Podcast
Questions and Answers
Which of the following best describes a small bowel obstruction (SBO)?
Which of the following best describes a small bowel obstruction (SBO)?
- A chronic inflammatory condition of the ileum
- A congenital condition of absent ganglion cells
- A narrowing of the colon causing decreased motility
- A blockage in the small intestine preventing the normal movement of contents (correct)
Which of the following is most commonly associated with small bowel obstruction?
Which of the following is most commonly associated with small bowel obstruction?
- Crohn's disease
- Adhesions (correct)
- Tumors
- Intussusception
Which type of bowel sounds are expected above the obstruction in a patient with SBO?
Which type of bowel sounds are expected above the obstruction in a patient with SBO?
- High-pitched (correct)
- Absent
- Normal
- Hypoactive
Which of the following statements best explains the presence of nausea and vomiting in SBO?
Which of the following statements best explains the presence of nausea and vomiting in SBO?
What pathophysiologic mechanism results in abdominal distension in SBO?
What pathophysiologic mechanism results in abdominal distension in SBO?
A nurse is caring for a patient with suspected SBO. Which order should the nurse anticipate first?
A nurse is caring for a patient with suspected SBO. Which order should the nurse anticipate first?
A patient with SBO has absent bowel sounds below the obstruction. What does this indicate?
A patient with SBO has absent bowel sounds below the obstruction. What does this indicate?
A nurse reviews labs for a patient with SBO: Na+ 131, K+ 3.0, Cl– 92. Which finding is the priority concern?
A nurse reviews labs for a patient with SBO: Na+ 131, K+ 3.0, Cl– 92. Which finding is the priority concern?
A client with a history of abdominal surgery presents with cramping, no bowel movement in 2 days, and vomiting. What is the likely cause?
A client with a history of abdominal surgery presents with cramping, no bowel movement in 2 days, and vomiting. What is the likely cause?
Which of the following are likely clinical manifestations of small bowel obstruction? (Select all that apply)
Which of the following are likely clinical manifestations of small bowel obstruction? (Select all that apply)
The nurse notes a patient's abdomen is distended and tender, bowel sounds are high-pitched, and the patient reports no bowel movement in 48 hours. What action is appropriate?
The nurse notes a patient's abdomen is distended and tender, bowel sounds are high-pitched, and the patient reports no bowel movement in 48 hours. What action is appropriate?
Which of the following electrolyte disturbances is most common with prolonged vomiting from SBO?
Which of the following electrolyte disturbances is most common with prolonged vomiting from SBO?
Which diagnostic tools are used to confirm SBO? (Select all that apply)
Which diagnostic tools are used to confirm SBO? (Select all that apply)
A patient with SBO is experiencing severe dehydration. Which finding supports this assessment?
A patient with SBO is experiencing severe dehydration. Which finding supports this assessment?
Which of the following is the most likely initial physiological consequence of a mechanical SBO?
Which of the following is the most likely initial physiological consequence of a mechanical SBO?
Which of the following symptoms is a hallmark of small bowel obstruction (SBO)?
Which of the following symptoms is a hallmark of small bowel obstruction (SBO)?
High-pitched bowel sounds are heard in a patient. What does this most likely indicate?
High-pitched bowel sounds are heard in a patient. What does this most likely indicate?
Which finding is more common in a partial SBO?
Which finding is more common in a partial SBO?
Why do patients with SBO often experience tachycardia?
Why do patients with SBO often experience tachycardia?
A patient with an SBO is unable to pass gas or have a bowel movement. What is the physiological basis of this symptom?
A patient with an SBO is unable to pass gas or have a bowel movement. What is the physiological basis of this symptom?
Which are early clinical signs of small bowel obstruction? (Select all that apply)
Which are early clinical signs of small bowel obstruction? (Select all that apply)
A nurse is assessing a patient with suspected SBO. Which finding should be reported to the provider immediately?
A nurse is assessing a patient with suspected SBO. Which finding should be reported to the provider immediately?
