Paralytic ileus is a temporary slowing or paralysis of peristalsis through the lower digestive tract. It mimics an intestinal obstruction without an actual mechanical cause.
Paralytic ileus is an acute condition that is reversible and may resolve on its own, but if symptoms become severe or the ileus lasts longer than 72 hours, it should be treated as an emergency.
In this article:
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- Constipation
- Dysfunctional Gastrointestinal Motility
- Ineffective Tissue Perfusion (Gastrointestinal)
- Nausea
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 Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section, we will cover subjective and objective data related to paralytic ileus.
Review of Health History
1. Identify the patient’s general symptoms.
Paralytic ileus mimics an intestinal obstruction without a physical blockage. It can cause various symptoms, such as:
- Abdominal distension
- Nausea
- Vomiting
- Lack of appetite (anorexia)
- Feeling of fullness
- Constipation
- Bloating
2. Determine the cause.
Different conditions can cause paralytic ileus, including:
- Inflammation of the abdominal cavity (appendicitis, pancreatitis, cholecystitis, etc.)
- Infectious processes
- Medications such as opioids and anticholinergics
- Electrolyte imbalances
- Thyroid diseases
- Heart attack
- Abdominal surgery
- Chronic conditions like renal failure, respiratory failure, and spinal cord injuries
3. Ask about any abdominal discomfort.
Paralytic ileus is not often painful but may be uncomfortable due to abdominal distension and bloating that develops slowly.
4. Expect an ileus following abdominal procedures.
Postoperative ileus is a relatively common adverse effect of any procedure that disrupts GI motility. Bowel function should resume on its own within 1-3 days post-op.
Physical Assessment
1. Perform an abdominal examination.
On physical examination, the patient frequently exhibits distention, mild diffuse tenderness upon palpation, and tympanic sound on percussion.
2. Auscultate for bowel sounds.
Absent or hypoactive bowel sounds are a distinctive characteristic.
3. Monitor for bowel movements or flatus.
Due to the paralysis of GI motility, the patient will not have bowel movements or pass flatus (gas).
Diagnostic Procedures
1. Analyze laboratory studies.
A laboratory investigation should be completed to help find any possibly treatable ileus causes, such as hypokalemia or infection.
2. Obtain a sample for bloodwork.
- Complete blood cell (CBC) count rules out bleeding or an elevated white count, which may be seen with an abscess, infection, or intestinal ischemia.
- Electrolyte panels check for imbalances in the electrolytes.
3. Schedule an imaging scan.
Imaging scans provide an accurate visualization of the GI system.
- Plain X-rays, both supine and upright, show air in the colon and rectum without a transition point, as well as dilated small bowel loops.
- CT scan is conducted if the plain film is unclear. Oral and intravenous contrast most effectively excludes other intra-abdominal diseases, such as tumors or abscesses.
- Ultrasound shows swollen and dilated bowel segments not caused by a mechanical obstruction, confirming the diagnosis.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you’ll learn more about possible nursing interventions for a patient with paralytic ileus.
1. Address the cause.
The primary focus should be treating the underlying condition if it can be identified.
2. Rest the bowel.
No oral intake of food or liquids for 24 to 72 hours until bowel function returns.
3. Consider parenteral nutrition.
If, after seven days, the patient is still unable to tolerate appropriate oral intake, total parenteral nutrition (TPN) is advised to prevent malnutrition.
4. Infuse IV fluids as ordered.
Administer IV fluids as ordered to replenish lost fluids, correct electrolyte imbalances, and prevent dehydration.
5. Decrease or discontinue medications causing ileus.
Cutting back or discontinuing opiate use can reduce the risk of slowed peristalsis. Consider non-opioids and nonpharmacologic methods.
6. Promote peristalsis.
If the bowel function does not return as quickly as it should, prokinetics, which are drugs that increase peristalsis, may help.
7. Provide relief.
Insert a nasogastric tube through the nose and into the stomach to drain air and fluid and reduce uncomfortable symptoms.
8. Offer chewing gum.
Chewing gum may help prevent a postoperative ileus by stimulating the vagus nerve, which promotes peristalsis.
9. Encourage early ambulation.
Early ambulation is one of the most effective ways to restart bowel function following surgical procedures.
10. Assist the patient in preparing for surgery.
Most incidences of paralytic ileus resolve on their own with supportive therapy. However, surgery may be required if the ileus is prolonged.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for paralytic ileus, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for paralytic ileus.
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.
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.
Dysfunctional Gastrointestinal Motility
Paralytic ileus is characterized as a functional problem of the nerves and muscles, which causes dysfunctional gastrointestinal motility mimicking a mechanical obstruction.
Nursing Diagnosis: Dysfunctional Gastrointestinal Motility
Related to:
- Disease process
- Inflammatory process
- Dehydration
- Medications
- Electrolyte imbalance
- Recent surgery
As evidenced by:
- Abdominal distension
- Abdominal discomfort
- Constipation
- Nausea
- Vomiting
- Sluggish bowel sounds
- Absence of flatus
Expected outcomes:
- Patient will not experience abdominal distension or discomfort following abdominal surgery.
