Auscultating for Bowel Sounds After Surgery

[jo716]

So in nursing school, they teach that you should auscultate all four quadrants for bowel sounds, and if you hear nothing you should listen for 5 minutes until you say that they are absent (if you hear none).

In your practice do you always listen for 5 minutes and write "absent" bowel sounds in a fresh post-op patient, or do you listen for a bit, and if you don't hear a thing, chart down "hypoactive bowel sounds" instead and keep assessing periodically (and also for flatus)?

Because aren't we also taught to notify the MD when there are absent bowel sounds as it could mean a paralytic ileus? But since a paralytic ileus is more of a concern if the bowels don't get back into action in the first 72 hours...which is the best action for the nurse?

This is a bit confusing because what I've experienced in my capstone differs from what they taught in school...so i'm wondering how you all do it on the job?

Thanks!

[RN1982]

I think after any major abdominal surgery, you can almost expect the patient to have absent bowel sounds. I don't listen for five minutes if there are no bowel sounds and I chart that they are absent, not hypoactive.

[AKSkier]

I would say it depends on what type of surgery. If it is a major abdominal surgery, of course you will not hear any bowel sounds immediately post op. And you do not need to call the doctor. They don't expect to hear any at first. If it is some other surgery, it depends, but probably will hear bowel sounds.

Please chart what you hear (or don't hear). If you auscultate and do not hear bowel sounds, then chart that they are absent, not hypoactive.

[suanna]

5minutes is a bit long for my tastes. I listen for 15-30 sec in each quad. If you are taking 5min to hear one instance of bowel sounds the patient has very compromised GI motility at best and you have just wasted 5min documenting something that will not change the treatment in any way.

[Mollypita]

This is another one of those things that are far different in theory than in practice. Who has 20 uninterrupted minutes to auscultate bowel sounds in a post-op? What you're seeing in clinical or on the job is how it's done, ditto to the above posters.

[chicookie, BSN, RN]

Yeah in real life not going to happen. ALWAYS chart what you see, hear, not what you think you hear or saw, or what you think it should be.

[highlandlass1592, BSN, RN]

You have to remember the effect general anesthesia has upon bowel motility. I assess for almost a minute but realize that bowel motility may take a while to return after the administration of anesthesia. That is why our post-op hearts come out with NG's or OG's to suction. But if the bowel ain't moving, it ain't moving..I'm going to chart absent bowel sounds, not hypoactive. As for notifying MD, you're expected to use your critical thinking skills in such a situation. If this is a fresh post-op, of course the MD is going to expect absent bowel sounds initially...and that should alleviate with time. However, if you've had a pt who had bowel sounds lose them suddenly, abdomen becoming firm..then you've definitely got a case for notifying an MD.

[NurseLoveJoy88, ASN, RN]

I have another question. If you do chart absent bowel sounds, don't you have to chart what you did about it ? i.e ambulating if indicated, notify the doc, ... or do you just write continue to monitor.

I had a post op pt. this weekend and whenever I charted something my instructor was on my back asking me " what did I do about it"? So if the BS are absent what should you do?

[highlandlass1592, BSN, RN]

I have another question. If you do chart absent bowel sounds, don't you have to chart what you did about it ? i.e ambulating if indicated, notify the doc, ... or do you just write continue to monitor.

I had a post op pt. this weekend and whenever I charted something my instructor was on my back asking me " what did I do about it"? So if the BS are absent what should you do?

Well, first off...your instructor is trying to lead you down the path of critical thinking, teaching you to think the problem through and come up with different interventions you may need to utilize..and realize that frequent monitoring is "doing something". (I'm guessing your instructor is also trying to teach you the need of follow-up assessments and to not just let things lay...both very important points to make.) I think the question about charting what you did about it is interesting..as nurses, we chart many things. And when we chart an assessment with what could be an abnormal finding, then of course we're going to need to chart interventions....which could apply in the limited scenario you've presented. However, what do you need to do if the finding is not only anticipated but normal? I'd say charting a thorough assessment and normal post-op care would be all that was needed. Let me explain.

