6 Peritonitis Nursing Care Plans

February 27, 2014

Peritonitis is the acute or chronic inflammation of the peritoneum, the membrane that lines the abdominal cavity and covers the visceral organs. Inflammation may extend throughout the peritoneum or may be localized as an abscess. Peritonitis commonly decreases intestinal motility and causes intestinal distention with gas. mortality is 10% with death usually a result of bowel obstruction.

The peritoneum is sterile, despite the GI tract normally contains bacteria. When bacteria invade the peritoneum due to an inflammation or perforation of the GI tract peritonitis usually occurs. Bacterial invasion usually results from appendicitis, diverticulitis, peptic ulcer, ulcerative colitis, volvulus, abdominal neoplasms, or a stab wound. It may also be associated with peritoneal dialysis.

Nursing Care Plans

Early treatment of GI inflammation conditions and preoperative and postoperative therapy help prevent peritonitis. Patient care includes monitoring and measures to prevent complications and the spread of infection.

Here are six (6) nursing care plans (NCP) and nursing diagnosis for patients with peritonitis:

Risk for Infection

Risk for Infection: At increased risk for being invaded by pathogenic organisms.

Risk factors may include

Inadequate primary defenses (broken skin, traumatized tissue, altered peristalsis)
Inadequate secondary defenses (immunosuppression)
Invasive procedures

Possibly evidenced by

Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.

Desired Outcomes

Achieve timely healing; be free of purulent drainage or erythema; be afebrile.
Verbalize understanding of the individual causative/risk factor(s).

Nursing Interventions	Rationale
Note individual risk factors. Abdominal trauma, acute appendicitis, peritoneal dialysis are common risk factors.	Influences choice of interventions.
Assess vital signs frequently, noting unresolved or progressing hypotension, decreased pulse pressure, tachycardia, fever, tachypnea.	Signs of impending septic shock. Circulating endotoxins eventually produce vasodilation, shift of fluid from circulation, and a low cardiac output state.
Note changes in mental status: confusion, stupor, altered LOC.	Hypoxemia, hypotension, and acidosis can cause deteriorating mental status.
Note skin color, temperature, moisture.	Warm, flushed, dry skin is early sign of septicemia. Later manifestations include cool, clammy, pale skin and cyanosis as shock becomes refractory.
Monitor urine output.	Oliguria develops as a result of decreased renal perfusion, circulating toxins, effects of antibiotics.
Maintain strict aseptic technique in care of abdominal drains, incisions and/or open wounds, dressings, and invasive sites. Cleanse with appropriate solution.	Prevents access or limits spread of infecting organisms and cross-contamination.
Perform and teach proper hand washing technique.	Reduces risk of cross-contamination and/or spread of infection.
Observe drainage from wounds and/or drains.	Provides information about status of infection.
Maintain sterile technique when catheterizing patient, and provide catheter care and encourage perineal cleansing on a routine basis.	Prevents access, limits bacterial growth in urinary tract.
Monitor and/or restrict visitors and staff as appropriate. Provide protective isolation if indicated.	Reduces risk of exposure to and/or acquisition of secondary infection in immuno compromised patient.
Obtain specimens and monitor results of serial blood, urine, wound cultures.	Identifies causative microorganisms and helps in assessing effectiveness of antimicrobial regimen.
Assist with peritoneal aspiration, if indicated.	May be done to remove fluid and to identify infecting organisms so appropriate antibiotic therapy can be instituted.
Administer antimicrobials: gentamicin (Garamycin), amikacin (Amikin), clindamycin (Cleocin), via IV/peritoneal lavage.	Therapy is directed at anaerobic bacteria and aerobic Gram-negative bacilli. Lavage may be used to remove necrotic debris and treat inflammation that is poorly localized or diffused.
Prepare for surgical intervention if indicated.	Surgery may be treatment of choice (curative) in acute, localized peritonitis, e.g., to drain localized abscess; remove peritoneal exudates, ruptured appendix or gallbladder; plicate perforated ulcer; or resect bowel.