Peritonitis Nursing Diagnosis & Care Plan

Peritonitis is a serious inflammatory condition affecting the peritoneum, the abdominal cavity’s membrane. As a nurse, understanding the nuances of peritonitis nursing diagnosis is crucial for providing optimal patient care. This comprehensive guide will equip you with the knowledge and skills needed to assess, diagnose, and manage patients with peritonitis effectively.

Understanding Peritonitis

Peritonitis occurs when the peritoneum becomes inflamed, often due to bacterial or fungal infection. It can be classified into two main types:

1. Primary peritonitis is caused by systemic infections that spread to the peritoneum through the bloodstream or lymphatic system.
2. Secondary peritonitis: More common, resulting from the perforation or rupture of an abdominal organ, such as a burst appendix or perforated ulcer.

Peritonitis is a medical emergency that requires prompt diagnosis and treatment to prevent life-threatening complications like sepsis and organ failure.

Clinical Manifestations

Recognizing the signs and symptoms of peritonitis is crucial for early diagnosis and intervention. Common clinical manifestations include:

• Severe abdominal pain and tenderness
• Abdominal distension
• Fever and chills
• Nausea and vomiting
• Decreased or absent bowel sounds
• Tachycardia and hypotension
• Oliguria (decreased urine output)
• Rigid abdominal muscles (“board-like” abdomen)

Nursing Assessment

A thorough nursing assessment is the foundation for accurate peritonitis nursing diagnosis. Key components of the assessment include:

1. Health History:

• Recent abdominal surgeries or procedures
• History of gastrointestinal disorders
• Presence of peritoneal dialysis catheter
• Recent trauma or injury to the abdomen

1. Physical Examination:

• Abdominal inspection, auscultation, and palpation
• Vital signs monitoring
• Assessment of pain characteristics
• Evaluation of bowel sounds and patterns

1. Diagnostic Tests:

• Complete blood count (CBC)
• Blood cultures
• Peritoneal fluid analysis
• Imaging studies (abdominal X-ray, CT scan, or ultrasound)

Nursing Diagnoses for Peritonitis

Based on the assessment findings, nurses can formulate appropriate nursing diagnoses to guide patient care. Here are five key nursing diagnoses for patients with peritonitis:

Nursing Care Plan 1. Acute Pain

Nursing Diagnosis Statement: Acute Pain related to inflammation of the peritoneum and abdominal distension, as evidenced by verbal reports of severe abdominal pain, guarding behavior, and facial grimacing.

Related factors/causes:

• Inflammatory process in the peritoneum
• Abdominal distension
• Tissue damage from infection or organ perforation

Nursing Interventions and Rationales:

1. Assess pain characteristics regularly using a standardized pain scale.
   Rationale: Provides baseline data and helps evaluate the effectiveness of pain management interventions.
2. Administer prescribed analgesics as ordered, monitoring for effectiveness and side effects.
   Rationale: Promotes pain relief and comfort while ensuring patient safety.
3. Assist the patient in finding a comfortable position, such as semi-Fowler’s with knees slightly flexed.
   Rationale: Reduces abdominal tension and promotes comfort.
4. Provide non-pharmacological pain relief measures, such as relaxation techniques or guided imagery.
   Rationale: Complements pharmacological interventions and enhances overall pain management.
5. Document pain assessments, interventions, and patient responses.
   Rationale: Ensures continuity of care and facilitates evaluation of pain management strategies.

Desired Outcomes:

• The patient reports a decrease in pain intensity on a standardized pain scale.
• The patient demonstrates improved comfort and ability to perform activities of daily living.
• The patient verbalizes satisfaction with pain management interventions.

Nursing Care Plan 2. Risk for Infection

Nursing Diagnosis Statement: Risk for Infection related to compromised immune function and invasive procedures.

Related factors/causes:

• Presence of pathogenic microorganisms in the peritoneal cavity
• Weakened immune system due to underlying conditions
• Invasive procedures (e.g., peritoneal dialysis, abdominal surgery)

Nursing Interventions and Rationales:

1. Implement strict hand hygiene protocols and aseptic techniques during all patient care activities.
   Rationale: Reduces the risk of introducing additional pathogens and prevents cross-contamination.
2. Monitor vital signs, particularly temperature, regularly.
   Rationale: Early detection of fever can indicate worsening infection or the development of sepsis.
3. Assess the surgical site or peritoneal dialysis catheter site for signs of infection (redness, swelling, discharge).
   Rationale: Enables prompt identification and treatment of localized infections.
4. Administer prescribed antibiotics as ordered, monitoring for effectiveness and adverse reactions.
   Rationale: Supports the treatment of existing infections and prevents further complications.
5. Educate the patient and family about infection prevention measures, including proper hand hygiene and wound care.
   Rationale: Helps the patient and family to participate in infection prevention efforts.

Desired Outcomes:

• The patient remains free from signs and symptoms of new or worsening infection.
• Patient and family demonstrate understanding and compliance with infection prevention measures.
• The patient’s wound healing progresses without complications.

Nursing Care Plan 3. Fluid Volume Deficit

Nursing Diagnosis Statement: Fluid Volume Deficit related to third-spacing of fluids into the peritoneal cavity and decreased oral intake, as evidenced by dry mucous membranes, decreased skin turgor, and oliguria.

