Assessment of Pain and Dependency Levels in Patient with Paralytic Ileus Associated with Prolonged Antacid Use: Case Report

Syifaurrahmah Syifaurrahmah, Sandra Perbrianti, Nursiswati Nursiswati

Abstract


Paralytic ileus is a disorder that results in a halt of intestinal flow, causing fluid and gas accumulation. Although paralytic ileus is commonly associated with postoperative conditions, it may also influenced by electrolyte imbalances from long-term antacid use and age-related factors that increase mortality risk. If inadequately unmanaged, the condition can result in significant pain, increased risk of complications, and greater care dependency. The purpose to describe a case of paralytic ileus in an elderly patient with long-term antacid use and evaluate changes in pain intensity and care dependency during treatments. This case report involved a 74-year-old male patient with paralytic ileus and a primary nursing diagnosis of acute pain. Pain intensity and care dependency were assessed using the Numeric Rating Scale and Care Dependency Scale during a four-day hospitalization period. The patient showed clinical improvement, include the return of flatus and defecation, normalization of electrolyte levels, reduced pain intensity (NRS 6 to 3), and increased independence (CDS 46 to 62). Discussion: Nursing care included electrolyte correction and pain management through pharmacological therapy and guided imagery, which contribute to decreased pain an improved care dependency, particularly in continence-related aspects. Recall bias related medication history was identified as a limitation. This case underscores the importance of early recognition of electrolyte imbalance and comprehensive nursing assessment in patients with paralytic ileus. Holistic nursing care supported by multidisciplinary collaboration and non-pharmacological intervention played a critical role in enhancing patient outcomes and promoting functional independence during hospitalization.


Keywords


Ileus paralitik, ketidakseimbangan elektrolit, antasida, guided imagery, Care Dependency Scale

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Acar, K., & Aygin, D. (2019). Efficacy of Guided Imagery for Postoperative Symptoms, Sleep Quality, Anxiety, and Satisfaction Regarding Nursing Care: A Randomised Controlled Study. Journal of PeriAnesthesia Nursing, 34(6), 1241-1249. https://doi.org/10.1016/j.jopan.2019.05.006

Acar, K., & Ersöz, H. (2024). Effect of Guided Imagery on Patient Comfort, Vital Signs, Pain, Anxiety, and Satisfaction in Cancer Patients Undergoing Port Catheterisation With Local Anaesthesia. Cancer Nursing, 47(2), 93-99. https://doi.org/10.1097/NCC.0000000000001194

Aghakhani, N., Faraji, N., Alinejad, V., Goli, R., & Kazemzadeh, J. (2022). The effect of guided imagery on the quality and severity of pain and pain-related anxiety associated with dressing changes in burn patients: A randomised controlled trial. Burns, 48(6), 1331-1339. https://doi.org/10.1016/j.burns.2021.11.020

Alahmari, A. M. A., Alsuayri, A. H. F., Alsadi, H. M. J., Alshahrani, B. K. G., Alyahya, F. M. A., Saadi, S. K. al, Alamri, A. D. A.., Alshahrani, H. S., Alamri, F. T. M., Alshahrani, M. A. M., Albalawi, A. A., & Alnaim, M. F. (2021). Prevalence and Updated Management of Paralytic Ileus: A Simple Review. Journal of Pharmaceutical Research International, 61-66. https://doi.org/10.9734/jpri/2021/v33i42B32425

Al-Shoha, M., Klair, J. S., Girotra, M., & Garcia-Saenz-de-Sicilia, M. (2015). Magnesium Toxicity-Induced Ileus in a Postpartum Patient Treated for Preeclampsia With Magnesium Sulphate. ACG Case Reports Journal, 2(1), 227-229. https://doi.org/10.14309/crj.2015.67

Chukwuemeka, H., John, O., Nkechinyere, J., & Ifeyinwa, R. (2022). Paralytic Ileus Secondary to Electrolyte Imbalance: A Case Study in a 16 Year Old Female. The Korean Journal of Food & Health Convergence, 8(1), 17-20. https://doi.org/10.13106/kjfhc.2022.vol8.no1.17.

