CHAPTER ONE.

1.0 INTRODUCTION
This is a client care study of Mr I.A a retired civil servant that was rushed into the
accident and emergency unit of general hospital Ilorin Kwara state on the 15 th of
august 2022, with complaint of abdominal pain, inability to pass gas and decreased
urine output 1month prior admission. On examination, patient abdomen was
tender, bloated and rigid abdominal muscles, He was diagnosed of peritonitis.

Peritonitis is the acute or chronic inflammation of the peritoneum, the membrane

lining the abdominal cavity and covering visceral organ. Peritonitis is characterized
as primary and secondary peritonitis. (Oloriegbe, 2014).
Primary peritonitis is caused by the spread of an infection from the blood and
lymph nodes of the peritoneum.
Secondary peritonitis is the most common type of peritonitis, happens when the
infection comes from the gastrointestinal or biliary tract.

Peritonitis is usually infectious and often life-threatening.Peritonitis is one of the most

common causes of acute abdomen requiring emergency laparatomy. Despite
tremendous advancements in medical care, peritonitis still is associated with high
morbidity and mortality rates. The postoperative mortality rates vary between 8.4%
and 34% from isolated studies.

Research shows various etiologies that contribute to peritonitis which

include: perforation of the terminal ileum (34.7 %), peptic ulcer perforation (15.2 %),
perforated appendicitis (8.7 %), perforation of the sigmoid colon (8.7
%), intussusceptions(7.1%), volvulus (2.7%) (Eric, 2017).

The diagnosis of peritonitis is largely based on the person's signs and symptom.
Symptoms usually include pain, tenderness, rigid abdominal muscles, fever, nausea
and vomiting. Antibiotics are almost always required, along with surgery or
drainage. In cases where the diagnosis is unclear, close observation, ultrasound,
computed tomography, and laboratory test can be helpful (Medline, 2019).

Pharmacological therapy: antibiotics, fluid therapy, analgesic, proton pump inhibitors.

 1.1 OBJECTIVES
o General Objectives:
This study focuses on peritonitis, causative factors and disease process as well
as medical and nursing managements for peritonitis.

o Specific Objectives:
 Identify factors that can predispose the client to peritonitis
 Discuss the disease process of peritonitis and the roots of the signs and
symptoms of the disease
 Discuss the medical and surgical management of peritonitis
 Provide a nursing care plan for the prioritized client's problem/diagnosis
 To discuss on the anatomy and physiology of the condition
 To discuss briefly the patient health history

o DEFINITION OF TERMS
Peritonitis: Inflammation of the peritoneum.
Appendicitis: Inflammation of the appendix.
Hypotension: Low blood pressure.
Pancreatitis: Inflammation of the pancreas.

CHAPTER TWO
LITERATURE REVIEW

2.0 ANATOMY AND PHYSIOLOGY OF THE PERITONEUM

The peritoneum is a serous membrane lining the inner walls of the abdominal and
pelvic cavities (parietal peritoneum) and surface of all intra-abdominal organs
(visceral peritoneum). It consists microscopically of a single surface layer of
squamous cells of mesothelial origin supported by a deeper connective tissue layer.
This parietal layer of the peritoneum reflects onto the abdominal visceral organs to
form the visceral peritoneum. It thereby creates a potential space between the two
layers (i.e, the peritoneal cavity).
The peritoneum consists of a single layer of flattened mesothelial cells over loose
areolar tissue. The loose connective tissue layer contains a rich network of vascular
and lymphatic capillaries, nerve endings, and immune-competent cells, particularly
lymphocytes and macrophages. The peritoneal surface cells are joined by junctional
complexes, thus forming a dialyzing membrane that allows passage of fluid and
certain small solutes. Pinocytotic activity of the mesothelial cells and phagocytosis by
macrophages allow for the clearance of macromolecules.
The peritoneal cavity is a potential space between the parietal and visceral
peritoneum which contains peritoneal fluid; acts as a lubricant, decreasing the friction
between opposing surface(Rosa Angela, 2010).
The peritoneum provides support and protection for the abdominal organs, and is the
main conduit for the associated lymph vessels, nerves and abdominal arteries and
veins.
2.1 PERITONITIS
Peritonitis is the acute or chronic inflammation of the peritoneum, the membrane
lining the abdominal cavity and covering visceral organ. (Oloriegbe, 2014).
 2.1.1 TYPES OF PERITONITIS
1. Primary peritonitis
2. Secondary peritonitis
PRIMARY PERITONITIS
Primary peritonitis is caused by the spread of an infection from the blood and lymph
nodes of the peritoneum.
SECONDARY PERITONITIS
Secondary peritonitis is the most common type of peritonitis, happens when
the infection comes from the gastrointestinal or biliary tract.

