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LOGOCompanyandSlogan Ascending colonic perforated purulent peritonitis Sepsis Septic shock ICU Nursing rounds LOGOLOGOCompanyandSloganLOGO Main content LOGOCompanyandSlogan Case name: Li Yan Gender: Female Age: Ethnicity: Han Married: Unmarried Occupation: Unemployed Place of birth: Wuxiang, Shanxi mdashmdash: LOGO LOGO Company and Slogan Patients with current medical history have no obvious incentives for the right lower abdomen with nausea, vomiting, diarrhea. After the consultation at the local hospital, two oral antibiotics (cephalosporins and erythromycin) were given poorly. The abdominal pain gradually worsened for more than ten days. Aggravated and extended to abdominal pain. Visiting the Provincial People's Hospital for a B-ultrasound examination showed that a large amount of effusion in the abdominal cavity was found to cause laparotomy. The patient was refused and was given an abdominal drainage tube (right mid-abdomen). Since the onset of symptoms, poor appetite. LOGOCompanyandSlogan has no previous history of hypertension, history of heart disease, diabetes, history of cerebrovascular disease, hepatitis, tuberculosis, history of malaria, vaccination history is unknown, history of surgery, no history of trauma, history of blood transfusion, food, drug allergy history Had I treatment. LOGOCompanyandSlogan was admitted to the hospital to check the body temperature: ℃ pulse: sub-breathing: sub-blood pressure: mmHg height: weight: Kg abdomen swelling no bowel type and peristaltic wave can be seen on the right mid-abdomen a drainage tube with pale yellow purulent drainage fluid leading to liver and spleen The tenderness of the whole abdomen and rebound tenderness are obvious. The right lower abdomen is especially heavy and the mobile dullness-positive bowel sounds are weakened. Auxiliary examination: Ultrasound of the abdomen: Ultrasound of gallbladder in the gallbladder with massive effusion in the abdominal cavity. Blood test: WBC: * ^ L Neutral:% LOGOCompanyandSlogan Preliminary diagnosis of LOGO ascending colon perforating purulent peritonitis sepsis Septic shock LOGOCompanyandSlogan condition development, admission time ：: General anesthesia emergency laparotomy after admission, operation time :: ascending colonic perforation repair, ileostomy, transfer from general surgery to ICU after critically ill surgery time ::,: maximum body temperature at night LOGOCompanyandSlogan disease development :: into the ml volume urine volume ml abdominal drainage ml. Color Doppler ultrasound: Moderate mitral insufficiency of tricuspid valve, mild and moderate insufficiency of tricuspid valve,: T: ℃ P: Min R: Min BP: mmHg Yellow turbid solution ml raised colon yellow drainage solution ml edema in both hands. ． : Oxygen and poor chest radiographs of patients with mild edema of both lower extremities see high-density shadow stoma opening to start intestinal nutrition LOGOCompanyandSlogan's condition development :: try off-line nasal feeding sugar water :: try off-line h consciousness is not uncomfortable. Dexamethasone mg into the ampulla-nasal cannula for Lmin, blood oxygen saturation. :: The body temperature is normal and the breathing is unstable up to the sub-minute blood oxygen instability prepared ventilator. LOGOCompanyandSlogan related disease knowledge Ascending colon perforation structure: The length between the ascending colon and the right bowel of the colon varies depending on the position of the cecum. The posterior wall of the ascending colon is attached to the right kidney and front of the psoas major muscle with little activity. Causes: peptic ulcer, inflammatory bowel disease, intestinal diverticulum, intestinal tumor, mesenteric ischemic disease, strangulated intestinal obstruction, incarcerated hernia and iatrogenic, spontaneous, traumatic intestinal perforation. Pathogenesis: Intestinal wall necrosis caused by primary or secondary intestinal tract rupture, perforated intestinal contents overflow into the peritoneal cavity, causing acute diffuse peritonitis, infection, toxic shock, or even death. LOGOCompanyandSlogan related diseases Knowledge Clinical manifestations :, abdominal pain, bloating : Abdominal pain often occurs suddenly as a continuous knife-cut pain and worsens during deep breathing and coughing. The extent of pain is related to the extent of the spread of peritonitis. Symptoms of systemic infection poisoning: fever, chills, heart rate, blood pressure drop, and other toxic shock manifestations. Abdominal examination: Abdominal breathing weakens or disappears. There is obvious tenderness in the whole abdomen, rebound tenderness, muscle tone, rigidity, rigidity, diagnosis of liver dullness, disappearance of mobile dullness, bowel sounds, or disappearance. LOGOCompanyandSlogan related diseases Knowledge disease treatment: To clarify the diagnosis of intestinal perforation, the location and cause of intestinal perforation must be clarified. 