Question about small bowel obstruction

[NurseyPoo7]

I had a patient today - small bowel series said a partial obstruction. Pts c/o severe abd pain, hes currently on 40mg Oxycontin Q12 and 4mg Dilaudid Q3 hr, but still c/o pain 7-9/10 between doses. Patient is A&O but can be forgetful. Pt vomiting mucusy-green liquid. Pt also told me this morning he had diarrhea the night before. As far as i know, no BM for me on my shift today. Pt is still on a regular diet, no NGT . Colonoscopy showed 1 small polyp but otherwise negative.

Now, I called the MD on call to give him an update regarding the constant c/o pain, vomiting, etc.

The MD says to me "Oh, well if he's having diarrhea, that means the SBO is resolving."

Um, I was always taught if a pt with SBO is having diarrhea, that means the only thing able to get AROUND the obstruction is the liquid. All other formed stool just continues to further the blockage.

Who's right?

[Magsulfate, BSN, RN]

If there is an obstruction, the patient might have a small amt of liquid stool and it maybe be pretty often. SO, the green emesis, small amt of liquid stool,, that is a good sign there is an obstruction. Actually, all the pain meds he's recieving is continuing to contribute to his obstruction by slowing down the gut. Those kinds of pain meds will cause severe constipation. IF this patient is already on these meds before the obstruction, I can bet that it contributed to this.

All I can suggest is to document EVERYTHING, each vomiting episode, each and every stool, and describe it,... document each contact with the doctor and even quote the doctor in your documentation. Just cover your hiney, and that might be all that you can do. Continue to advocate for the patient.

[shodobe]

Why no NGT? Sometimes they will give barium to see the obst and this sometimes will help to resolve the issue. NGT not being there is strange. It would help with any N&V the patient might have. Any surgical consult? Regular diet seems out of place. I would think the colonoscopy would show the obst, if not maybe look at something else. Heavy pain meds, not good because too much can cause constipation. Maybe a gallbladder problem? I will be interested to find out what is the problem. good luck

[ghillbert, MSN, NP]

Sounds odd to me - regular diet and no NGT? Weird. I'd be tending towards your assessment... but it's hard to know by reading a few details online. As suggested, just document what he said and do what you can. Did the doc think it was something that was just gonna resolve spontaneously?

[lovingtheunloved, ASN, RN]

Dr. needs to realize too, that patients tend to think that a loose stool in any amount is "diarrhea." Maybe it was one small watery BM, maybe 20 huge code browns, but I would totally question the Dr's thinking on this. And what's up with no NG?

[athena55, BSN, RN]

with a partial bowel obstruction you would find normal stools or diarrhea

with complete obstruction you would have an absence of stools.

The vomiting of green bile may indicate obstruction in the proximal small intestine..You had said the colonscopy was negative, correct? Did they do a CT?

I agree with the other posters regarding the use of narcotics. How distended is this patient? I would have dropped an NGT especially in light of the vomiting....Keep the bowels at rest for a wee bit....

athena