# A patient is post-op day 1 from open colon resection. Review the bowel function trend and answer the questions.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393506&lang=en  
> language: en  
> subject: Reduction of Risk Potential  
> category: ROR

## Question

A patient is post-op day 1 from open colon resection. Review the bowel function trend and answer the questions.

| Time | Data |
| --- | --- |
| Post-op day 1 | Bowel sounds absent in all 4 quadrants. NG to suction draining bilious fluid 250 mL/8h. No flatus. Pain controlled with PCA morphine. |
| Post-op day 2 | Bowel sounds hypoactive. NG output 180 mL/8h. No flatus yet. Patient ambulated x2 with assistance. |
| Post-op day 3 | Bowel sounds active in all 4 quadrants. Patient passed flatus this AM. NG output 80 mL/8h. Tolerating ice chips. |
| Post-op day 4 | Active bowel sounds. Multiple flatus passages. NG removed. Tolerating clear liquids without nausea. |

Q1. What does the trend show?

Expected resolution of postoperative ileus
Worsening ileus requiring surgical re-exploration
Acute small bowel obstruction
Anastomotic leak

Q2. Which combination of interventions BEST supports continued recovery?

Strict bed rest, IV opioids only, NG tube to high suction
Early progressive ambulation, multimodal analgesia minimizing opioids, gum chewing as sham feeding, NG removal when flatus returns and stepwise diet advancement
Aggressive enema and laxatives starting on post-op day 1
Continuous opioid infusion to keep patient comfortable and immobile

## Explanation

The trend shows expected post-op ileus resolution: bowel sounds returning by day 2, flatus on day 3, advancement to clear liquids on day 4. Priority interventions: early ambulation (single most evidence-based intervention for ileus resolution), gum chewing (sham feeding stimulates peristalsis), minimize opioid use with multimodal analgesia, advance diet as flatus and bowel function return. Continued NG suction past resolution delays recovery.

## In-depth explanation

Post-op ileus is normal up to ~3 days for colon surgery; beyond is prolonged ileus. Three highest-impact interventions: early ambulation, multimodal pain control to minimize opioids, and gum chewing. NG tube removal once flatus returns; advance diet stepwise.

## Clinical scenario

**Post-op day 1 from open colon resection**. NG tube to low intermittent suction. Receiving morphine PCA. The nurse evaluates bowel function recovery.

## Key concepts

- **Postoperative ileus** — Transient impaired bowel motility post-op; up to 3 days for colon surgery is expected; > 3 days = prolonged ileus.
- **Sham feeding (gum chewing)** — Stimulates cephalic-vagal phase of digestion; reduces ileus duration in post-op patients.
- **Multimodal analgesia** — Acetaminophen, NSAID, regional anesthesia minimize opioid burden; opioids worsen ileus.

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