A small bowel obstruction is a blockage that stops food, fluid, and gas from moving through the small intestine. Common causes are adhesions from past surgery, hernias, and tumors. Your priorities are relieving pressure with an NG tube, replacing fluids and electrolytes, and watching for signs of strangulation.
Each care plan below follows the nursing process (ADPIE).
Deficient Fluid Volume
- Vomiting
- Fluid shifting into the blocked bowel
- NG tube suction losses
- NPO status
- Dry mucous membranes
- Tachycardia
- Low urine output
- Electrolyte imbalances such as low potassium
- Urine output of at least 30 mL/hr within 8 hours
- Electrolytes return to normal range within 24 to 48 hours
- Client keeps normal fluid balance and returns to oral intake
- Strict intake and output, including NG drainage
- Vital signs
- Potassium, sodium, and BUN
- Skin turgor and mucous membranes
| INTERVENTION | RATIONALE |
|---|---|
| Give IV fluids and electrolyte replacement as ordered | These replace losses from vomiting and suction. |
| Insert or maintain the NG tube to low intermittent suction as ordered | Suction removes fluid and gas and relieves pressure in the bowel. |
| Check NG tube placement and patency per protocol | A working tube in the right place prevents vomiting and aspiration. |
| Keep the client NPO | Food and fluid by mouth would add to the blockage. |
EVALUATION
- Urine output meets the goal
- Electrolytes are normal
- Client tolerates the diet as it is advanced
Acute Pain
- Bowel distention and cramping above the blockage
- Crampy, wave-like abdominal pain
- Abdominal distention
- Client rates pain 8 out of 10
- Vomiting
- Client rates pain at 3 out of 10 or less within 1 hour of treatment
- Client is pain free once the obstruction resolves
- Pain intensity and character
- Abdominal girth and bowel sounds
- Signs of strangulation such as fever, constant severe pain, and rising WBC
| INTERVENTION | RATIONALE |
|---|---|
| Give pain medicine as ordered and reassess | Pain relief improves comfort and rest. |
| Place the client in semi-Fowler's position | This eases pressure on the diaphragm and helps breathing. |
| Report constant severe pain, fever, or a rigid abdomen right away | These can mean the bowel has lost its blood supply and needs surgery. |
| Provide frequent mouth care | NPO status and an NG tube dry the mouth. |
EVALUATION
- Client rates pain at 3 or lower
- Distention is decreasing
- Bowel sounds and flatus return
Practice this in Chart Review
Read NG output, labs, and orders for a client with a bowel obstruction.
Play Chart ReviewQuick answers
Why is an NG tube placed for a small bowel obstruction?
To decompress the bowel. Suction removes trapped fluid and gas, which relieves vomiting, pain, and pressure.
What sign shows the obstruction is resolving?
Return of bowel sounds and passing gas or stool, along with less distention.
For learning only. Individualize every care plan to your client, and follow your program, current guidelines, provider orders, and facility policy.