Abdomen agudo perforativo y aplicación del proceso de atención de enfermería

Abstract

The acute abdomen is responsible for 10% of the visits to the emergency department, with 50% admitted; of which 30% to 40% are surgically operated; and from 5% to 10% of these interventions are by perforation of viscera and relating with generalized peritonitis, can lead to septic shock, constitute a high degree of morbidity and mortality. Its causes vary between obstruction, diverticulitis, neoplasms, and ulcers. It is characterized by abdominal pain type colic, rigid abdomen (in table), absence of elimination of gases, vomiting, diarrhea, diaforesis, hyperthermia, dehydration, tachycardia, bradycardia and arterial hypertension, leukocytosis. It is diagnosed by anamnesis, complete blood count and image examinations, of immediate surgical treatment. Its complications vary: sepsis and septic shock, where the prognosis will depend on immunologic and physiological factors of the patient. The objective of the present study is to identify the causes of the emergence of the acute perforative abdomen and its complications in patients of 61 years male sex and application of the nursing care process according to the theory of Marjory Gordon. The clinical case is a 61-year-old male patient, with a pathological history of arterial hypertension and type 2 diabetes mellitus. He goes to the Theophilus Dávila Hospital, in the city of Machala on the 19-07-2018. For presenting abdominal pain of 2 weeks of evolution , is self-medicated while staying ambulatory and at 14 days the abdominal table is exacerbated presenting pain type colic of great intensity, abdomen distended (in table), absence of elimination of Flatos, with the valuation. Vital Signs: TA: 132/79 mmhg, T°: 38.7 ° C, FR: 31 rpm, FC: 99 ppm, SO2:94%. Physical examination: Presents pale facies, Algic, diaphoretic, rigid abdomen, globulous, painful to superficial and deep palpation; also, emphasizing glucose: 279 mg/dl. According to evaluation of surgery, with diagnosis of acute inflammatory abdomen, the exploratory laparotomy is performed emergent with surgical findings: Fecal peritonitis 1800 cc, colon right and transverse, with ischemic and necrotic signs, perforation of 2 cm at level of transverse colon, tumor mass in a straight-sigmoid junction of more or less 10 cm, adhered to bladder wall and infiltrating abdominal wall; Performing a total colectomy plus ileostomy. It passes to recovery room in poor clinical conditions with diagnosis of septic shock, where it is valued by UCI, and it is indicated reference to health unit of greater complexity. At 2 days, it is transferred, in the same clinical conditions with diagnosis of sepsis not specified. The method applied is the analysis of the clinical history and scientific articles of relevant information. With the exhaustive analysis of the case, it is determined that the perforation was due to the obstruction in rectosigmoid by stenosis at the level of tumor mass, that prevented the outflow of fecal feces and gases, causing the intestinal loops to cause ischemia and necrosis of right and transverse colon and for 2 weeks evolution time. Therefore, it’s concluded that the cause was intestinal obstruction and the complication, is septic shock and that in addition the colonic perforations do not occur frequently.