Nursing Care Plan Peritonitis

CARE SETTING

Inpatient acute medical or surgical unit

RELATED CONCERNS

1. Appendectomy, see Nursing Care Plan CD-ROM
2. Inflammatory bowel disease: ulcerative colitis, regional enteritis (Crohn’s disease, ileocolitis)
3. Pancreatitis
4. Psychosocial aspects of care
5. Renal dialysis: peritoneal
6. Sepsis/speticemia
7. Surgical intervention
8. Total nutritional support: parenteral/enteral feeding
9. Upper gastrointestinal/esophageal bleeding
10. Patient Assessment Database

ACTIVITY/REST

May report: 
Weakness

May exhibit: 
Difficulty ambulating

CIRCULATION

May exhibit: 

1. Tachycardia, diaphoresis, pallor, hypotension (signs of shock)
2. Tissue edema

ELIMINATION

May report: 

1. Inability to pass stool or flatus
2. Diarrhea (occasionally)

May exhibit: 

1. Hiccups; abdominal distension; quiet abdomen
2. Decreased urinary output, dark color
3. Decreased/absent bowel sounds (ileus); intermittent loud, rushing bowel sounds (obstruction); abdominal rigidity, distension, rebound tenderness; hyperresonance/tympany (ileus); loss of dullness over liver (free air in abdomen)

FOOD/FLUID

May report: 
Anorexia, nausea/vomiting, thirst

May exhibit: 

1. Projectile vomiting
2. Dry mucous membranes, swollen tongue, poor skin turgor

PAIN/DISCOMFORT

May report: 
Sudden, severe abdominal pain, generalized or localized, referred to shoulder, intensified by movement


May exhibit: 

1. Distention, rigidity, rebound tenderness; distraction behaviors; restlessness; self-focus
2. Muscle guarding (abdomen); flexion of knees

RESPIRATION

May exhibit: 
Shallow respirations, tachypnea

SAFETY

May report: 
Fever, chills

SEXUALITY

May report: 
History of pelvic organ inflammation (salpingitis), puerperal infection, septic abortion, retroperitoneal abscess

TEACHING/LEARNING

May report: 

1. History of recent trauma with abdominal penetration, e.g., gunshot/stab wound or blunt trauma to the abdomen; bladder perforation/ruptured gallbladder, perforated carcinoma of the stomach, perforated gastric/duodenal ulcer, gangrenous obstruction of the bowel, perforation of diverticulum, UC, regional ileitis; strangulated hernia
2. Discharge plan
3. DRG projected length of inpatient stay: 4.9 days
4. Assistance with homemaker/maintenance tasks
5. Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES

1. CBC: WBCs elevated, sometimes more than 20,000. RBC count may be increased, indicating hemoconcentration.
2. Serum protein/albumin: May be decreased because of fluid shifts.
3. Serum amylase: Usually elevated.
4. Serum electrolytes: Hypokalemia may be present.
5. ABGs: Respiratory alkalosis and metabolic acidosis may be noted.
6. Cultures: Causative organism (often Escherichia coli, streptococci, staphylococcus, or rarely, pneumococcus) may be identified from blood, exudate/secretions or ascitic fluid, cloudy peritoneal dialysate.
7. Abdominal x-ray: May reveal gas distension of bowel/ileus. If a perforated viscera is the cause, free air will be found in the abdomen.
8. Chest x-ray: May reveal elevation of diaphragm.
9. Pelvic ultrasound: Can diagnose peritonitis caused by ruptured appendix or diverticulitis.
10. Paracentesis: Peritoneal fluid samples may contain blood, pus/exudate, amylase, bile, and creatine.

NURSING PRIORITIES

1. Control infection.
2. Restore/maintain circulating volume.
3. Promote comfort.
4. Maintain nutrition.
5. Provide information about disease process, possible complications, and treatment needs.

DISCHARGE GOALS

1. Infection resolved.
2. Complications presented/minimized.
3. Pain relieved.
4. Disease process, potential complications, and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.