Which of the following interventions would be most appropriate for preventing the development of a paralytic ileus in a client who has undergone renal surgery?
A. Encourage the client to ambulate every 2 to 4 hours.
B. Offer 3 to 4 ounces of a carbonated beverage periodically.
C. Encourage use of a stool softener.
D. Continue intravenous fluid therapy.
Correct Answer: A. Encourage the client to ambulate every two (2) to four (4) hours.
Ambulation stimulates peristalsis. A client with paralytic ileus is kept NPO until peristalsis returns. Encouraging ambulation very early in the postoperative period is a simple but very important prevention and treatment measure. Regular and serial clinical assessments should be exerted with open eyes and mind for worsening complications or a missed diagnosis.
Option B: Management of postoperative ileus revolves around supportive care. After excluding serious or treatable conditions, supportive treatment and optimizing care almost always resolve the ileus. These measures include intravenous fluid replacement, electrolyte replacement, early ambulation, and often nasogastric tube placement.
Option C: A stool softener will not stimulate peristalsis. Multiple studies have assessed a few treatment measures to overcome ileus but with no clinically significant outcomes. Studies on gum-chewing showed some improvement in the ileus. Therefore, this is occasionally but not widely used in clinical practice.
Option D: Intravenous fluid infusion is a routine postoperative order that does not have any effect on preventing paralytic ileus. A careful balance between postoperative pain control and analgesics, especially opiates use, is crucial to prevent or treat the ileus. Non-opiate analgesics are encouraged. Optimizing electrolytes and other metabolites are important.
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