If a gastric acid perforates, which of the following actions should not be included in the immediate management of the client?
A. Blood replacement
B. Antacid administration
C. Nasogastric tube suction
D. Fluid and electrolyte replacement
Correct Answer: B. Antacid administration
Antacids aren’t helpful in perforation. The client should be treated with antibiotics. Perforation of the stomach is a full-thickness injury of the wall of the organ. Since peritoneum completely covers the stomach, perforation of the wall creates a communication between the gastric lumen and the peritoneal cavity. If the perforation occurs acutely, there is no time for an inflammatory reaction to wall off the perforation, and the gastric content is free to enter the general peritoneal cavity, causing chemical peritonitis.
Option A: The client should be treated with blood replacement. Broad-spectrum antibiotics have been shown to reduce the risk of wound infection. Metronidazole and either a cephalosporin or an aminoglycoside will suffice.
Option C: NG tube suction should also be performed to prevent further spillage of stomach contents into the peritoneal cavity. A nasogastric tube should also be placed. Intravenous analgesia and PPIs should be given as necessary. A urinary catheter enables close monitoring of urine output. Surgical management is the mainstay of treatment for most stomach perforations.
Option D: The client should be treated with fluid and electrolyte replacement. Initial management consists of aggressive resuscitation, oxygen therapy, intravenous fluids, and broad-spectrum antibiotics. Definitive surgical treatment should be done at the earliest possible time.
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