Small bowel obstruction (SBO) refers to a complete or partial blockage in the small intestine. It can be caused by scar tissue from a previous surgery, hernias, cancer, and inflammatory bowel disorders.
An SBO prevents contents from passing through into the large intestine. This causes waste products to build up above the portion of the obstruction. Symptoms include abdominal pain, vomiting, dehydration, constipation, and bloating.
Diagnosis for an SBO is determined with a combination of tests. A physical exam, abdominal X-ray, CT scan, ultrasound, and barium enemas are used to determine if the small bowel is obstructed and where exactly the blockage is. Patients are hospitalized to rest the bowel, with NPO status and IV fluids. If bowel rest does not improve symptoms, or if there is a complete blockage, surgery may be required.
The Nursing Process
Nurses will be involved in caring for patients with an SBO in the inpatient setting. Depending on the severity of the blockage, patients will need to receive IV fluids to maintain hydration and nasogastric suctioning to allow the bowel to rest and recover. Nurses will educate patients on risk factors, symptoms, and management of their condition.
Nursing Care Plans Related to Small Bowel Obstruction
Acute Pain Care Plan
Patients with small bowel obstruction can experience pain due to inflammation and blockage within the small intestine.
Nursing Diagnosis: Acute Pain
- Inflammation of scar tissue
As evidenced by:
- Reports of cramping
- Guarding behaviors
- Facial grimacing
- Patient will report a decrease or relief in cramping and pain
- Patient will display a relaxed appearance with vital signs within normal limits
Acute Pain Assessment
1. Assess the patient’s pain level.
Assess the patient’s type of pain and pain level. Observe where the pain is located, a description of the pain (sharp, dull, continuous), and the intensity. Assess regularly for any changes in pain levels or location.
2. Assess nonverbal pain cues.
Observe for nonverbal cues that may indicate a patient is in pain, even when they deny it. Nonverbal cues include facial grimacing, restlessness, sweating, and abdominal guarding.
3. Assess changes in vital signs.
Changes in vital signs can signify increased pain. A patient may become hypertensive or tachycardic when their pain increases from their baseline. Note pain level when taking vital signs to help compare patient’s vital signs with their verbal and nonverbal pain assessments. Keep in mind the patient can still experience pain without a change in vital signs.
Acute Pain Interventions
1. Administer pain medications as ordered.
Managing pain is better achieved when pain medications are given routinely. Pain medication will likely be administered IV as the patient with an SBO will likely not be able to tolerate oral medications and will be prescribed NPO status for bowel rest.
2. Provide comfort measures.
Comfort measures such as massage, deep breathing, and guided imagery can help ease a patient’s pain. Additionally, distraction activities such as watching TV, playing games, or reading can help focus their mind on something else as a way of coping with the pain.
3. Cluster nursing care with pain medication.
Perform nursing care when the pain medication is at its peak therapeutic level. Anticipate administering pain medication before pain is severe, and then waiting until the relief is at its highest, so the patient is most comfortable and in the least amount of pain before tasks such as repositioning, ambulating, or bathing.
4. Place nasogastric tube.
A patient with small bowel obstruction will need a nasogastric tube to help decompress the stomach. The decompression will relieve abdominal distention and help decrease the patient’s pain.
Imbalanced Nutrition: Less Than Body Requirements Care Plan
Patients with small bowel obstruction can experience imbalanced nutrition due to impaired digestion and lack of absorption in the bowel.
Nursing Diagnosis: Imbalanced Nutrition
- Restricted intake as ordered to rest the bowel
- Altered absorption of nutrients
- Vomiting or diarrhea
As evidenced by:
- Hyperactive bowel sounds
- Loss or lack of appetite
- Weight loss
- Abnormal electrolyte panel
- Decreased energy
- Patient’s weight will become stabilized while in the hospital without further weight loss
- Patient will maintain nutritional and electrolyte lab values within normal range
- Patient will report an increase in appetite and energy levels
Imbalanced Nutrition: Less Than Body Requirements Assessment
1. Assess lab values.
The nurse can monitor for abnormalities in nutritional lab values such as albumin and electrolyte levels such as potassium and sodium.
2 . Monitor intake and output.
SBO can cause the patient to experience vomiting, which can worsen malnutrition and electrolyte abnormalities. It’s important to record all intake and output sources accurately.
