Difficulty: Medium
Average Score: 63%
Full-length
Passage / Scenario
The nurse is caring for a 58-year-old client.Admission Note
Emergency Department
A client with colorectal cancer reports intractable bilious vomiting for the past day; it is accompanied by severe, colicky
abdominal pain. The client cannot tolerate oral intake and has not passed gas or had a bowel movement since the
symptoms began. The abdomen is distended, and bowel sounds are hyperactive.
Vital Signs
Emergency Department
T, 97.3 F (36.3 C)
P, 98
RR, 18
BP, 110/70
SpO2, 98% on room air
The nurse is contributing to the client's plan of care. For each potential intervention, click to specify if the intervention is indicated or not indicated for the care of the client.
Rationale
Small bowel obstruction (SBO) is an intestinal blockage that obstructs the flow of intestinal contents (eg, fluid, gas, fecal
material). The blockage may be due to mechanical (eg, surgical adhesions, hernias, tumors) or nonmechanical/functional (eg,
paralytic ileus) causes. As intestinal contents accumulate, clients develop abdominal distension, colicky abdominal pain,
bilious vomiting, and inability to pass flatus or stool.
Clients with SBO are at risk for fluid, electrolyte, and nutritional imbalances due to decreased intestinal absorption. Clients may
develop bowel necrosis and perforation due to impaired intestinal blood flow, which can lead to peritonitis and sepsis.
The practical nurse should anticipate assisting the registered nurse with the following interventions for a client with SBO:
ÔÇó Inserting a nasogastric tube for gastrointestinal decompression to reduce abdominal distension and improve intestinal
blood flow
ÔÇó Administering antiemetics (eg, ondansetron) to prevent further fluid and electrolyte imbalance from vomiting
ÔÇó Preparing the client for abdominal CT scan to determine the size and location of intestinal obstruction
ÔÇó Administering IV fluids to improve fluid volume status
In clients with SBO, bowel rest (ie, NPO status) with gastric decompression is prescribed; therefore, a soft diet is not
indicated. Stimulant laxatives increase intestinal motility and are not indicated for clients with intestinal obstruction due to
the risk for bowel perforation.
material). The blockage may be due to mechanical (eg, surgical adhesions, hernias, tumors) or nonmechanical/functional (eg,
paralytic ileus) causes. As intestinal contents accumulate, clients develop abdominal distension, colicky abdominal pain,
bilious vomiting, and inability to pass flatus or stool.
Clients with SBO are at risk for fluid, electrolyte, and nutritional imbalances due to decreased intestinal absorption. Clients may
develop bowel necrosis and perforation due to impaired intestinal blood flow, which can lead to peritonitis and sepsis.
The practical nurse should anticipate assisting the registered nurse with the following interventions for a client with SBO:
ÔÇó Inserting a nasogastric tube for gastrointestinal decompression to reduce abdominal distension and improve intestinal
blood flow
ÔÇó Administering antiemetics (eg, ondansetron) to prevent further fluid and electrolyte imbalance from vomiting
ÔÇó Preparing the client for abdominal CT scan to determine the size and location of intestinal obstruction
ÔÇó Administering IV fluids to improve fluid volume status
In clients with SBO, bowel rest (ie, NPO status) with gastric decompression is prescribed; therefore, a soft diet is not
indicated. Stimulant laxatives increase intestinal motility and are not indicated for clients with intestinal obstruction due to
the risk for bowel perforation.