Deviation in the Standard of Postoperative Care Resulting in Ileus

Evaluate breaches in the standard of care by asking and answering the questions herein in accordance with your particular fact pattern to determine whether or not there has or has not been a Deviation in the Standard of Postoperative Care Resulting in Ileus

Answer the following questions to find out if the standard of care was followed for your case.

  • Which type of surgery did the patient undergo?
    Abdominal surgery
    Extra abdominal surgery
    Why is this important?
    Post-operative ileus (POI) is usually regarded as the transient impairment of intestinal motility occurring after operation. It is generally considered as a normal and almost inevitable event consistently occurring after major abdominal surgical procedures, and to a lesser extent also following extra-abdominal surgery such as major orthopedic or cardiothoracic procedures.
    (2006) 43 ECURPS 1 12-65

  • Was an epidural anesthetic administered? Why is this important?
    Answer this question
    
Epidural anesthesia may play an important role in decreasing post-operative ileus, by blocking inhibitory reflexes originating from the spinal cord.

    (2003) 1 CLGAHE 2 71-80 



  • Was the patient monitored periodically for signs of ileus? Why is this important?
    Answer this question
    
Following abdominal surgery the surgical site and the abdomen must be assessed frequently.

    (2006) 21 JPANEN 2S1 S7-S15 



  • With which of the following symptoms did the patient present? Why is this important?
    Answer this question
    
The physiologic inhibition of gastric motility and the propulsive action that defines post operative ileus is accompanied by specific clinical characterizations.

    (2006) 21 JPANEN 2S1 S7-S15 



  • Were discharge instructions provided? Why is this important?
    Answer this question
    
Patients must receive thorough discharge instructions reflecting the treatment they have received, the new medications they have been prescribed, and the necessary follow up evaluations required after discharge to minimize the likelihood of relapse and re-admission to the healthcare facility.

    (2003) 1CLGAHE 2 7 



  • Was a laparoscopic or an open surgery performed? Why is this important?
    Answer this question
    
The use of minimally invasive techniques such as laparoscopy produces less physical tissue trauma compared with open surgery. Laparoscopic procedures are required to prevent complications of open surgery.

    (2006) 43 ECURPS 1 12-65 



  • Were diagnostic laboratory studies performed? Why is this important?
    Answer this question
    
Laboratory testing is necessary to rule out other differential diagnoses when clinical signs of ileus present.

    (2008) 92 EMEDCN 3 649-670 



  • Were diagnostic imaging studies performed? Why is this important?
    Answer this question
    
Plain abdominal roentgenograms reveal pronounced small bowel dilatation, but may reveal less pronounced large bowel dilatation. Additional imaging, such as abdominal CT or barium studies, may be necessary to exclude small bowel obstruction.

    (2008) 92 EMEDCN 3 649-670 



  • With which of the following signs or symptoms did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
The symptoms of small bowel obstruction are abdominal distensions, vomiting, crampy abdominal pain and inability to pass flatus.

    (2008) 92 EMEDCN 3 649-670 



  • Was a CT scan of the abdomen performed? Why is this important?
    Answer this question
    
CT is considered the best modality for determining which patients would benefit from conservative management and close follow-up and which patients would benefit from immediate surgical intervention.

    (2008) 92 EMEDCN 3 649-670 



  • Did the imaging study show signs of bowel obstruction? Why is this important?
    Answer this question
    
Most patients with small bowel obstruction are classified as having simple obstructions that involve mechanical blockage of the flow of luminal contents without compromised viability of the intestinal wall.

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  • Was treatment initiated upon confirmation of the patient’s bowel obstruction? Why is this important?
    Answer this question
    
Patients with intestinal obstruction are usually dehydrated and depleted of sodium, chloride, and potassium, requiring aggressive IV replacement.

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  • Was the electrolyte imbalance corrected? Why is this important?
    Answer this question
    
IV replacement with an isotonic saline solution such as lactated Ringer's solution is the standard treatment for dehydration.

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  • Was a nasogastric tube inserted? Why is this important?
    Answer this question
    
Nasogastric decompression is required in patients with vomiting or abdominal distension.

    (2008) 92 EMEDCN 3 649-670 



  • Did the clinician modify the patient’s pain medications to prevent ileus? Why is this important?
    Answer this question
    
Since opioids can cause post-operative ileus, it may be necessary to modify the pain medications if symptoms of ileus present.

    (2003) 1CLGAHE 2 71-80 



  • Were repeat imaging studies performed? Why is this important?
    Answer this question
    
Repeat imaging studies must be performed periodically in a patient with prolonged post-operative ileus to check for improvement of the condition and also to check for any further pathology.

    (2008) 92 EMEDCN 3 649-670 



  • Was the patient started on a liquid diet upon the return of bowel sounds? Why is this important?
    Answer this question
    
When the patient is taking adequate fluids, his/her diet may be increased. Once the abdomen decompresses and bowel sounds return, the patient can be placed on a liquid diet.

    Click here for additional information at ClinicalKey.com