Surgical Nursing

1. PERITONITIS

3. The peritoneum consists of two layers
• Parietal Peritoneum
The parietal peritoneum lines the internal surface of the
abdominopelvic wall.
• Visceral Peritoneum
The layers of tissue that cover the outer surface of most
organs in the abdomen, including the intestines.

4. Definition
• The inflammation of the peritoneum
• The inflammation may be localized or generalized

5. Etiology and Pathophysiology
• Generally caused by infection from perforation of GI tract
or by chemical stress, as in pancreatitis
• Gangrene of bowel, traumatic injuries and surgical
contaminants may also cause peritonitis

6. Clinical Manisfestations
• Abdominal pain, rebound trnderness
• Malaise
• Nausea
• Abdominal distension
• Fever
• Muscle rigidity
• Diminished or absent bowel sounds
• Decreased urine output

7. Diagnostic Evaluation
• Complete blood count
• Peritoneal aspiration
• Abdominal x ray

8. Management
• Bed rest in a semi Fowler’s position
• Oxygen inhalation
• NG tube for nasogastric suctioning
• Total parentaral nutrition
• IV fluids and electrolyte to correct hypovolemia
• Analgesics to control pain

9. Management
• Nothing by mouth
• Antibiotic therapy
• Surical management
a). Surgery for correction of cause
b). Possible bowel resection
c). Close perforation

10. Nursing Assessment
• Temperature for baseline data
• Guarded movement and/ or self splinting
• Reduction or absence of bowel sounds
• Presence and characteristics of abdominal pain

11. Nursing Diagnosis
• Anxiety related to pain
• Anxiety related to prognosis
• Constipation related to absence of motility
• Altered nutrition less than body requirement related to nothing by
mouth status
• Pain related to pathologic process

12. Nursing Interventions
• Keep the patient in semi Fowler’s position
• Administer oxygen as needed
• Monitor vital signs and central venous pressure
• Administer analgesics for pain relief
• Monitor IV therapy and gastrointestinal decompression

13. Nursing Interventions
• Monitor intake and output
• Auscultate for bowel sounds and note the passage of flatus
• Assess for increasing distension
• Administer antibiotics as ordered
• Observe for complications of peritonitis such as:
- Sepsis
- Adhesions
- Paralytic ileus