Can someone help me with this med-surg question?

Long Term Care Columnist / Guide · Feb 11, 2004

It takes a while for the bowel to "wake up" after having been invaded, so to speak.........assessing for bowel tones helps to determine when the patient can begin taking PO foods and fluids, whether s/he is developing an ileus (paralysis of part of the bowel), if there is flatus (gas), and so on. Also, the quality, frequency, and location of bowel sounds can mean different things (too many to list here---read your Med/Surg book!).

BarbPick · Feb 12, 2004

It takes a while for the bowel to "wake up" after having been invaded, so to speak.........assessing for bowel tones helps to determine when the patient can begin taking PO foods and fluids, whether s/he is developing an ileus (paralysis of part of the bowel), if there is flatus (gas), and so on. Also, the quality, frequency, and location of bowel sounds can mean different things (too many to list here---read your Med/Surg book!).

You can take this answer to the bank, maybe Las vegas and be a winner !!!!!!!!!!!!

meownsmile, BSN, RN · Feb 13, 2004

Yep,, abdominal surgery traumatizes the bowel so the peristalsis slows or stops. During recouperation, the slower the mobility the slower the motility. Hence patients are encouraged to ambulate as soon as possible and continue to increase ambulation until full recovery is obtained. Same with lungs, the more a patient lays around the less deeply they breath, the more likely pneumonia is to set in. Deep breathing excersises help dry moisture that may pool in the lungs(remember your lung function and fluid loss from respiration). Deep breathing helps dry up the moisture and prevents the bacteria from growing in the dark damp recesses of the lungs(we all know bacteria love those damp dark places to grow). It doesnt sound all that important, but to a surgical patient bowel ilius and pneumonia are two of the biggest complications.

janleb · May 4, 2004

after surgery, especially with the use of general anesthesia. It slows down peristalsis. In a way your body is in a state of shock. think about how traumatizing abd surgery is. Without peristalsis fecal matter cannot move through the intestines. Therefor if you were to eat a full meal you would be sorrry you did along with vomiting, nause, and feeling your going to pull out the stiches put in. Your bowel has to have enough time to heal.. Most of the time start out on ice and sips move up to clear liquids, soft diet bland and so on as well as the pt tolerated it. So to keep your pt comfortable there are mouth washes, ice chips to keep the mouth moist and vaseline lip therepy. But bowel sounds eventually come back but you have to listen for more than two seconds. Janice

lady_jezebel · May 7, 2004

Everyone here covered it. Just wanted to add to the last post. Most post-surgical pts are on an "advanced as tolerated" diet. If there are no bowel tones present, or they are hypoactive, it is likely that the pt will have nausea/vomiting after eating solid food (hence the jello, ice chips, broths). Since bowel motility can be almost nil, the food just eaten will move upward (out the mouth, as vomit) instead of downward (through the intestines) in order to relieve gastric pressure. Our pts are almost always naseaus until their bowel sounds become more active.

I also ask the pt if they are passing gas. If they are instead burping/belching but have no gas & hypoactive bowels, it's probably not a wise idea for the pt to eat solid food. Once again, nothing is moving through the digestive tract yet.

Absolutely no bowel sounds present on post-op day #2 can indicate 1)potential paralytic ilieus (dangerous), or that 2) the narcotic/epidural use for continuing pain control is also affecting bowel motility (should self-resolve gradually, or once the narcotic is reduced).

laurakoko · May 11, 2004

Another thing to remember when assessing the abdomen, with the laparoscopic procedures, is.. the surgeon places air in the abdomen to be able to view the procedure through the scope. This "air" left in the belly is misplaced, meaning it is not in the bowel, but in the areas surrounding the bowel. This sometimes is the reason patients will also have shoulder pain, after a lap procedure, due to this "air". The only way for the body to get rid of it is to get up! It is so important for your patients to get up within the first 12 hours of surgery. Even with extensive procedures, get them up, it will make a world of difference.

Havin' A Party!, ASN, RN · May 11, 2004

... maybe Las vegas ...

Is that where you've been the last several months? :)

lady_jezebel · May 11, 2004

Another thing to remember when assessing the abdomen, with the laparoscopic procedures, is.. the surgeon places air in the abdomen to be able to view the procedure through the scope. This "air" left in the belly is misplaced, meaning it is not in the bowel, but in the areas surrounding the bowel. This sometimes is the reason patients will also have shoulder pain, after a lap procedure, due to this "air". The only way for the body to get rid of it is to get up! It is so important for your patients to get up within the first 12 hours of surgery. Even with extensive procedures, get them up, it will make a world of difference.

Thanks for the tip! :)