MEDICAL SURGICAL NURSING DEPARTMENT

1. PERITONITS
PRESENTED BY: MR. SAGAR
A.MASNE
FIRST YEAR MSC NURSING

2. DEFINITION
•PERITONITIS :IS AN INFLAMMATION
(IRRITATION) OF THE PERITONEUM, THE
THIN TISSUE THAT LINES THE INNER WALL
OF THE ABDOMEN AND COVERS MOST OF
THE ABDOMINAL ORGANS

3. ETIOLOGICAL FACTORS
• BACTERIAL INFECTION: INCLUDES GRAM-NEGATIVE BACILLI
(E.G., ESCHERICHIA COLI)
• MEDICAL PROCEDURES, SUCH AS PERITONEAL DIALYSIS.
PERITONEAL DIALYSIS USES TUBES (CATHETERS) TO REMOVE WASTE
PRODUCTS FROM YOUR BLOOD WHEN YOUR KIDNEYS CAN NO
LONGER ADEQUATELY DO SO. AN INFECTION MAY OCCUR DURING
PERITONEAL DIALYSIS DUE TO UNCLEAN SURROUNDINGS, POOR
HYGIENE OR CONTAMINATED EQUIPMENT.
• A RUPTURED APPENDIX, STOMACH ULCER OR PERFORATED COLON.
ANY OF THESE CONDITIONS CAN ALLOW BACTERIA TO GET INTO THE
PERITONEUM THROUGH A HOLE IN YOUR GASTROINTESTINAL TRACT.

4. ETIOLOGICAL FACTORS
• PANCREATITIS. INFLAMMATION OF YOUR PANCREAS (PANCREATITIS)
COMPLICATED BY INFECTION MAY LEAD TO PERITONITIS IF THE
BACTERIA SPREAD OUTSIDE THE PANCREAS.
• DIVERTICULITIS. INFECTION OF SMALL, BULGING POUCHES IN YOUR
DIGESTIVE TRACT (DIVERTICULITIS) MAY CAUSE PERITONITIS IF ONE
OF THE POUCHES RUPTURES, SPILLING INTESTINAL WASTE INTO
YOUR ABDOMEN.
• TRAUMA. INJURY OR TRAUMA MAY CAUSE PERITONITIS BY ALLOWING
BACTERIA OR CHEMICALS FROM OTHER PARTS OF YOUR BODY TO
ENTER THE PERITONEUM.EG:ACCIDENT.

5. ETIOLOGICAL FACTORS
• FECAL PERITONITIS: RESULTS FROM THE PRESENCE
OF FAECES IN THE PERITONEAL CAVITY. IT CAN RESULT
FROM ABDOMINAL TRAUMA AND OCCURS IF THE LARGE
BOWEL IS PERFORATED DURING SURGERY.
• FOREIGN BODY: PERITONITIS MAY ALSO BE CAUSED BY
THE RARE CASE OF A STERILE FOREIGN BODY
INADVERTENTLY LEFT IN THE ABDOMEN AFTER SURGERY
(E.G., GAUZE, SPONGE ).

6. RISK FACTORS
• PREVIOUS HISTORY OF PERITONITIS
• HISTORY OF ALCOHOLISM
• LIVER DISEASE
• FLUID ACCUMULATION IN THE ABDOMEN
• WEAKENED IMMUNE SYSTEM
• PELVIC INFLAMMATORY DISEASE

7. PATHOPHYSIOLOGY
DUE TO ETIOLOGICAL FACTORS
INFLAMMATION OF THE PERITONEAL CAVITY
ABCESS OF INFECTION-DUE TO INFLAMMATION
DEATH IN SEVERE CASES

8. CLINICAL FEATURES
• THE BLUMBERG SIGN (A.K.A. REBOUND TENDERNESS, MEANING THAT
PRESSING A HAND ON THE ABDOMEN ELICITS LESS PAIN THAN
RELEASING THE HAND ABRUPTLY, WHICH WILL AGGRAVATE THE PAIN,
AS THE PERITONEUM SNAPS BACK INTO PLACE).
• DIFFUSE ABDOMINAL RIGIDITY ("ABDOMINAL GUARDING") IS OFTEN
PRESENT, ESPECIALLY IN GENERALIZED PERITONITIS
• FEVER
• SINUS TACHYCARDIA
• DEVELOPMENT OF ILEUS PARALYTICUS (I.E., INTESTINAL PARALYSIS),

