Peritonitis

I'm posting this in relation to my previous posting about appendicitis. Peritonitis is the inflammation of the peritoneum, serous membrane lining the abdominal cavity and covering the viscera. It is usually a result of bacterial infection, organisms out from certain diseases of the GI tract or, in women, from the internal reproductive organs. It can also be a result from external sources such as injury or trauma (e.g. gunshot wound, stab wound) or an inflammation that extends from an organ outside the peritoneal area, such as the kidney. Symptoms depend on the location and extent of inflammation. Diffuse pain is felt initially then becomes more constant and aggravates in movement. Abdomen is tender (rebound tenderness) and distended and muscles become rigid. Paralytic ileus may be present. Usually, nausea and vomiting occur and peristalsis is diminished. Purse rate and temperature increases.

Common bacteria:

• Escherichia coli
• Klebsiella
• Proteus
• Pseudomonas

Other common causes:

• Appedicitis
• Perforated ulcer
• Diverticulitis
• Bowel perforation

May be associated with:

• Abdominal surgical procedures
• Peritoneal dialysis

Complications

• Sepsis
• Shock due to septicemia or hypovolemia
• Intestinal obstruction due to bowel adhesions
• Post-OP tenderness and pain MUST be reported as well as wound dehiscence

Lab Findings (Click here for normal lab values)

• Leukocyte count elevated
• Potassium, Sodium and Chloride may reveal altered levels

Diagnostics (click here for diagnostic procedures)

• Abdominal X-Ray
• CT Scan
• Impression: Abscess formation, X-Ray shows air and fluid levels as well as distended bowel loops

Nursing Management
Assess:

• Vital Signs
• GI Function
• Fluid/Electrolyte balance
• Nature of pain

Nursing Intervention (N/I):

• Administer analgesics
• Position client for comfort to decrease pain: Side-lying, knees flexed decreases tension of abdominal organs
• Monitor intake and output
• Monitor CVP
• Increase fluid and food intake gradually
• Prepare for emergency surgery if complication is inevitable
• Observe and record character of drains
• Care must be taken when moving and turning t prevent drains from being dislodged

Discharge Teaching:

• Teach and demonstrate to the patient and family about the importance of incision and drain care

Image taken: www.bartleby.com