6 Peritonitis Nursing Care Plans

Risk for Infection

Patients with peritonitis are at risk for infection due to several factors, including inadequate primary defense mechanisms such as compromised skin and mucosal barriers, weakened immune systems due to underlying medical conditions or immunosuppressive therapies, and invasive procedures that can introduce harmful microorganisms into the body. These factors can make it easier for bacteria and other pathogens to enter the body and cause infection, which can be particularly dangerous in the case of peritonitis, an inflammation of the abdominal lining that can lead to serious complications.

Nursing Diagnosis

• Risk for Infection

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

• The client will achieve timely healing; be free of purulent drainage or erythema; be afebrile.
• The client will verbalize understanding of the individual causative/risk factor(s).

Nursing Assessment and Rationales

1. Note individual risk factors. Abdominal trauma, acute appendicitis, peritoneal dialysis are common risk factors.
Influences choice of interventions.

2. Assess vital signs frequently, noting unresolved or progressing hypotension, decreased pulse pressure, tachycardia, fever, and tachypnea.
Signs of impending septic shock. Circulating endotoxins eventually produce vasodilation, a shift of fluid from circulation, and a low cardiac output state.

3. Note changes in mental status: confusion, stupor, and altered LOC.
Hypoxemia, hypotension, and acidosis can cause deteriorating mental status.

4. Note skin color, temperature, and moisture.
Warm, flushed, dry skin is an early sign of septicemia. Later manifestations include cool, clammy, pale skin and cyanosis as shock becomes refractory.

5. Monitor urine output.
Oliguria develops as a result of decreased renal perfusion, circulating toxins, and the effects of antibiotics.

6. Observe drainage from wounds and/or drains.
Provides information about the status of infection.

7. Obtain specimens and monitor results of serial blood, urine, and wound cultures.
Identifies causative microorganisms and helps in assessing the effectiveness of antimicrobial regimen.

Nursing Interventions and Rationales

1. Maintain strict aseptic technique in care of abdominal drains, incisions and/or open wounds, dressings, and invasive sites. Cleanse with an appropriate solution.
Prevents access or limits the spread of infecting organisms and cross-contamination.

2. Perform and teach proper hand washing techniques.
Reduces risk of cross-contamination and/or spread of infection.

3. Maintain sterile technique when catheterizing patients, provide catheter care, and encourage perineal cleansing on a routine basis.
Prevents access, and limits bacterial growth in the urinary tract.

4. 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 an immunocompromised patient.

5. Assist with peritoneal aspiration, if indicated.
May be done to remove fluid and to identify infecting organisms so appropriate antibiotic therapy can be instituted.

6. Administer antimicrobials: gentamicin (Garamycin), amikacin (Amikin), and 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 the inflammation that is poorly localized or diffused.

7. Prepare for surgical intervention if indicated.
Surgery may be the 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.