2.2 CAUSES OF PERITONITIS

1. Surgical procedure such as peritoneal dialysis
2. Ruptured appendix
3. Pancreatitis
4. Chemical irritation
5. Bile spillage
6. Trauma
7. Bacteria especially E.coli, streptococci, pneumococcal
8. Pelvic inflammatory disease
9. Surgery
10. A digestive problems such as Crohn’s diseases or diverticulitis

2.3 BACTERIA IN PERITONITIS

1. GASTROINTESTINAL SOURCE:
E Coli
Streptococci
Bacteriodes
Clostridium
Klebsiella Pneumonia
Straphylococcus
2. OTHER SOURES:
Chlamydia
Gonococcus
B Hemolytic Streptococci
Pneumococcus
Mycobacterium Tuberculosis
 2.4 PATHOPHYSIOLOGY
Peritonitis is the inflammation of the peritoneum. In a normal condition the
peritoneum appears grayish and glistering, but becomes dull after the onset of
peritonitis.
Peritonitis is caused by leakage of contents from abdominal organ into the abdominal
cavity, usually as a result of inflammation, infection, ischemia, trauma or perforation.
Bacterial proliferation occurs and oedema of the tissues result and exudation of the
fluid develops. Fluid in the peritoneum becomes turbid with increasing amount of
protein, elevated level of white blood cells and cellular debris
The immediate response of the intestinal tract is hyper motility,followed by paralytic
ileus with an accumulation of air and fluid in the bowel. The exudates become creamy
and spread to the whole peritoneum leading to severe abdominal pain, rigid abdomen,
swelling, tenderness and fever.

2.5 CLINICAL MANIFESTATION

1. Abdominal pain
2. Abdominal rigidity
3. Fever
4. Swelling and tenderness of the abdomen
5. Loss of appetite
6. Nausea
7. Vomiting
8. Hypotension
9. Decreased bowel sound
10. Organ dysfunction
11. Bloating
12. Fluid in the abdomen
13. Chills
14. Abdominal guarding
 2.6 DIAGNOSTIC EVALUATION
1. Physical examination
2. Blood test: elevated white blood cell
3. Arterial blood gasses will reveal metabolic acidosis
4. Paracentesis identifies the causative organism
5. Abdominal X-ray may reveal free air in the peritoneal cavity, gas and fluid collection
in small and large intestine
6. Chest X-ray will show elevated diaphragm
7. Computed tomography

2.7 GENERAL MANAGEMENT

2.7.1 MEDICAL MANAGEMENT

1. Antibiotics: An antibiotic is a type of antimicrobial substance active against bacteria
and is the most important type of antibacterial agent for fighting bacterial infections.
E.g Flagyl, Rocephine
2. Analgesics: are administered to relieve pain. E.g Pentazocine
3. Anti-emetics: Antiemetic drugs help to block specific neurotransmitters in the body.
These neurotransmitters trigger impulses such as nausea and vomiting, so blocking the
impulses will help shut them down e.g. metoclopramide
4. Intravenous fluid and electrolyte
5. Rectal tube to facilitate passage of gas
6. Abdominal paracentesis to remove accumulating fluid
7. Operative procedures to close perforations, remove infection source, drain abscesses
and lavage peritoneal cavity (Laparotomy).