In the scenario presented with absent bowel sounds in a post-operative patient, you're going to chart your assessment of the bowel sounds, you're going to chart the finding of an NG/OG and it's patency, what suction setting it's at, any drainage and it's assessment (color, amount, consistency, etc.) and then you're going to chart your re-assessment when it's next indicated. If your instructor were to ask you about your initial finding, ("what are you going to do about it?"), saying you'd do all these things would be an appropriate reply. Then, when you'd anticipate the bowel motility to return, and if you don't find it has, you are going to take your assessment and actions down a different path, which may include notifying the MD, checking the gastric tube for placement & patency, and possibly checking labs...would really depend upon the patient and the situation. The key is your nursing assessment. Does that make sense? It's kind of a hard scenario to envision without more specific patient indicators, I hope I"m communicating accurately the general idea.

Post-operative care is really very involved, moreso depending upon the type of surgery the patient has and his/her comorbidities. You need to have a good handle on your patient's operative course and history to be able to do a good and thorough post-operative assessment. Even if your patient is taken to the PACU for their initial recovery (I work with open heart patients and we recover them in the ICU), you still need to have a grasp of the issues at hand.

I hope that answers your questions..if not, repost and I'll try to be more thorough in my reply. Good luck to you in your studies.

[NurseLoveJoy88, ASN, RN]

Well, first off...your instructor is trying to lead you down the path of critical thinking, teaching you to think the problem through and come up with different interventions you may need to utilize..and realize that frequent monitoring is "doing something". (I'm guessing your instructor is also trying to teach you the need of follow-up assessments and to not just let things lay...both very important points to make.) I think the question about charting what you did about it is interesting..as nurses, we chart many things. And when we chart an assessment with what could be an abnormal finding, then of course we're going to need to chart interventions....which could apply in the limited scenario you've presented. However, what do you need to do if the finding is not only anticipated but normal? I'd say charting a thorough assessment and normal post-op care would be all that was needed. Let me explain.

In the scenario presented with absent bowel sounds in a post-operative patient, you're going to chart your assessment of the bowel sounds, you're going to chart the finding of an NG/OG and it's patency, what suction setting it's at, any drainage and it's assessment (color, amount, consistency, etc.) and then you're going to chart your re-assessment when it's next indicated. If your instructor were to ask you about your initial finding, ("what are you going to do about it?"), saying you'd do all these things would be an appropriate reply. Then, when you'd anticipate the bowel motility to return, and if you don't find it has, you are going to take your assessment and actions down a different path, which may include notifying the MD, checking the gastric tube for placement & patency, and possibly checking labs...would really depend upon the patient and the situation. The key is your nursing assessment. Does that make sense? It's kind of a hard scenario to envision without more specific patient indicators, I hope I"m communicating accurately the general idea.

Post-operative care is really very involved, moreso depending upon the type of surgery the patient has and his/her comorbidities. You need to have a good handle on your patient's operative course and history to be able to do a good and thorough post-operative assessment. Even if your patient is taken to the PACU for their initial recovery (I work with open heart patients and we recover them in the ICU), you still need to have a grasp of the issues at hand.

I hope that answers your questions..if not, repost and I'll try to be more thorough in my reply. Good luck to you in your studies.

Your reply was more than thorough ! Thanks so much for clearing this up for me. It makes a whole lot more sense to me now.

[leslie :-D]

However, if you've had a pt who had bowel sounds lose them suddenly, abdomen becoming firm..then you've definitely got a case for notifying an MD.

yes to above.

and, also notify md if absent bowel sounds persist, with developing symptomology, i.e., distention, rigidity, etc.

leslie

eta: oops- didn't read highland's last post, which went over absent bs.

[WalkieTalkie, RN]

LOL, one of the books I have says that you should listen to all 4 quadrants--5 minutes per each quadrant. Sorry, I don't have 20 freaking minutes to listen to non-existant or rare bowel sounds on a person who has been on pump for 6 hours. It's expected that a lot of post-op patients will have rare to hypoactive bowel sounds post-op. It's something called anesthiesa... heh. My general rule of thumb is that if I still don't hear anything after my first couple of assessments, I will notify the doc.