🏥 Surgical Nursing Care Plan on Acute Intestinal Obstruction with Laparotomy

Medical-Surgical Nursing | NANDA Nursing Care Plan Format

Surgical Nursing Care Plan | Practical File Ready

⚠️ Educational Purpose Only: This surgical nursing care plan is prepared for academic practical file work. Not for actual patient care or clinical decision-making.

📄 Page 1 — Student Information

Student Name[Your Name]
CourseBSc Nursing / GNM / ANM
SubjectMedical-Surgical Nursing
Surgical Care Plan TopicAcute Intestinal Obstruction with Laparotomy
FormatNANDA-I Surgical Nursing Care Plan Format
Clinical AreaEmergency Ward / Surgical Ward / Operation Theatre / Post-operative Ward
Date of Submission[Enter Date]
Clinical Instructor[Instructor Name]

📄 Page 2 — Patient Identification Data

NameMr. Mahendra Singh
Age55 Years
SexMale
AddressJodhpur, Rajasthan
OccupationShopkeeper
Marital StatusMarried
ReligionHindu
DiagnosisAcute Intestinal Obstruction
Surgical ProcedureExploratory Laparotomy
Type of SurgeryEmergency Abdominal Surgery
Type of AnesthesiaGeneral Anesthesia
Type of FamilyNuclear Family
Family Size4 Members
Ward NameMale Surgical Ward
Bed Number12
Date of Admission21/05/2026
Date of Surgery21/05/2026
Doctor InchargeDr. S. K. Parihar, MS General Surgery
Hospital NameGovernment Medical College Hospital, Jodhpur

📄 Page 3 — Chief Complaints & Present Illness History

Chief Complaints

History of Present Illness

Mr. Mahendra Singh, a 55-year-old male, was admitted to the emergency ward with complaints of severe abdominal pain, abdominal distension, repeated vomiting and inability to pass stool and flatus for 24 hours.

The pain was colicky in nature and gradually increased in intensity. Vomiting was initially food particles and later became bilious. Patient also complained of nausea, restlessness, weakness and reduced oral intake. There was no history of trauma.

On examination, abdomen was distended and tender, bowel sounds were exaggerated initially. X-ray abdomen showed multiple air-fluid levels suggestive of intestinal obstruction. Patient was kept NPO, Ryle’s tube was inserted for gastric decompression, IV fluids were started and emergency exploratory laparotomy was planned.

Past Medical History

Past Surgical History

📄 Page 4 — Family History & Family Composition

Family History

Family Composition

Name Age/Sex Education Occupation Relationship Health Status
Mr. Mahendra Singh 55/M 10th Pass Shopkeeper Self / Patient Acute Intestinal Obstruction with Laparotomy
Mrs. Sushila Singh 50/F 8th Pass Homemaker Wife Healthy
Mr. Ravi Singh 25/M Graduate Private Job Son Healthy
Miss Neha Singh 20/F College Student Student Daughter Healthy

Family Tree

👨
Mr. Mahendra Singh
Patient
Acute Intestinal Obstruction with Laparotomy

👩
Mrs. Sushila Singh
Wife
Healthy

👨
Mr. Ravi Singh
Son
Healthy

👩
Miss Neha Singh
Daughter
Healthy

Male Female Patient Highlighted

📄 Page 5 — Dietary, Personal, Socio-economic & Environmental History

Dietary History

Personal History

Socio-economic History

Environmental History

📄 Page 6 — Physical Examination

General Condition

Patient was conscious, oriented and restless at the time of admission due to severe abdominal pain and vomiting. He appeared dehydrated and anxious. After surgery, patient was conscious, cooperative and recovering under close monitoring.

Vital Signs on Admission

General Appearance

Abdominal Examination

Systemic Examination

Abdomen Distended and tender pre-operatively; post-operative midline abdominal wound dressing present.
Cardiovascular System Tachycardia present initially due to pain/dehydration; S1 and S2 heard normally.
Respiratory System Respiratory rate mildly increased due to pain; chest clear bilaterally.
Central Nervous System Conscious, oriented, restless due to pain; no neurological deficit.
Skin Dry skin and reduced turgor before fluid correction; post-operative wound dressing present.

📄 Page 7 — Vital Signs Monitoring Record

Date / Time Temperature Pulse Respiration BP SpO₂ Pain Score
21/05/2026 — Admission99°F104/min22/min100/7098%8/10
21/05/2026 — Post-op98.8°F96/min20/min110/7499%6/10
22/05/2026 — POD 198.6°F88/min18/min116/7699%4/10
23/05/2026 — POD 298.4°F82/min18/min118/7899%3/10
24/05/2026 — POD 398.4°F78/min16/min120/7899%2/10
25/05/2026 — Discharge98.2°F76/min16/min118/7699%1/10
Nursing Trend: Patient’s tachycardia and low blood pressure improved after fluid correction and surgery. Pain reduced gradually during post-operative recovery.

