During the admission assessment of a client with a small-bowel obstruction, the nurse anticipates which clinical manifestations? Select all that apply.

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Small-bowel obstruction can have mechanical or non-mechanical causes. Mechanical obstruction is commonly caused by obstruction of the bowel resulting from surgical adhesions, hernias, intussusception, or tumors. Paralytic ileus, a non-mechanical obstruction, may occur after abdominal surgery or narcotic use. When a small-bowel obstruction develops, fluid and gas collect proximal to the obstruction, producing rapid onset of nausea and vomiting (Option D), colicky intermittent abdominal pain (Option C), and abdominal distension (Option A). The nurse should recognize symptoms of bowel obstruction quickly as delay could lead to vascular compromise, bowel ischemia, or perforation. Nursing management of an obstruction includes placing the client on NPO status, inserting a nasogastric tube, administering prescribed IV fluids, and instituting pain control measures. (Option B) Symptoms of a large-bowel obstruction differ slightly from small-bowel obstruction and include gradual onset of symptoms, cramping abdominal pain, abdominal distension, absolute constipation, and lack of flatus. Constipation and decreased flatus resulting from small-bowel obstruction would occur later, as the stool and gas in the large colon would be expelled for a few days. (Option E) Pain during defecation usually indicates a rectal problem such as inflammation, anal fissure, or thrombosed hemorrhoids. Educational objective: Common symptoms of small-bowel obstruction include rapid onset of nausea and vomiting, colicky intermittent abdominal pain, and abdominal distension. Absolute constipation and lack of flatus are usually seen with large-bowel obstruction. Initial treatment of an obstruction includes placing the client on NPO status, inserting a nasogastric tube, administering IV fluids, and instituting pain control measures.

During the Admission Assessment of a Client with a Small-Bowel