2.7.2 NURSING MANAGEMENT

1. Monitor vital signs especially respiratory closely
2. Monitor and document the severity, consistency, location of pain
3. Position place on the side with knee flexed. This position decreases tension on the
abdominal organs and maximize comfort.
4. Accurate recording of intake and output
5. Maintain IV therapy
6. Monitor for signs of dehydration
7. Carry out all abdominal surgery pre and post operative care
8. Maintain drainage if present
9. Wound dressing using aseptic technique(Oloriegbe, 2014)
 2.8 COMPLICATIONS
1. Septicaemia
2. Hypovolaemia
3. Renal failure
4. Liver failure
5. Supra-abdominal abscess formation

2.9 PROGNOSIS
The prognosis of peritonitis if properly treated (surgery and antibiotics) have a mortality
rate of about <10% in healthy people. The mortality rate rises to about 40% in the elderly
or with those with significant underlying illness, as well as a case that present late
(Mabewa, 2018).

CHAPTER THREE
3.0 CLIENT BIOGRAPHIC DATA

NAME: Mr I.A.

ADDRESS: Oyun Kwara state

AGE: 62years old

GENDER: male

NATIONALITY: Nigerian

STATE OF ORIGIN: Kwara state

MARITAL STATUS: MARRIED

OCCUPATION: Retired civil servant

NEXT OF KIN: Mr O.A

RELATIONSHIP: Son

DATE OF ADMISSION: 15_August_2022

BED NO: Bed 3

 CASE NOTE NUMBER: 1392670

DOCTOR IN CHARGE: DR M.O

3.1General Appearance onAdmission

Mr I.A is a 62year old man dark in complexion with rough hair cut, patient presented
with history of abdominal pain, bloating since 1month ago prior the time he was brought
into General hospital Kwara state.

3.2 Physical Examination Inspection

Head: Symmetrical with black hair

Face:Symmetric movement

Ears: No discharge from both ears

Eye: Eye look sucken

Mouth:Lips are dark in color and dry

Teeth: There is no presence of dental caries

Tongue: Pink

Upper limb: Equal in length, no abnormality detected

Chest: Does not moves with respiration, absence of secretion

Abdomen: abdomen was distended and umbilicus was flat.

Pelvis-No enlarged lymph node

Lower-limb-Presence of edema in both legs.

3.2 NURSING ASSESSMENT (Gordon’s Functional Health Pattern)

 Health perception and health management pattern: He perceives health as a vital

essence of life. Mr. I.A promised to adhere to every health education given to him.
 Tho Mr I.A is a known PUD patient that was diagnosed 5years ago but not regular on
medication.

Vital signs observed on admission

Bloodpressure:140/90mmHg
RespiratoryRate:26 cycle per minute
Temperature:37.2C
PulseRate:120 beat per minute

 Drugs Allergy: No drug allergies

 Nutrition/ Metabolic pattern: He does not have any therapeutic diet.

He eats three-times a day and takes about 1 to 2L of water daily. He is not allergic to
any food.

 Elimination: Patient voids based on the amount of water he takes. Patient passes
urine 4-5 times dailywith no pain. He defecates at least once a day. On admission,
patient passes urine with a catheter in a urine bag.

 Sleep and Rest: the client sleeps well at night for about 6-8 hours.

 Activity and Exercise: The client is not able to carry out activity of daily living
independently.

 Communication/Special Senses: He sees well, hears well and does not use glasses,
all other senses function well. He speaks Yoruba/English language
.
 Cognitive and perceptual pattern: Patient has no sensory deficit. Patient knew less
about his condition and was eager to know and complied with medications.

 Role/Relationship: He relates well with his family members, nurses, doctors and
other health care workers.

 . Cognitive and perceptual pattern: He was scared of the prognosis of the disease,
but during the course of treatment he became optimistic that he would get better.
 Roles and relationship pattern: Patient has a close relationship with his wife and
children and also socializes well with his family.

