Compilation Bachelor of Science in Nursing Laguna State Polytechnic University

1. PERITONITIS
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OVERVIEW OF THE DISEASE
Peritonitis is inflammation of the peritoneum, which is the serious membrane liming the
abdominal cavity and covering the viscera.
CAUSES
 A ruptured appendix, diverticulum, or stomach ulcer
 Digestive diseases such as Crohn's disease and diverticulitis
 Perforations of the stomach, intestine, gallbladder, or appendix
 Trauma to the abdomen, such as an injury from a knife or gunshot wound
 Bacterial infection (most common- Escherichia coli and Klebsiella)
CLINICAL MANIFESTATION
Diffuse Pain that become constant, localized and more intense but can be relief by
movement
 Abdominal pain or tenderness
 Bloating or a feeling of fullness (distention) in your abdomen
 Fever
 Nausea and vomiting
 Loss of appetite
 Diarrhea
 Fatigue

2. PERITONITIS
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ASSESSMENT
Method Findings
Inspection Inspect for distention of the abdomen
Auscultation Bowel movement
Percussion Tympanic
Palpation For tenderness, wave like motion
DIAGNOSTIC TEST
Diagnostic test Rationale
Blood tests Use 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 To use an X-ray to check for holes or
other perforations in your gastrointestinal
tract also it may show air and fluid level
as well as distended bowel loops
Abdominal Ultrasound – may reveal
abscesses and fluid collection
Ultrasound Aspiration may assist in easier
placement of drains.
CT scan- may show abscess formation
MRI- used for diagnosis of intra-
abdominal abscesses
Peritoneal Aspiration , culture and
sensitivity studies
Reveal infection and identify the causative
organism.

3. PERITONITIS
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MEDICAL MANAGEMENT
 Fluid, colloid and electrolyte replacement is the major focus of medical
management
 Administration of several liters of an isotonic solution is prescribed.
 Intestinal intubation and suction assist in relieving abdominal distention and in
promoting intestinal function
 Oxygen therapy by nasal cannula or mask generally promotes adequate
oxygenation.
 Analgesics medication are prescribed for pain.
 Antibiotic therapy is initiated early in the treatment of peritonitis. Large doses of a
broad- spectrum antibiotic are administered IV until the specific organism causing
the infection is identified and appropriate antibiotic therapy can be initiated.
 sedatives antidiarrheal and anti peristaltic are given to decrease peristalsis and rest
bowel
SURGICAL MANAGEMENT
 Exploratory Laparotomy laparotomy this is to remove or repair the inflamed or
perforated organ

4. PERITONITIS
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NURSING DIAGNOSIS
 Altered fluid balance
 Altered protection due to infection, drains, and possibly repeated surgeries
 Anxiety
NURSING INTERVENTION
 Intensive care is needed
 Monitor blood pressure by arterial line if shock is present
 Assess pain, GI function and fluid and electrolyte balance is important
 Report nature of pain, its location in the abdomen and changes in location
 Administered analgesic medication as prescribed and positioning of the patient for
comfort are helpful to decrease the pain
 Position on the side with knees flexed; this position decrease tension on the
abdominal organ
 Accurate recording of all intake and output and central venous pressure and
pulmonary artery assist in calculating fluid replacement
 Closely monitor IV fluid
 Assess for signs that indicate peritonitis is subsiding
 Decrease temperature and pulse rate
 Softening of the abdomen
 Return of peristaltic sounds and bowel movement
 Passing flatus (Brunner and Suddart’s, 2014)