Question

Hospital Day 2 - The patient now has an NGT draining brown, fecal-smelling fluid and 0.9%NS infusing at 75 mL/hr via left forearm IPID. The CT scan of Mrs. Morrow’s abdomen reveals ascites, a large ovarian tumor, and a large abdominal tumor compressing the transverse colon. Today she now undergoes resection of the large, compressive bowel lesion, omentectomy, and resection of as much ovarian cancer as possible, including a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and diverting colostomy. Her surgery is complicated because the cancer has eroded the bowel and she had a small perforation.

Post-Operative Day 3 – Mrs. Morrow is progressing satisfactorily until today, when she complains of feeling warm. Her oral temperature is 102.6°F and she is tachycardic at 110 bpm, and tachypneic at 26 breaths/min. Her abdomen is painful with palpation and the provider suspects secondary bacterial peritonitis.

1. What orders do you anticipate?
2. What assessments will you do for peritonitis?
3. Her MAR has order for pantoprazole 40 mg IVP now. IV access is a triple lumen central venous catheter with D5½NS with 20mEqKCL at 75 mL/hr in one lumen and a hydromorphone PCA in the second, and Cefotaxime infusing in the third. Which lumen will you use to administer the pantoprazole? How will you prepare this medication? How will you administer it?

Answer 1

ANSWER a.): ORDERS THAT THE PROVIDER WOULD ANTICIPATE:

• TREATMENT FOR SECONDARY BACTERIAL PERITONITIS:SECONDARY BACTERIAL PERITONITIS REFERS TO THE INFECTION WHICH MAY OCCUR DUE TO THE INFECTED ASCITIC FLUID .
• FIRST , TREAT THE PATIENT WITH ANTIBIOTICS AS AN ANTIMICROBIAL REGIMEN OF CARBAPENEMS AND NEWER CHINOLONES OR COMBINATIONS .
• ANTIBIOTICS USED FOR SEPSIS INFECTION MAY NOT BE EFFECTIVE.CONTROL OF THE SOURCE OF INFECTION WHICH MAY BE COMMUNITY-ACQUIRED INFECTION.
• CONTINUOUS POSTOPERATIVE PERITONEAL LAVAGE:LARGE BORE DRAINS ARE INSERTED INTO THE ABDOMEN FOR CONTINUOS AND EFFECTIVE POSTOPERATIVE IRRIGATION.
• DECOMPRESSION OF THE INCREASED INTRA-ABDOMINAL PRESSURE.

ANSWER b.):ASSESSMENTS FOR PERITONITIS:

• BLOOD TESTS: BLOOD EXAMINATION IS DONE TO DETECT THE LEVEL OF WHITE BLOOD CELLS IN THE BLOOD COUNT. BLOOD CULTURE IS DONE TO DETECT THE TYPE OF BACTERIA RESPONSIBLE FOR INFECTION.
• ABDOMINAL X-RAYS:TO DETECT ANY PERFORATIONS IN THE GASTROINTESTINAL TRACT .
• ULTRASOUND AND COMPUTERIZED TOMOGRAPHY ARE ALSO USED FOR MORE PRECISE ASSESSMENT.
• PARACENTESIS: IT REFERS TO THE ASPIRATION OF THE PERITONEAL FLUID FOR INVESTIGATION.THE PERITONEAL FLUID IS ANALYZED FOR THE LEVEL OF THE WHITE BLOOD CELL COUNT.IF THE COUNT IS HIGHER THEN IT INDICATED THE PRESENCE OF INFECTION OR INFLAMMATION IN THE ABDOMEN.CULTURE OF THE FLUID IS DONE TO DETECT THE TYPE OF BACTERIA WHICH CAUSES THE INFECTION.

ANSWER c.):

• PANTOPRAZOLE IS ADMINISTERED THROUGH THE 4-LUMEN INSTEAD OF 3-LUMEN TO INCREASE THE AVAILABILITY OF CENTRAL INFUSION LINES.
• IT IS PREPARED WITH 5% DEXTROSE INJECTION,USP, 0.9% SODIUM CHLORIDE INJECTION,OR LACTATED RINGER'S INJECTION DUE TO ITS COMPATABILITY WITH THIS COMBINATION.
• ADMINISTRATION IS THROUGH THE INTRAVENOUS ROUTE OVER A PERIOD OF APPROXIMATELY 15 MINUTES AT THE RATE OF 7ml /MINUTE.THE USED DRUG IS PROTONIX I.V.