Peritonitis

Peritonitis Nursing Diagnosis Interventions and Care Plans

Peritonitis Nursing Diagnosis NCLEX Review Care Plans

Nursing Study Guide for Peritonitis

Peritonitis is a medical condition wherein the abdominal wall lining or membrane called the peritoneum becomes inflamed, typically due to an infection.

The causative agent of this abdominal infection can be either bacteria or fungi. Peritonitis can be a complication of liver cirrhosis or kidney disease (spontaneous bacterial peritonitis).

Secondary peritonitis occurs when there is a perforation or rupture of the abdomen. It can also arise due to poor hygiene while on peritoneal dialysis.

Signs and Symptoms of Peritonitis

  • Fever
  • Abdominal pain and/or tenderness
  • Feeling of fullness
  • Bloating
  • Nausea and vomiting
  • Loss of appetite
  • Diarrhea
  • Thirst
  • Low urine output
  • Inability to pass stool or gas
  • Confusion
  • Fatigue

Symptoms of Peritonitis while on peritoneal dialysis include the presence of white strands or fibrin strands in the dialysis fluid, and/or cloudy appearance of the dialysis fluid.

Causes and Risk Factors of Peritonitis

Peritonitis can be caused by disease, trauma, or medical procedure. Liver disease such as cirrhosis or kidney disease may lead to peritonitis.

Stomach ulcers, perforated abdomen or colon, or ruptured appendix can introduce bacteria or fungi into the peritoneum, causing an infection.

Trauma, pancreatitis and diverticulitis may also result to peritonitis.

Peritoneal dialysis, when done in unclean environment, or with contaminated equipment and poor hygiene, may result to peritonitis.

The use feeding tubes or some gastrointestinal surgeries may put the patient at higher risk for peritonitis.

Complication of Peritonitis

Peritonitis is an urgent infection that requires the use of antibiotics and possible surgical intervention, as it may lead to the fatal spread of infection throughout the body, also known as sepsis.

Diagnosis of Peritonitis

  • Physical exam and history taking – to check for the symptoms of Peritonitis and any history
  • Blood tests – to check for
  • Imaging – X-ray or CT scan to visualize the abdominal cavity and check for any perforations
  • Paracentesis or peritoneal fluid analysis – to check for the presence of pathogenic bacteria or fungi by using a needle to get a sample of peritoneal fluid

Treatment for Peritonitis

  1. Antibiotics. The first line of treatment for peritonitis is to give a course of antibiotics, which is dependent on the type of bacteria that have caused the infection and inflammation. The doctor may start with broad spectrum antibiotics, then switch with the type of antibiotics to which the causative bacteria are sensitive.
  2. Surgery. The infected abdominal tissue may need to be removed to treat the underlying infection, as well as to prevent its spread.
  3. Other supportive medications. Antipyretics for fever, pain relief medications, and intravenous fluids may be needed for symptom control.

Nursing Care Plans for Peritonitis

  1. Hyperthermia secondary to infective process of peritonitis as evidenced by temperature of 38.5 degrees Celsius, rapid breathing, profuse sweating, and chills

Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

InterventionsRationales
Assess the patient’s vital signs at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. Paracetamol) administered.
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed antibiotic and anti-pyretic medications.Use the antibiotic to treat bacterial infection (peritonitis), which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.
Peritonitis Nursing Care Plan

2. Nursing Diagnosis: Risk for Infection

Desired Outcome: The patient will be able to avoid the development of an infection.

InterventionsRationales
Assess vital signs and observe for any signs of infection as well as for any signs of respiratory distress, and gastrointestinal problems such as diarrhea, nausea, and vomiting.To assess for the evidence of ongoing infection. Sepsis or infection of the blood may develop from peritonitis, and can be evidenced by fever accompanied by respiratory distress.
Perform a focused assessment on the abdominal region, particularly checking for abdominal pain, abdominal rigidity, diminishes or absent bowel sounds, and rebound tenderness.Peritonitis is a serious complication of pancreatitis, diverticulitis, trauma, liver disease, or kidney disease. It is evidenced by abdominal pain, abdominal rigidity, diminishes or absent bowel sounds, and rebound tenderness.
Prepare the patient for paracentesis.To obtain a sample of peritoneal fluid in order to identify the presence of an infection and its causative agent.
Teach the patient how to perform proper hand hygiene.To maintain patient safety and reduce the risk for cross contamination.
Administer antibiotics as prescribed.To treat the underlying infection with broad spectrum antibiotics, then switch with the type of antibiotics to which the causative bacteria are sensitive. This is also done to prevent the risk of developing sepsis in a patient with peritonitis.
Peritonitis Nursing Care Plan

Nursing Diagnosis: Acute Pain related to inflammation of the peritoneum as evidenced by pain score of 10 out of 10, verbalization of abdominal pain, guarding sign on the abdomen, abdominal rigidity, and restlessness

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.

InterventionsRationale
Administer prescribed pain medications.To alleviate the symptoms of acute abdominal pain. Pain on the right upper quadrant of the abdomen suggests the involvement of the head of the pancreas, while left upper quadrant pain refers to the tail of the pancreas. Right upper quadrant pain suggests gall bladder involvement, while right lower quadrant pain may indicate inflamed appendix. Narcotic analgesics such as meperidine should be preferred over morphine, as the latter has a side effect of biliary pancreatic spasms.
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.  To monitor effectiveness of medical treatment for the relief of abdominal pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.  
Elevate the head of the bed and position the patient in semi Fowler’s.To increase the oxygen level by allowing optimal lung expansion.
Place the patient in complete bed rest during severe episodes of pain. Perform non pharmacological pain relief methods: relaxation techniques such as deep breathing exercises, guided imagery, and provision of distractions such as TV or radio.To reduce gastrointestinal stimulations thereby decreasing pancreatic activity. To provide optimal comfort to the patient.
Peritonitis Nursing Care Plan

Other possible nursing diagnoses:

  • Imbalanced Nutrition: Less than Body Requirements
  • Deficient Fluid Volume

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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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4 comments

  1. Fabiana

    Great explanation!
    What sources do you used?

    Tks

    Fabiana

    • Mostly Peer reviewed, Pubmed, Saunders. Then I have an MD take a look if he has time 🙂 . I really want to keep it up to date with the info. If you think something could be added. Please let me know.

      Thanks,
      Anna

  2. thnk uh vry much..! 🙂

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