Daniels, A. H., Ritterman, S. A., & Rubin, L. E. (2015). Paralytic Ileus in the Orthopaedic Patient. Journal of the American Academy of Orthopaedic Surgeons, 23(6), 365-372. https://doi.org/10.5435/jaaos-d-14-00162

Djikstra, A., TWN Dassen, Veltman, G., & Tiesinga, L. (2005). Diagnostic accuracy of the care dependency scale. Journal of Advanced Nursing, 50(4), 410-416. https://hdl.handle.net/11370/f65b7dc9-ca73-4a0f-b202-387bb85677b1

Elgar, G., Smiley, P., Smiley, A., Feingold, C., & Latifi, R. (2022). Age Increases the Risk of Mortality by Four-Fold in Patients with Emergent Paralytic Ileus: Hospital Length of Stay, Sex, Frailty, and Time to Operation as Other Risk Factors. International Journal of Environmental Research and Public Health, 19(9905), 9905. https://doi.org/10.3390/ijerph19169905

Elswort Beach, & Orlando Jesus. (2023). Ileus. Pubmed. https://pubmed.ncbi.nlm.nih.gov/32644363

Finsterer, J., & Strobl, W. (2024). Gastrointestinal involvement in neuromuscular disorders. Journal of Gastroenterology and Hepatology, 39(10), 1982-1993. https://doi.org/10.1111/jgh.16650

Global Burden of Disease. (2021). Paralytic ileus and intestinal obstruction. Institute for Health Metrics and Evaluation. https://www.healthdata.org/research-analysis/diseases-injuries-risks/factsheets/2021-paralytic-ileus-and-intestinal

Greg McLatchie, Neil Borley, & Jonna Chikwe. (2013). Oxford Handbook of Clinical Surgery.

Henry Bailey, Robert Love, Norman Williams, Ronan O'connell, & Andrew McCaskie. (2018). Bailey & Love's Short Practice of Surgery.

Institute for Health Metrics and Evaluation. (2021). Global Health Metrics. www.thelancet.com

Isha Shrimanker, & Sandeep Bhattarai. (2023). Electrolytes. Pubmed.

Janice Hinkle, Kerry Cheever, & Kristen Overbaugh. (2022). Medical-Surgical Nursing 15th Edition.

Kerrie Chambers. (2024, May). Comfort Promotion: Guided Imagery. Elsevier.

Kerry, S., Frank Arnold, & Spencer Dean. (2022). Chronic Constipation in Adults. American Family Physician, 1-8.

Kodeeswara, P., & Subhash, J. (2015). Guided Imagery Therapy. 4(5), 56-58. https://doi.org/10.9790/1959-04535658

Kraft, M. D., Btaiche, I. F., Sacks, G. S., & Kudsk, K. A. (2005). Treatment of electrolyte disorders in adult patients in the intensive care unit. In American Journal of Health-System Pharmacy (Vol. 62, Issue 16, pp. 1663-1682). American Society of Health-Systems Pharmacy. https://doi.org/10.2146/ajhp040300

Kutlay Aydın, Berk, A. Z., Halise Tokdemir, & Begüm Ergan. (2019). Hypermagnesemia Induced Paralytic Ileus: A Case with Normal Renal Function and Review of the Literature. Türk Yoğun Bakım Derneği Dergisi/Türk Yoğun Bakım Dergisi, 18(2), 103-108. https://doi.org/10.4274/tybd.galenos.2019.86658

Liamis, G., Milionis, H., & Elisaf, M. (2008). A Review of Drug-Induced Hyponatremia. In American Journal of Kidney Diseases (Vol. 52, Issue 1, pp. 144-153). https://doi.org/10.1053/j.ajkd.2008.03.004

Maton, P. N., & Burton, M. E. (1999). Antacids Revisited A Review of Their Clinical Pharmacology and Recommended Therapeutic Use.

Nazzani, S., Bandini, M., Preisser, F., Mazzone, E., Marchioni, M., Tian, Z., Stubinski, R., Clementi, M. C., Saad, F., Shariat, S. F., Montanari, E., Briganti, A., Carmignani, L., & Karakiewicz, P. I. (2019). Postoperative paralytic ileus after major oncological procedures in the enhanced recovery after surgery era: A population based analysis. Surgical Oncology, 28, 201-207. https://doi.org/10.1016/j.suronc.2019.01.011

Nugent, S. M., Lovejoy, T. I., Shull, S., Dobscha, S. K., & Morasco, B. J. (2021). Associations of Pain Numeric Rating Scale Scores Collected during Usual Care with Research Administered Patient Reported Pain Outcomes. Pain Medicine, 22(10), 2235-2241. https://doi.org/10.1093/pm/pnab110

