paralytic ileus [Gk, paralyein, to be paralyzed, eilein, to twist] , a decrease in or absence of intestinal peristalsis. It may occur after abdominal surgery or peritoneal injury or be associated with severe pyelonephritis; ureteral stone; fractured ribs; myocardial infarction; extensive intestinal ulceration; heavy metal poisoning; porphyria; retroperitoneal hematomas, especially those associated with fractured vertebrae; or any severe metabolic disease. The most common overall cause of intestinal obstruction, paralytic ileus is mediated by a hormonal component of the sympathoadrenal system. Also called adynamic ileus. ▪ OBSERVATIONS: Paralytic ileus is characterized by abdominal tenderness and distension, absence of bowel sounds, lack of flatus, and nausea and vomiting. There may be fever, decreased urinary output, electrolyte imbalance, dehydration, and respiratory distress. Loss of fluids and electrolytes may be extreme, and, unless they are replaced, the condition may lead to hemoconcentration, hypovolemia, renal insufficiency, shock, and death. ▪ INTERVENTIONS: Typically, computed tomography of the abdomen and pelvis is performed with PO and IV contrast to rule out anatomical obstruction. The patient is kept in bed in a low Fowler’s position, and nothing is given by mouth. A nasogastric tube may be inserted into the stomach and connected to intermittent suction and the patient is positioned to facilitate the advancement of the tube, which is checked at intervals, usually every 30 to 60 minutes. The character of GI drainage is monitored at intervals, usually every 2 to 4 hours, and any increase or decrease in the amount or changes in the color or consistency is reported. Bowel sounds, blood pressure, pulse, and respirations are checked every 2 to 4 hours, or as indicated in a particular circumstance, and rectal temperature usually every 4 hours. Abdominal girth is measured at least every 2 hours, and any increase is reported. Parenteral fluids with electrolytes and medication to promote peristalsis are administered as ordered; intake and output are measured, and, if less than about 30 mL of urine is excreted per hour, the physician is informed. The patient is helped to turn and deep breathe every 2 to 4 hours and is given oral hygiene every 1 to 2 hours. Active or passive range-of-motion exercises are performed every 4 hours. Walking is helpful as gravity is a useful force. When intestinal output increases and bowel sounds return, the intestinal tube may be clamped and small amounts of warm tea may be given. If pain, distension, or cramps do not recur, the intestinal tube may be removed, but a rectal tube or an enema may be ordered to relieve distension. ▪ PATIENT CARE CONSIDERATIONS: The concerns of the health care providers include monitoring and reporting the signs of paralytic ileus and its potential complications, ensuring that the patient is as comfortable as possible, explaining the purpose of the intestinal tube, and walking with the patient, encouraging ambulation. The patient is instructed to try to avoid mouth breathing because swallowed air can increase distension. Before surgery, patients need reassurance that the sutures are strong and the distended abdomen will not burst.
