, its emotional effects, and intervention measures. Introduction Small bowel obstruction occurs when small intestines are blocked, either partially of completely. The consequence is failure of the materials in the intestines to move outside the body for secretion. This means that materials such as stool, waste fluids, and gases accumulate in the intestines and often lead to critical health condition as the buildup strains the small intestines. This identifies the role of nursing in ensuring a healthy society at individual, family, and communal levels through awareness for preventive measures and treatment and post treatment initiative for effective recovery from effects of small bowel obstruction. Nursing roles include care provision, educating the public on preventive and management measures against diseases and their symptoms, counseling, and clinical approaches towards a healthy society. This scope demands nurses’ knowledge of health complications such as causes, symptoms, effects, diagnosis, and treatment measures. This paper demonstrate background knowledge of small bowel obstruction through reviewing irritable bowel syndrome, its anatomy and physiology, its epidemiology and laboratory tests and diagnostics for excluding other conditions, its emotional effects on patients, interventions measures, and significance of these information nursing practice. Anatomy and physiology of irritable bowel syndrome Irritable bowel syndrome is characterized by pain and change in bowel movements because of abnormal muscle contraction and expansion. It is majorly associated with the large intestines but extends to the small intestines. The large intestines form the last section of the digestive system and forms about six feet. It is also called the large bowel and is made up of the cecum, “colon, rectum, and anus” (Canadian Cancer Society, 2013, p. 1). Colon and rectum are the major sections of the large bowel. There are four sections of the colon. The first section is the ascending colon that enjoins the cecum and moves upwards towards the leaver where it connects to the transverse colon that runs horizontally towards the spleen. The transverse colon is located at the upper section of the abdomen and joins with the descending colon that runs downwards, on the left side of the abdomen, and connects to the sigmoid colon. The sigmoid colon connects to the rectum that ends the lower bowel at the anal canal (Allen and Harper, 2011; Canadian Cancer Society, 2013). The major sections of the lower bowel, the “colon, and rectum” have similar structural composition that is identified from their component tissues. The inner most layer of the rectum and the colon is the mucosa that consists of “epithelium,” “lamina propria,” and “muscularis mucosa” (Canadian Cancer Society, 2013, p. 1). The propria is an integrating tissue while the muscularis mucosa is rich in muscles. After the mucosa in a layer of submucosa that is rich in “connective tissues, glands, blood vessels, lymphatic vessels, and nerves” (Canadian Cancer Society, 2013, p. 1). A layer of muscles follows this before the outer layer that exist only in the colon, serosa (Canadian Cancer Society, 2013). Both colon and rectum absorbs nutrients from digested food into the body. They also absorb water and offer a passage for elimination of waste products. This however occurs in steps and at different sections of the colon and the rectum. Digestion of food from the small bowel is completed in the colon with the aid of bacteria. The digested food is in liquid form but the epithelium absorbs water and nutrients, leaving the stool in the passage. The epithelium also secrets mucus that aids flow of the waste to the rectum as the colon contracts and relaxes. The rectum then offers a temporary storage of the stool and coordinates with the brain, when it gets full, for bowel movements, which releases stool through the anal canal (Canadian Cancer Society, 2013). The small bowel is relatively longer and consists of “duodenum,” “jejunum,” and “ileum” (Canadian Cancer Society 1, 2013, p. 1). Structural composition of the sections of the small bowel is however similar that of the large bowel. The small intestines ensure large percentage of digestion and nutrient absorption before passing remains to the large bowel (Canadian Cancer Society 1, 2013). Epidemiology of irritable bowel syndrome Fedorak, Vanner and Bridges explain that while no data exist in Canada over incidence of irritable bowel syndrome, the problem is likely to be diagnosed among 120000 people in Canada per year. Studies also project that post-infectious irritable bowel syndrome has an incidence rate of 10 percent. The risk of suffering from post-infectious irritable bowel syndrome, in Walkerton, however increased by almost five percent following contamination of the main source of water supply in the area. Prevalence of the disorder was however reported, in the year 2008, at 2.4 percent of Canadian’s total population. This related to self-reported cases and increased from the previous prevalence rate of 2.2 percent in the year 2005. Some other