Peritonitis – Pathophysiology, Podcast, and Nursing Care Plan

Intestines

Peritonitis

Peritonitis occurs when the membrane that lines the inner wall of the abdomen and supports and covers most of the abdominal organs becomes inflamed. Peritonitis can be caused by a fungal or bacterial infection. It can also be caused by rupture or perforation in the abdomen.

Peritonitis will always require immediate medical intervention primarily to fight infection. If peritonitis is not treated the patient can develop sepsis.

Patients with a history of peritonitis in the past have an increased risk for getting peritonitis in the future along with patients who have a history of Cirrhosis, Crohn’s disease, Diverticulitis, Appendicitis,  Peritoneal dialysis, and Pancreatitis.

There are two types of peritonitis:

Spontaneous Peritonitis: usually caused by infected fluid that collects in the peritoneal cavity.  It is also seen in patients who receive peritoneal dialysis.

Secondary Peritonitis: this condition usually occurs when bacteria enter the peritoneal cavity via a perforation in the GI tract. Examples include penetrating abdominal trauma, ruptured appendix, and even perforated ulcers.

** to remember the difference, Secondary Peritonitis occurs Secondary to another event. An example would be a patient had an appendicitis then as a result of bacteria entering the peritoneal cavity a secondary peritonitis occurs.

 

Sign and Symptoms

The patient exhibit the following signs and symptoms:

  • Fever
  • Abdominal pain and swelling
  • Decreased urine output
  • Nausea and vomiting
  • Decreased appetite
  • Thirst
  • Unable to pass gas or stool

Diagnostics

The physician or healthcare practitioner may use the following to diagnose Peritonitis.

  • Blood Tests:  among the blood tests, a CBC will be drawn to see if there is a high white blood cell (WBC) count, which would be indicative of infection.
  • Peritoneal Fluid: the fluid in the peritoneum will be sampled by needle aspiration. This fluid is normally clear as it is sterile. It should look like fluid that comes out of a blister.  However, if it is cloudy, this is usually due to the presence of  white blood cells that may be indicative of an infection or inflammation. The sample will be sent out to lab for analysis and culture.
  • CT scan will show more detail than an x-ray.
  • X-rays
  • Ultrasound may be helpful.

Treatments

Patients with peritonitis usually need to be hospitalized and the following treatments may be utilized:

  • Surgery – to remove infected tissue and to treat the underlying cause of infection in the first place.  The source of the infection must be treated to keep infection from spreading.
  • Antibiotics – To fight infection and to prevent the infection from spreading.
  • IV fluids – This will assist in maintaining blood pressure and hydration.
  • Supplemental oxygen as needed.
  • Pain medications – as needed.

** If patient was on peritoneal dialysis, the healthcare provider may order dialysis to be done via a different route until the infection can be brought under control.

 Nursing Care Plan

Nursing Diagnosis

1. Acute pain related to inflammatory process of the peritonitis as evidenced by patient rates pain at 8/10 on pain scale and states abdominal cramping and tenderness in abdomen.

Desired outcomes:

Patient will report a decrease in pain from 8 to 0 on the pain scale by discharge.

InterventionsRationals
InterventionsRationals
Assess level of pain using appropriate pain scale. Assess pain 30 minutes before and after pain medication is given.Using an appropriate age pain rating scale will help the healthcare providers monitor the level of pain and adjust pain medications as needed.
Administer pain medications as prescribed and indicated.Analgesics are helpful in relieving pain and helping in the recovery process.
Have patient maintain limited bedrest and activityThis will help to minimize pancreatic secretions and pain.
Incorporate nonpharmacologic measures to assist with control of pain.Ideally, the use of comfort measures will distract the patient from pain and may increase the effectiveness of pharmacological measures.

2. Risk for Infection related to development of inflammatory process or worsening peritonitis.

Desired outcomes:

By discharge, the patient will remain free signs and symptoms of infection.

InterventionsRationals
InterventionsRationals
Assess vital signs including temperature every 4 hours and as needed. Report any abnormal findings to the healthcare provider.Fever is often one of the first signs of infection.
Assess mental status and level of consciousnesses every 4-6 hours.Mental status changes, confusion, or any deterioration from baseline can signify infection.
Report and note any abnormal laboratory values (i.e. elevated WBC count) to the healthcare provider.Certain abnormal laboratory results could be an indicator of infection.

Other possible nursing diagnosis:

Risk for imbalanced fluid volume

Impaired gas exchange

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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