Question

Patient C.D. is a 55-year-old female who had a mastectomy done two days ago. Her medical history is significant for breast cancer, hypertension, and anemia. During change of shift report, you hear from the outgoing night shift nurse that yesterday, on the first day after surgery, the patient was experiencing persistent nausea. This was considered to be an unfortunate side effect of the anesthesia used during surgery. The patient ate only clear liquids yesterday morning but then her nausea improved slightly after receiving an anti-nausea medication. The patient ate solid food yesterday afternoon and evening. Today the patient reports to you that she is having abdominal discomfort and more nausea. She is not interested in eating her breakfast. When you ask, she says she is not passing flatus. You suspect the patient has a postoperative ileus.

1. In addition to what she has already reported, what other signs or symptoms might you expect to find consistent with an ileus?

2. What should nurses do for all surgical patients to help prevent the development of a postoperative ileus?

Answer 1

Ans) A paralytic ileus that is caused by medication can often be treated by taking another medicine, such as metoclopramide (Reglan), to stimulate the movement of the intestines. Another option is to discontinue use of the medication that is causing the ileus.

- Postoperative Ileus (POI) is a frequent, frustrating occurrence for patients and surgeons after abdominal surgery.

- If approved for clinical use, phase III studies indicate that alvimopan will likely become a useful adjunct to postoperative care of patients undergoing colorectal surgery. Until that time multi-modal, fast-track approaches hold the greatest promise for POI reduction. As laid out in the alvimopan trails, this consists of: no nasogastric tube, morphine PCA and ketorolac for pain control, ambulation and liquids on POD day 1, and solid food on POD.

- Prevention methods of postoperative ileus include:

• Stool softeners

• Adequate fluid intake

• Early ambulation

• Monitoring fluid balance to reduce bowel edema which can lead to ileus

• Avoid excess doses of opioids.