An Interesting Case
Kai Tiaki : the journal of the nurses of New Zealand, Volume II, Issue 1, January 1909, Page 19
An Interesting Case
M. W., act. 20, admitted to Hospital 7 p.m., 13th June, 1908. Patient was m a partially collapsed state, and complained of abdominal pains. Temp, was 100.4, pulse 120, R. 28. The history showed that the patient had been m her usual health up till seven hours before admission, with the exception of what she considered slight occasional indigestion. At twelve noon, on day of admission, she had a meal of fowl, potatoes and cabbages. Two hours later was seized with severe abdominal pain and nausea, no vomiting. Medical attendance was procured, and hospital treatment advised. Perforated gastric ulcer was diagnosed soon after admission to hospital, and operation performed about three hours later. A perforation of the stomach was found on the anterior surface of the cardiac end, near the lesser curvature, about the diameter of an ordinary lead pencil. Peritoneal cavity contained coagulated lymph, and stomach contents. The perforation was closed with cat-gut and the peritoneal cavity was irrigated with saline solution, a drain was inserted into lower end of wound, and the cavity was also drained through a counter opening above the pukes. Strych. 1.60 gr. was given during operation, and repeated four hourly for the following 36 hours. On returning to bed the patient was put m Fowler's position, she recovered from the anaesthetic quietly, had no severe pain, and a good pulse. Continuous rectal injection of saline was started immediately, quantity 01. every two hours, with brandy drc. 11, and lemco drc. V added. Owing to the bowel containing some faecal matter, a S. and W. enema was given, a little flatus and some faeces was expelled. Vomiting occurred three times. The vomit consisted of fragments of undigested food and yellowish fluid. Sips of hot water was given after recovery from the anaesthetic. The catheter was passed six hourly. Temp, at six a.m. was normal, P. 106, Resp. 25. General appearance was good, patient had only slight pain, and dozed at intervals. June 14th : At twelve noon woutid was dressed, some sanguinous discharge from upper wound, and some purulent discharge from lower, an hour later bowels acted twice, with normal motion. June 15th : Wound was dressed, some sanguinous discharge from lower wound. Saline per rectum was discontinued, and
two ounce nutrient enemata of egg, peptone, and brandy given two hourly, well retained. Temp, remained at 99 during day, rising to 100 m the evening. Pulse was regular — 1 10-116 per mm. Patient slept well that night, June 16th : Nutrients changed to four ounces four hourly, but not well retained. Chicken tea, rasin tea, lemon water, albumen water, half an ounce m succession, given per mouth every hour. Wound wps dressed, similar discharge, no nausea, or vomiting, and appearance was good. The patient was bright and cheerful all the day. June 17th : Nutrient enemata were discontinued, and meat enules were inserted per rectum four hourly, nourishment given per mouth as on previous day. June 18th ; Tube was removed from wound, and gauze drain inserted, nourishment given as before, including whey, tea, coffee and chicken broth. Temp, was normal, pulse 90-100. June 19th : Meat enules discontinued, other treatment as on previous day. June 20th : The stitches were removed from upper and lower wounds. Fluid diet increased to one ounce hourly. Bowels moved naturally, and there was no pain or discomfort. June 21st : Nourishment was increased to two ounces hourly, and variety increased with Benger's food ; barley water, milk, clear soups, and broths. The patient was cheerful and comfortable. Temp, was normal, pulse rate 88-200 per mm. June 23rd : Diet again increased, with junket and arrowroot added. June 25th-30th : The patient had no pain. Diet was increased to pounded chicken , mashed potatoes, egg, and thin bread and butter without crusts. A soap and water enema was given every alternate day with good results. Wound was dressed daily, and very slight discbarge. July Ist -6th : Patient progressed satisfactorily, taking nourishment well, bowels acting regularly and naturally, with no discomfort of any kind. Wounds almost healed. July 12th : Patient up m chair. Wounds healed, and on full diet. July 30th * Patient discharged 42 days after admission looking slightly pale, but well nourished, and feeling quite well. Edith M. I/Ewis, 26th September, 1908.