data sources estimates overall prevalence rate at 15 percent and 25 percent indicating possible prevalence of about five million cases in the entire Canadian population. The actual prevalence rate is further estimated to be higher than six percent, above the self-reported cases, because majority of Canadians do not seek medical attention. The prevalence is further dependent on factors such as a person’s health condition as Canadian women with “chronic hepatitis C virus” report as high as a prevalence rate of 66 percent while those with version B of the virus repost a lower rate of 22 percent (Fedorak, Vanner and Bridges, 2012, p. 1). The syndrome is further more prevalent in western regions of Canada compared to eastern regions and the change is gradual. Canadian females are further more susceptible to the infection than its males are. Control measures target the syndrome’s symptoms and over the counter drugs exist for symptoms like diarrhea and constipation. Patients are also hospitalized for management of symptoms (Fedorak, Vanner and Bridges, 2012). Laboratory tests and diagnostic to exclude other conditions Laboratory tests for excluding other complications are “full blood count,” “erythrocyte sedimentation rate or plasma viscosity,” “c-reactive protein,” and “antibody testing for celiac disease” (National Institute for Health and Clinical Excellence, 2008, p. 8). Full blood count is a test for eliminating possible anemia or thrombocytopenia, complications that cause abnormal inflammation. Positive results of the test would associate symptoms to anemia and thrombocytopenia instead of a diagnosis for irritable bowel syndrome. Erythrocyte sedimentation rate or plasma viscosity also evaluates possibility that reported symptoms by a patient are due to inflammation in the abdomen and not necessarily existence of irritable bowel syndrome. C-reaction protein test also eliminates possible effects of inflation towards observed symptoms while antibody testing is used to eliminate possibility of celiac disease. Other tests for eliminating alternative diagnosis include “urea and electrolytes and liver function tests,” celiac serology, “thyroid function and calcium in IBS-C and IBS-D,” and haematinics (Keshav and Culver, 2011, p. 156). Other tests include analysis of stool sample to eliminate possible bacterial infection, proctoscopy for elimination of “anterior mucosal prolapse” of IBS-C, and sigmoidoscopy in order to determine possibility of colitis inflammation. Sigmoidoscopy is normally followed by a biopsy, if it yields negative results, in order to eliminate possibility of “colitis and crohn’s disease” (Keshav and Culver, 2011, p. 156). Patients who offer symptoms of lack of iron in their bodies should be subjected to colonoscopy to determine significance of iron deficiency or irritable bowel syndrome to observed symptoms. There are other tests such as “upper GI endoscopy,” “abdominal ultrasound,” “pelvic ultrasound,” “small bowel radiology,” and breath test for identifying significance of other complications, than Irritable bowel syndrome, towards observed symptoms (Keshav and Culver, 2011, p. 156). Emotional effects of irritable bowel syndrome on patients and associated interventions Pain and discomfort, as the major symptoms of the syndrome, explains its effects on people’s emotions. The pain and discomfort are undesirable in the body and therefore elicit poor attitudes. Stomach cramps due to drastic contraction of bowel muscles are examples. Forcing a person to prolonged attempts to pass stool or increasing the frequency with which a patient seek relief from bowel movement also generate undesired feelings towards bad emotions. Coordinative role of the brain that links pain and emotion also explains effects of irritable bowel syndrome on emotions. Pain from the bowel section is transmitted to the brain that is also linked thoughts and feelings and to dictate emotions. Consequently, the level of pain that the syndrome elicits, and based on other moderating factors, is likely to shift a patient’s emotion and the rate of shift is likely to be proportional to the degree of pain. Associated stress with realized pain is also likely to shift a patient’s emotions. Many strategies exist for managing emotions that develops because of symptoms of irritable bowel syndrome. Relaxation is one of the strategies and allows the body and the mind to calm down. An achieved level of stability develops a positive attitude towards realized symptoms, a factor that can moderate felt pain and consequently moderate developed emotional instability from the pain. “Cognitive behavioral therapy” is another treatment measure to emotional effect of the syndrome. It involves multiple steps that change a patient’s behavior towards better styles for managing the syndrome. One of the therapy’s effects is moderation of fears that patients develop following realization of symptoms. The therapy also helps in stress management and strengthens patients’ emotional potential to reduce significance of the syndrome and its symptoms on patients’ emotions. Hypnosis also helps