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Friday, October 14, 2022

Peritonitis: Causes, Symptoms, Diagnosis, Management, Nursing Interventions by Nurses Note


Peritonitis occurs when bacteria or other microorganisms cause a generalized or localized inflammation of the peritoneum, the membrane lining the abdominal cavity and abdominal organs.

Pathophysiology and Causes

Primary Peritonitis 

Also known as spontane+ous bacterial peritonitis (SBP). This occurs when bacteria cross through the intestinal wall into the peritoneum, causing infection. SBP can occur in patients with cirrhosis, nephrotic syndrome, and ovarian diseases.

Secondary Peritonitis 

This type of peritonitis is due to perforation, rupture of an organ, trauma, or peritoneal dialysis.

Symptoms of  Peritonitis

1. Initially, local type of abdominal pain tends to become constant, diffuse, and more intense. 

 2. Abdomen becomes extremely tender and muscles become rigid; rebound tenderness and ileus may be present; the patient lies very still, usually with legs drawn up. 

 3. Percussion: Resonance and tympany due to paralytic ileus; loss of liver dullness may indicate free air in abdomen. 

 4. Auscultation: Decreased bowel sounds. 

 5. Nausea and vomiting often occur; peristalsis diminishes; anorexia is present. 

 6. Elevation of temperature and pulse as well as leukocytosis. 

 7. Fever; thirst; oliguria; dry, swollen tongue; signs of dehydration.

8. Weakness, pallor, diaphoresis, and cold skin are a result of the loss of fluid, electrolytes, and protein in to the abdomen. 

 9. Hypotension, tachycardia, and hypokalemia may occur. 

10. With generalized peritonitis, large volumes of fluid may be lost into abdominal cavity (ascites). Shallow respirations may result from abdominal distention and upward displacement of the diaphragm.

Ulcerative Colitis: Causes Symptoms Diagnosis Treatment Complications Nursing Assessment Diagnosis Intervention

Diagnostic Evaluation of Peritonitis

1. WBC count to determine if leukocytosis is present (leukopenia if severe). 

2. ABG levels may show hypoxemia or metabolic acidosis with respiratory compensation. 

3. Urinalysis may indicate urinary tract problems as primary source. 

4. Peritoneal aspiration (paracentesis) to demonstrate blood, pus, bile, bacteria (Gram’s stain), amylase.

5. Abdominal x-rays may show free air in peritoneal cavity, gas and fluid collection in small and large intestines, generalized bowel dilation, intestinal wall oedema. 

6. CT scan of abdomen or sonography may reveal intra-abdominal mass, abscess, ascites. 

7. Radionuclide scans (gallium, hepatobiliary iminodiacetic acid, and liver/spleen scan) may identify an intra-abdominal abscess.

 8. Chest x-ray may show elevated diaphragm. 9. Exploratory laparotomy may be performed to identify the underlying cause.

Management of Peritonitis

 1. Treatment of inflammatory conditions preoperatively and postoperatively with antibiotic therapy may prevent peritonitis. Broad-spectrum antibiotic therapy to cover aerobic and anaerobic organisms is initial treatment, followed by specific antibiotic therapy after culture and sensitivity results. 

 2. Bed rest, NPO status, respiratory support, if needed. 

 3. IV fluids and electrolytes, possibly TPN. 

 4. Analgesics for pain; antiemetics for nausea and vomiting. 

 5. NG intubation to decompress the bowel. 

 6. Possibly rectal tube to facilitate passage of gas. 

 7. Operative procedures to close perforations, remove infection source (ie, inflamed organ, necrotic tissue), drain abscesses, and lavage peritoneal cavity. 

 8. Abdominal paracentesis may be done to remove accumulating fluid. 

 9. Blood transfusions, if appropriate. 

10. Oral feedings after return of bowel sounds and passage of gas and/or feces.

Complications of Peritonitis

 1. Intra-abdominal abscess formation (ie, pelvic subphrenic space). 

 2. Septicemia.

 3. Hypovolemic problems. 

 4. Renal or liver failure. 

 5. Respiratory insufficiency.

Nursing Assessment of Peritonitis

 1. Assess for abdominal distention and tenderness, guarding, rebound, hypoactive or absent bowel sounds to determine bowel function. 

 2. Observe for signs of shock—tachycardia and hypotension. 

 3. Monitor vital signs, ABG levels, CBC, electrolytes, and central venous pressure to monitor hemodynamic status and assess for complications.

Nursing Diagnoses of Peritonitis

• Acute Pain related to peritoneal inflammation.

• Deficient Fluid Volume related to vomiting and interstitial fluid shift

• Imbalanced Nutrition: Less Than Body Requirements related to GI symptomatology.

Packed Cell Volume (PCV): Uses, Test Method, Normal and Abnormal Ranges

Nursing Interventions of Peritonitis

Achieving Pain Relief

 1. Place the patient in semi-Fowler’s position before surgery to enable less painful breathing. 

 2. After surgery, place the patient in Fowler’s position to promote drainage by gravity. 

 3. Provide analgesics as prescribed.

Maintaining Fluid and Electrolyte Volume 

 1. Keep the patient NPO to reduce peristalsis. 

 2. Provide IV fluids to establish adequate fluid intake and to promote adequate urine output, as prescribed. 

 3. Record accurately intake and output, including the measurement of vomitus and NG drainage. 

 4. Minimize nausea, vomiting, and distention by use of NG suction, antiemetics. 

 5. Monitor for signs of hypovolemia: dry mucous membranes, oliguria, postural hypotension, tachycardia, diminished skin turgor.

Achieving Adequate Nutrition 

 1. Administer TPN, as ordered, to maintain positive nitrogen balance until patient can resume oral diet.

 2. Reduce parenteral fluids and give oral food and fluids per order when the following occur:

 a. Temperature and pulse return to normal. 

b. Abdomen becomes soft. 

c. Peristaltic sounds return (determined by abdominal auscultation). 

d. Flatus is passed and patient has bowel movements.

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