Report severe distension, persistent vomiting, or absent bowel sounds beyond the expected window.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is monitoring T-tube drainage on the first postoperative day after a cholecystectomy. Which amount of bile-colored drainage is within expected limits?
Answer: A. On the first postoperative day, a T-tube commonly drains a moderate amount of bile, around 300 to 500 mL, which then gradually decreases over the following days as the duct heals and bile flows into the duodenum. Output greater than 1,000 mL/day or sudden cessation should be reported, but several hundred milliliters is expected initially.
Question 2 of 5
A client is recovering from surgery and reports a sudden onset of shortness of breath, pleuritic chest pain, and anxiety, with an oxygen saturation of 88 percent. What complication does the nurse suspect first?
Answer: A. Sudden dyspnea, pleuritic chest pain, hypoxia, and anxiety after surgery strongly suggest pulmonary embolism, often from a postoperative DVT. The nurse raises the head of the bed, applies oxygen, and notifies the provider. These acute findings are not typical of constipation, mild wound pain, or simple postoperative fatigue.
Question 3 of 5
On the third postoperative day, a client who has been NPO and on IV fluids has a serum sodium of 128 mEq/L, headache, and confusion. The nurse recognizes which electrolyte imbalance?
Answer: A. A serum sodium of 128 mEq/L is below the normal range, indicating hyponatremia, which can cause headache, confusion, and in severe cases seizures, sometimes from excess hypotonic IV fluid postoperatively. The findings and value are not consistent with hypernatremia, hyperkalemia, or hypercalcemia.
Question 4 of 5
A nurse is caring for a client on postoperative day 2 after a total knee arthroplasty who reports sudden chest pain, shortness of breath, and tachycardia. Which complication does the nurse suspect first?
Answer: A. Sudden dyspnea, pleuritic chest pain, and tachycardia in a postoperative orthopedic patient are classic signs of pulmonary embolism, often from a deep vein thrombosis. This is a medical emergency requiring immediate oxygen, provider notification, and evaluation.
Question 5 of 5
A client is 24 hours postoperative following bowel surgery and has absent bowel sounds, abdominal distention, and no passage of flatus. The nurse recognizes these findings as consistent with which complication?
Answer: A. Paralytic ileus is a temporary cessation of intestinal peristalsis common after abdominal surgery and anesthesia. Signs include absent bowel sounds, distention, lack of flatus or stool, and nausea. Management includes nothing by mouth, possible nasogastric decompression, and gradual return of motility.
Keep the streak going with more questions like these, each with a full rationale.
What is postoperative ileus?
The gut becomes silent and distended, causing nausea, no passage of flatus, and abdominal distension. Return of bowel function, signaled by flatus, is a key recovery milestone. Most cases resolve with supportive care.
Key points to remember
- Anesthesia, bowel handling during surgery, opioids, and immobility slow peristalsis.
- Signs include absent or hypoactive bowel sounds, abdominal distension, nausea, vomiting, and no flatus or stool.
- Passage of flatus is the classic sign that peristalsis has returned.
- Opioids worsen and prolong ileus, so multimodal and opioid-sparing analgesia is preferred.
- Prolonged ileus can lead to fluid and electrolyte imbalances and vomiting with aspiration risk.
- A nasogastric tube to suction may be ordered to decompress the bowel for severe distension.
Common causes
- Bowel motility stops post-op
- Anesthesia, opioids, handling
Signs & symptoms
- Absent bowel sounds, distension
- No flatus/stool, N/V
- Cramping, firm abdomen
Nursing priorities
- Auscultate all four abdominal quadrants for bowel sounds and assess for distension.
- Encourage early ambulation, which is the most effective way to restore motility.
- Keep the patient NPO or on the ordered diet progression and advance only with return of function.
- Maintain IV fluids and monitor electrolytes; manage an NG tube if ordered.
- Use opioid-sparing pain control and consider non-opioid adjuncts to limit gut slowing.
Labs & values
Patient teaching
- Walking as soon as you are able helps your bowels wake up and start moving again.
- Tell the nurse when you pass gas, as it is an important sign of recovery.
- Report worsening bloating, nausea, or vomiting rather than waiting it out.
Red flags: report now
- Report severe distension, persistent vomiting, or absent bowel sounds beyond the expected window.
- Sudden severe abdominal pain, rigidity, or fever may indicate obstruction or perforation, not simple ileus.
- Do not advance the diet while bowel sounds are absent and the patient has not passed flatus.
References
Clinical references for this topic
