Postoperative patient has nausea, hypoactive bowel sounds, and repeated vomiting of dark brown emesis despite antiemetics. Which order would you anticipate?

• A. Place an NG tube to low intermittent suction
• B. Begin oral feeding
• C. Start IV diuretics
• D. Administer a second antiemetic

Answer: (A)

Decompressing the stomach with an NG tube to low intermittent suction is the best next step when a postoperative patient has persistent nausea and vomiting with hypoactive bowel sounds. This pattern suggests a postoperative ileus or gastric outlet distention rather than a simple need for more antiemetics. The NG tube continuously removes gastric contents, relieves distention, reduces the risk of aspiration during vomiting, and gives the bowel a chance to recover. It also allows you to monitor the amount and nature of gastric output.

Beginning oral feeding would worsen nausea and could worsen distention if the gut isn’t ready. Starting IV diuretics has no role here and could cause electrolyte imbalances without addressing the underlying issue. While a second antiemetic might be considered in some cases, it won’t resolve gastric distention or ileus; decompression is the appropriate immediate intervention to address the root problem.