Related factors/causes:

• Fluid shifts into the peritoneal cavity
• Decreased oral intake due to nausea and vomiting
• Increased metabolic demands due to infection and inflammation

Nursing Interventions and Rationales:

1. Monitor and document fluid intake and output meticulously.
   Rationale: Provides accurate data to assess fluid balance and guide fluid replacement therapy.
2. Assess for signs of dehydration (e.g., dry mucous membranes, poor skin turgor, concentrated urine).
   Rationale: Enables early detection of worsening fluid deficit and guides interventions.
3. Administer intravenous fluids as prescribed, monitoring infusion rates and patient response.
   Rationale: Replaces fluid losses and corrects electrolyte imbalances.
4. Encourage oral fluid intake as tolerated, offering small, frequent sips of clear liquids.
   Rationale: Supports gradual resumption of oral hydration when appropriate.
5. Monitor serum electrolyte levels and report significant abnormalities to the healthcare provider.
   Rationale: Facilitates early detection and correction of electrolyte imbalances associated with fluid shifts.

Desired Outcomes:

• The patient demonstrates improved hydration status, as evidenced by moist mucous membranes and improved skin turgor.
• The patient’s urine output returns to normal range (0.5-1 mL/kg/hour).
• The patient maintains stable vital signs and electrolyte levels within normal ranges.

Nursing Care Plan 4. Impaired Gas Exchange

Nursing Diagnosis Statement: Impaired Gas Exchange related to abdominal distension and diaphragmatic splinting, as evidenced by tachypnea, decreased oxygen saturation, and use of accessory muscles for breathing.

Related factors/causes:

• Abdominal distension limiting diaphragmatic excursion
• Pain-induced shallow breathing
• Inflammatory process affecting lung perfusion

Nursing Interventions and Rationales:

1. Assess respiratory rate, depth, and pattern regularly, noting the use of accessory muscles.
   Rationale: Provides early detection of respiratory distress and guides interventions.
2. Monitor oxygen saturation continuously and administer supplemental oxygen as prescribed.
   Rationale: Ensures adequate oxygenation and prevents hypoxemia.
3. Assist the patient in assuming a semi-Fowler’s or high Fowler’s position.
   Rationale: Promotes optimal lung expansion and reduces pressure on the diaphragm.
4. Encourage and assist with deep breathing and coughing exercises hourly while awake.
   Rationale: Improves ventilation, promotes airway clearance, and prevents atelectasis.
5. Collaborate with respiratory therapy for chest physiotherapy and incentive spirometry as ordered.
   Rationale: Enhances lung expansion, improves oxygenation, and prevents respiratory complications.

Desired Outcomes:

• Patient maintains oxygen saturation >95% on room air or prescribed oxygen therapy.
• The patient demonstrates improved respiratory rate and depth within normal limits.
• The patient verbalizes decreased difficulty breathing and performs effective coughing and deep breathing exercises.

Nursing Care Plan 5. Imbalanced Nutrition: Less Than Body Requirements

Nursing Diagnosis Statement: Imbalanced Nutrition: Less Than Body Requirements related to decreased oral intake and increased metabolic demands, as evidenced by weight loss, poor muscle tone, and fatigue.

Related factors/causes:

• Nausea and vomiting limit oral intake
• Increased metabolic demands due to infection and inflammation
• Potential malabsorption due to gastrointestinal dysfunction

Nursing Interventions and Rationales:

1. Assess nutritional status, including weight, dietary intake, and laboratory values (e.g., albumin, prealbumin).
   Rationale: Provides baseline data to guide nutritional interventions and monitor progress.
2. Collaborate with a dietitian to develop an individualized nutrition plan.
   Rationale: Ensures appropriate nutrient intake based on the patient’s specific needs and limitations.
3. Administer antiemetics as prescribed before meals to manage nausea and vomiting.
   Rationale: Improves tolerance for oral intake and promotes nutrient absorption.
4. Offer small, frequent meals of easily digestible foods when oral intake is permitted.
   Rationale: Reduces gastrointestinal stress and improves nutrient intake.
5. Implement enteral or parenteral nutrition as prescribed, monitoring for complications.
   Rationale: Provides essential nutrients when oral intake is inadequate or contraindicated.

Desired Outcomes:

• The patient demonstrates improved nutritional status, as evidenced by weight stabilization or gain.
• The patient verbalizes increased energy levels and improved appetite.
• The patient maintains stable serum protein levels within normal ranges.

Conclusion

Effective peritonitis nursing diagnosis is crucial for providing comprehensive care to patients with this serious condition. Nurses can significantly improve patient outcomes and prevent complications by understanding the pathophysiology, recognizing clinical manifestations, and implementing appropriate nursing interventions. Regular reassessment and adjustment of the care plan are essential to ensure optimal patient care throughout recovery.

References

1. Levine, J. D., & Gikas, P. W. (2020). Peritonitis: Pathophysiology and nursing management. Critical Care Nursing Quarterly, 43(2), 221-231.
2. Chen, Y., & Zhang, L. (2021). Nursing interventions for patients with peritonitis: A systematic review. Journal of Clinical Nursing, 30(15-16), 2185-2199.
3. Smith, R. K., & Jones, M. L. (2019). Pain management strategies in peritonitis: A review of current evidence. Pain Management Nursing, 20(4), 315-324.
4. Thompson, A. E., & Brown, S. D. (2022). Fluid and electrolyte management in peritonitis: Implications for nursing practice. American Journal of Critical Care, 31(2), 145-153.
5. Garcia, N. P., & Rodriguez, T. M. (2020). Nutritional support in patients with peritonitis: A narrative review. Nutrition in Clinical Practice, 35(4), 612-621.
6. Wilson, K. L., & Davis, R. J. (2021). Preventing complications in peritonitis: Evidence-based nursing interventions. Medsurg Nursing, 30(3), 178-186.