2. Acute diffuse peritonitis caused by perforation, toxic shock due to infection, and even death, so once the diagnosis is actively treated. The surgical method should be based on the cause of intestinal perforation and the site of perforation, the time of perforation, the degree of contamination of the abdominal cavity, the general state of the patient, etc. to choose feasible perforation repair, partial bowel resection or intestinal ostomy. LOGOCompanyandSlogan related diseases Knowledge Complications: Purulent peritonitis Septic shock sepsis LOGOCompanyandSlogan Anxiety: Related to fear of disease prognosis Morphological abnormalities: Related to ileostomy An inefficient respiratory pattern: Related to a large amount of fluid in the abdominal cavity leading to incomplete lung dilatation Abdominal distension, abdominal pain: Nursing diagnosis related to peritonitis inflammation and stimulation, toxin absorption LOGOCompanyandSloganLOGOCompanyandSlogan Nursing measures, body position: The patient takes a semi-recumbent bed and lifts the bed to promote intra-abdominal exudate flow to the pelvic cavity to reduce toxin absorption and relieve symptoms of poisoning. Limiting the infection while avoiding the diaphragmatic elevation caused by bloating reduces the effect of bloating on breathing and circulation. Fasting and gastrointestinal decompression: Indwelling gastric tube and continuous gastrointestinal decompression suck out gastrointestinal contents and gas to improve blood circulation of the gastrointestinal wall and reduce gastrointestinal contents to continue to flow into the abdominal cavity to reduce abdominal pain and bloating. LOGOCompanyandSlogan care measures, empty the faeces bag in time for local cleaning and care to prevent infection. Closely observe the color, character and quantity of the stool and report it to the doctor if there is any abnormality. Keep the airway unobstructed. Follow your doctor's advice. Low concentration and continuous sputum if necessary. Pay attention to psychological nursing, grasp the patient's psychological state in time, patiently enlighten, comfort and cooperate with their loved ones to eliminate adverse factors and enhance patients' confidence to overcome the disease, so that they actively cooperate with treatment and nursing to promote physical recovery. LOGOCompanyandSlogan nursing measures, observe and record the amount, color, and character of the drainage fluid. Squeeze the drainage tube frequently to prevent clots or pus clogging. Keep drainage open to prevent intra-abdominal infection. LOGOCompanyandSlogan nursing measures, closely observe the changes of the condition, pay close attention to blood pressure, pulse, breathing, urine output and mental consciousness, especially pay attention to its circulation, breathing and renal function monitoring. Observe abdominal symptoms and signs, especially pay attention to tenderness and abdominal distension. Understand the recovery of intestinal motility. Find changes in the condition and report to the doctor in time. LOGOCompanyandSlogan Health Education, Knowledge: Explain to patients the importance of fasting, gastrointestinal decompression, and semi-recumbent position during non-operative periods. Teach patients to pay attention to changes in abdominal symptoms and signs. Dietary guidance: Explain the post-operative dietary knowledge and encourage them to follow a gradual, small meals and more nutritious, light, digestible liquid, semi-liquid diet. Given its history of hyperthyroidism, a low iodine diet is given. LOGOCompanyandSlogan health education and psychological counseling: Relieve patients' anxiety and help them build confidence to overcome the disease, so that they actively cooperate with the treatment of medical staff and communicate with patients in order to understand the progress of the disease in time to provide relevant clinical basis for treatment. Safety instructions: Explain to patients the role and importance of various drainage tubes to prevent them from extubating themselves. If the tubes automatically fall off, report to the doctor for treatment in time. Do not reply immediately. LOGOCompanyandSlogan Thank you for participating!