PERITONITIS

OVERVIEW OF THE DISEASE

Peritonitis is inflammation of the peritoneum, which is the serious membrane liming the

abdominal cavity and covering the viscera.

CAUSES

A ruptured appendix, diverticulum, or stomach ulcer

Digestive diseases such as Crohn's disease and diverticulitis

Perforations of the stomach, intestine, gallbladder, or appendix

Trauma to the abdomen, such as an injury from a knife or gunshot wound

Bacterial infection (most common- Escherichia coli and Klebsiella)

CLINICAL MANIFESTATION

Diffuse Pain that become constant, localized and more intense but can be relief by

movement

Abdominal pain or tenderness

Bloating or a feeling of fullness (distention) in your abdomen

Fever

Nausea and vomiting

Loss of appetite

Diarrhea

Fatigue

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PERITONITIS

ASSESSMENT

Method Findings

Inspection Inspect for distention of the abdomen

Auscultation Bowel movement

Percussion Tympanic

Palpation For tenderness, wave like motion

DIAGNOSTIC TEST

Diagnostic test Rationale

Blood tests Use to check for a high white blood cell count. A blood culture also may be performed to determine if there are bacteria in your blood.

Imaging tests To use an X-ray to check for holes or other perforations in your gastrointestinal tract also it may show air and fluid level as well as distended bowel loops

Abdominal Ultrasound – may reveal abscesses and fluid collection Ultrasound Aspiration may assist in easier placement of drains.

CT scan- may show abscess formation

MRI- used for diagnosis of intra- abdominal abscesses

Peritoneal Aspiration , culture and sensitivity studies

Reveal infection and identify the causative organism.

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PERITONITIS

MEDICAL MANAGEMENT

Fluid, colloid and electrolyte replacement is the major focus of medical

management

Administration of several liters of an isotonic solution is prescribed.

Intestinal intubation and suction assist in relieving abdominal distention and in

promoting intestinal function

Oxygen therapy by nasal cannula or mask generally promotes adequate

oxygenation.

Analgesics medication are prescribed for pain.

Antibiotic therapy is initiated early in the treatment of peritonitis. Large doses of a

broad- spectrum antibiotic are administered IV until the specific organism causing

the infection is identified and appropriate antibiotic therapy can be initiated.

sedatives antidiarrheal and anti peristaltic are given to decrease peristalsis and rest

bowel

SURGICAL MANAGEMENT

Exploratory Laparotomy laparotomy this is to remove or repair the inflamed or

perforated organ

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PERITONITIS

NURSING DIAGNOSIS

Altered fluid balance

Altered protection due to infection, drains, and possibly repeated surgeries

Anxiety

NURSING INTERVENTION

Intensive care is needed

Monitor blood pressure by arterial line if shock is present

Assess pain, GI function and fluid and electrolyte balance is important

Report nature of pain, its location in the abdomen and changes in location

Administered analgesic medication as prescribed and positioning of the patient for

comfort are helpful to decrease the pain

Position on the side with knees flexed; this position decrease tension on the

abdominal organ

Accurate recording of all intake and output and central venous pressure and

pulmonary artery assist in calculating fluid replacement

Closely monitor IV fluid

Assess for signs that indicate peritonitis is subsiding

Decrease temperature and pulse rate

Softening of the abdomen

Return of peristaltic sounds and bowel movement

Passing flatus (Brunner and Suddart’s, 2014)

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