Bowel sounds, hyperactive
Sometimes audible without a stethoscope, hyperactive bowel sounds reflect increased intestinal motility (peristalsis). They’re commonly characterized as rapid, rushing, gurgling waves of sounds. (See Characterizing bowel sounds, page 98.) They may stem from life-threatening bowel obstruction or GI hemorrhage, or from GI infection, inflammatory bowel disease (which usually follows a chronic course), food allergies, or stress.
Emergency Actions
After detecting hyperactive bowel sounds, quickly check the patient’s vital signs and ask him about associated symptoms, such as abdominal pain, vomiting, and diarrhea. If he reports cramping abdominal pain or vomiting, continue to auscultate for bowel sounds. If bowel sounds stop abruptly, suspect complete bowel obstruction. Prepare to assist with GI suction and decompression, to give I.V. fluids and electrolytes, and prepare the patient for surgery.
If he has diarrhea, record its frequency, amount, color, and consistency. If you detect excessive watery diarrhea or bleeding, prepare to administer an antidiarrheal, I.V. fluids and electrolytes and, possibly, blood transfusions.
History
If you’ve ruled out life-threatening conditions, obtain a detailed medical and surgical history. Ask the patient if he has had a hernia or abdominal surgery because these may cause mechanical intestinal obstruction. Does he have a history of inflammatory bowel disease? Also, ask about recent eruptions of gastroenteritis among family members, friends, or coworkers. If the patient has traveled recently, even within the United States, was he aware of any endemic illnesses?
In addition, determine whether stress may have contributed to the patient’s problem. Ask about food allergies and recent ingestion of unusual foods or fluids.
Physical assessment
Begin your examination by taking your patient’s vital signs. Check for fever, which suggests infection. Having already auscultated, now gently inspect, percuss, and palpate the abdomen.
Medical causes
Crohn’s disease
Hyperactive bowel sounds usually arise insidiously in those with Crohn’s disease. Associated signs and symptoms include diarrhea, cramping abdominal pain that may be relieved by defecation, anorexia, low-grade fever, abdominal distention and tenderness and, in many cases, a fixed mass in the right lower quadrant. Muscle wasting, weight loss, and signs of dehydration may occur as Crohn’s disease progresses.
Gastroenteritis
With gastroenteritis, hyperactive bowel sounds follow sudden nausea and vomiting and accompany “explosive” diarrhea. Abdominal cramping or pain is common, typically after a peristaltic wave. Fever may occur, depending on the causative organism.
GI hemorrhage
Hyperactive bowel sounds provide the most immediate indication of persistent upper GI bleeding. Other findings include hematemesis, coffee-ground vomitus, abdominal distention, bloody diarrhea, rectal passage of bright red clots and jellylike material or melena, and pain during bleeding. Decreased urine output, tachycardia, and hypotension accompany blood loss.
Malabsorption
Malabsorption — typically lactose intolerance — may cause hyperactive bowel sounds. Associated signs and symptoms include diarrhea and, possibly, nausea and vomiting, angioedema, and urticaria.
Mechanical intestinal obstruction
Mechanical intestinal obstruction — a potentially life-threatening disorder — causes hyperactive bowel sounds to occur simultaneously with cramping abdominal pain every few minutes; bowel sounds may later become hypoactive and then disappear. With small-bowel obstruction, nausea and vomiting occur earlier and with greater severity than in large-bowel obstruction. With complete bowel obstruction, hyperactive sounds are also accompanied by abdominal distention and constipation, although the part of the bowel distal to the obstruction may continue to empty for up to 3 days.
Ulcerative colitis (acute)
Hyperactive bowel sounds arise abruptly in patients with acute ulcerative colitis. The hallmark of this disorder is recurrent bloody diarrhea (usually containing pus and mucus) accompanied by anorexia, abdominal pain, nausea and vomiting, fever, and tenesmus. Weight loss, arthralgia, and arthritis may occur.
Special considerations
Prepare the patient for diagnostic tests. These may include endoscopy to view a suspected lesion, barium X-rays, or stool analysis.
I.V. fluids and electrolytes may be necessary to replace losses from diarrhea. Oral food and fluid restrictions may be needed to rest the GI tract.
If the patient has GI bleeding, insert an I.V. line for fluid and blood administration. Administer drugs such as vasopressin to manage bleeding. Insert a nasogastric tube to suction and monitor drainage.
Pediatric pointers
Hyperactive bowel sounds in children usually result from gastroenteritis, erratic eating habits, excessive ingestion of certain foods (such as unripened fruit), or food allergy.
Patient counseling
Explain prescribed dietary changes to the patient. These may range from complete food and fluid restrictions to a liquid or bland diet. Because stress commonly precipitates or aggravates bowel hyperactivity, teach the patient relaxation techniques such as deep breathing. Encourage rest and restrict the patient’s physical activity.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Hyperactivity
Read excerpts from these other book chapters related to Hyperactivity:
Medical Books Excerpts
- Agitation
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Agitation
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Agitation
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Agitation
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
More About Causes of Hyperactivity
» Next page: Agitation (Nursing: Interpreting Signs and Symptoms)
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