9. CLINICAL FEATURES
• TENDERNESS IN YOUR ABDOMEN
• PAIN IN YOUR ABDOMEN THAT GETS MORE INTENSE WITH
MOTION OR TOUCH
• ABDOMINAL BLOATING OR DISTENTION
• NAUSEA AND VOMITING
• DIARRHEA
• CONSTIPATION OR THE INABILITY TO PASS GAS

10. CLINICAL FEATURES
• MINIMAL URINE OUTPUT
• ANOREXIA, OR LOSS OF APPETITE
• EXCESSIVE THIRST
• FATIGUE
• FEVER AND CHILL

11. DIAGNOSTIC EVALUATION
• BLOOD TESTS. A SAMPLE OF YOUR BLOOD MAY BE DRAWN AND SENT TO A LAB 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. YOUR DOCTOR MAY WANT TO USE AN X-RAY TO CHECK FOR HOLES
OR OTHER PERFORATIONS IN YOUR GASTROINTESTINAL TRACT. ULTRASOUND MAY
ALSO BE USED. IN SOME CASES, YOUR DOCTOR MAY USE A COMPUTERIZED
TOMOGRAPHY (CT) SCAN INSTEAD OF AN X-RAY.
• PERITONEAL FLUID ANALYSIS. USING A THIN NEEDLE, YOUR DOCTOR MAY TAKE A
SAMPLE OF THE FLUID IN YOUR PERITONEUM (PARACENTESIS), ESPECIALLY IF YOU
RECEIVE PERITONEAL DIALYSIS OR HAVE FLUID IN YOUR ABDOMEN FROM LIVER
DISEASE. IF YOU HAVE PERITONITIS, EXAMINATION OF THIS FLUID MAY SHOW AN
INCREASED WHITE BLOOD CELL COUNT, WHICH TYPICALLY INDICATES AN INFECTION
OR INFLAMMATION. A CULTURE OF THE FLUID MAY ALSO REVEAL THE PRESENCE OF

12. DIAGNOSTIC PROCEDURE
• INCREASED WBC. THE WHITE BLOOD CELL COUNT IS ALMOST ALWAYS
ELEVATED.
• SERUM ELECTROLYTE STUDIES. SERUM ELECTROLYTE STUDIES MAY REVEAL
ALTERED LEVELS OF POTASSIUM, SODIUM, AND CHLORIDE.
• ABDOMINAL XRAY. AN ABDOMINAL XRAY MAY SHOW AIR AND FLUID LEVELS AS
WELL AS DISTENDED BOWEL LOOPS.
• ABDOMINAL ULTRASOUND. ABDOMINAL ULTRASOUND MAY REVEAL ABSCESSES
AND FLUID COLLECTIONS.
• CT SCAN. A CT SCAN OF THE ABDOMEN MAY REVEAL ABSCESS FORMATION.
• MRI SCAN .MRI MAY BE USED FOR DIAGNOSIS OF INTRA-ABDOMINAL ABSCESSES.
• PERITONEAL FLUID ANALYSIS. EXAMINATION OF THIS FLUID MAY SHOW AN
INCREASED WHITE BLOOD CELL COUNT, WHICH TYPICALLY INDICATES AN
INFECTION OR INFLAMMATION. A CULTURE OF THE FLUID MAY ALSO REVEAL THE

13. MEDICAL TREATMENT
• FLUID. THE ADMINISTRATION OF SEVERAL LITERS OF AN ISOTONIC SOLUTION IS
PRESCRIBED.
• ANALGESICS. ANALGESICS ARE PRESCRIBED FOR PAIN.
• INTUBATION AND SUCTION. INTESTINAL INTUBATION AND SUCTION ASSIST IN
RELIEVING ABDOMINAL DISTENTION AND IN PROMOTING INTESTINAL FUNCTION.
• OXYGEN THERAPY. OXYGEN THERAPY BY NASAL CANNULA OR MASK GENERALLY
PROMOTES ADEQUATE OXYGENATION.
• ANTIBIOTIC THERAPY. ANTIBIOTIC THERAPY IS INITIATED EARLY IN THE
TREATMENT OF PERITONITIS.