 Sexuality/Reproduction: He is married with a wife and Five (5) children.

 Coping/Stress Pattern: He copes well with stress by sharing his problem with his
family and friends and rests well when he can.
 Belief Pattern: He is a Muslim and believes that his problem will be solved soon.

3.3 LABORATORY INVESTIGATIONS

FULL BLOOD COUNT
Test name Result Normal Remark
range
Hemoglobin 14.6g/dl 14-18g/dl Normal
level
Platelet count 114 150-400 Normal
Hematocrit 42.6% 42-54 Normal
Red blood cell 5.57 4.5-6.0 Normal
White blood cell 15.2 4.0-11.0 Abnormal

URINALYSIS
TEST NAME RESULTS
Colour Yellow
PH 5.0
SPECIFIC GRAVITY 1.020
PROTEIN URINE NEG
GLUCOSE URINE NEG
KETONES NEG
UROBILINOGEN NORMAL

E/U/CR
TEST NAME RESULT NORMAL REMARK
RANGE
Sodium 131mmol/l 135-145mmol/l Normal
Potassium 3.4mmol/l 3.5-5mmol/l Normal
Chloride 95mmol/l 95-110mmol/l Normal
Blood Urea 16mg/dl 15-45mg/dl Normal
Creatinine 0.5mg/dl 0.5-1.5mg/dl Normal

3.4 PHARMACOTHERAPY
1. IV Paracetamol 1g 8hourly
2. IV Flagyl 500mg 8hourly
3. IM Pentazocine 30mg 6hourly
4. IV Rocephine 1g 12hourly
5. IV Omeprazole 40mg daily

DRUG REVIEW
1. PARACETAMOL
Group: Analgesics and antipyretic
Action: It alters the response of heat regulating centre in the hypothalamus and raises
your waq as aza as the pain threshold. It also acts on pain perception apparatus of the
thalamus and hypothalamus in the CNS.
Indications: pyrexia, pain.
Dosage: 1g
Route: Intravenously
Frequency: 8hourly
Side effect: Skin rashes, bronchospasm, liver damage, leukopenia, agranulocytosis
and pancytopenia
Contraindications: Hypersensitivity, liver disease, renal impairment
2. FLAGYL
Group: Anti-microbial or Anti-protozoal
Mode of action: alter the biosynthesis of cell wall of the microbe thereby altering cell
permeability with loss of intracellular constituents.
Indication: liver abscess, appendicitis, sepsis, ulcerative gingivitis, vaginal and
urethral trichomoniasis.
Dosage: 200mg-800mg
Route: orally, intravenously.
Side effect: gastrointestinal disturbance, drowsiness, dizziness, headache, reversible
leucopenia.
Contraindication: blood dyscrasias, pregnancy known hypersensitivity reaction,
hepatic encephalopathy.
3. PENTAZOCINE
Group: non-narcotic analgesics
Mode of action: it has a depressive effect on the sensory nerve cells and sensory
centre in the brain causing a sedative effect with reduced pain and discomfort.
Indication: for relief of all types of pain in acute and chronic disorders either
associated with surgery, trauma, burns e.t.c.
Dosage: 30-60mg (im, iv), 25-100mg(oral)
Route: orally, intramuscularly, intravenously
Side effect: dizziness, nausea, vomiting, euphoria, hallucination, respiratory and
circulatory depression, headache, sedation.
Contraindication: pregnancy, hypersensitivity reaction, hypertension, myocardial
infarction, impaired renal and hepatic function.
Nursing responsibilities:
1. Ambulatory patient should be warned not to operate machinery or drive car or
unnecessary exposure to hazard.
2. To be used with caution in patients with head injury.
3. Patient should avoid movement for 15minute after receiving the drug.
4. Alcohol and barbiturate should not be used with pentazocine, since they may increase
the respiratory and CNS depressant effect of pentazocine.