📄 Page 8 — Diagnostic Investigations

Sr. No. Investigation Normal Value Patient Value Interpretation
1Hemoglobin13–17 g/dL12.8 g/dLMildly low
2Total WBC Count4,000–11,000/mm³13,800/mm³Raised, possible inflammation/infection
3Platelet Count1.5–4 lakh/mm³2.6 lakh/mm³Normal
4Random Blood Sugar80–140 mg/dL124 mg/dLNormal
5Blood Urea15–40 mg/dL46 mg/dLMildly raised due to dehydration
6Serum Creatinine0.7–1.3 mg/dL1.2 mg/dLUpper normal
7Serum Sodium135–145 mEq/L132 mEq/LMild hyponatremia
8Serum Potassium3.5–5.0 mEq/L3.3 mEq/LMild hypokalemia due to vomiting
9Urine RoutineNo sugar/proteinNormalNo abnormality
10ECGNormal sinus rhythmSinus tachycardiaDue to pain/dehydration
11X-ray Abdomen ErectNo air-fluid levelsMultiple air-fluid levels presentSuggestive of intestinal obstruction
12USG AbdomenNormal bowel loopsDilated bowel loops with reduced distal movementIntestinal obstruction suspected
13Blood Group-O PositiveRecorded for emergency surgery

📄 Page 9 — Medical & Surgical Management / Drug Chart

Medical Management

Surgical Management

Name of Surgery: Exploratory Laparotomy
Indication: Acute Intestinal Obstruction
Date of Surgery: 21/05/2026
Type of Anesthesia: General Anesthesia
Operative Site: Abdomen / Midline incision
Operative Finding: Adhesive intestinal obstruction with dilated bowel loops
Procedure Done: Exploratory laparotomy performed, adhesions released, bowel viability checked, obstruction relieved, peritoneal lavage done, abdomen closed in layers and sterile dressing applied.
Drain: Abdominal drain placed as per surgical finding
Post-operative Status: Patient shifted to post-operative ward in stable condition with Ryle’s tube, IV fluids, urinary catheter and abdominal drain.

Pre-operative Nursing Care

Post-operative Nursing Care

Drug Chart

Drug Name Dose Route Frequency Purpose Nursing Responsibility
Inj. Ceftriaxone 1 g IV BD Broad-spectrum antibiotic Check allergy, administer slowly, monitor rash, diarrhea and IV site.
Inj. Metronidazole 500 mg IV TDS Anaerobic infection control Monitor nausea, metallic taste, abdominal discomfort and IV site.
Inj. Pantoprazole 40 mg IV OD Gastric protection Administer before meals/early morning, monitor abdominal discomfort.
Inj. Ondansetron 4 mg IV SOS/TDS Controls nausea and vomiting Assess nausea/vomiting, monitor headache and constipation.
Inj. Tramadol 50 mg IV/IM SOS Moderate to severe pain relief Monitor sedation, dizziness, nausea, respiratory status and pain relief.
Inj. Paracetamol 1 g IV TDS/SOS Pain and fever relief Monitor temperature, pain score and total daily dose.
IV Ringer Lactate 500 ml IV As ordered Fluid and electrolyte replacement Monitor flow rate, IV site, intake-output and signs of overload.
IV Normal Saline 500 ml IV As ordered Fluid replacement Check patency, monitor input-output and edema.
Potassium Chloride As prescribed IV infusion As ordered Correction of hypokalemia Never give IV push, dilute properly, monitor ECG and serum potassium.

📄 Page 10 — NANDA Nursing Diagnoses

Sr. No. NANDA Nursing Diagnosis Related To Evidenced By / Risk Factors
1 Acute Pain Intestinal obstruction, abdominal distension and surgical incision Pain score 8/10 pre-operatively and 6/10 post-operatively, guarding, restlessness
2 Deficient Fluid Volume Repeated vomiting, reduced oral intake and third-space fluid loss due to intestinal obstruction Dry skin, reduced skin turgor, tachycardia, low BP, reduced urine output
3 Risk for Infection Abdominal surgery, surgical wound, drain, urinary catheter and invasive lines Midline abdominal dressing, abdominal drain, Foley catheter, IV cannula
4 Imbalanced Nutrition: Less Than Body Requirements NPO status, vomiting and reduced oral intake Weakness, decreased appetite, NPO status, post-operative diet restriction
5 Impaired Physical Mobility Abdominal pain, surgical incision and weakness Difficulty turning, sitting and walking after laparotomy
Note: Main detailed nursing care plans are prepared for the first three priority diagnoses: Acute Pain, Deficient Fluid Volume and Risk for Infection.

