A client is admitted through the ED for treatment of a strangulated intestinal obstruction with perforation. Which initial intervention would you perform first?

• A. Insertion of an NG tube for decompression
• B. Barium enema examination
• C. Oral intake as tolerated
• D. Administration of morphine via a patient-controlled analgesia device

Answer: (A)

In this emergency scenario, the priority is to decompress the GI tract and stabilize the patient for definitive surgical care. Inserting a nasogastric tube for decompression accomplishes this right away by removing gastric and proximal intestinal contents, relieving distention, and reducing the risk of aspiration if vomiting occurs during transport or surgery. It also helps minimize ongoing intraluminal pressure while preparation for definitive management is arranged, such as IV fluid resuscitation and antibiotics.

Why the other choices aren’t first steps: a barium enema would introduce contrast into a system with perforation, risking leakage into the peritoneal cavity and delaying definitive treatment. Allowing oral intake is inappropriate with an obstruction, as it would worsen distention and vomiting. Administering morphine via a PCA could mask symptoms and slow GI motility, complicating assessment and delay of surgical intervention. The NG decompression is the immediate action that buys time and supports stabilization.