4. ROCEPHIN

Group: antibiotics

Mode of action: it inhibits the synthesis of bacterial cell wall, mitosis and growth of

bacteria.

Indication: infectious fever, gonococcal infection, meningitis, urinary tract infection,

preoperatively.

Dosage: 500mg -1g

Route: intravenously

Side effect: diarrhea, abdominal pain, mouth soreness, body rashes, pruritis,

hypersensitivity reaction.

Contraindication: history of hypersensitivity to penicillin.

Nurses responsibilities:

1. Use with caution if client is hypersensitive to penicillin

2. Instruct client to take full course of the drug to maintain therapeutic blood levels

3. Instruct not to drink alcohol beverages or alcohol containing medication to avert

abdominal pain, nausea, vomiting, hypotension, tachycardia, sweating.

5. OMEPRAZOLE
Group: Proton pump inhibitor
Action: Inhibit the activity of the acid (proton pump) band to hydrogen potassium
adenosine at secretory surface of the stomach
Indication: peptic ulcer, gastro esophageal reflux disease
Contraindication: pregnant woman, lactating woman
Side effect: Nausea, vomiting, constipation.
Nurses Responsibilities:
1. Monitor urinalysis for hematuria and proteinuria. Periodic liver function tests with
prolonged use.
2. Report any changes in urinary elimination such as pain or discomfort associated with
urination, or blood in urine.
3. Administer the right dose at the right time.(Mustapha, 2009).

3.5 NURSING MANAGEMENT

Assessment
1. Assess Mr I.A level of pain
2. Monitor his vital signs especially temperature and pulses
3. Monitor the patient input and output
4. Assess for sign of dehydration
5. Assess for Mr I.A level of comfort and knowledge regarding his condition
6. Assess Mr I.A level of mobility

Nutrition
1. Mr I.A is advised to increase his protein diet to improve tissue perfusion
2. IV fluids was given parenterally
3. Food should be provided in small portion

Exercise
1. Assist the patient to perform range of motion exercise
2. Help the patient to ambulate round the ward
3. The patient is advised to perform activities of daily living he can perform
Physical care
1. Provide bath care for the patient who can’t on their own
2. Monitor patient during physical care to prevent fall and injury
3. Provide a clean environment to the patient
4. Improve the patient oral care
Elimination
 1. Patient should be placed on Paul’s tube or catheterization to monitor urine input
and output
2. IV fluids should be administered when patient shows signs of dehydration.
Diversional Therapy
Occupational therapy and diversional therapy in form of handicrafts, reading material
or a radio is provided to keep him busy and diverted from loneliness and pain.

NURSING DIAGNOSIS
1. Acute pain related to inflammatory process as evidenced by patient verbalization.
2. Anxiety related to unknown outcome of surgical
procedureas evidenced by restlessness.
3. Ineffective breathing pattern related to depressant effect of the anaesthesia
evidence by dyspnea.
4. Risk for infection related to surgical procedure evidence by signs and symptoms.
5. Risk for deficient fluid volume related to patient on nil per oral (NPO) evidence
by diminished urinary output.
6. Functional urinary incontinence related to surgical intervention evidence by
urinary catheter in situ.
7. Self care deficit related to immobility evidence by inability to carry out Activity
of Daily Living.
8. Risk for impaired skin integrity related to immobility.