3. Assess nutrition and diet.
Talk with the patient about their current nutritional intake. Inquire about foods that exacerbate symptoms or any food allergies they are aware of.
Imbalanced Nutrition: Less Than Body Requirements Interventions
1. Maintain NPO status as ordered.
Patients will generally be NPO at first to rest the bowel. This reduces hyperactivity in the bowel and decreases vomiting which will limit the loss of fluids and nutrients, therefore decreasing further malnutrition.
2. Weigh daily.
Daily weight can help evaluate the patient for malnutrition. It also provides information on how effective the ongoing treatment is while the patient is in the hospital.
3. Resume diet as tolerated.
Once the patient is no longer NPO and is cleared to eat, encourage the patient to advance their diet slowly. Starting with a clear liquid diet and then moving on to smaller meals gives the small intestine a chance to readjust and absorb what is being introduced.
4. Encourage patient involvement.
The patient may be hesitant about eating, fearing that food may cause more symptoms. Encouraging them to make a list of foods they enjoy and would be willing to try may help them feel in control. Also having a chance to eat the foods they most enjoy will help increase their appetite and willingness to eat.
Constipation Care Plan
Patients with a small bowel obstruction can experience varying degrees of constipation.
Nursing Diagnosis: Constipation
- Inflammation within the bowels
- Narrowing of the lumen
As evidenced by:
- Abdominal pain
- Abdominal distention
- Infrequent passage of stool
- Straining and discomfort with defecation
- Verbalizes feeling bloated
- Patient will verbalize having a bowel movement without straining
- Patient will implement two strategies to relieve constipation
- Patient will have a bowel movement at least every 2-3 days
1. Assess their usual pattern.
Assess the patient’s pattern for bowel movements, including the frequency and consistency of the stools. This provides a baseline to assess for any changes in their status.
2. Assess diet and fluid intake.
Inquire about the patient’s diet and fluid intake. Ask if they have noticed specific foods that cause constipation or a change in the color and consistency of their stool. Assess the amount and type of liquids the patient consumes.
3. Assess for pain or straining with defecation.
Ask the patient if they have pain with defecating. Hemorrhoids are often caused by straining and can cause pain themselves, contributing to the patient withholding stooling, which creates a cycle of constipation.
1. Provide a warm sitz bath as appropriate.
The warm water of a sitz bath can help relieve pain and discomfort for a patient experiencing constipation related to an SBO or hemorrhoids.
2. Encourage hydration.
Once the patient is allowed to consume fluids, encourage hydration. Discourage them from drinking alcohol or caffeine, and educate these fluids can dehydrate them. Adequate fluid intake helps soften the stool, making it easier to pass through the intestines and rectum.
3. Encourage fiber when appropriate.
Fiber should be encouraged to help with constipation but needs to be introduced very slowly. Too much fiber too quickly can cause abdominal distress or diarrhea. The patient may need education on fibrous foods or supplements at discharge.
4. Encourage physical activity.
A sedentary lifestyle can contribute to constipation. Encourage walking in the hospital and once discharged as this increases gastric motility and emptying.
References and Sources
- Abdominal Adhesions | NIDDK. (n.d.). National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved April 22, 2022, from https://www.niddk.nih.gov/health-information/digestive-diseases/abdominal-adhesions
- Baiu, H. (2018, 05 22). Small Bowel Obstruction. JAMA Network. https://jamanetwork.com/journals/jama/fullarticle/2681748#:~:text=A%20small%20bowel%20obstruction%20is,being%20handled%20during%20an%20operation.
- Bowel Obstruction Causes & Symptoms. (n.d.). Bladder & Bowel Community. Retrieved April 22, 2022, from https://www.bladderandbowel.org/bowel/bowel-problems/bowel-obstruction-small-bowel-obstruction/
- Intestinal or bowel obstruction – discharge. (2020, September 30). MedlinePlus. Retrieved April 22, 2022, from https://medlineplus.gov/ency/patientinstructions/000150.htm
- Schick, M. (n.d.). Small Bowel Obstruction – StatPearls. NCBI. Retrieved April 22, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK448079/
- Understanding an Intestinal Obstruction. (n.d.). Johns Hopkins Medicine. Retrieved April 22, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/understanding-an-intestinal-obstruction