-Progression of mass
-Pulse - 4 hourly
-Instructions are given to the nurse to report if the patient vomits and to save the specimen for inspection. Unless the vomitus is a small quantity of clear fluid, no time should be lost in passing and retaining a trans nasal gastric aspiration tube, in order to keep the stomach empty.
-Water - 30 ml hourly oral
*Oral feeding - desire for food, usually about the 4th or 5th day, is an indication that satisfactory progress is being made. The first feeds should be fluids only and progression to solid food can take place over the next few days.
*With fluid balance chart and daily assay of electrolytes must be instituted
-Morphine - once it has been decided definitely to treat the patient conservatively. Pain, as opposed to tenderness, is very seldom complained of after the first 12 hours of the treatment. No morphine or its derivatives should be given in borderline cases that are being watched closely for a few hours to observe whether the pulse rate and other signs are tending to settle.
IV ampicillin, gentamicin & metronidazole
Oral 3rd generation cephalosporin - change to this when the patient is permitted to receive nourishment by mouth.
Glycerine suppository - if the bowels are not opened naturally by the 4th or 5th day. No purgatives of any kind are given until resolution is complete - that is, until the temperature and pulse have been normal for a week and pain and physical signs are absent.
As for any patient confined to bed, prophylaxis against thrombosis of the pelvic and leg veins should be given with compression stockings and subcutaneous low-dose heparin.
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