NUR 390 KEITH RN CASE STUDY: SMALL BOWEL
OBSTRUCTION EVALUATION | 2026 UPDATE
Keith RN Case Study: Small Bowel Obstruction (SBO)
Annie Couch
Concordia St. Paul College of Nursing
NUR 390 Adult I
Lead: Dr. JaQualine Abbe C Section Instructor: Prof. Terri Moore
, SBO Keith RN Case Study
Mary O’Reilly is a 55-year-old woman with a prior history of partial colectomy w/colostomy and small
bowel obstruction three months ago that resolved with bowel rest and required no surgical intervention.
History of
Three days ago, Mary developed a sudden onset of sharp generalized abdominal pain with nausea,
Present
vomiting and decreased output from her colostomy bag. She has had two small glasses of water today.
Mary is admitted to the medical/surgical unit, and you will be the nurse caring for her. Problem
You receive the following highlights of report from the emergency department (ED) nurse:
CT of her abdomen/pelvis revealed high-grade small bowel obstruction.
Lactate 2.8, WBC 14.7, Sodium 143, Potassium 3.7, Creatinine 1.35
An NG was placed, and she is on low intermittent suction. She had NG output of 225 mL of bile green
liquid.
Received hydromorphone 0.5 mg IV for pain one hour ago. Abdominal pain decreased from 9/10 to
3/10 and she is resting more comfortably.
Abd. is firm, slightly distended, with tympanic bowel sounds.
Initial HR/BP was 102 and 92/48.
Most recent vital signs: T: 99.8 (o) P: 78 (reg) R: 18 BP: 108/52 after 1000 mL 0.9% NS bolus
20 g. peripheral IV in left forearm.
What data from the history is RELEVANT and has clinical significance to the nurse?
Relevant Data from Present Problem Clinical Significance
- Sudden onset abd pain is consistent with
SBO
- Sharp sudden onset abdominal pain - Prior SBO with possible scar tissue buildup
- Hx of SBO post surg is a risk factor for recurrent SBO
- Hx of colectomy - Nausea and vomiting are symptoms of SBO
- N/V - Elevated lactate can mean ischemia, could
- elevated lactate and WBC be occuring with decreased flow to area of
- CT showing high grade SBO bowel that is blocked.
- lower colostomy output than normal - WBC increase indicates inflammatory
response
- Lower colostomy output below the area of
blockage is consistent with bowel blockage
further up the GI tract.
OBSTRUCTION EVALUATION | 2026 UPDATE
Keith RN Case Study: Small Bowel Obstruction (SBO)
Annie Couch
Concordia St. Paul College of Nursing
NUR 390 Adult I
Lead: Dr. JaQualine Abbe C Section Instructor: Prof. Terri Moore
, SBO Keith RN Case Study
Mary O’Reilly is a 55-year-old woman with a prior history of partial colectomy w/colostomy and small
bowel obstruction three months ago that resolved with bowel rest and required no surgical intervention.
History of
Three days ago, Mary developed a sudden onset of sharp generalized abdominal pain with nausea,
Present
vomiting and decreased output from her colostomy bag. She has had two small glasses of water today.
Mary is admitted to the medical/surgical unit, and you will be the nurse caring for her. Problem
You receive the following highlights of report from the emergency department (ED) nurse:
CT of her abdomen/pelvis revealed high-grade small bowel obstruction.
Lactate 2.8, WBC 14.7, Sodium 143, Potassium 3.7, Creatinine 1.35
An NG was placed, and she is on low intermittent suction. She had NG output of 225 mL of bile green
liquid.
Received hydromorphone 0.5 mg IV for pain one hour ago. Abdominal pain decreased from 9/10 to
3/10 and she is resting more comfortably.
Abd. is firm, slightly distended, with tympanic bowel sounds.
Initial HR/BP was 102 and 92/48.
Most recent vital signs: T: 99.8 (o) P: 78 (reg) R: 18 BP: 108/52 after 1000 mL 0.9% NS bolus
20 g. peripheral IV in left forearm.
What data from the history is RELEVANT and has clinical significance to the nurse?
Relevant Data from Present Problem Clinical Significance
- Sudden onset abd pain is consistent with
SBO
- Sharp sudden onset abdominal pain - Prior SBO with possible scar tissue buildup
- Hx of SBO post surg is a risk factor for recurrent SBO
- Hx of colectomy - Nausea and vomiting are symptoms of SBO
- N/V - Elevated lactate can mean ischemia, could
- elevated lactate and WBC be occuring with decreased flow to area of
- CT showing high grade SBO bowel that is blocked.
- lower colostomy output than normal - WBC increase indicates inflammatory
response
- Lower colostomy output below the area of
blockage is consistent with bowel blockage
further up the GI tract.