PRE OPERATIVE NURSING CARE PLAN OF MR I.ADIAGNOSED WITH

PERITONITIS
S/ NURSING DIAGNOSIS OBJECTIVE INTERVENTION SCIENTIFIC EVALUATION
N RATIONALE
1 Acute pain related to Patient will verbalize 1. Assess level of pain. 1. Serve as Patient verbalizes
inflammatory less or 2. Encourage the patient to baseline less pain within 20-
process as evidenced by no pain within 20- obtain a comfortable position. information. 30minutes of
patient verbalization. 30minutes of Nursing 3. Provide a diversional therapy 2. To improve the Nursing
intervention. e.g. watching comfortability of intervention.
of favourite program on TV. the patient.
4. Administer 3. This promotes
prescribedanalgesics. relaxation and
distraction from
pain.
4. To reduce
pain.
2 Anxiety related to Patients will be less 1. Assess level of anxiety. 1. To ascertain Patient was less
unknown outcome of surgical anxious within 2. Allow patient to verbalize his the knowledge anxious within
procedure as evidenced by 10minminute of feelings. of the patient 10minute of
restlessness. nurse-patient 3. Reassure the patient. about the disease nursing
 interaction. 4. Administer anxiolytic drug as condition. intervention.
prescribed. 2. This will help
the nurse to know
which specific
management to
give.
3. To improve the
patient’s hope of
getting better.
4. To reduce
anxiety.

POST OPERATIVE NURSING CARE PLAN OF MR I.ADIAGNOSED WITH

PERITONITIS
S/ NURSING DIAGNOSIS OBJECTIVE INTERVENTION SCIENTIFIC EVALUATION
N RATIONALE
1 Ineffective breathing pattern Patient will breathe with 1. Assess the respiratory 1. Serve as a Patient breathes with
related to depressant effect ease at a rate of 18-22b/m rate of the patient. baseline. ease at the rate of 18-
anaesthetic within 1hr of 2. Position the patient in a 2. Aid air entrance 22b/m within 1hr of
Evidence by dyspnea. nursing intervention. semi-fowlers position. and promotes lung nursing intervention.
3. Administer oxygen as ventilation.
prescribed. 3. To improve
4. Encourage patient to take oxyhaemoglobin
deep breathe. level.
4. To aid
lung expansion and
ventilation.

2 Acute pain related to Patient will verbalize 1. Assess level of pain. 1. To serve as further Patient verbalizes less
inflammatory less or no pain within 10-
2. Encourage the patient to nursing management pain within
process as evidenced by 20 minutes of Nursing obtain a comfortable 2. To improve the 15minutes of Nursing
patient verbalization. intervention. position. comfortability of the intervention.
3. Provide a diversional patient.
therapy e.g. watching of 3. This promotes
favourite program on TV. relaxation and
4. Administer distraction from
prescribed analgesicse.g. pain.
IM Pentazocine. 4. To reduce pain.
3 Risk for deficient fluid Patients willdemonstrate 1. Assess level of 1. Serve as a Patient shows no sign
volume related to patient no signs and symptoms of dehydration. baseline. and symptoms of
placed on nil per oral dehydration within 2. Monitor input and 2. To determine the dehydration within
(NPO). 24hours of nursing output. level of fluid and 24hours of nursing
intervention. 3. Administer IV fluid as electrolyte in the intervention.
prescribed e.g. IV0.9% body.
Normal saline. 3. To replace lost
4. Monitor the weight of fluid and prevent
the patient. dehydration.
4. To prevent fluid
overload.

4 Risk for infection related to Patient will show no sign 1. Monitor vital signs. 1. Increase in vital Patient was free from
surgical procedure. of infection 2. Ensure strict aseptic signs signifies infection
throughout the period technique. infection. throughout the period
of hospitalization. 3. Maintain personal and 2. Reduce the chance of hospitalization.
environmental hygiene. of getting infected.
4. Give high protein diet. 3. To prevent
5. Administer antibiotics as infection.

