Question for your med/surg instructor

[blackribbon]

I am one year out of nursing school and have a question that no one seems to be able to answer. I was hoping that someone in school would ask their instructor for me. When you are assessing bowel sounds, what are you actually assessing? I was always under the impression that it was to assess that there was no bowel obstructions or abnormalities in the COLON, but I am constantly seeing people who are charting Bowel sounds x4 in patients with ileostomies and no working colon. When I am asked, they say that we are charting small bowel sounds... Yes, we do hear small bowel sounds but hearing a small bowel sound in one part of a quadrant doesn't tell us any useful information as far as I can tell since it winds around and a small bowel obstruction may still exist in that very quadrant. My nursing instructors were always very adamant that we understand the path of the colon and followed it while documenting bowel sounds. I want to know how to document properly in a patient with no colon and what it is that we are supposed to be assessing.

[nurseprnRN, BSN, RN]

You're assessing peristalsis in the whole gut. Your instructors taught you how to listen to all four quadrants because that's the best way to describe where you hear what, not to follow the large intestine only to the exclusion of the small intestines. Small bowel obstructions are not uncommon at all, and can obviously occur in someone with no colon. Hyperactive sounds are common there too, and as important to note as absent ones.

I can see how this misunderstanding would be confusing. But remember that you are assessing the entire abdomen when you listen for bowel sounds, and this will make better sense to you.

If I have given you an answer that feels incomplete please come back and let me know.

[blackribbon]

So if I hear required two gurgles (not hypo or hyper active) in the the LUQ of a patient with no colon, what is that telling me? Is that saying that there is no small bowel obstruction in the entire LUQ?

If I follow the length of the large intestines and hear two gurgles, then it is a pretty good indicator that that section of the bowel is working.

If was are just listening for any small bowel sound, then it almost seems like a waste of time because it isn't really giving us much of a picture of what is going on since there still could be an obstruction in that quadrant.

What am I missing?

[nurseprnRN, BSN, RN]

So if I hear required two gurgles (not hypo or hyper active) in the the LUQ of a patient with no colon, what is that telling me? Is that saying that there is no small bowel obstruction in the entire LUQ?

What you say in your charting is, "Hypoactive/normal/hyperactive bowel sounds heard in LUQ." You don't have to make a medical diagnosis, but you do give data that can be compared to later assessments by anyone. You also follow that finding with your other GI assessment data.

If I follow the length of the large intestines and hear two gurgles, then it is a pretty good indicator that that section of the bowel is working.

Maybe. What if you're hearing sounds that are actually originating nearby, in some small bowel? They might be, you know, because they can overlie the colon. It sorta doesn't matter as much as you might think, though.

If was are just listening for any small bowel sound, then it almost seems like a waste of time because it isn't really giving us much of a picture of what is going on since there still could be an obstruction in that quadrant.

This is what you're missing, except you kind of aren't. I think you're just unclear on the purpose of spot-checking abdomens over time.

You aren't being asked to diagnose precisely where an obstruction may (or may not) be lurking. You're documenting that at the time you listened to RUQ, LUQ, LLQ, & RLQ, you heard bowel sounds (or didn't) where you heard them (or didn't). :) You are collecting data to be added to other data you use when assessing GI function: Is the pt anorexic, nauseated, vomiting, passing flatus, passing stool, or was he before/isn't now? Does he have pain or a mass on palpation anywhere? You (and whoever else reads your carefully-crafted notes) need more data than just the presence of the sound of peristalsis to know more about what's going on in there and how/if it changes over time to begin to think about why the assessment data are changing.

Does that help?