Bowel Obstruction

An adult with previous abdominal surgery develops waves of cramping pain, vomiting, abdominal distention, and no flatus. The important question is not simply when the last bowel movement occurred; it is whether intestinal flow is blocked and whether bowel perfusion is threatened. A mechanical obstruction creates a barrier. The bowel contracts against it, while fluid, gas, and secretions accumulate proximally. Vomiting and fluid sequestration can rapidly reduce circulating volume. Increasing intraluminal pressure can impair venous drainage, produce bowel-wall edema, and progress to arterial ischemia, necrosis, or perforation. The RN therefore assesses two problems in parallel: the severity of the obstruction and the patient’s perfusion. A patient with intermittent colicky pain may have uncomplicated obstruction; a shift to constant severe pain, peritoneal findings, or shock changes the priority to urgent surgical escalation.