📄 Page 11 — Nursing Care Plan 1: Acute Pain

Assessment Nursing Diagnosis Goal / Expected Outcome Planning Implementation Evaluation
Subjective Data:
Patient complains, “Pet me bahut tez dard ho raha hai.” Post-operatively patient reports pain at abdominal incision site.

Objective Data:
Pain score 8/10 before surgery and 6/10 after surgery. Patient appears restless and guards abdomen. Midline abdominal surgical dressing present.

Acute Pain related to intestinal obstruction, abdominal distension and surgical incision as evidenced by pain score 8/10 pre-operatively, 6/10 post-operatively, guarding and restlessness. Short-Term Goal:
Patient will report reduction in pain from 6/10 to 3/10 within 24–48 hours after surgery.

Long-Term Goal:
Patient will perform deep breathing, turning and gradual ambulation with tolerable pain before discharge.

  • Assess pain location, intensity, duration and aggravating factors.
  • Monitor vital signs regularly.
  • Provide comfortable position and abdominal support.
  • Administer analgesics as prescribed.
  • Reduce abdominal distension by maintaining Ryle’s tube as ordered.
  • Teach relaxation and splinting during movement.
  • Assessed pain score using 0–10 pain scale every 4 hours.
  • Observed facial expression, guarding, restlessness and difficulty in movement.
  • Positioned patient in comfortable semi-Fowler’s position as tolerated.
  • Supported abdomen during coughing, turning and deep breathing.
  • Maintained Ryle’s tube patency and observed drainage as ordered.
  • Administered Inj. Tramadol and Inj. Paracetamol as prescribed.
  • Encouraged slow deep breathing and relaxation techniques.
  • Assisted patient during turning and early ambulation.
  • Reassessed pain after analgesic administration.
Patient reported pain reduction from 6/10 to 2/10 within 72 hours. Patient was able to turn, sit and walk slowly with support before discharge.
Outcome: Goal achieved. Patient’s pain reduced and comfort improved.

📄 Page 12 — Nursing Care Plan 2: Deficient Fluid Volume

Assessment Nursing Diagnosis Goal / Expected Outcome Planning Implementation Evaluation
Subjective Data:
Patient reports repeated vomiting, weakness and inability to take oral fluids.

Objective Data:
Dry skin, reduced skin turgor, pulse 104/min, BP 100/70 mmHg, reduced urine output, mild electrolyte imbalance, Ryle’s tube drainage present.

Deficient Fluid Volume related to repeated vomiting, reduced oral intake and third-space fluid loss due to intestinal obstruction as evidenced by dry skin, reduced skin turgor, tachycardia, low BP and reduced urine output. Short-Term Goal:
Patient will maintain stable vital signs and adequate urine output within 24–48 hours.

Long-Term Goal:
Patient will maintain normal hydration status and corrected electrolyte balance before discharge.

  • Assess hydration status regularly.
  • Monitor vital signs and urine output.
  • Maintain strict intake-output chart.
  • Administer IV fluids and electrolytes as prescribed.
  • Monitor Ryle’s tube output and vomiting.
  • Observe laboratory values for electrolyte imbalance.
  • Assessed skin turgor, mucous membrane, thirst, weakness and urine output.
  • Monitored pulse, BP, respiration and temperature regularly.
  • Maintained strict intake-output chart including IV fluids, urine, vomiting and Ryle’s tube drainage.
  • Administered IV Ringer Lactate and Normal Saline as prescribed.
  • Administered potassium correction as ordered with proper dilution and monitoring.
  • Observed Ryle’s tube drainage amount and color.
  • Monitored urine output through Foley catheter.
  • Reviewed serum sodium, potassium, urea and creatinine reports.
  • Reported persistent vomiting, reduced urine output or abnormal electrolyte values to physician.
Patient’s hydration status improved. Pulse reduced to 78/min, BP improved to 120/78 mmHg, urine output became adequate and electrolyte imbalance was corrected before discharge.
Outcome: Goal achieved. Fluid volume and electrolyte balance improved.

📄 Page 13 — Nursing Care Plan 3: Risk for Infection

Assessment Nursing Diagnosis Goal / Expected Outcome Planning Implementation Evaluation
Subjective Data:
Patient asks, “Operation ke baad infection to nahi hoga?”