The patient reports abdominal pain and vomiting. The abdomen is visibly distended. What nursing assessment is most useful next?
The patient reports abdominal pain and vomiting. The abdomen is visibly distended. What nursing assessment is most useful next?
Which of the following would you expect in the physical exam of a patient with SBO? (Select all that apply)
Which of the following would you expect in the physical exam of a patient with SBO? (Select all that apply)
A nurse notes high-pitched bowel sounds in the RUQ and absent sounds in other quadrants. What does this likely indicate?
A nurse notes high-pitched bowel sounds in the RUQ and absent sounds in other quadrants. What does this likely indicate?
A patient with SBO has HR 122 bpm, BP 88/54 mmHg, dry mucous membranes, and poor skin turgor. Which conclusion is most accurate?
A patient with SBO has HR 122 bpm, BP 88/54 mmHg, dry mucous membranes, and poor skin turgor. Which conclusion is most accurate?
A nurse is assessing bowel sounds in a patient with known SBO. Which interpretation of sounds is most concerning?
A nurse is assessing bowel sounds in a patient with known SBO. Which interpretation of sounds is most concerning?
Which findings may help differentiate between small bowel obstruction and large bowel obstruction? (Select all that apply)
Which findings may help differentiate between small bowel obstruction and large bowel obstruction? (Select all that apply)
Which of the following changes suggests worsening of an SBO?
Which of the following changes suggests worsening of an SBO?
A patient with SBO complains of worsening pain and increasing abdominal girth. Which intervention is most important for the nurse to anticipate?
A patient with SBO complains of worsening pain and increasing abdominal girth. Which intervention is most important for the nurse to anticipate?
What is the primary imaging study used to diagnose a small bowel obstruction?
What is the primary imaging study used to diagnose a small bowel obstruction?
Which laboratory test is most relevant in evaluating fluid and electrolyte imbalance in SBO?
Which laboratory test is most relevant in evaluating fluid and electrolyte imbalance in SBO?
What is the priority assessment in a patient with a newly diagnosed SBO?
What is the priority assessment in a patient with a newly diagnosed SBO?
What is the primary goal of nasogastric (NG) tube insertion in the management of SBO?
What is the primary goal of nasogastric (NG) tube insertion in the management of SBO?
Why is NPO status ordered for patients with small bowel obstruction?
Why is NPO status ordered for patients with small bowel obstruction?
Which labs should be monitored in a patient with SBO and vomiting? (Select all that apply)
Which labs should be monitored in a patient with SBO and vomiting? (Select all that apply)
A nurse is preparing to insert an NG tube in a patient with SBO. Which of the following actions is appropriate?
A nurse is preparing to insert an NG tube in a patient with SBO. Which of the following actions is appropriate?
A patient with an SBO has an NG tube in place and reports nausea. What is the priority nursing action?
A patient with an SBO has an NG tube in place and reports nausea. What is the priority nursing action?
A client with an SBO is receiving IV fluids. The nurse notes HR 118 bpm and BP 90/60 mmHg. What is the best nursing action?
A client with an SBO is receiving IV fluids. The nurse notes HR 118 bpm and BP 90/60 mmHg. What is the best nursing action?
A nurse is evaluating the response to treatment for a patient with an SBO. Which assessment finding suggests improvement?
A nurse is evaluating the response to treatment for a patient with an SBO. Which assessment finding suggests improvement?
The patient has an NG tube on low intermittent suction. Which of the following lab values should the nurse monitor closely?
The patient has an NG tube on low intermittent suction. Which of the following lab values should the nurse monitor closely?
Which of the following are collaborative (interdisciplinary) interventions for SBO? (Select all that apply)
Which of the following are collaborative (interdisciplinary) interventions for SBO? (Select all that apply)
A patient with SBO develops a fever and a rigid abdomen. What should the nurse suspect?
A patient with SBO develops a fever and a rigid abdomen. What should the nurse suspect?
What indicates the need for surgical intervention in a patient with SBO?
What indicates the need for surgical intervention in a patient with SBO?
