Inflammation of the peritoneal cavity, caused by either bacteria or chemicals, can be primary or secondary, and acute or chronic. Primary peritonitis is a rare condition in which the peritoneum is infected via the blood/lymphatic circulation. Secondary sources of inflammation are the GI tract, ovaries/uterus, urinary system, traumatic injuries, or surgical contaminants. Surgical intervention may be curative in localized peritonitis, as occurs with appendicitis/appendectomy, ulcer plication, and bowel resection. If peritonitis is diffuse, medical management is necessary before or in place of surgical treatment.
CARE SETTING
Inpatient acute medical or surgical unit
RELATED CONCERNS
Appendectomy, see Nursing Care Plan CD-ROM
Inflammatory bowel disease: ulcerative colitis, regional enteritis (Crohn’s disease, ileocolitis)
Pancreatitis
Psychosocial aspects of care
Renal dialysis: peritoneal
Sepsis/speticemia
Surgical intervention
Total nutritional support: parenteral/enteral feeding
Upper gastrointestinal/esophageal bleeding
Patient Assessment Database
ACTIVITY/REST
May report: Weakness
May exhibit: Difficulty ambulating
CIRCULATION
May exhibit: Tachycardia, diaphoresis, pallor, hypotension (signs of shock)
Tissue edema
ELIMINATION
May report: Inability to pass stool or flatus
Diarrhea (occasionally)
May exhibit: Hiccups; abdominal distension; quiet abdomen
Decreased urinary output, dark color
Decreased/absent bowel sounds (ileus); intermittent loud, rushing bowel sounds (obstruction); abdominal rigidity, distension, rebound tenderness; hyperresonance/tympany (ileus); loss of dullness over liver (free air in abdomen)
FOOD/FLUID
May report: Anorexia, nausea/vomiting, thirst
May exhibit: Projectile vomiting
Dry mucous membranes, swollen tongue, poor skin turgor
PAIN/DISCOMFORT
May report: Sudden, severe abdominal pain, generalized or localized, referred to shoulder, intensified by movement
May exhibit: Distention, rigidity, rebound tenderness; distraction behaviors; restlessness; self-focus
Muscle guarding (abdomen); flexion of knees
RESPIRATION
May exhibit: Shallow respirations, tachypnea
SAFETY
May report: Fever, chills
SEXUALITY
May report: History of pelvic organ inflammation (salpingitis), puerperal infection, septic abortion, retroperitoneal abscess
TEACHING/LEARNING
May report: History of recent trauma with abdominal penetration, e.g., gunshot/stab wound or blunt trauma to the abdomen; bladder perforation/ruptured gallbladder, perforated carcinoma of the stomach, perforated gastric/duodenal ulcer, gangrenous obstruction of the bowel, perforation of diverticulum, UC, regional ileitis; strangulated hernia
Discharge plan
DRG projected length of inpatient stay: 4.9 days
Assistance with homemaker/maintenance tasks
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
CBC: WBCs elevated, sometimes more than 20,000. RBC count may be increased, indicating hemoconcentration.
Serum protein/albumin: May be decreased because of fluid shifts.
Serum amylase: Usually elevated.
Serum electrolytes: Hypokalemia may be present.
ABGs: Respiratory alkalosis and metabolic acidosis may be noted.
Cultures: Causative organism (often Escherichia coli, streptococci, staphylococcus, or rarely, pneumococcus) may be identified from blood, exudate/secretions or ascitic fluid, cloudy peritoneal dialysate.
Abdominal x-ray: May reveal gas distension of bowel/ileus. If a perforated viscera is the cause, free air will be found in the abdomen.
Chest x-ray: May reveal elevation of diaphragm.
Pelvic ultrasound: Can diagnose peritonitis caused by ruptured appendix or diverticulitis.
Paracentesis: Peritoneal fluid samples may contain blood, pus/exudate, amylase, bile, and creatine.
