Nursing Care Plan Peritonitis

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Inpatient acute medical or surgical unit


  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


May report: 

May exhibit: 
Difficulty ambulating


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


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)


May report: 
Anorexia, nausea/vomiting, thirst

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


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


May exhibit: 
Shallow respirations, tachypnea


May report: 
Fever, chills


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


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.

  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.


  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.


  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.

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