Gastrointestinal Complications

Gastrointestinal Complications

Following administration of anesthesia or pain medication, patients may experi-
ence nausea, vomiting, constipation, or paralytic ileus.

WHAT WENT WRONG?
Nausea is a common side effect of both anesthesia and pain medications. Apatient’s
reaction to anesthetic agents varies. Some patients have a lot of nausea after anes-
thesia that may last for several hours. Abdominal surgery may cause direct visceral
afferent stimulation, resulting in nausea and vomiting. Medications may act upon
the chemoreceptor trigger zone, located within the medulla outside the blood-brain
barrier. Once the patient begins vomiting, antiemetic medication may be necessary
to break the cycle. Opiod-based medications and decreased activity can both cause
slowing of peristaltic activity, leading to constipation. Patients having abdominal
procedures are at greater risk for paralytic ileus as a postoperative complication.

SIGNS AND SYMPTOMS

• Nausea as a side effect of medication
• Vomiting due to visceral afferent stimulation or activation of chemoreceptor
trigger zone
• Mild, generalized abdominal discomfort and distention with paralytic ileus
due to decreased intestinal motility
• Slow bowel sounds with constipation; absent bowel sounds with paralytic
ileus due to changes in intestinal motility

TEST RESULTS

• Electrolyte abnormality due to vomiting.
• Abdominal flat and upright x-ray shows stool in constipation, gas-filled intes-
tinal loops in paralytic ileus.

TREATMENT
• Monitor abdomen for distention; listen for bowel sounds.
• Assess for dehydration as a result of prolonged vomiting.
• Restrict oral intake in paralytic ileus or if nausea and vomiting are present.
• Nasogastric (NG) tube connected to suction to prevent vomiting in paralytic
ileus.
• Progress diet as tolerated once bowel sounds return and patient is passing
flatus rectally.
• Administer intravenous fluids.
• Administer total parenteral nutrition.
• Administer antiemetics as required.

NURSING DIAGNOSES
• Risk for imbalanced nutrition: less than what body requires
• Risk for imbalanced fluid volume
• Risk for delayed surgical recovery
• Risk for constipation
• Altered bowel elimination
NURSING INTERVENTIONS
• Ask patient about presence of nausea.
• Monitor vital signs for changes.
• Listen to bowel sounds; assess abdomen for distention.
• Monitor intravenous site for signs of infiltration, pain, and redness.
• Monitor intake and output.
• Monitor color and amount of fluid drained from NG tube.
• Ask patient if he or she is passing any flatus rectally or having bowel move-
ment.