5 Functional urinary
incontinence related to
surgical procedure evidence use of foley catheter
by urinary catheter in situ. within 24 hours
6 Self care deficit related to Patient will be able to
immobility evidence by
inability to carry out activity with the assistant of the 2. Maintain privacy during 2. To avoid exposing with the assistance of
daily living (ADL).
7 Risk for impaired skin
integrity related to
immobility.
prescribe e.g IV Rocephine. 4. High protein diet
boosts immunity.
5. To combat
infection.
Patient will be able to 1. Ensure urinarycatheter is 1. For elimination of Patient was able to
eliminate urine with the passed. urine. eliminate urine with
2. Assess color, odour and 2. Provides the use of foley
component of the urine. information about catheter within
of nursing intervention. 3. Monitor input and output adequacy of urine 24hours of nursing
chart. output. intervention.
4. Ensure catheter is not 3. To determine the
kink. fluid and electrolyte
5. Ensure aseptic technique in the body.
in providing care to the 4. Kinking can
catheter. prevent urine flow.
5. Reduces risk for
infection.
1. Asses ability to carry out 1. Serve as a Patient was able to
perform self care task ADL. baseline. perform self care task
nurse within 24hrs of bathing as appropriate. the patient / breaches the nurse within 24hrs
nursing intervention 3. Provide frequent in privacy. of nursing intervention.
assistance in ADL. 3. To reduce energy
4. Encourage patient to be expenditure.
independent. 4. To be able to carry
out ADL.
Patient will demonstrate 1. Assess the skin integrity. 1. Serve as a Patient demonstrate
skin integrity free of 2. Change patient position baseline. skin integrity free of
pressure ulcer at least every 2hours. 2. To prevent skin pressure ulcer
throughout period of 3. Prevent pressure against breakdown and throughout period of
hospitalization. any other part of the body promote circulation. hospitalization
with the use a pillow. 3. Pressure constricts
4. Slightly massage with vessels and hence
lotion or gel. impedes blood
5. Encourage ambulation supply.
when the patient is fit. 4. Massaging
promote circulation.
5. Ambulation
reduces pressure on
the skin from
immobility hence
preventing skin
breakdown.

3.6 DAILY NURSING CARE FOR MR I.A

DAY 1 (15/08/2022)
1. At 11:50am, Mr I.A was brought in accident & emergencyconscious and alert
accompanied by relatives.
2. Vital signs on admission was; Temperatuer-36.2 degree Celsius, Pulse rate-92b/m,
Respiratory rate-20c/m, Blood Pressure-112/86mmHg.
3. Patient is on oxygen therapy via nasal prong nursed in fowler’s position.
4. Patient is on NPO till further notice.
5. Nasogatric tube was inserted to hasten return of bowel function and relieving
gastrointestinal discomfort.
6. Patient was placed on IVF Normal saline alternate with 5%Dextrose
saline 1L 8hourly, IV Febramol 1g 8hourly, IM Pentazocine 30mg 6hourly, IV Flagyl
500mg 8hourly,IV Rocephine 1g 12hourly, IV Omeprazole 40mg daily.

DAY 2 (16/08/2022)
1. Personal and environmental hygiene were maintained.
2. Bed pan was served as desired.
3. Vital signs monitored, and read; Temperature-36.2 degrees Celsius, Pulse rate- 98b/m,
Respiratory rate- 20c/m, Blood pressure- 120/78mmHg.
4. He had IV Flagyl 500mg 8hourly, IM Pentazocine 30mg 6hourly, IV Febramol 1g
8hourly, IV Omeprazole 40mg, IVF Normal saline and IVF 5%Dextrose saline.
5. Patient nursed in fowler’s position and on oxygen therapy via nasal prongs.
6. Patient is on closed bag drainage, draining concentrated urine.
7. Intake and output monitored; 4600/3500mls

DAY 3 (17/08/2022)
1. Personal and environmental hygiene were maintained and Bed pan was served as
desired.
2. Vital signs monitored, prescribed medication was administered.
3. Patient is closely monitored and still on oxygen therapy via nasal prongs.
4. Patient still on nil per oral (NPO).
5. Intake and output monitored; 1200/560mls
6. Patient still on nasogastric tube draining greenish effluent.

DAY 4 (18/08/2022)
1. Personal and environmental hygiene maintained.
2. Vital signs monitored and charted.
3. Oxygen therapy still in progress via nasal prongs with respiratory rate of 20c/m.
4. Prescribed medication administered at due time.
5. Patient still on nasogastric tube draining greenish effluent.
6. Intake and output monitored.
7. Daily wound dressing was done to reduce risk for infection and promote healing.
8. Patient is on closed bag drainage, draining clear urine.

