Peritonitis Nursing Care Plans Diagnosis and Interventions
Peritonitis NCLEX Review and Nursing Care Plans
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
- Abdominal pain and/or tenderness
- Feeling of fullness
- Nausea and vomiting
- Loss of appetite
- Low urine output
- Inability to pass stool or gas
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
- 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.
- Surgery. The infected abdominal tissue may need to be removed to treat the underlying infection, as well as to prevent its spread.
- Other supportive medications. Antipyretics for fever, pain relief medications, and intravenous fluids may be needed for symptom control.
Nursing Diagnosis for Peritonitis
Peritonitis Nursing Care Plan 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.
|Peritonitis Nursing Interventions||Rationales|
|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.
|Peritonitis Nursing Interventions||Rationales|
|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 3
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.
|Peritonitis Nursing Interventions||Rationale|
|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 4
Fluid Volume Deficit / Deficient Fluid Volume
Nursing Diagnosis: Fluid Volume Deficit related to fluid shifts from extracellular into intestines and/or peritoneal space and active fluid volume loss (due to vomiting), medically restricted intake, nasogastric or intestinal aspiration, and failure of regulatory mechanisms (i.e., fever, hypermetabolic state) secondary to peritonitis as evidenced by decreased skin turgor, dry mucous membranes, decreased urine output, increased urine concentration, weak peripheral pulses, delayed capillary refill, hypotension, and tachycardia
- The patient will exhibit improved fluid balance as evidenced by normal urinary output (with normal specific gravity), stable vital signs, good skin turgor, moist mucous membranes, normal capillary refill, and weight within the normal range.
|Peritonitis Nursing Interventions||Rationale|
|Monitor vital signs. Note for the presence of hypotension (including changes with posture), tachycardia, fever, and tachypnea. If available, measure central venous pressure.||This helps in the assessment of the degree of hypovolemia or effectiveness of fluid replacement therapy and patient’s response to medications.|
|Sustain accurate measurements of intake and output (I&O) and correlate with the patient’s daily weight measurements. Include measured losses as well as measurements from gastric suction, drains, dressings, diaphoresis, Hemovacs, and abdominal girth for third spacing of fluid.||All of these measurements reflect the overall hydration status of the patient. The patient may exhibit decreased urine output secondary to fluid deficit and decreased renal perfusion, however, the weight may still increase. This suggests the presence of tissue edema or ascites. When gastric suction losses is increased markedly, excessive fluid can be sequestered in the intestines and peritoneal space leading to ascites.|
|Obtain measurement of urine specific gravity.||Urine specific gravity reflects the patient’s hydration status and changes in renal function. When the urine specific gravity is not within the acceptable range, this may indicate developing acute renal failure due to hypovolemia and effects of toxins. A number of antibiotics can also be toxic to the kidneys, affecting its function and may lead to changes in urine output.|
|Observe the presence of skin or mucous membrane dryness and decreased skin turgor. Also, take note and monitor the presence of peripheral and sacral edema.||Fluid deficit, fluid shifts, and nutritional imbalance may exacerbate poor skin turgor and formation of taut edematous tissues.|
|Eliminate noxious stimuli from the environment (e.g., noxious sights and odors). Reduce the intake of ice chips.||Reducing noxious stimuli decreases gastric stimulation and vomiting response. Too much use of ice chips during gastric aspiration can raise gastric washout of electrolytes.|
|Monitor laboratory examination results, specifically hemoglobin levels to hematocrit ratio (Hb/Hct), levels of electrolytes, protein, albumin, blood urea nitrogen (BUN), and creatinine (Cr). If the patient’s hemodynamic status is unstable, measure the patient’s pulmonary artery pressure and central venous pressure frequently (preferably hourly).||These laboratory studies give information on hydration status and organ function. Changes in the levels of these parameters along with systemic changes in the body are possible due to hypovolemia, fluid shifts, circulating toxins, hypoxemia, and accumulation of necrotic tissue products.|
|Replenish lost fluid by administering plasma or blood, intravenous fluids, and electrolytes as indicated. Note the patient’s response to therapy.||This can restore the effective circulating volume of the patient as well as electrolyte balance. Colloids, such as plasma and blood, aid in shifting the water back into the intracellular compartment by raising the osmotic pressure gradient. Administration of diuretics may also help in flushing out circulating toxins and improve renal function.|
|Maintain NPO (nil per os meaning ‘nothing by mouth’ or NBM) with nasogastric or intestinal aspiration.||This decreases bowel hyperactivity and fluid loss from diarrhea.|