- Patient will have at least one bowel movement every three days.
Assessment:
1. Assess the patient’s medical and surgical history.
Paralytic ileus is typically a temporary delay in motility due to a surgical procedure or chemical disturbance like medications, electrolyte imbalance, and metabolic disorders.
2. Assess and monitor the patient’s bowel sounds.
Patients experiencing paralytic ileus will display absent or sluggish bowel sounds.
3. Conduct a meticulous abdominal assessment.
Paralytic ileus does not cause colic or abdominal pain but may cause abdominal tenderness and distension. Upon inspection and percussion, the abdomen is observed to be distended and tympanic.
Interventions:
1. Keep the patient NPO as ordered.
Patients with paralytic ileus are kept NPO until the return of bowel sounds or flatus. This allows the bowel to rest and recover and prevents worsening complications.
2. Administer fluid and electrolyte replacement.
Fluid and electrolyte replacement can help prevent dehydration and electrolyte imbalances, which hastens the return of peristalsis in patients with paralytic ileus.
3. Administer medications as indicated.
Prokinetic drugs like metoclopramide are prescribed to stimulate peristalsis, improve gastrointestinal motility, and resolve nausea and vomiting.
4. Insert a nasogastric tube as indicated.
An NG tube may be indicated for patients with severe cases of paralytic ileus to decompress the gastrointestinal tract and relieve distension.
5. Assist the patient in ambulation.
Ambulation can help increase gastrointestinal motility and resolve paralytic ileus and its associated symptoms like bloating.
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.
Nausea
Since the bowels do not function properly with an ileus, fluids and gas can accumulate, which stretches the bowel walls, causing unpleasant symptoms like distension, bloating, constipation, nausea, and vomiting.
Nursing Diagnosis: Nausea
Related to:
- Anxiety
- Fear
- Unpleasant sensory stimuli
- Disease process
- Bowel obstruction
- Inflammatory process
- Abdominal discomfort
- Abdominal distension
As evidenced by:
- Gagging sensation
- Food aversion
- Increased salivation
- Sour taste
- Increased swallowing
- Vomiting
Expected outcomes:
- Patient will state relief from nausea.
- Patient will implement two interventions to help decrease nausea and prevent vomiting.
Assessment:
1. Assess the patient’s electrolyte levels.
Fluid and electrolyte imbalances, including hypokalemia, hypercalcemia, hypomagnesemia, and hypophosphatemia, can induce paralytic ileus but may also result from nausea and vomiting. Detecting imbalances is essential to treating a paralytic ileus and preventing further complications.
2. Assess the patient’s hydration status.
Nausea is associated with an aversion to fluids and food, resulting in an increased risk of dehydration, especially if accompanied by vomiting. Dehydration can further aggravate symptoms of paralytic ileus.
Interventions:
1. Keep the patient NPO.
Keeping the patient NPO reduces nausea and vomiting and enables the bowels to rest for faster healing, recovery, and return of peristaltic movement.
2. Administer intravenous fluids as indicated.
IV fluids can help correct dehydration and fluid and electrolyte imbalances in patients with nausea and vomiting.
3. Encourage routine oral care and hygiene.
Nausea and vomiting leaves an unpleasant taste and odor in the patient’s mouth. Providing oral care resolves these unpleasant sensations and reduces the incidence of persistent and recurring nausea and vomiting.
4. Use antiemetics cautiously.
Some antiemetics may inadvertently reduce bowel motility and worsen paralytic ileus. Metoproclamide is often the drug of choice to not only reduce nausea but restart bowel motility.
5. Encourage nonpharmacologic ways to reduce nausea.
Nonpharmacologic interventions like music therapy, guided imagery, and distraction can help reduce nausea.
References
- Beach, E., & De Jesus, O. (2022, June 27). Ileus – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. Retrieved March 2023, from https://www.ncbi.nlm.nih.gov/books/NBK558937/
- Cagir, B. (2022, December 22). Postoperative ileus treatment & management: Medical care, surgical care, diet. Diseases & Conditions – Medscape Reference. Retrieved March 2023, from https://emedicine.medscape.com/article/2242141-treatment#showall
- Doenges, M. E., Moorhouse, M. F. (1993). Nurses’s Pocket Guide: Nursing Diagnoses with Interventions (4th Ed.). F.A. Davis Company.
- Cleveland Clinic. (2021, October 8). Paralytic ileus: Definition, causes, symptoms & treatments. Retrieved March 2023, from https://my.clevelandclinic.org/health/diseases/21853-paralytic-ileus#symptoms-and-causes
- Khatri, M. (2022, August 14). What is ileus? WebMD. Retrieved March 2023, from https://www.webmd.com/digestive-disorders/what-is-ileus
- Lewis, S.. Paralytic Ileus Causes and Treatments. Healthgrades. https://www.healthgrades.com/right-care/digestive-health/paralytic-ileus. Accessed Dec. 6, 2022
- Paralytic Ileus. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21853-paralytic-ileus. Accessed Dec. 3, 2022
- Weledji, E.P.. Perspectives on paralytic ileus. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533151/. Published Oct. 4, 2020