DAY 5 (19/08/2022)
1. Personal and environmental hygiene maintained.
2. Vital signs monitored and charted; Temperature-36.4degree Celsius, Pulse- 88c/m,
Blood pressure- 120/80mmHg.
3. Oxygen therapy still in progress via nasal prongs with respiratory rate of 22c/m.
4. Patient was nursed in fowler’s position.
5. Daily wound dressing done.
6. Prescribed medication administered at due time.
7. Intake and output monitored.
DAY 6 (20/08/2022)
1. Personal and environmental hygiene maintained.
2. Vital signs monitored and charted.
3. Oxygen therapy still in progress via nasal prongs with respiratory rate of 20c/m.
4. Prescribed medication administered at due time.
5. Patient still on nil per oral (NPO).
6. Intake and output monitored; 3000/2390mls.
7. Daily wound dressing done.
8. Patient is on closed bag drainage, draining clear urine.

DAY 7 (21/08/2022)
1. Personal and environmental hygiene maintained.
2. Vital signs monitored and charted.
3. Oxygen therapy discontinued and patient maintain respiratory rate of 22c/m.
4. Prescribed medication administered at due time.
5. Bladder training commenced.
6. Nasogastric tube was disconnected.
7. Oral sip of water only was commenced.
8. Intake and output monitored; 3250/2370mls.

DAY 8 (22/08/2022)
1. Personal and environmental hygiene maintained.
2. Vital signs monitored and charted; Temperature- 36.5 degree Celsius, Respiratory
rate- 20c/m, Pulse rate- 94b/m, Blood pressure- 120/68mmHg.
3. Prescribed medication administered at due time.
4. Patient was nursed in semi-fowler’s position.
5. Intake and output monitored.
6. Daily wound dressing.
7. Water was given and well tolerated.
8. Patient was ambulated

DAY 9 (23/08/2022)
1. Personal and environmental hygiene maintained.
2. Vital signs monitored and charted; Temperature- 36.5 degree Celsius, Respiratory
rate- 20c/m, Pulse rate- 92b/m, Blood pressure- 116/60mmHg.
3. Prescribed medication administered and charted.
4. Patient was nursed in semi-fowler’s position.
5. Intake and output monitored; 2620/2820mls.
6. Daily wound dressing.
7. Pap was commenced and well tolerated.
DAY 10 (24/08/2022)
1. Personal and environmental hygiene maintained.
2. Vital signs monitored and charted.
3. Prescribed medication administered and charted.
4. Patient was nursed in semi-fowler’s position.
5. Intake and output monitored; 1500/800mls
6. Nutritious diet encouraged.

DAY 11 (25/08/2022)
1. Personal and environmental hygiene maintained.
2. Patient condition was improving.
3. Vital signs monitored and charted.
4. Prescribed medication administered and charted.
5. Patient still being managed conservatively
6. Intake and output monitored.
7. Nutritious diet encouraged

DAY 12 (26/08/2022)
1. Personal and environmental hygiene maintained.
2. Vital signs monitored and charted.
3. Prescribed medication administered and charted.
4. Patient still being managed conservatively
5. Intake and output monitored.
6. Nutritious diet encouraged.

DAY 13 (27/08/2022)
1. Personal and environmental hygiene maintained.
2. Vital signs monitored and charted.
3. Prescribed medication administered and charted.
4. Patient still being managed conservatively
5. Intake and output monitored.
6. Nutritious diet encouraged.
7. Patient is being work up for discharge.

DAY 14 (28/08/2022)
1. Patient’s condition greatly improved.
2. Wound dressing was done.
3. Vital signs was checked and documented; Temperature- 36.5 degree Celsius, Pulse
rate- 92b/m, Respiratory rate- 20c/m, Blood pressure- 120/64mmHg.
4. Doctor saw and reported that his condition is satisfactory and was consequently
discharged.