Bowel obstruction: recognition and priorities
Four signs together: colicky abdominal pain, vomiting, distension, and the cessation of stool and gas. The absence of gas is the sign that separates an obstruction from a slow transit, and it must be asked about specifically rather than inferred from the stool record. Auscultation early on gives high-pitched, hyperactive sounds above the obstruction. Later the abdomen goes silent, and silence here is a worsening, not an improvement. Ask about previous abdominal surgery, since adhesions are the leading cause, and about a hernia, which is examined. Immediate priorities: nothing by mouth, venous access, fluids as prescribed, and a nasogastric tube on decompression when it is ordered. Record what drains, its volume and its appearance, and include it in the fluid balance. The electrolytes matter: vomiting and gastric drainage remove potassium and chloride. Follow them and report the results. Signs of strangulation, which convert this into a surgical emergency: pain that becomes constant and severe rather than colicky, fever, tachycardia, hypotension, a rigid abdomen, a rising lactate. A client who is nothing by mouth with a tube in place needs mouth care every few hours. It is the intervention most often forgotten and the one they will remember.