# Situation: A 66-year-old man weighing 70 kg, who had open abdominal surgery 3 years ago, is admitted with colicky mid-abdominal pain, repeated bilious vomiting since yesterday, and no flatus for 12 hours. An abdominal X-ray shows dilated small-bowel loops with air-fluid levels. He is kept nil per os (NPO), a nasogastric (NG) tube is connected to low suction, and intravenous (IV) fluids are started. The obstruction is managed without surgery. Findings on day 2 and day 3 are compared: NG drainage in 24 hours: 1,200 mL → 300 mL Abdominal girth: 98 cm → 92 cm Flatus: none → passed several times Pain: colicky 6/10 → mild 1/10 The NG tube is removed on day 3. Which diet order is BEST for him now?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630282  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 66-year-old man weighing 70 kg, who had open abdominal surgery 3 years ago, is admitted with colicky mid-abdominal pain, repeated bilious vomiting since yesterday, and no flatus for 12 hours. An abdominal X-ray shows dilated small-bowel loops with air-fluid levels. He is kept nil per os (NPO), a nasogastric (NG) tube is connected to low suction, and intravenous (IV) fluids are started.

The obstruction is managed without surgery. Findings on day 2 and day 3 are compared:
NG drainage in 24 hours: 1,200 mL → 300 mL
Abdominal girth: 98 cm → 92 cm
Flatus: none → passed several times
Pain: colicky 6/10 → mild 1/10
The NG tube is removed on day 3. Which diet order is BEST for him now?

## 보기

1. His usual full diet, since passing flatus shows bowel function
2. Clear liquids, then soft low-residue foods as tolerated **✔ 정답**
3. High-fiber foods with bran to prevent a repeat obstruction
4. Nothing by mouth for 48 more hours to rest the bowel

**정답: 2**

## 해설

Falling NG drainage, smaller abdominal girth, passage of flatus, and minimal pain show that the adhesive obstruction is resolving. After nonoperative resolution, eating resumes gradually, starting with liquids or soft low-residue foods and advancing as tolerated while the nurse watches for returning distension, cramps, or vomiting.

## 심화 해설

Signs that the obstruction is resolving
Comparing day 2 and day 3 shows clear improvement: NG drainage fell from 1,200 mL to 300 mL in 24 hours, abdominal girth decreased from 98 cm to 92 cm, he passed flatus several times, and colicky pain eased from 6/10 to mild 1/10. Together these show that the adhesive small-bowel obstruction is resolving and that bowel function is returning. After nonoperative resolution, eating resumes gradually, starting with clear liquids and advancing to soft, low-residue foods as tolerated.

Why the diet is advanced gradually
The bowel has been distended and inflamed, and its motility is still recovering. Starting with clear liquids tests tolerance with minimal load. If he tolerates liquids without distension, cramps, nausea, or vomiting, the diet advances to soft, low-residue foods, which leave little undigested material to pass through a bowel that may still be partly narrowed by adhesions. A sudden full diet or a high-fiber meal can overwhelm recovering motility and provoke a recurrence of symptoms.

| Diet option | Assessment |
| --- | --- |
| Usual full diet at once | Flatus is a good sign, but intake resumes gradually |
| Clear liquids, then soft low-residue foods | Correct: gradual advance with monitoring |
| High-fiber foods with bran | Bulky roughage is not the first step after an obstruction |
| NPO for 48 more hours | Obstruction has resolved; prolonged NPO only delays nutrition |

What the nurse monitors
Watch out! Resolution can be incomplete, and obstruction from adhesions can recur. As the diet advances, the nurse watches for returning abdominal distension, colicky pain, nausea or vomiting, and reduced flatus or stool, and reports these promptly. The nurse also continues to check bowel sounds, abdominal girth, intake and output, and electrolytes, especially potassium, which was low on admission. If symptoms return, the client is made NPO again and the physician is notified.

Why prolonged NPO is not the answer
Keeping him NPO after the obstruction has resolved provides no benefit and delays nutrition in a 66-year-old who has already had several days without food. Early, careful refeeding supports healing and recovery of bowel function. The goal is to reintroduce food at the right pace, not to keep the bowel at rest indefinitely.

Exam takeaway
Key point! Falling NG output, decreasing girth, passing flatus, and less pain = resolving obstruction. Resume intake gradually: clear liquids first, then soft low-residue foods, watching for distension, cramps, or vomiting.

## 임상 시나리오

Diet After a Resolved ObstructionAdvancing intake safely after NG removal
NG drainage fell from 1,200 to 300 mL, girth decreased, flatus returned, and pain eased to 1/10. The adhesive obstruction is resolving.

Start clear liquids, then advance to soft, low-residue foods as tolerated. A full or high-fiber diet at once can provoke recurrence.

Continue monitoring girth, bowel sounds, flatus, intake and output, and potassium.

CautionIf distension, colicky pain, or vomiting returns, stop oral intake and notify the physician; adhesive obstruction can recur.

## 핵심 개념

- **Adhesive small-bowel obstruction** — Blockage of the small bowel by fibrous bands formed after abdominal surgery.
- **Low-residue diet** — A diet low in fiber that leaves little undigested material in the bowel.
- **Clear liquid diet** — Transparent fluids such as broth and water used to test tolerance when resuming intake.
- **Flatus** — Passage of intestinal gas, a sign that bowel motility is returning.
- **Nonoperative management** — Treatment of obstruction with NPO, NG decompression, and IV fluids instead of surgery.

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