Question

You are the nurse caring for Mr. Noah Poupe. He is day 3 post-op from abdominal surgery and has experienced N/V without relief, despite receiving anti-emetics. Since surgery he has no reports of flatus. His last BM was 4 days before surgery. This morning he had an NG tube in place for gastric decompression, and his NG tube is hooked up to low-intermittent suction. Mr. Poupe also has an NPO diet ordered.

1. What does the term “gastric decompression” mean? How does an NG tube help assist with this?

2. Name one nutritional and bowel concern for Mr. Poupe.

Miss Pho is a 25-year-old female who was admitted to the hospital with a diagnosis of dehydration secondary to a Crohn’s flare-up. (Crohn’s Disease is a chronic inflammatory disease of the intestines). Her skin is pale, her mucous membranes are dry, and her skin turgor is poor. Miss Pho reports increasing bouts of diarrhea along abdominal pain and weakness.

Because Miss Pho is unable to tolerate PO fluids, IV fluids are ordered. The surgeon has come to discuss bowel diversion options with Miss Pho, as this is her seventh Crohn’s flare-up in the past year.

1. What are the two main types of bowel diversions included in this week’s learning outcomes?

2. Compare and contrast how each type of bowel diversion can affect a patient’s nutritional status and bowel elimination.

Answer 1

Gastric decompression is the removal of gas or excess fluid obtained from stomach through the nasogastric tube.

Here,the NG tube has two uses:

1.It prevents stress on operated site by decompression.

2.The NG tube goes to esophagus and stomach through nose ,so NPO(nil per os; nothing by mouth) diet can be delivered through this tube.

Abdominal post operative concerns:Mechanical small bowel obstruction,intraabdominal bleeding leading to haemorrhage, Nausea and vomiting etc

Bowel Diversions:

1.Ileostomy : opening in ileum

2.Colostomy: opening in colon

Nutritional status and bowel elimination in colostomy:Early oral feeding in the patients undergoing colostomy is safe, and associated with reduced post-operative discomport; it can accelerate the return of bowel function and improve rehabilitation. It should be progressed from a liquid to low residue diet. To improve healing, the diet should also be high in protein, energy, vitamins, and minerals. Diet should provide normal or increased salt intake. One to two quarts of fluid, taken between meals, should be ingested daily. Gradually introduce new foods; if done slowly, offending foods can be indentified and obstruction can be controlled or prevented.Some foods may cause flatulence (gas), odors, diarrhea and/or constipation.

Nutritional status and bowel elimination for ileostomy :Postoperatively, it is important to provide a high-energy, high-protein diet for wound healing that is low in excess insoluble fiber. The high-fiber foods are suggested to avoid for preoperative care for about 4 weeks.Diet should have an adequate amount of fluids, especially in hot water. Since obesity can cause more discomfort.

We have to determine the location of an amount of the intestine that was resected to predict likelihood of diarrhea, malabsorption, and malnutrition.