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Bowel obstruction and ileus: the decompression tube, fluids, abdominal checks and when to call

  • Assessment

In obstruction and ileus the nurse decompresses with the tube, replaces fluids, examines the abdomen often and calls at the first sign of strangulation.

Updated

What it is

In mechanical obstruction something blocks the bowel (adhesions, hernia, tumour, twisting); in ileus the bowel stops moving without a blockage, often after abdominal surgery, with low potassium or with opioids. Non-operative care (nothing by mouth, a decompression tube, intravenous fluids and electrolytes) works for most adhesive obstructions. The nurse's key task is to examine the abdomen repeatedly and to recognise the signs that the bowel's blood supply is at risk, which needs surgery.

Reference values

  • Inspection: distension, visible peristalsis (a possible sign of obstruction), scars and hernias.
  • Bowel sounds: hyperactive sounds may mean obstruction; hypoactive sounds occur after abdominal surgery, in peritonitis and in paralytic ileus.
  • Palpation: guarding, rigidity and rebound tenderness are abnormal; rigidity and rebound suggest peritonitis.
  • Ileus triggers: abdominal surgery, abdominal infection, low potassium, kidney or lung disease and medicines, especially opioids.
  • Daily questions: last flatus and last bowel movement.

How to measure it (and why)

  1. Examine in order: inspect, listen, then palpate lightly, painful area last — touching first alters the bowel sounds.
  2. Measure and record vomit and tube drainage with their appearance — they guide fluid replacement.
  3. Keep nil by mouth and keep the nasogastric tube draining as ordered — it relieves distension and vomiting and prevents aspiration.
  4. Give IV fluids and electrolytes as prescribed and keep a fluid balance — dehydration and low potassium are common.
  5. Follow potassium, urea and creatinine — dehydration can injure the kidneys.
  6. Ask each shift about flatus and stool and record them — their return suggests the bowel is working again.
  7. If contrast is given, make sure the X-ray is done at the ordered time — it shows whether the obstruction is resolving.
  8. Reassess pain, abdomen and vital signs often — strangulation can develop quietly.
  9. Screen nutrition if nil by mouth lasts — prolonged obstruction leads to malnutrition.

How to read it

  • Pain that becomes constant or severe, with rigidity or rebound tenderness, suggests strangulation or ischaemia.
  • A hernia found on examination can be the cause and must be reported.
  • Possible complications: dehydration and electrolyte imbalance, perforation, infection, and death of bowel tissue.
  • High tube output without clinical improvement after 72 hours prompts the team to reconsider surgery.
  • People with diabetes may need earlier surgery, according to the guideline.

Next step: when to call for help

  • Call at once for rigidity, rebound tenderness, or pain that becomes constant or severe.
  • Call if vomiting continues despite the tube, or the tube stops draining while distension grows.
  • Call for signs of dehydration, including urine output below the protocol's limit.
  • Call if the early warning score rises.
  • Report the X-ray result after contrast to the team.

Test yourself

Think of the answer, then tap the question to see it.

What are the core measures of non-operative care for bowel obstruction?

Nothing by mouth, decompression with a nasogastric tube, IV fluids and correction of electrolytes, especially potassium.

Why do you listen before you palpate the abdomen?

Because touching first can change the bowel sounds you are trying to assess.

Which findings suggest strangulation?

Signs of peritonitis such as rigidity and rebound tenderness, and pain that becomes constant or severe. Surgery is needed without delay.

What are two common causes of ileus?

Any two of: abdominal surgery, abdominal infection, low potassium, kidney or lung disease, and medicines such as opioids.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Intestinal obstruction and Ileus (MedlinePlus, U.S. National Library of Medicine, 2026); Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update (World Journal of Emergency Surgery (open access, PMC), 2018); Nursing Skills, 12.3 Gastrointestinal and Genitourinary Assessment (Open RN (Chippewa Valley Technical College), LibreTexts, 2021).

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