Physiological Adaptation Q 10
A female client is experiencing a painful and rigid abdomen and is diagnosed with a perforated peptic ulcer. A surgery has been scheduled and a nasogastric tube is inserted. The nurse should place the client before surgery in
A. Sims position
B. Supine position
C. Semi-fowlers position
D. Dorsal recumbent position
Correct Answer: C. Semi-fowlers position
Semi-fowlers position will localize the spilled stomach contents in the lower part of the abdominal cavity. Initiation of fluid resuscitation should start as soon as the diagnosis is made. Insertion of a nasogastric tube to decompress the stomach and a Foley catheter to monitor urine output are essential steps.
Option A: Placing the client in a Sims position could let the stomach contents spill out of the perforation. Tachycardia and abdominal tenderness with rigidity are common clinical signs. Severe pain, systemic inflammatory response from chemical peritonitis, and fluid deficit either due to poor intake or vomiting or pyrexia lead to compensatory tachycardia.
Option B: The supine position could aggravate the pain of the ulcer. PPU is a surgical emergency associated with high mortality if left untreated. In general, all patients with PPU require prompt resuscitation, intravenous antibiotics, analgesia, proton pump inhibitor medications, nasogastric tube, urinary catheter, and surgical source control.
Option D: Placing the patient in a dorsal recumbent position would put pressure on the stomach contents and still aggravate the pain. When PUD worsens and eventually perforate, gastric juice and gas enter the peritoneal cavity leading to chemical peritonitis. Sudden onset of abdominal pain or acute deterioration of the ongoing abdominal pain is typical of PPU. Typically the pain never completely subsides despite usual premedical remedies and forces the patient to seek medical attention.