NCP Peritonitis

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.


Inpatient acute medical or surgical unit


Appendectomy, see Nursing Care Plan CD-ROM

Inflammatory bowel disease: ulcerative colitis, regional enteritis (Crohn’s disease, ileocolitis)


Psychosocial aspects of care

Renal dialysis: peritoneal


Surgical intervention

Total nutritional support: parenteral/enteral feeding

Upper gastrointestinal/esophageal bleeding

Patient Assessment Database


May report: Weakness

May exhibit: Difficulty ambulating


May exhibit: Tachycardia, diaphoresis, pallor, hypotension (signs of shock)

Tissue edema


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)


May report: Anorexia, nausea/vomiting, thirst

May exhibit: Projectile vomiting

Dry mucous membranes, swollen tongue, poor skin turgor


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


May exhibit: Shallow respirations, tachypnea


May report: Fever, chills


May report: History of pelvic organ inflammation (salpingitis), puerperal infection, septic abortion, retroperitoneal abscess


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.


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.


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.


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.