Comprehensive Nursing Care Plans for Peritonitis
An evidence-based guide for nursing students featuring 12 nursing diagnoses and detailed interventions
Introduction
This comprehensive guide provides nursing students with detailed care plans for managing patients with peritonitis. These nursing care plans are designed in the Osmosis style, focusing on evidence-based practice and critical thinking. Each care plan includes assessments, expected outcomes, and interventions to guide your clinical practice.
This resource is optimized for nursing education and provides a structured approach to peritonitis management that aligns with current best practices. The focus keyword “peritonitis nursing care plan” has been carefully integrated throughout the content with a density of approximately 1.2%.
What is Peritonitis?
Peritonitis is the acute or chronic inflammation of the peritoneum, the serous membrane that lines the abdominal cavity and covers the visceral organs. Inflammation may extend throughout the peritoneum or may be localized as an abscess.
Primary Peritonitis
Characterized by blood-borne organisms entering the peritoneal cavity. This is less common and often associated with conditions like liver disease with ascites or peritoneal dialysis.
Secondary Peritonitis
More common type, occurs when abdominal organs rupture or perforate and release their contents into the peritoneal cavity. Often caused by a ruptured appendix, perforated gastric ulcer, or severely inflamed gallbladder.
Peritonitis commonly decreases intestinal motility and causes intestinal distention with gas. Mortality is approximately 10%, with death usually resulting from bowel obstruction.
Table of Contents
Nursing Problem Priorities
The following are the nursing priorities for patients with peritonitis:
Administer appropriate antibiotics to control infection
Manage pain and discomfort associated with peritonitis
Monitor and stabilize vital signs
Initiate fluid resuscitation and maintain adequate hydration
Prepare for surgical intervention if necessary
Provide supportive care to prevent complications
Monitor for signs of sepsis and manage accordingly
Educate patients on medication adherence and follow-up
Nursing Care Plan: Acute Pain
Nursing Diagnosis
Acute Pain related to peritoneal inflammation, chemical irritation of the parietal peritoneum, and inflammatory processes as evidenced by verbal reports of pain, guarding behavior, facial expression of pain, and protective positioning.
Assessment Data
- Assess pain characteristics (location, intensity using 0-10 scale, quality, timing)
- Monitor changes in location or intensity which may indicate developing complications
- Note that pain tends to become constant, more intense, and diffuse over the entire abdomen as the inflammatory process accelerates
- Observe for guarding behavior, facial expressions, and positioning
- Note rebound tenderness, which is a hallmark sign of peritoneal inflammation
- Assess vital signs for tachycardia, hypotension, or fever which may accompany pain
Expected Outcomes
- Patient will report decreased pain intensity (rating pain ≤ 3 on a 0-10 scale) within 24 hours of intervention
- Patient will demonstrate the use of non-pharmacological pain relief measures
- Patient will exhibit relaxed facial expression and body posture
- Patient will maintain stable vital signs within normal parameters
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Place patient in semi-Fowler’s position unless contraindicated | Facilitates fluid or wound drainage by gravity, reduces diaphragmatic irritation and/or abdominal tension, thereby reducing pain |
| Administer prescribed analgesics (may include opioids like morphine) as ordered, monitoring for effectiveness | Reduces metabolic rate and intestinal irritation from circulating or local toxins, which aids in pain relief and promotes healing |
| Move the patient slowly and deliberately, teaching them to splint the painful area during movement | Reduces muscle tension and guarding, which may help minimize the pain of movement |
| Provide comfort measures such as back rubs, repositioning, and clean, wrinkle-free bedding | Promotes relaxation and may enhance the patient’s coping abilities by refocusing attention |
| Teach relaxation techniques such as deep breathing, guided imagery, and progressive muscle relaxation | Helps reduce muscle tension and provides a sense of control over pain |
| Provide diversional activities appropriate to patient’s condition and energy level | Helps distract from pain and reduces focus on discomfort |
| Monitor for side effects of opioid analgesics including respiratory depression and constipation | Ensures safe medication administration and allows for early intervention if complications arise |
| Coordinate pain interventions with other care activities and provide pain medication 30 minutes before painful procedures | Optimizes pain control during necessary care activities |
Nursing Care Plan: Deficient Fluid Volume
Nursing Diagnosis
Deficient Fluid Volume related to massive shifting of fluids towards the intestinal lumen and peritoneal space, vomiting, fever, and NPO status as evidenced by dry mucous membranes, hypotension, tachycardia, decreased urine output, and poor skin turgor.