in relaxing the body and therefore stabilizes emotions. Based on interpersonal ties and their effects on stress, Brief dynamic therapy moderates stress from symptoms and help in maintaining positive attitudes (Canadian Psychological Association, 2012). Nursing interventions related to therapy, stress relief, and exercise Nursing interventions focus on managing symptoms through therapy, stress relief, exercise, behavioral, and medicinal approach. Encouraging patients to change from large volumes of meals to frequent but small quantity meals is one of the available interventions and reduces bowel strain. Integrating this with increased consumption of fibre foods also, help in managing diarrhea based irritable bowel syndrome and therefore control associated pain and stress. Awareness creation among patients and the public to discourage consumption of foods that cause gas of that worsens symptoms of the syndrome is another intervention. Nurses can also apply psychological treatment measures and advocate for physical activities as initiatives for managing the syndrome’s stress (White, Duncan and Baumle, 2012). Symptoms that result from constipation can however be managed through interventions such as encouraging high level of fluid consumption, promoting exercise, medications for relieving specific symptoms, and psychological approaches for stress management (White, Duncan and Baumle, 2010). Significance of the information to nurses and its effects on nursing practice This information is important for nurses to know because it develops a basis for understanding strategies to effective management of irritable bowel syndrome. The knowledge of anatomy and physiology of the bowel is for example important because it helps nurses to identify abnormality in the bowel’s functionality. Significance of epidemiology however rises from its identification of the syndrome as a health problem in the society. Knowledge of effects of symptoms on patients and intervention strategies is however important because it assists in diagnosis and treatment of the complication. The knowledge will affect nursing practice through empowering nurses and ensuring efficiency and effectiveness in diagnosis and treatment of the syndrome. Knowledge of tests for eliminating other complications, for example, ensures accurate diagnosis. Nurses’ awareness of diversified intervention strategies is also import to determination of the most suitable approach for managing patients’ conditions. Conclusion The bowel consist of the small and the large intestines whose structural compositions is the same. The intestines digest food and absorb nutrients and water before passing stool through the anal canal. Its movement aids the passage and abnormal movement identifies irritable bowel syndrome. Even though no reliable data exist in Canada over epidemiology of irritable bowel syndrome, its incidence, and prevalence are significant. The syndrome affects victims’ emotions through induced pain and stress that the brain coordinates. Intervention measures such as awareness towards healthy eating behavior, exercise, medication, and therapy however helps to manage the emotional concerns. This information is important to nurses because it empowers them towards effective and efficient diagnosis and treatment of the syndrome and offers a basis for implementing nursing roles. References Allen, C. and Harper, V. (2011). Laboratory manual for anatomy and physiology. Hoboken, NJ: John Wiley & Sons. Canadian Cancer Society 1. (2013). Anatomy and physiology of the small intestine. Canadian Cancer Society. Retrieved from: http://www.cancer.ca/en/cancer-information/cancer-type/small-intestine/anatomy-and-physiology/?region=bc. Canadian Cancer Society. (2013). Anatomy and physiology of the colon and rectum. Canadian Cancer Society. Retrieved from: http://www.cancer.ca/en/cancer-information/cancer-type/colorectal/anatomy-and-physiology/?region=on. Canadian Psychological Association. (2012). “Psychology works” fact sheet: Irritable bowel syndrome. Canadian Psychological Association. Retrieved from: http://www.cpa.ca/docs/File/Publications/FactSheets/PsychologyWorksFactSheet_IrritableBowelSyndrome.pdf. Fedorak, R., Vanner, S. and Bridges, R. (2012). Canadian digestive health foundation public impact series 3: Irritable bowel syndrome n Canada. Incidence, prevalence, and direct economic impact. Canadian Journal of Gastroenterol (26.5): 252-256. Keshav, S. and Culver, E. (2011). Gastroenterology: Clinical causes uncovered. Hoboken, NJ: John Wiley & Sons. National Institute for Health and Clinical Experience. (2008). Irritable bowel syndrome in adults:Diagnosis and management of irritable bowel syndrome in primary care. National Institute for Health and Clinical Experience. Retrieved from: http://www.nice.org.uk/nicemedia/pdf/cg061niceguideline.pdf. White, L., Duncan, G. and Baumle, W. (2010). Foundations of adult health nursing. New York, NY: Cengage Learning. White, L., Duncan, G. and Baumle, W. (2012). Medical surgical nursing: An integrated approach. 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