A nurse is evaluating a care plan for a patient with SBO. Which outcome indicates that the plan is effective?
A nurse is evaluating a care plan for a patient with SBO. Which outcome indicates that the plan is effective?
Flashcards
Small Bowel Obstruction (SBO)
Small Bowel Obstruction (SBO)
A physical blockage in the small intestine preventing normal movement of contents.
Common cause of SBO
Common cause of SBO
Postsurgical adhesions are the leading cause of small bowel obstruction in adults.
Bowel Sounds Above SBO
Bowel Sounds Above SBO
Bowel sounds become high-pitched and hyperactive above the obstruction due to increased peristalsis.
Nausea and Vomiting in SBO
Nausea and Vomiting in SBO
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Abdominal Distension in SBO
Abdominal Distension in SBO
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Initial action for suspected SBO
Initial action for suspected SBO
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Bowel Sounds Below SBO
Bowel Sounds Below SBO
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Priority lab abnormality
Priority lab abnormality
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SBO cause post-surgery
SBO cause post-surgery
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Manifestation of SBO
Manifestation of SBO
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Next nursing action (SBO)
Next nursing action (SBO)
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Electrolyte disturbance common with Vomiting
Electrolyte disturbance common with Vomiting
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SBO Diagnostic Tools
SBO Diagnostic Tools
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Dehydration sign (SBO)
Dehydration sign (SBO)
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Initial SBO Physiology
Initial SBO Physiology
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Hallmark Symptom SBO
Hallmark Symptom SBO
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Partial SBO stool
Partial SBO stool
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SBO and Tachycardia
SBO and Tachycardia
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SBO Bowel Movement
SBO Bowel Movement
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Early SBO signs
Early SBO signs
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Study Notes
Small Bowel Obstruction (SBO) Definition
- SBO is a physical blockage in the small intestine.
- SBO prevents the normal movement of intestinal contents.
Common Cause of SBO
- Post-surgical adhesions are the leading cause of SBO in adults.
Expected Bowel Sounds
- High-pitched and hyperactive bowel sounds are expected above the obstruction due to increased peristalsis.
Nausea and Vomiting in SBO
- Proximal accumulation of intestinal contents leads to reverse peristalsis.
- Obstruction causes accumulation of fluid and contents above the blockage.
- Reverse peristalsis is triggered, resulting in vomiting.
Abdominal Distension Mechanism
- Fluid, gas, and secretions accumulate proximal to the obstruction, causing distension.
Initial Nursing Order for Suspected SBO
- An abdominal X-ray should be anticipated first to confirm obstruction before treatment.
Absent Bowel Sounds Below Obstruction
- Absent bowel sounds below the obstruction indicate halted peristalsis past the obstruction point.
Priority Lab Concern with SBO
- Hypokalemia (K+ 3.0) can lead to cardiac arrhythmias and must be addressed promptly.
SBO Cause After Abdominal Surgery
- Prior surgery can result in adhesions and cause SBO.
Clinical Manifestations of Small Bowel Obstruction
- Abdominal distension
- Cramping abdominal pain
- Nausea and vomiting
- Bowel sounds are typically absent below the obstruction, and bowel movement frequency decreases.
Signs of SBO and Nursing Action
- Distended and tender abdomen, high-pitched bowel sounds, and no bowel movement in 48 hours suggests SBO.
- The priority nursing action is to notify the provider immediately.
Common Electrolyte Disturbance
- Prolonged vomiting from SBO commonly leads to hypokalemia due to potassium loss.
Diagnostic Tools for SBO
- Abdominal X-rays and CT scans can show dilated loops and air-fluid levels.
- Labs are essential to evaluate fluid and electrolyte status.
Sign of Severe Dehydration
- Poor skin turgor is indicates dehydration caused by fluid loss from vomiting and third spacing.
Physiological Consequence
- The most likely initial physiological consequence of a mechanical SBO is the accumulation of intestinal contents and gas above the obstruction, occurring before systemic complications
Hallmark Symptom of SBO
- Nausea and vomiting are classic symptoms of SBO because contents accumulate above the obstruction.
