Peritonitis is an inflammation of the peritoneum, the thin tissue lining the abdomen. It can be caused by injury, infection, or other factors that lead to inflammation extending from organs. Symptoms include abdominal pain, fatigue, fever, nausea and vomiting. Complications can include sepsis, shock, intestinal obstruction, and abscess formation if not treated properly. Treatment involves antibiotics, fluids, analgesia, and sometimes surgery to drain abscesses or remove infected tissue. Nursing care focuses on pain management, fluid balance, monitoring for complications, and preventing recurrence through strict aseptic technique during peritoneal dialysis.

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