Bowel sounds, hypoactive

Hypoactive bowel sounds, detected by auscultation, are diminished in regularity, tone, and loudness from normal bowel sounds. They don't herald an emergency; in fact, they're considered normal during sleep. Hypoactive bowel sounds may portend absent bowel sounds, which can indicate a life-threatening disorder.

Hypoactive bowel sounds result from decreased peristalsis, which, in turn, can result from a developing bowel obstruction. The obstruction may be mechanical (as from a hernia, tumor, or twisting), vascular (as from an embolism or thrombosis), or neurogenic (as from mechanical, ischemic, or toxic impairment of bowel innervation). Hypoactive bowel sounds can also result from the use of certain drugs, abdominal surgery, and radiation therapy.

History and physical examination

After detecting hypoactive bowel sounds, look for related symptoms. Ask the patient about the location, onset, duration, frequency, and severity of any pain. Cramping or colicky abdominal pain usually indicates a mechanical bowel obstruction, whereas diffuse abdominal pain usually indicates intestinal distention related to paralytic ileus.

Ask the patient about any recent vomiting. When did it begin? How often does it occur? Does the vomitus look bloody? Ask about changes in bowel habits. Does he have a history of constipation? When was the last time he had a bowel movement or expelled gas?

Obtain a detailed medical and surgical history of conditions that may cause mechanical bowel obstruction, such as an abdominal tumor or hernia. Does the patient have a history of severe pain; trauma; conditions that can cause paralytic ileus, such as pancreatitis; bowel inflammation or gynecologic infection, which may produce peritonitis; or toxic conditions such as uremia? Has he recently had radiation therapy or abdominal surgery or ingested a drug, such as an opiate, which can decrease peristalsis and cause hypoactive bowel sounds?

After the history is complete, perform a physical examination. Inspect the abdomen for distention, noting surgical incisions and obvious masses. Gently percuss and palpate the abdomen for masses, gas, fluid, tenderness, and rigidity. Measure abdominal girth to detect any subsequent increase in distention. Check for poor skin turgor, hypotension, narrowed pulse pressure, and other signs of dehydration and electrolyte imbalance, which may result from paralytic ileus.

Medical causes

Mechanical intestinal obstruction.Bowel sounds may become hypoactive after a period of hyperactivity. The patient may also have acute colicky abdominal pain in the quadrant of obstruction, possibly radiating to the flank or lumbar region; nausea and vomiting (the higher the obstruction, the earlier and more severe the vomiting); constipation; and abdominal distention and bloating. If the obstruction becomes complete, signs of shock may occur.

Mesenteric artery occlusion.After a brief period of hyperactivity, bowel sounds become hypoactive and then quickly disappear, signifying a life-threatening crisis. Associated signs and symptoms include fever; a history of colicky abdominal pain leading to sudden and severe midepigastric or periumbilical pain, followed by abdominal distention and possible bruits; vomiting; constipation; and signs of shock. Abdominal rigidity may appear late.

Paralytic (adynamic) ileus.Bowel sounds are hypoactive and may become absent. Associated signs and symptoms include abdominal distention, generalized discomfort, and constipation or passage of small, liquid stools and flatus. If the disorder follows acute abdominal infection, fever and abdominal pain may occur.

Other causes

Drugs.Certain classes of drugs reduce intestinal motility and thus produce hypoactive bowel sounds. These include opiates, such as codeine; anticholinergics, such as propantheline bromide; phenothiazines, such as chlorpromazine; and vinca alkaloids such as vincristine. General or spinal anesthetics produce transient hypoactive sounds.

Radiation therapy.Hypoactive bowel sounds and abdominal tenderness may occur after irradiation of the abdomen.

Surgery.Hypoactive bowel sounds may occur after manipulation of the bowel. Motility and bowel sounds in the small intestine usually resume within 24 hours; colonic bowel sounds, in 3 to 5 days.

Nursing considerations

▪ Frequently assess for indications of shock, such as thirst; anxiety; restlessness; tachycardia; cool, clammy skin; and weak, thready pulse.

▪ Monitor vital signs and auscultate for bowel sounds every 2 to 4 hours.

▪ If severe pain, abdominal rigidity, guarding, and fever accompany hypoactive bowel sounds, perform emergency interventions to treat paralytic ileus from peritonitis.

▪ If GI suction and decompression are needed using a nasogastric or intestinal tube, restrict oral intake, maintain tube patency, monitor drainage, provide oral and nasal hygiene, keep the head of the bed elevated, and turn the patient to facilitate passage of the tube through the GI tract.

▪ Prepare the patient for diagnostic studies, such as X-ray studies and endoscopic procedures.

▪ Provide comfort measures as needed, such as placing the patient with paralytic ileus in semi-Fowler's position.

Patient teaching

▪ Encourage the patient to ambulate to stimulate peristalsis or, if he can't tolerate ambulation, range-of-motion exercises or turning from side to side may stimulate peristalsis.

▪ Explain all diagnostic procedures and the need to withhold food and fluids.

▪ Teach the patient about the cause of hypoactive bowel sounds and the treatment plan after a diagnosis is established.

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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