Objective Data:
Exploratory laparotomy done. Midline abdominal surgical dressing present. Abdominal drain, Ryle’s tube, Foley catheter and IV cannula present.
Risk for Infection related to abdominal surgery, surgical wound, abdominal drain, urinary catheter, Ryle’s tube and invasive lines. Short-Term Goal:
Patient will remain free from signs of surgical wound and systemic infection during hospitalization.

Long-Term Goal:
Patient will demonstrate proper wound care and remain free from fever, pus discharge, redness, swelling and wound gaping before follow-up.
  • Monitor temperature and infection signs.
  • Observe surgical wound and drain site regularly.
  • Maintain aseptic technique during wound, drain and catheter care.
  • Administer antibiotics as prescribed.
  • Maintain hand hygiene and clean environment.
  • Educate patient and family about infection prevention.
  • Monitored temperature, pulse and wound condition regularly.
  • Observed abdominal dressing for bleeding, soakage, discharge and foul smell.
  • Observed abdominal drain output for amount, color and odor.
  • Maintained aseptic technique during dressing, drain care and catheter care.
  • Performed hand hygiene before and after patient care.
  • Administered Inj. Ceftriaxone and Inj. Metronidazole as prescribed.
  • Maintained Foley catheter care and observed urine characteristics.
  • Encouraged deep breathing exercises to prevent respiratory infection.
  • Encouraged protein-rich diet after oral intake was allowed.
  • Educated patient not to touch wound and tubes with unclean hands.
  • Taught warning signs such as fever, redness, swelling, pus discharge, foul smell and wound opening.
Patient remained afebrile. Surgical dressing was clean and dry. Drain output reduced gradually. No pus discharge, redness, foul smell or wound gaping was observed. Patient understood infection prevention measures.
Outcome: Goal achieved. No signs of surgical wound or systemic infection were observed.

📄 Page 14 — Discharge Summary

Patient Name: Mr. Mahendra Singh
Age/Sex: 55 Years / Male
Hospital Name: Government Medical College Hospital, Jodhpur
Ward: Male Surgical Ward
Date of Admission: 21/05/2026
Date of Surgery: 21/05/2026
Date of Discharge: 25/05/2026
Final Diagnosis: Acute Intestinal Obstruction
Surgery Performed: Exploratory Laparotomy under General Anesthesia

Summary of Hospital Stay

Mr. Mahendra Singh, a 55-year-old male, was admitted in emergency with complaints of severe colicky abdominal pain, abdominal distension, repeated vomiting and inability to pass stool and flatus for 24 hours.

On examination, abdomen was distended and tender. X-ray abdomen showed multiple air-fluid levels suggestive of intestinal obstruction. Patient was kept NPO, Ryle’s tube was inserted, IV fluids and electrolyte correction were started, and emergency exploratory laparotomy was planned after stabilization.

Exploratory laparotomy was performed on 21/05/2026 under general anesthesia. Adhesions were released and obstruction was relieved. Post-operatively, patient was monitored for pain, infection, dehydration, electrolyte imbalance, drain output, Ryle’s tube drainage, urine output and return of bowel function. Patient improved gradually. Bowel sounds returned, flatus was passed, oral diet was tolerated and wound remained clean and dry.

Condition at Discharge

Discharge Medications

Medication Dose Frequency Purpose
Tab. Cefixime 200 mg Twice daily for 5 days Antibiotic
Tab. Metronidazole 400 mg Three times daily for 5 days Anaerobic infection control
Tab. Paracetamol 500 mg SOS after food Pain and fever relief
Tab. Pantoprazole 40 mg Once daily before breakfast for 5 days Gastric protection
Multivitamin 1 tablet Once daily Recovery support

Follow-Up Advice

📄 Page 15 — Health Education

1. Wound Care

2. Medication Advice

3. Diet Advice After Laparotomy

4. Activity and Rest

5. Prevention of Complications

6. Warning Signs Requiring Immediate Medical Help

Patient Teaching Outcome: Patient and family verbalized understanding of wound care, medication, diet progression, activity restriction, follow-up and warning signs.

📄 Page 16 — Bibliography

  1. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, Latest Edition, Wolters Kluwer.
  2. NANDA International Nursing Diagnoses: Definitions and Classification 2024–2026.
  3. Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Latest Edition.
  4. Bailey & Love’s Short Practice of Surgery, Latest Edition.
  5. Indian Nursing Council recommended Medical-Surgical Nursing syllabus and clinical practical guidelines.
  6. Hospital surgical nursing care protocols for pre-operative and post-operative care.

⚕️ Medical Disclaimer: This surgical nursing care plan is prepared for educational and academic purposes only for ANM, GNM and BSc Nursing students. It is not intended for actual patient care or clinical decision-making. Always follow hospital protocol, physician orders and standard nursing textbooks.

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