Medical management of a patient with peritonitis includes antibiotics. I/V fluids and?

RAK Nursing Officer - 2019

Medical & Surgical Nursing

Hard

Appeared in: RAK Nursing Officer - 2019

Explanation

Nasogastric (NG) suctioning is essential for decompressing the stomach and small bowel in patients with peritonitis.
This intervention helps to rest the bowel, which is crucial to prevent further leakage of gastrointestinal contents into the inflamed peritoneal cavity.
Decompression alleviates abdominal distension, reduces nausea and vomiting, and minimizes the risk of aspiration pneumonia, a serious complication in critically ill patients.
It is a standard component of initial supportive care, alongside keeping the patient NPO (nothing by mouth), administering IV fluids, and starting broad-spectrum antibiotics.

Option B: Enemas are strictly contraindicated in peritonitis. They increase intra-abdominal pressure, which can lead to the rupture of an inflamed organ (like the appendix) or spread existing infection throughout the abdominal cavity.
Option C: A patient with acute peritonitis must be kept NPO (nothing by mouth). Introducing a clear fluid diet would stimulate gastrointestinal motility and secretions, which would worsen pain and could increase peritoneal contamination.
Option D: Early ambulation is not an initial priority for a patient with acute peritonitis. These patients are often in severe pain, hemodynamically unstable, and require bed rest for close monitoring and to conserve energy.

Clinical Relevance

Nursing practice connection: Use the key finding related to The question tests the knowledge of the comprehensive medical management for a patient diagnosed with peritonitis, focusing on interventions beyond antibiotics and IV fluids to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary role in managing a patient with peritonitis includes meticulous monitoring of vital signs for signs of septic shock (tachycardia, hypotension, fever), assessing pain levels, and managing the NG tube.
It is critical to ensure the patency of the NG tube and accurately measure and document the amount and character of the gastric output. This data is vital for assessing the progression of bowel decompression and for calculating fluid replacement needs.
Strict intake and output monitoring is essential to guide IV fluid therapy and prevent fluid volume deficit or overload.

How to Approach the Question

First, understand the pathophysiology of peritonitis: it is the inflammation of the peritoneum, usually due to bacterial infection from a perforation in the GI tract.
Recognize the core principles of management: 1) Treat the infection (antibiotics), 2) Support circulation (IV fluids), and 3) Rest the bowel to prevent further contamination.
Evaluate each option based on the principle of 'bowel rest'.
Nasogastric suctioning actively decompresses the stomach and bowel, promoting rest. This fits the management goals.
Enemas and a clear fluid diet would stimulate the bowel, which is contraindicated.
Early ambulation is a recovery intervention, not an acute management priority for a critically ill patient. Therefore, it is incorrect in this context.

Concept Tested & Keywords

Concept Tested: The question tests the knowledge of the comprehensive medical management for a patient diagnosed with peritonitis, focusing on interventions beyond antibiotics and IV fluids.
Stem keywords: peritonitis, medical management, antibiotics, I/V fluids
Lead-in keywords: includes

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