NURSING PRIORITIES
1. Control infection.
2. Restore/maintain circulating volume.
3. Promote comfort.
4. Maintain nutrition.
5. Provide information about disease process, possible complications, and treatment needs.
DISCHARGE GOALS
1. Infection resolved.
2. Complications presented/minimized.
3. Pain relieved.
4. Disease process, potential complications, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.
CARE SETTING
Inpatient acute medical or surgical unit
RELATED CONCERNS
Appendectomy, see Nursing Care Plan CD-ROM
Inflammatory bowel disease: ulcerative colitis, regional enteritis (Crohn’s disease, ileocolitis)
Pancreatitis
Psychosocial aspects of care
Renal dialysis: peritoneal
Sepsis/speticemia
Surgical intervention
Total nutritional support: parenteral/enteral feeding
Upper gastrointestinal/esophageal bleeding
Patient Assessment Database
ACTIVITY/REST
May report: Weakness
May exhibit: Difficulty ambulating
CIRCULATION
May exhibit: Tachycardia, diaphoresis, pallor, hypotension (signs of shock)
Tissue edema
ELIMINATION
May report: Inability to pass stool or flatus
Diarrhea (occasionally)
May exhibit: Hiccups; abdominal distension; quiet abdomen
Decreased urinary output, dark color
Decreased/absent bowel sounds (ileus); intermittent loud, rushing bowel sounds (obstruction); abdominal rigidity, distension, rebound tenderness; hyperresonance/tympany (ileus); loss of dullness over liver (free air in abdomen)
FOOD/FLUID
May report: Anorexia, nausea/vomiting, thirst
May exhibit: Projectile vomiting
Dry mucous membranes, swollen tongue, poor skin turgor
PAIN/DISCOMFORT
May report: Sudden, severe abdominal pain, generalized or localized, referred to shoulder, intensified by movement
May exhibit: Distention, rigidity, rebound tenderness; distraction behaviors; restlessness; self-focus
Muscle guarding (abdomen); flexion of knees
RESPIRATION
May exhibit: Shallow respirations, tachypnea
SAFETY
May report: Fever, chills
SEXUALITY
May report: History of pelvic organ inflammation (salpingitis), puerperal infection, septic abortion, retroperitoneal abscess
TEACHING/LEARNING
May report: History of recent trauma with abdominal penetration, e.g., gunshot/stab wound or blunt trauma to the abdomen; bladder perforation/ruptured gallbladder, perforated carcinoma of the stomach, perforated gastric/duodenal ulcer, gangrenous obstruction of the bowel, perforation of diverticulum, UC, regional ileitis; strangulated hernia
Discharge plan
DRG projected length of inpatient stay: 4.9 days
Assistance with homemaker/maintenance tasks
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
CBC: WBCs elevated, sometimes more than 20,000. RBC count may be increased, indicating hemoconcentration.
Serum protein/albumin: May be decreased because of fluid shifts.
Serum amylase: Usually elevated.
Serum electrolytes: Hypokalemia may be present.
ABGs: Respiratory alkalosis and metabolic acidosis may be noted.
Cultures: Causative organism (often Escherichia coli, streptococci, staphylococcus, or rarely, pneumococcus) may be identified from blood, exudate/secretions or ascitic fluid, cloudy peritoneal dialysate.
Abdominal x-ray: May reveal gas distension of bowel/ileus. If a perforated viscera is the cause, free air will be found in the abdomen.
Chest x-ray: May reveal elevation of diaphragm.
Pelvic ultrasound: Can diagnose peritonitis caused by ruptured appendix or diverticulitis.
Paracentesis: Peritoneal fluid samples may contain blood, pus/exudate, amylase, bile, and creatine.
NURSING PRIORITIES
1. Control infection.
2. Restore/maintain circulating volume.
3. Promote comfort.
4. Maintain nutrition.
5. Provide information about disease process, possible complications, and treatment needs.
DISCHARGE GOALS
1. Infection resolved.
2. Complications presented/minimized.
3. Pain relieved.
4. Disease process, potential complications, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.
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