|Change position often, give frequent skin care, and keep a dry or wrinkle-free bedding.||It must be noted that edematous tissue is prone to breakdown because normal circulation is compromised.|
|Monitor the patient’s ECG for dysrhythmias as a result of electrolyte imbalance.||Due to the inflammatory process, peritonitis causes a decrease in sodium and chlorine levels leading to electrolyte disturbances. Electrolyte imbalance may lead to the occurrence of dysrhythmias and may cause complications during resuscitation.|
Peritonitis Nursing Care Plan 5
Nursing Diagnosis: Acute Pain related to chemical irritation of the parietal peritoneum due to circulating toxins, and physical agents such as tissue trauma and fluid accumulation in the abdominal or peritoneal cavity secondary to peritonitis as evidenced by pain score of 10 out of 10, abdominal distension and rigidity, verbalization/coded reports of pain, rebound tenderness, muscle guarding on the abdomen, facial mask of pain, anxiety (distraction behavior and autonomic/emotional responses), and expressive behavior (i.e., restlessness and irritability)
- For the patient to report that the pain is relieved or controlled as evidenced by a pain score of 0 out of 10.
- For the patient to demonstrate the utilization of relaxation skills and other methods to encourage comfort
- For the patient to demonstrate stable vital signs and absence of restlessness
|Peritonitis Nursing Interventions||Rationale|
|Identify and examine the pain intensity of the patient using the pain scale (with 0 being the least painful and 10 being the most painful). Take note also of the location, duration, radiation, and quality of pain. Example pain assessment questions: Is the pain dull, sharp, shooting, constant? Is the pain stabbing, cramping, throbbing?||Pain assessment is necessary to detect and characterize the pain which may aid in deciding what intervention is best to use for pain relief. This may also help in evaluating if the pain treatment is working and whether the underlying condition is improving or worsening. Alteration in the location or intensity of pain is not common but may suggest the occurrence of developing complications. When the inflammatory process advances, the pain tends to be more constant, more intense, and diffused over the entire abdomen. If an abscess develops, pain may be localized.|
|Elevate the patient’s head and maintain in semi-Fowler’s position as indicated. Allow the patient to sit on their back with the bed angle at 30-45 degrees. The patient’s legs may be straight or bent.||The semi-Fowler’s position facilitates wound fluid or wound drainage by gravity. This decreases diaphragmatic irritation and/or abdominal tension, and thereby decreasing pain. This can also increase the oxygen level to reach optimal lung expansion.|
|Place the patient in bed rest in the course of severe pain episodes. Provide nonpharmacologic pain relief measures such as massage, back rubs, deep breathing exercises, and guided imagery. Teach the patient relaxation and visualization techniques and offer diversional activities such as watching TV or listening to the radio.||These methods encourage relaxation and may improve the patient’s coping abilities by refocusing attention. This can also decrease gastrointestinal stimulations and may give optimal comfort to the patient.|
|Move the patient slowly and carefully while splinting the painful area.||This decreases muscle tension and guarding, thereby lessening pain of movement.|
|Eliminate noxious stimuli and give frequent oral care.||Removal of noxious stimuli reduces nausea and vomiting, thereby minimizing intra-abdominal pressure and pain.|
|Administer medication such as analgesics, narcotics, antiemetics, antipyretics, as indicated.||Analgesics reduce pain by reducing metabolic rate and intestinal irritation brought about by circulating or local toxins. Aside from pain relief, analgesics can also promote healing. If the pain is severe, this may warrant the use of narcotics. During the initial diagnostic process, administration of analgesics may be withheld because they can mask signs and symptoms. Antiemetics decrease the occurrence of nausea and vomiting, thereby decreasing abdominal pain. Antipyretics reduces fever, thereby decreasing discomfort.|
|Evaluate the patient’s vital signs and the quality of pain at least 30 minutes post-administration of medication.||This will aid in monitoring the patient’s response to treatment as well as treatment effectiveness. The time of monitoring vital signs is dependent on the peak time of the administered drug.|
|Note the patient’s age, developmental level, and current condition (e.g., ventilated, sedated, cognitively impaired)||The patient’s age, developmental level, and current state may influence the patient’s ability to report pain parameters.|
|Observe the patient’s nonverbal cues and pain behavior (e.g., facial expressions such as grimacing, narrowed focus, crying, withdrawal and how the patient holds his/her body)||It is important to note that nonverbal cues may or may not support the patient’s intensity of pain. It may only indicate if the client cannot verbalize his/her pain.|
Peritonitis Nursing Care Plan 6
Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to inability to ingest (i.e., nausea or vomiting), and inability to digest food or absorb nutrients (i.e., intestinal dysfunction, increased metabolic needs, and metabolic abnormalities) secondary to peritonitis.
