PERITONITIS

3. DEFINITION
PERITONITIS is an inflammation of the peritoneum the
thin tissue that lines the inner wall of the abdomen and
covers most of the abdominal organs.

6. CAUSES
 PERITONITIS can be caused by internal and external factors:
 INJURY trauma like gunshot or stab wound
 INFLAMMATION an inflammation that extends from an organ
outside the peritoneal area
 BACTERIA the most common bacteria implicated are Escherichia
coli,Klebsila,Peoteus,Pseudomonas and Streptococcus.
 CHEMICAL : i.e. bile barium
 ISCHEMIC STRANGULATED BOWL VASCULAR OCCULUSION

7. PATHOPHYISIOLOGY

9. CLINICAL MANIFESTATION
 Symptoms depend on the extent and location of the inflammation
 PAIN at first there is diffuse pain which tends to become constant
localized and more intense over SITE
 Excessive fatigue
 Passing less urine
 Fever and chills
 Abdominal distension
 Nausea and vomiting
 TENDERNESS of affected area

10. COMPLICATIONS
SEPSIS is the major cause of death from peritonitis
SHOCK it may result from septicemia or hypovolemia
INTESTINAL OBSTRUCTION can occur due to bowl
adhesions
BACTERIMIA
Paralytic ileus
Abscess formation
Liver abscess
Adhesions

11. ASSESSMENT AND DIAGNOSTIC
FINDINGS
Physical examination
Peritoneal fluid analysis(using a thin needle doctor may
take a sample of fluid in peritoneum ,paracentesis)
Increased WBC
Altered level of serum potassium and sodium
Abdominal x-ray
Abdominal ultrasound may reveal abscess
CT scan show abscess formation
MRI

12. MEDICAL MANAGEMENT
FLUID : The administration of several liters of an isotonic
solution is prescribed
ANALGESICS: analgesics are prescribed for pain
INTUBATION AND SUCTION: these assist in relieving
abdominal distension and in promoting intestinal
function.
OXYEGEN THEARPY: oxygen by nasal cannula or mask
promotes oxygenation.
ANTIBIOTIC THERAPY : ANTIBIOTICS ae initiated
early in treatment of peritonitis

13. SURGICAL MANEGMENT
 EXCISION: SURGICAL TREATMENT is directed towards excision especially if
appendix is involved
 RESECTION :may be done with or without anastomosis
 FECAL DIVERSION : a fecal diversion may need to be created with extensive SEPSIS

14. NURSING MANAGEMENT
INTENSIVE CARE is often needed for patients with
peritonitis
NURSING ASSESMENT
Assessment should be ongoing and precise
PAIN :Pain should be assessed continuously and should
be acted upon.
GI FUNCTION. GI function should be monitored to asses
response to interventions.
FLUID AND ELECTROLYTE. should be balanced.

15. NURSING DIAGNOSIS
ACUTE PAIN related to peritoneal irritation
DEFICIENT FLUID VOLUME related to massive shifting of
fluid towards the intestinal lumen and depletion in the
vascular space
RISK FOR SHOCK related to septicemia or hypovolemia.
NURSING CARE PLANNING AND GOALS
 Reduce level of pain
 Restore fluid and electrolyte balance.
 Prevent complications
 Restore normal GI functions

16. NURSING INTERVENTIONS
Blood pressure monitoring the patients blood pressure is
measured by arterial line if shock is present
Medications :administration of analgesics and anti emetics
can be done as prescribed
Pain management : analgesics and POSITIONING can
help in decreasing pain
INPUT AND OUTPUT monitoring
IV fluids
Drainage monitoring

17. PREVENTION OF PERITONITIS
BASICS of aseptic technique 5 min hand scrub face masks
during exchanges ,warming of PD bags using dry heat,
aseptic technique for adding medicines
Aseptic technique when making critical connections to
solution containers and the patient's transfer set
Masks reduce the risk of contamination with nasopharyngeal
organisms