Blocked Bruno — Bowel Obstruction
No stool, no flatus, high-pitched bowel sounds above the block — vomiting relieves, then it's silence
Bruno had abdominal surgery two years ago and now hasn't passed gas or stool in three days. His abdomen is distended and tight, and he's vomiting a foul, bilious fluid every hour.
Bruno's bowel obstruction traps gas, fluid and stool behind a mechanical blockage from adhesions. Above the obstruction, bowel sounds are high-pitched and hyperactive as the bowel fights to push contents through; below it, nothing passes. As the bowel distends and perfusion fails, sounds fall silent — a sign of worsening ischemia, not improvement. Fluid and electrolytes shift dramatically, and a sudden, severe increase in pain followed by fever signals perforation.
Read Blocked Bruno's full story →The story arc
The setup
Scar tissue from Bruno's abdominal surgery two years ago has slowly formed adhesions that now kink a loop of bowel.
The turn
Bruno hasn't passed gas or stool in three days, his abdomen is distended, and bowel sounds are high-pitched and rushing above the blockage.
The crisis
Bruno begins vomiting foul, bilious fluid repeatedly, his abdomen grows tighter, and his bowel sounds suddenly go silent.
The save
The nurse keeps Bruno NPO, inserts and maintains a nasogastric tube to low intermittent suction for decompression, monitors electrolytes and fluid balance closely, and watches for the sudden severe pain and fever that would signal perforation requiring emergency surgery.
NCLEX study section — Bowel Obstruction
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Gastrointestinal & Renal
Take this chapter into practice questions on the same topic.