Postop patient with absent bowel sounds and abdominal distension; what is your concern?

• A. Normal postoperative change
• B. Possible ileus or obstruction; monitor for N/V; notify physician if no progression
• C. Urinary retention
• D. Pulmonary embolism

Answer: (B)

When a postoperative patient has absent bowel sounds and abdominal distension, the main concern is impaired bowel motility or a possible obstruction. This pattern points to a postoperative ileus or a potential mechanical obstruction rather than a normal, self-limiting recovery. Absent or hypoactive sounds with distension indicate that the gut isn’t moving contents forward, which can lead to vomiting, electrolyte imbalances, and further complications if not monitored and evaluated. The appropriate response is to monitor progression, keep the patient NPO, assess for nausea or vomiting, check for signs of obstruction (such as increasing pain or vomiting), consider bowel rest with possible decompression (like an NG tube), and notify a physician if there’s no improvement or if red flags appear. Urinary retention would present with a distended bladder and urinary symptoms, not absent bowel sounds; pulmonary embolism would present with respiratory symptoms rather than primary abdominal findings.