Management of Abdominal Injury

Subject: Midwifery I (Theory)

Overview

Abdominal injury symptoms include a distended abdomen, nausea and vomiting, decreased bowel motions, rebound tenderness, fever, and shoulder pain. Stabilization of the patient for surgery is part of the treatment of abdominal injuries. IV antibiotics coverage/prophylaxis or comprehensive treatment for infection prevention and reduction In the absence of a laparotomy, refer the patient to another institute for surgical care.

Signs and Symptoms

Distended abdomen
Nausea and vomiting
Reduced bowel motions
Rebound tenderness
Fever
Shoulder ache

Management

Prepare the patient for surgery by stabilizing him or her (laparotomy, possible hysterectomy, possible bowel repair)
If necessary, keep the patient in nil per oral Nasogastric aspiration.
Catheterization is used to monitor the patient's entire intake and output. IV fluid administration is used to hydrate the patient. IV antibiotic coverage/prophylaxis or full treatment for infection prevention and reduction is used.
In the absence of a laparotomy, refer the patient to another institute for surgical care.

References

Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhnadar (Publisher and Distributor), Bhotahity, Kathmandu
Postabortion care, a reference manual for improving quality of care, USAID/Nepal, FHD, HMG
Sadler, T.W. 2000, Langman’s medical embryology, 8th edition. Lippincott Williams and Wilkins, A walters Kluwer company, Philadelphia.
Safe motherhood Newsletter, Editorial, June- 2002, Safe motherhood sub-committee co- ordinator. Family health division, Department of Health division, Moh, HMG.
Saxton, D.F., 2001, Mosby’s comprehensive review of the nursing 17th edition, Mosby year book, St. Louis-London, Philadelphia, Sydney

Things to remember

Distended abdomen, nausea and vomiting, decreased bowel motions, rebound discomfort, fever, and shoulder pain are all signs and symptoms of abdominal injury.
Stabilization of the patient for surgery is part of the management of abdominal injuries (laparotomy, possible hysterectomy, possible bowel repair).
Coverage with IV antibiotics/prophylaxis or full treatment for infection prevention and reduction.
In the absence of a laparotomy, refer the patient to another institute for surgical care.

Questions and Answers

What are the management of abdominal injury?

Management

Ensure the patient is stable before operation (laparotomy, possible hysterectomy, possible bowel repair).
Maintain the patient in oral nil.
If necessary, nasogastric aspiration.
To track the patient's total intake and outflow while catheterized.
Hydration of the patient with IV fluid injection.
Infection prevention and reduction with full treatment or IV antibiotic prophylaxis.
Refer the patient to another institute for surgical care if a laparotomy is not possible.

List the signs and symptoms of abdominal injury?

Abdominal injury symptoms and signs include:

Enlarged abdomen
Nausea and diarrhoea
Reduction in bowel movements
Rebound sensitivity
Fever
Shoulders hurt