Indicative Bowel Sounds
- High-pitched or "tinkling" bowel sounds typically indicate early SBO.
Common Finding in Partial SBO
- Frequent small, liquid stools are more common in a partial SBO, as liquid stool may still pass.
Cause of Tachycardia in SBO
- Dehydration leads to low circulating volume, prompting a compensatory increase in heart rate, causing tachycardia.
Physiological Basis of No Gas/BM
- The obstruction stops the forward passage of gas and feces, preventing bowel movements.
Early Clinical Signs of SBO
- Cramping abdominal pain
- Hyperactive bowel sounds
- Vomiting
- Constipation may follow later
- Fecal impaction is more common in large bowel issues.
Worsening Obstruction Signaled By
- Absent bowel sounds may signal worsening obstruction or paralytic ileus and must be reported urgently.
Useful Nursing Assessment
- Auscultating bowel sounds is most useful to evaluate for hyperactive or absent sounds and to guide diagnosis.
Expected Physical Exam Findings of SBO
- Visible peristalsis
- High-pitched bowel sounds
- Firm, distended abdomen
- Tympany on percussion
High-Pitched Bowel Location
- High-pitched bowel sounds in the RUQ and absent sounds in other quadrants likely indicate SBO localized to the upper small intestine. Hyperactive peristalsis is indicated.
SBO and HR/BP
- Elevated heart rate, low blood pressure, dry mucous membranes, and poor skin turgor are signs of hypovolemia and compensatory tachycardia.
Most Concerning Bowel Sounds
- A sudden cessation of previously active sounds may indicate bowel ischemia or perforation—a medical emergency.
SBO vomiting
- SBO causes early, sometimes fecal vomiting, with less distention.
- Large Bowel Obstruction (LBO) causes late-onset symptoms with greater abdominal expansion and causes ribbon-like stools.
Worsening of SBO
- Fever and rebound tenderness suggest potential ischemia or perforation, which are signs of a surgical emergency.
Anticipated Nursing Interventions
- Worsening symptoms may indicate progression to ischemia or perforation.
- Imaging should be requested urgently.
Imaging Study
- A plain abdominal X-ray is the first-line imaging to assess SBO, that shows air-fluid levels and dilated bowel loops.
Labs Needed
- Electrolyte levels help assess dehydration and vomiting-related losses (e.g., Na+, K+, Cl-).
Assessment for SBO
- Assessing for abdominal distension and bowel sounds are directly related to the progression or resolution of SBO.
NG Tube Goals
- An NG tube removes gas and fluid proximal to the obstruction, relieving symptoms and preventing perforation.
NPO Orders
- Keeping the patient NPO minimizes bowel activity and reduces the risk of further complications.
Labs to monitor
- SBO leads to losses of Na+, Cl–, and K+ via vomiting.
- Monitor sodium, chloride and potassium
Proper NG
- Proper placement must be confirmed (pH < 5 or X-ray) before suctioning or using the tube to prevent aspiration.
Tube Complications
- NG tubes can become clogged or displaced.
- Rechecking patency ensures effective decompression.
Nursing Actions if IV Fluids
- Signs of hypovolemia include elevated heart rate and low blood pressure so IV fluids need to be increased.
Assessing Treatments
- Return of bowel function and decompression are a sign the passage of gas or stool is indictaing that treatments are working.
Lab Monitoring
- Suctioning gastric contents can deplete potassium, leading to hypokalemia.
- Potassium should be monitored.
Patient Care
- These are key team-based interventions to stabilize the patient and must be collaborative.
- Surgical consult
- IV fluid replacement
- Nasogastric decompression
Suspect Perforation
- Fever and board-like abdomen suggest peritonitis, often from a perforated bowel.
Sign of Surgery
- Rising WBC, tachycardia, and worsening pain suggest strangulation or ischemia needing surgical management.
Action is Effective
- Tolerating food and passing stool/flatus indicate resolution of the obstruction and successful intervention.
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