- The patient will regain ideal weight, muscle tone, and skin turgor.
|Peritonitis Nursing Interventions||Rationale|
|Auscultate for bowel sounds and take note if bowel sounds are absent or hyperactive.||Bowel sounds are absent frequently, however, inflammation and intestinal irritation may be associated with intestinal hyperactivity, decreased water absorption, and diarrhea. Constipation is often indicated with absent bowel sounds while hyperactive bowel sounds indicate an increase in intestinal activity/motility.|
|Monitor the patient’s nasogastric (NG) tube output. Note also for the presence of vomiting and diarrhea. Excessive amounts of gastric aspirations and occurrence of vomiting and diarrhea may suggest bowel obstruction which may warrant further assessment and investigation. Over a 24-hour period, if the NG tube output is less than 500 ml, accompanied by at least 2 other signs of return of normal bowel function, the NG tube can be removed. Ensure that the NG tubes are positioned properly to avoid getting a consistently high NG tube output despite resolving the acute issue of the patient. Note that the most recommended location for an NG tube is past the pylorus to minimize the risk of aspiration.|
|Measure the patient’s abdominal girth. Take note of the trends in this measurement.||Abdominal girth measurement provides a quantitative measure of changes in gastric or intestinal distension and/or fluid accumulation (ascites). Measurement of abdominal girth is usually done at the level of the umbilicus.|
|Evaluate the abdomen frequently for return to softness, restoration of bowel sounds, and passage of flatus.||Return to softness, restoration of bowel sounds, and passage of flatus indicate that the normal bowel function has returned to normal. These also indicate that the patient may resume oral intake.|
|Record the patient ‘s weight regularly.||Changes in hydration may be reflected by initial losses or gains in weight, however sustained losses may already suggest nutritional deficit.|
|Monitor the patient’s laboratory examination results specifically the levels of BUN, protein, prealbumin, albumin, glucose, and nitrogen balance as indicated. Notify the healthcare provider of critical values in these measurements.||These parameters reflect organ function and nutritional status. These can also aid in identifying the patient’s nutritional need to achieve optimal bodily functions. Albumin levels within the normal range may indicate adequate protein in the system.|
|Progress the patient’s diet as tolerated. You may transition from clear liquids to soft food while noting the patient’s response to the diet advancement.||It is important to note that diet progression when oral intake is already resumed must be done carefully to minimize the risk of gastric irritation. While in a soft food diet, the food must be mildly seasoned, tender, and easy to digest. The patient must not intake fried or spicy foods, or raw fruits and vegetables while on this diet. They must not also drink alcoholic beverages.|
|Administer total parenteral nutrition (TPN) as indicated.||TPN encourages nutrient utilization and maintains positive nitrogen balance in patients who cannot absorb nutrients orally. TPN provides patients with all or most of the required calories through solutions containing a mixture of carbohydrates, protein, fat, vitamins, and minerals which is administered intravenously through a peripherally inserted central catheter (PICC) line. A central line or a port-a-cath can also be used to administer TPN.|
|Record the patient’s required calorie (energy sources) intake.||Measurement of the patient’s calorie needs will aid in the acceleration of the healing process. This will also help in monitoring the patient’s nutritional status.|
|Educate the patient on the food substances required to maintain a balance in the body’s metabolism.||Patients must eat nutritious food to accelerate the healing process and to achieve nutritional needs.|
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. (2022). 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
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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.
thnk uh vry much..! 🙂