14. NURSING INTERVENTION
• NURSING ASSESSMENT:
• 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 ASSESS RESPONSE TO
INTERVENTIONS.
• FLUID AND ELECTROLYTE. F&E SHOULD BE BALANCED.
• NURSING DIAGNOSIS
• BASED ON ASSESSMENT DATA, THE DIAGNOSES APPROPRIATE FOR THE PATIENT
ARE:
• ACUTE PAIN RELATED TO PERITONEAL IRRITATION.
• DEFICIENT FLUID VOLUME RELATED TO MASSIVE SHIFTING OF FLUIDS TOWARDS
THE INTESTINAL LUMEN AND DEPLETION IN THE VASCULAR SPACE.

15. CONT….
• NURSING CARE PLANNING & GOALS
• THE GOALS APPROPRIATE FOR A PATIENT WITH
PERITONITIS INCLUDE:
• REDUCE LEVEL OF PAIN.
• RESTORE FLUID AND ELECTROLYTE BALANCE.
• PREVENT COMPLICATIONS.
• RESTORE NORMAL FUNCTIONS.

16. CONT…..
• NURSING INTERVENTIONS
• NURSING INTERVENTIONS FOCUS ON THE FOLLOWING:
• BLOOD PRESSURE MONITORING. THE PATIENT’S BLOOD PRESSURE IS MONITORED BY
ARTERIAL LINE IF SHOCK IS PRESENT.
• MEDICATIONS. ADMINISTRATION OF ANALGESIC AND ANTI EMETICS CAN BE DONE AS
PRESCRIBED.
• PAIN MANAGEMENT. ANALGESICS AND POSITIONING COULD HELP IN DECREASING
PAIN.
• I&O MONITORING. ACCURATE RECORDING OF ALL INTAKE AND OUTPUT COULD HELP
IN THE ASSESSMENT OF FLUID REPLACEMENT.
• IV FLUIDS. THE NURSE ADMINISTERS AND CLOSELY MONITORS IV FLUIDS.
• DRAINAGE MONITORING. THE NURSE MUST MONITOR AND RECORD THE CHARACTER
OF THE DRAINAGE POSTOPERATIVELY.

17. CONT….
• DISCHARGE AND HOME CARE GUIDELINES
• THE NURSE’S RESPONSIBILITIES DURING DISCHARGE AND FOR
HOME CARE INCLUDE:
• EDUCATION. THE NURSE SHOULD EDUCATE THE PATIENT AND THE
FAMILY ABOUT THE CARE FOR INCISIONS AND DRAINS IF THE
PATIENT WILL BE SENT HOME WITH THE DRAINS STILL IN PLACE.
• REFERRAL. REFERRAL FOR HOME CARE MAY BE INDICATED FOR
FURTHER MONITORING AND PATIENT AND FAMILY TEACHING.

18. DOCUMENTATION
• CLIENT’S DESCRIPTION AND RESPONSE TO PAIN.
• ACCEPTABLE LEVEL OF PAIN.
• PRIOR MEDICATION USE.
• DEGREE OF DEFICIT.
• CURRENT SOURCES OF FLUID INTAKE.
• I&O.
• FLUID BALANCE.
• PRESENCE OF EDEMA.
• RESULTS OF DIAGNOSTIC TESTS.

19. CONT…..
• VITAL SIGNS.
• PLAN OF CARE.
• TEACHING PLAN.
• RESPONSE TO INTERVENTIONS, TEACHING, AND ACTIONS
PERFORMED.
• ATTAINMENT OR PROGRESS TOWARD DESIRED OUTCOME.
• MODIFICATIONS TO PLAN OF CARE.
• LONG TERM NEEDS.
• SPECIFIC REFERRALS MADE.