Peritonitis Nursing Care Management and Study Guide

Peritonitis is the spark before sepsis. Contents leak into a sterile cavity, bacteria take off, and the patient can slide into septic or hypovolemic shock fast. Your job is to control pain, keep fluid and electrolytes ahead of the third-spacing, get antibiotics in early, and read the abdomen and vital signs for the turn toward shock.

What Is Peritonitis?

Peritonitis is inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera. It is usually bacterial, with organisms tracking in from GI tract disease or, in women, from the internal reproductive organs. Acute inflammatory bowel processes feed it: appendicitis and diverticulitis both can perforate and seed the cavity.

Pathophysiology

Contents leak from abdominal organs into the cavity and bacteria proliferate. Tissue edema follows, and fluid exudes into the peritoneal cavity within a short time, turning turbid with protein, white blood cells, cellular debris, and blood. The intestinal tract first answers with hypermotility, then drops into paralytic ileus as air and fluid accumulate in the bowel.

Causes

Trauma such as gunshot or stab wounds opens the cavity to contamination. Inflammation extending from an organ outside the peritoneal area, such as the kidneys, can reach it. The bacteria most often implicated are Escherichia coli, Klebsiella, Proteus, Pseudomonas, and Streptococcus.

Clinical Manifestations

Findings track the extent and location of inflammation. Pain starts diffuse, then becomes constant, localized, and more intense over the involved site. The affected abdomen turns extremely tender and distended, the muscles go rigid, and movement makes it worse. Expect a temperature of 37.8C to 38.3C with an increased pulse rate.

Complications

Widespread infection drives the danger. Sepsis is the major cause of death from peritonitis. Shock follows from septicemia or hypovolemia. The inflammatory process can also cause intestinal obstruction, mostly from bowel adhesions.

Assessment and Diagnostic Findings

The white blood cell count is almost always elevated. Serum electrolyte studies may show altered potassium, sodium, and chloride. An abdominal xray may show air and fluid levels and distended bowel loops. Abdominal ultrasound may reveal abscesses and fluid collections, a CT scan of the abdomen may reveal abscess formation, and MRI may be used to diagnose intra-abdominal abscesses.

Medical Management

Fluid, colloid, and electrolyte replacement is the focus. Several liters of an isotonic solution are prescribed, with analgesics for pain. Intestinal intubation and suction relieve abdominal distention and promote return of intestinal function. Oxygen by nasal cannula or mask supports adequate oxygenation. Antibiotic therapy starts early.

Surgical Management

Surgery removes infected material and corrects the cause. Treatment is directed toward excision, especially when the appendix is involved. Resection of the intestines may be done with or without anastomosis. With extensive sepsis, a fecal diversion may be created.

Nursing Management

Patients with peritonitis often need intensive care.

Nursing Assessment

Assess continuously. Pain should be assessed and acted on, GI function monitored to gauge response to interventions, and fluid and electrolytes kept in balance.

Nursing Diagnosis

Acute pain related to peritoneal irritation. Deficient fluid volume related to massive shifting of fluids toward the intestinal lumen and depletion of the vascular space. Risk for shock related to septicemia or hypovolemia.

Nursing Care Planning and Goals

Reduce pain, restore fluid and electrolyte balance, prevent complications, and restore normal GI function.

Nursing Interventions

Monitor blood pressure by arterial line if shock is present. Give analgesics and antiemetics as prescribed, and use positioning along with analgesics to ease pain. Record all intake and output accurately to guide fluid replacement, and administer and closely monitor IV fluids. Postoperatively, monitor and record the character of the drainage.

Evaluation

Pain is reduced, fluid and electrolyte balance is restored, complications are prevented, and normal GI function returns.

Discharge and Home Care Guidelines

If the patient goes home with drains still in place, teach the patient and family to care for the incision and drains. Refer for home care when further monitoring and patient and family teaching are needed.

Documentation Guidelines

Document the client's description of and response to pain, the acceptable level of pain, prior medication use, degree of deficit, current sources of fluid intake, intake and output, fluid balance, presence of edema, results of diagnostic tests, vital signs, plan of care, and teaching plan. Record response to interventions, teaching, and actions performed, attainment or progress toward desired outcomes, modifications to the plan of care, long term needs, and specific referrals made.