General care of the ( peritonitis ) patient

General care of the ( peritonitis ) patient

Patients are frequently hypovolaemic with electrolyte disturbances.
The plasma volume must be restored and electrolyte concentrations corrected. Central venous catheterisation and
pressure monitoring may be helpful, particularly in patients with concurrent disease. Plasma protein depletion may also need correction as the inflamed peritoneum leaks large amounts of protein. If the patient’s recovery is delayed for more than 7–10 days,intravenous nutrition is required.
Gastrointestinal decompression
A nasogastric tube is passed into the stomach and aspirated. Intermittent aspiration is maintained until the paralytic ileus has
resolved. Measured volumes of water are allowed by mouth when only small amounts are being aspirated. If the abdomen is soft and not tender, and bowel sounds return, oral feeding may be progressively introduced. In order to shorten the period of ileus .
Administration of antibiotics prevents the multiplication of bacteria and the release of endotoxins. As the infection is usually a
mixed one, initial treatment with parenteral broad-spectrum antibiotics active against aerobic and anaerobic bacteria should
be given.
Correction of fluid loss
A fluid balance chart must be started so that daily output by gastric aspiration and urine is known.
Throughout recovery, the haematocrit and serum electrolytes and urea must be checked regularly.
Analgesia
The patient should be nursed in the sitting-up position and must be relieved of pain before and after operation.
Freedom from pain allows early mobilisation and adequate physiotherapy in the postoperative period, which help to prevent basal pulmonary collapse, deep vein thrombosis and pulmonary embolism.
Vital system support