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How do you induce passing gas post-op?

Posted

Specializes in OB, ER. Has 12 years experience.

So it's 12 days since surgery to remove a bladder and make a new one from intestine. Still no gas, nausea with the littlest bit of oral intake. Is this ever normal? The doctor doesn't seem concerned and just wants to wait. I'm concerned the patient is frustrated and was supposed to be home already. Xray shows ileus. Otherwise healing well from surgery. Are there any tricks to get things moving other then moving. He does walk the halls a lot already.

12 days?! Sheesh. Distension? Tympany/pain on palp? Bowel movement?

MassED, BSN, RN

Specializes in ER. Has 15 years experience.

hold on, lemme go ask my husband...

For the normal patient who is sort of distended: Have them lie on one side with their knee pulled up (as if you're going to give them an enema.) Have them lie there for plus or minus 10 minutes. Then lie on their backs for an equal amount of time. Then lie on their other side with their knee pulled up... about the same amount of time. The principle is that gas will rise to the "top" and the bubble of gas will work its way through the sigmoid.

For someone who is deathly ill with constipation (and I've seen it happen) a cholinomimetic drug will cause peristalsis and relax sphincters. But this patient has suture lines in the gut and it could be (almost certainly will be) too forceful for this patient.

For the same reason, the surgeon probably won't order any enemas? The notion is to keep any pressure off the sutures. Having said that, gas accumulation could put tension on a suture line also.

Good luck.

1icurn.jn

Specializes in med/surg, emergency room.

chewing gum if ok with MD.

P_RN, ADN, RN

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89. Has 30 years experience.

NG tube?

Stand him on his head. Gas rises right? Right. Then apply gentle yet firm squeezes to the lower (now upper) abdomen.

Journal of Relief.

Look up the yoga poses called cat and cow. You basically get on your hands and kneed and alternatively arch your back and extend your neck and butt. Also, lying on your back and hugging your knees and rocking side to side works too

But holy cow, 12 days?? Isn't that concerning?

casi, ASN, RN

Specializes in LTC. Has 3 years experience.

Has he had a bowel movement?

canesdukegirl, BSN, RN

Specializes in Trauma Surgery, Nursing Management. Has 14 years experience.

Did this pt have a Kock pouch procedure?

I think that perhaps increasing some oral intake would help to a degree. What is the pt taking for nausea? Zofran? What kind of narcs are they on? It is helpful that the pt is ambulating. I am as concerned as you are that this pt has not had any gas. What do you find on auscultation of the abdominal quadrants?

I would try to encourage fluids if the pt is able to tolerate it. Start slowly, of course. If the pt is not able to tolerate PO, inquire about different medications to abate nausea. I know that MDs are trying to stay away from Phenergan (and rightly so because there is not a reversal drug for Phenergan) because in days past, MDs would routinely prescribe Phenergan and various narcs post op. This left the pt feeling extremely groggy and not at all open to the thoughts of ambulating.

If your pt cannot tolerate PO after exhausting anti-emetics and also has absent or diminished bowel sounds, I would be concerned about obstruction.

If the patient is on a regular diet, have him/her eat a half-3/4 cup serving of prunes, which act as a stimulant to peristalsis and provide much needed fiber. If the prunes don't stimulate the production of gas, this is not just a sluggish bowel.

Edited by thehipcrip

If pt is able to tolerate oral intake, give him beans or eggs.

Ghastly smell-astounds me sometimes!

Gum. Reglan. Starting sips of clears. Waiting on gas/bowel sounds/whatever before starting PO is old school. A small amount of PO tends to "trigger" the bowels to start working again.

I was thinking the same possibility Canes. So if also no true BM but yes to some liquid fecal you very well might be at that point - with distention and sharp pain on palp (not good) would mean must look by surgeon.

JustaGypsy

Specializes in ER, SANE, Home Health, Forensic.

Ask it nicely? (just couldn't help myself...)

suanna

Specializes in Post Anesthesia. Has 30 years experience.

X-Ray shows active ileus?! No nursing intervention is going to do much at this stage. I would be very cautious of anything PO- even sipps&chips. I've had patients with an ileus rapidly distend with very little intake. Before you know it you have an aspiration pneumonia or post portem care to add to your list of duties. With a current ileus I am surprised the docs haven't ordered an NG tube of some sort to relieve the upper GI tract. Until the ileus pattern resolves in the bowel you are playing with fire to put anything in from above. Reglan( metoclopramide ) has been used but with little sucess in my experience. It can also make an elderly patient (and my wife) NUTS!!! Dulcolax RS may be more helpful since it stimulates action in the gut distal to the ileus. As for walking, it can't hurt but recent studies showed no improvement in GI motility with patients that participated in a regular postoperative walking program and those who were on restricted activity of bed&chair. Pneumonia improves but not pooping. Keep in mind, if you increase your patients activity you are going to need to increase thise fluid intake (IV?)to compensate for insensible loss through perspiration and the like. Daily weights, mucous membrane assessment and good mouth care become VERY important for this patient. A parched cracked mouth is a great place for Candida(Thrush) to set up shop, A Candida pneumonia or even oral thrush isn't going to make your patient any happier. SORRY for the long post from a simple question about the gasses we pass. I'm a surgical intensive care nurse and I can get carried away in my care planning.

AgentBeast, BSN, RN

Specializes in Cardiology and ER Nursing. Has 7 years experience.

Can or two of Budweiser usually gets me gassy.