Paralytic ileus, also referred to simply as ileus, temporarily slows or paralyzes the peristalsis of food particles through the lower digestive tract. It mimics an intestinal obstruction without an actual obstruction happening. It can cause various symptoms, such as abdominal pain, nausea, vomiting, constipation, and bloating.
Different types of conditions can cause paralytic ileus, including:
- Inflammation of the abdominal cavity
- Infectious processes
- Medications such as opioids and anticholinergics
- Electrolyte imbalances
- Thyroid diseases
- Surgery
- Chronic conditions like renal failure
An ileus is diagnosed through an abdominal x-ray which allows visualization of swollen bowel without an obstruction. Lab tests can assess underlying causes.
Paralytic ileus is an acute condition that is reversible, but if symptoms become severe or the ileus lasts longer than 48 hours, it should be treated as an emergency.
Nursing Process
Electrolyte imbalance correction, controlled food and fluid intake, and simple bowel rest may hasten recovery. Nurses are vital in administering fluids and correcting electrolyte imbalances. A mixture of preventative and supportive interventions is necessary for ileus recovery.
Nursing Care Plans Related to Paralytic Ileus
Constipation
Paralytic ileus can cause constipation due to the lack of normal muscle contractions in the intestine, which is needed to move food particles through the lower digestive tract.
Nursing Diagnosis: Constipation
Related to:
- Decreased motility of gastrointestinal tract
- Electrolyte imbalance
- Opioid use
- Surgical intervention
As evidenced by:
- Abdominal distention
- Verbalization of abdominal pain
- Inability to pass stool
- Nausea
- Vomiting
- Reports of bloating
Expected outcomes:
- Patient will have a regular bowel movement.
- Patient will verbalize reduced abdominal pain and bloating.
- Patient will display an increase in activity level.
Assessment:
1. Assess the patient’s bowel habits and patterns of elimination.
Determining the patient’s usual bowel pattern will be helpful in understanding baseline data. A constipated person will have hard, dry or small stools in pieces less than 3 times a week.
2. Investigate verbalizations of pain in the abdomen or in defecation.
Pain may be caused by the discomfort of passing a large or hard stool or the feeling of tenderness in the intestines. Bloating can also cause pain due to paralyzed movement in the intestines.
3. Review imaging results.
An abdominal X-ray or ultrasound can confirm the presence of a pseudo-obstruction by showing swollen or dilated segments of stool without any blockage.
Interventions:
1. Instruct on bowel rest.
The patient may need to be restricted from eating anything by mouth to help the intestines rest until bowel sounds return or flatus is passed.
2. Administer parenteral nutrition.
The replacement of fluids, electrolytes, and nutrition can quickly hasten recovery.
3. Encourage increased activity within individual limits.
Mobilization helps stimulate intestinal peristalsis.
4. Administer prokinetics as prescribed.
Prokinetic drugs such as metoclopramide, cisapride or erythromycin may enhance gastrointestinal motility by increasing the frequency or strength of contractions.
Acute Pain
Paralytic ileus can cause excessive abdominal discomfort. The pain is caused by a buildup of gas and food.
Nursing Diagnosis: Acute Pain
Related to:
- Bloating
- Constipation
- Inability to pass gas and/or stool
As evidenced by:
- Moaning, crying, restlessness
- Guarding behavior
- Positioning to avoid pain
- Verbalization of pain
- Abdominal tenderness
Expected outcomes:
- Patient will report alleviation or control of pain.
- Patient will describe satisfactory pain control at a level less than 4 on the pain scale.
- Patient will display comfort, as evidenced by resting and unlabored breathing.
Assessment:
1. Assess for signs and symptoms of pain.
Pain tolerance varies in each individual, and some may deny the presence of pain if it is tolerable for them. Identifying the presence of pain will help in addressing it earlier. Elevated pulse, blood pressure, diaphoresis, or changes in activity may indicate signs of pain.
2. Monitor abdominal discomfort symptoms.
The patient may describe their abdominal discomfort as tenderness. Bloating is common, and nausea may occur. Assess for abdominal distention.
Interventions:
1. Provide a quiet and relaxing environment.
Some patients may perceive pain as worse when stressors are present in the environment. Providing a relaxed atmosphere will be conducive to alleviating pain.
2. Insert an NG tube.
This intervention will not prevent or shorten the duration of an ileus but can provide some relief from decompression once an ileus has occurred.
3. Administer NSAIDs over opioids.
Opioids are a significant cause of ileus following abdominal surgery. NSAIDs may assist in reducing the amount and duration of opioids needed to control pain.
4. Provide nonpharmacologic relief.
Paralytic ileus often resolves in a few days. Provide relief interventions through distraction, relaxation, and rest.
Ineffective Tissue Perfusion (Gastrointestinal)
Ineffective tissue perfusion is related to insufficient blood flow to the organs and tissues. In paralytic ileus, there is an obstruction in the bowel which can affect the body’s circulation.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Paralytic ileus
- Decreased bowel motility
- Hypovolemia
As evidenced by:
- Distended abdomen
- Tender abdomen
- Nausea, vomiting
- Abdominal distention
- Bloating
- Absent bowel sounds
Expected outcomes:
- Patient will be free of abdominal distention.
- Patient will display active bowel sounds.
Assessment:
1. Assess the patient’s bowel sounds.
Bowel noises are likely to be weak or non-existent. Insufficient blood supply may stop peristalsis (involuntary constriction and relaxation of the intestinal muscles) and slow digestion.
2. Monitor and record vital signs.
Watch out for hypotension and tachycardia, as these are the first indicators of hypovolemia in the circulatory system.
3. Measure abdominal girth.
Increasing abdominal girth correlates with worsening distention.
Interventions:
1. Instruct the patient to eat small, easily digestible meals.
Early nutrition in the postoperative period has been shown to decrease postoperative ileus and length of hospital stay.
2. Administer intravenous fluids and electrolytes.
Vomiting and dehydration may cause an imbalance in the patient’s electrolytes. IVF may be needed to replace electrolytes and circulating volume.
3. Encourage gum chewing.
If the patient can’t yet tolerate food orally, chewing gum has proven to be an effective method following surgery to restart bowel function.
4. Administer alvimopan.
This medication is a mu-opioid receptor antagonist that acts on GI receptors and can prevent the development of postoperative ileus.
References
- Paralytic Ileus. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21853-paralytic-ileus. Accessed Dec. 3, 2022
- Doenges, M. E., Moorhouse, M. F. (1993). Nurses’s Pocket Guide: Nursing Diagnoses with Interventions (4th Ed.). F.A. Davis Company.
- Weledji, E.P.. Perspectives on paralytic ileus. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533151/. Published Oct. 4, 2020
- Lewis, S.. Paralytic Ileus Causes and Treatments. Healthgrades. https://www.healthgrades.com/right-care/digestive-health/paralytic-ileus. Accessed Dec. 6, 2022
