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Discussion

SBO - what happened?!?!

I visited a Hospice patient ( hospice nurse here) who has a history of ileus - which Docs had said a while back that it resolved itself. I'm visiting her and she says she has to throw up. Up comes undigested (3 hrs. old), lunch. States she has a pain in her abdomen. She's A&OX3 with some forgetfulness. C/o of nausea, I checked her bowel sounds, and they were distinct (I realize now could have been the "roiling" stomach??). I check the BM book which charts "L" for stoolsX2 that day. I spoke with her nurse and asked if "L" means large or loose. She states "Large".

Side note: Patient has been taking vicodin for arthritis type pain for several months and taking 1 tab BID in the past few days. I did a rectal check and inserted a phenergan suppository and there was a small amt of stool (soft and grainy) in the vault. Anyway, during the night she eventually demands to go the hospital from the nursing home, and is diagnosed with an SBO. She'll be coming back tonight to the nursing home for comfort care only, she's 93 and has refused exploratory surgery in the past for her abdominal pains/ileus. Her son is currently refusing any surgery for her. I remember reading Docs progress note/or hearing somewhere that she would not survive the surgery that he had wanted to do previously.

Regarding my assessment, what should I have done differently?

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I think you covered all your bases. You assessed her BS, last BM, type and amount. addressed her N/V, while in there rx's the nausea got a feel (no pun) for her stool. She had only 1 episode of vomitting food. not like she had a tense/firm abd with no bm x days, protracted n/v etc. vomitting bile. None of the telltale SBO s/sx were there. You treated her nausea at the time, and noted abd pain. That pain could have been fleeting, gas related, anything. I don't think there was anything else for you to do then, with that assessment, other than what you did.

i agree w/grumpy, that you covered all bases.

the n/v is profound in sbo, as it progresses.

please consider an ng tube w/suction.

very quickly, she'll have absent bs, temp, tachy along w/n&v that most meds just cannot contain.

i know most wouldn't think of an ngt as a comfort measure.

but truly it is, versus what she'll experience w/o one.

just my :twocents:, for what it's worth.

leslie

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