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Peritonitis
Presenter Name
DONIQUE ADDERLEY, ANGELIQUE BETHELL, JANEE GIFFARD , FRANCHESKA MCINTOSH ,SHANIQUE MILLER-MINNIS
- Bacterial infection ( Escherichia coli, Klebsiella, Proteus, Pseudomonas, Streptococcus )
- A fungal infection
- Injury or trauma such as (gunshot wounds or stab wounds)
- Abdominal surgical procedures and peritoneal dialysis
- Appendicitis, perforated ulcer, diverticulitis, and bowel perforation
- Inflammation that extends from an organ outside the peritoneal area, such as the kidney.
Causes of Peritonitis
Pathophysiology of Peritonitis.
- Bacterial proliferation occurs
- Edema of the small tissue results and exudation of fluid develops in a short space of time.
- Then Fluid turbid with increase protein, white blood cells, cellular debris, and blood.
- Response of the intestinal tract is hypermotility follows by paralytic ileum with accumulation of air and fluid in the bowel.
Inflammation of the peritoneum, typically caused by bacterial infection either via the blood or after rupture of an abdominal organ.
Peritonitis
NURSING MANAGEMENT
MANAGEMENT
Nursing Diagnoses
- Acute pain r/t peritoneal irritation aeb abdominal tenderness, patient verbalization, P- 114bpm, R-26bpm.
- Deficient fluid volume r/t fluid in the peritoneal aeb abdominal distension, nausea, vomiting, Potassium level 2.8 mEq/L
- Infection r/t inflammation of peritoneal aeb T- 100o, WBC 14,000/mm3.
- Impaired gas exchange t/t increase abdominal pressure restricting expansion of lungs aeb R-26bpm, PaCO2 – 30 mmHg, HCO3 - 18mEq/L.
Nursing Interventions
Assess pain for Severity ,Location , Onset ,Duration ,relieving factors.
R: the assessment will not only define the type of pain but it will monitor relief of discomfort obtained to determine effectiveness of the treatment .
Keep Mrs. Garden on bed-rest. Provide a restful and quiet environment.
R: Rest minimizes pain , which can be aggravated by activity and stress.
Administer opioid and other analgesics as ordered.
R: Relieve severe pain and discomfort
Encourage Mr. Garden to request analgesic before pain becomes severe.
R: pain management is more effective when analgesics is given before becomes severe
Describe and explain the illness , all procedures and treatment plans to the patient.
R: Information helps minimize anxiety , which can exacerbate discomfort.
Nursing
Management
- Blood pressure monitoring.
- Medications.
- Pain management.
- I&O monitoring.
- IV fluids.
- Drainage monitoring.
Reference
- Blood pressure monitoring.
- Medications.
- Pain management.
- I&O monitoring.
- IV fluids.
- Drainage monitoring.
References
- Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarths textbook of medical-surgical nursing. Philadelphia: Wolters Kluwer.
- Pamela L. Swearingen, RN (2016) Nursing care planning resources.
Diagnosis/ Treatment Manifestations /Complications
Diagnosis
· Imaging test
· Ultrasound
· CT scan
· Peritoneal fluid analysis
· Serum electrolyte
· Peritoneal aspiration
· Complete Blood Count
· Blood Culture
Lab Result
- Elevated white blood cell WBC 14,000/mm3 indicates an infection.
- Decreased potassium causes Hypokalemia which occurs due to vomiting
- Decreased PaCO2 indicates hyperventilation which is the build up CO2 in the blood and the body is trying to get rid of it. Bicarbonate Metabolic acidosis - HCO3 18mEq/L
- TPN treatment to provide nutritional support and to relax the stomach (decreases peristalsis)
Treatment
- Antibiotics are used to treat bacterial infections.
- Examples: Ampicillin, Cirpofloxacin, Flagyl, Zosyn, Piperacillin
- Analgesics are used to manage the pain.
- Examples: Morphine.
- Intravenous Fusions are used to treat Hypokalemia because fluids move from the intestinal lumen to the peritoneal; therefore, fluid is lower in vascular space.
- Examples: Normal Saline, Lactated Ringers
Manifestations
- Fever
- Tachycardia
- Tachypnea
- Vomiting
- Abdominal pain
- Nausea
- Chills
- Difficulty passing gas or having bowel movement
Complications
- Sepsis
- Shock
- Postoperative complications such as wound evisceration and abscess formation
- Hepatorenal syndrome
- Secondary peritonitis including intra-abdominal abscess and intraperitoneal adhesion
Mr. Garden a 55-year-old man has been admitted to the hospital with suspected Peritonitis. He complains of constant, intense abdominal pain. He has also been experiencing intermittent nausea and vomiting. Vital signs:Temp 101°F (38.3°C), HR 114 bpm, RR 26, BP 92/58. Lab tests –WBC 14,000/mm3, ABG – pH 6.4, HCO3 18mEq/L, and PaCO2 30 mmHg, and K – 2.8 mEq/L. Orders: antibiotics, IVF, TPN, analgesics, rectal tube.