Nur Rofi'ah, S., Hakam, M., Murtaqib, & Mustakim. (2023). Guided Imagery Relaxation for Acute Pain in Pre-Operative Paralytic Ileus Patient: A Case Study. Journal of Indonesian Medical Emergencies, 2(1), 74-89. https://doi.org/10.58545/jkmi.v2i1.62

Nursiswati, N., Halfens, R. J. G., & Lohrmann, C. (2020). Psychometric properties of the Care Dependency Scale in stroke survivors in Indonesian hospitals. International Journal of Nursing Sciences, 7(3), 330-336. https://doi.org/10.1016/j.ijnss.2020.06.011

Parizad, N., Goli, R., Faraji, N., Mam-Qaderi, M., Mirzaee, R., Gharebaghi, N., Baghaie, R., Feizipour, H., & Haghighi, M.-M. (2021). Effect of guided imagery on anxiety, muscle pain, and vital signs in patients with COVID-19: A randomised controlled trial. Complementary Therapies in Clinical Practice, 43, 101335. https://doi.org/10.1016/j.ctcp.2021.101335

Patricolo, G. E., LaVoie, A., Slavin, B., Richards, N. L., Jagow, D., & Armstrong, K. (2017). Beneficial Effects of Guided Imagery or Clinical Massage on the Status of Patients in a Progressive Care Unit. Critical Care Nurse, 37(1), 62-69. https://doi.org/10.4037/ccn2017282

Pieczynski, J., Cosio, D., Pierce, W., & Serpa, J. G. (2020). Mind-Body Interventions for Rehabilitation Medicine. Physical Medicine and Rehabilitation Clinics of North America, 31(4), 563-575. https://doi.org/10.1016/j.pmr.2020.07.008

Piredda, M., Candela, M. L., Marchetti, A., Biagioli, V., De Maria, M., Facchinetti, G., Albanesi, B., Iacorossi, L., & De Marinis, M. G. (2022). The Care Dependency Scale: A cross validation study of inpatients with cancer. European Journal of Oncology Nursing, 56, 102087. https://doi.org/10.1016/j.ejon.2021.102087

Raniea Hamid, Gusti Noorrizka, Nyoman Wijaya, & Ana Yuda. (2014). Profile of the Use of Antacid Drugs obtained by Self-Medication (Study on Patients of Pharmacy "X" Surabaya). 1. 49-52.

Sharon Mantik Lewis, Heitkemper, M. M., & Shannon Ruff Dirksen. (2019). Lewis's Medical-Surgical Nursing (11th ed.).

Mosby. Solanki, S., Chakinala, R. C., Haq, K. F., Singh, J., Khan, M. A., Solanki, D., Vyas, M. J., Kichloo, A., Mansuri, U., Shah, H., Patel, A., Haq, K. S., Iqbal, U., Nabors, C., Khan, H. M. A., & Aronow, W. S. (2020). Paralytic ileus in the United States: A cross-sectional study from the national inpatient sample. SAGE Open Medicine, 8. https://doi.org/10.1177/2050312120962636

Stephen Lowry, Robert Dorian, Louis Alarcon, Parviz Amid, Dana Andersen, Roland Andersson, & Peter Angelos. (2015). Schwartz's Principles of Surgery Tenth Edition. www.ketabpezeshki.com

Wattchow, D., Heitmann, P., Smolilo, D., Spencer, N. J., Parker, D., Hibberd, T., Brookes, S. S. J., Dinning, P. G., & Costa, M. (2020). Postoperative ileus-An ongoing conundrum. Neurogastroenterology & Motility, 33(5). https://doi.org/10.1111/nmo.14046

Weledji, E. P. (2020). Perspectives on paralytic ileus. Acute Medicine & Surgery, 7(1). https://doi.org/10.1002/ams2.573

Wintery, E., Syam, A., Simadibrata, M., & Manan, C. (2003). Management of Paralytic Ileus. The Indonesian Journal of Gastroenterology Hepatology and Digestive Endoscopy, 80. https://media.neliti.com/media/publications/67547-EN-management-of-paralytic-ileus.pdf




DOI: https://doi.org/10.24198/jnc.v8i3.64489

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