👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Physiological Adaptation🔖 Free to read, print, and share
Also known as: paralytic ileus · bowels not working after surgery · no gut sounds post-op · intestinal slowdown after surgery
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Use this quick-reference guide to spot, treat, and prevent Postoperative Ileus on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
⚠️ Cause
Bowel motility stops post-op
Anesthesia, opioids, handling
🩺 Signs
Absent bowel sounds, distension
No flatus/stool, N/V
Cramping, firm abdomen
✅ Do
Early ambulation = key
NPO, NG to suction
IV fluids, replace lytes
📌 Avoid
Opioids worsen → minimize
Feeding before bowel sounds
📚 Postoperative Ileus — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Postoperative ileus is a temporary halt of normal bowel motility after surgery, common after abdominal procedures and from anesthesia and opioids. 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.
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Key points
Understand these first
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.
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Nursing priorities
What to do, in order
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.
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Red flags — report now
Escalate immediately
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.
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Labs & values
Numbers to know
Potassium normal 3.5-5.0 mEq/L (hypokalemia worsens ileus)
Sodium normal 135-145 mEq/L
Chloride normal 98-106 mEq/L
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Patient teaching
What patients must know
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.
❓ Postoperative Ileus: NCLEX FAQs
What are the priority nursing interventions for Postoperative Ileus?
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.
What are the warning signs of Postoperative Ileus a nurse must report?
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.
What do I need to know about Postoperative Ileus for the NCLEX?
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.
What patient teaching is important for Postoperative Ileus?
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.
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Quick Tip
Anesthesia, bowel handling during surgery, opioids, and immobility slow peristalsis.