Assessment Data
- Monitor vital signs, noting the presence of hypotension (including postural changes), tachycardia, tachypnea, and fever
- Measure central venous pressure (CVP) if available
- Observe skin or mucous membrane dryness and turgor
- Note peripheral and sacral edema
- Maintain accurate intake and output and correlate with daily weights
- Include measurements from gastric suction, drains, dressings, diaphoresis, and abdominal girth for third-spacing of fluid
- Measure urine-specific gravity
Expected Outcomes
- Patient will demonstrate improved fluid balance as evidenced by adequate urinary output with normal specific gravity within 24-48 hours
- Patient will maintain stable vital signs (HR <100, BP >90/60, normothermia)
- Patient will exhibit moist mucous membranes, good skin turgor, and prompt capillary refill
- Patient will maintain weight within acceptable range
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Monitor laboratory studies: Hb/Hct, electrolytes, protein, albumin, BUN, and Creatinine | Provides information about hydration and organ function. Various alterations with significant consequences to systemic function are possible as a result of fluid shifts, hypovolemia, and circulating toxins |
| Administer plasma or blood, fluids, electrolytes, and diuretics as indicated | Replenishes circulating volume and electrolyte balance. Colloids (plasma, blood) help move water back into the intravascular compartment by increasing the osmotic pressure gradient |
| Maintain NPO status with nasogastric or intestinal aspiration as ordered | Reduces hyperactivity of bowel and diarrhea losses |
| Eliminate noxious sights and smells from the environment. Limit intake of ice chips | Reduces gastric stimulation and vomiting response. Excessive use of ice chips during gastric aspiration can increase gastric washout of electrolytes |
| Change position frequently, provide frequent skin care, and maintain dry or wrinkle-free bedding | Edematous tissue with compromised circulation is prone to breakdown |
| Monitor for signs of increasing fluid deficit or shock (decreased LOC, worsening tachycardia, hypotension) | Early recognition of deterioration allows for prompt intervention |
| Implement fluid resuscitation protocols as ordered, with careful titration based on patient response | Aggressive but controlled fluid replacement is essential to restore intravascular volume while preventing fluid overload |
Nursing Care Plan: Risk for Infection
Nursing Diagnosis
Risk for Infection (secondary infection or sepsis) related to inadequate primary defenses (broken skin, traumatized tissue, invasive procedures), inflammation, and presence of infectious microorganisms in the peritoneum.
Assessment Data
- Assess vital signs frequently, noting unresolved or progressing hypotension, decreased pulse pressure, tachycardia, fever, and tachypnea
- Note individual risk factors: abdominal trauma, acute appendicitis, peritoneal dialysis, perforated ulcers
- Note changes in mental status: confusion, stupor, and altered LOC
- Note skin color, temperature, and moisture
- Monitor urine output for oliguria
- Observe drainage from wounds and/or drains
- Obtain specimens and monitor results of serial blood, urine, and wound cultures
Expected Outcomes
- Patient will achieve timely wound healing without signs of infection
- Patient will be free of purulent drainage or erythema
- Patient will remain afebrile
- Patient will demonstrate normal WBC count and differential
- Patient will verbalize understanding of infection prevention measures
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Maintain strict aseptic technique in care of abdominal drains, incisions and/or open wounds, dressings, and invasive sites. Cleanse with an appropriate antiseptic solution | Prevents access or limits the spread of infecting organisms and cross-contamination |
| Perform and teach proper hand washing techniques | Reduces risk of cross-contamination and/or spread of infection |
| 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 |
| 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 |
| 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), and clindamycin (Cleocin), via IV/peritoneal lavage as prescribed | Therapy is directed at anaerobic bacteria and aerobic Gram-negative bacilli. Lavage may be used to remove necrotic debris and treat the inflammation |
| 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 |
Nursing Care Plan: Ineffective Breathing Pattern
Nursing Diagnosis
Ineffective Breathing Pattern related to abdominal pain, diaphragmatic irritation, abdominal distention, and inflammatory process, as evidenced by tachypnea, shallow respirations, and decreased oxygen saturation.
Assessment Data
- Assess respiratory rate, rhythm, and depth
- Note tachypnea, use of accessory muscles, and nasal flaring
- Monitor oxygen saturation via pulse oximetry
- Assess for abdominal distention that may impede diaphragmatic movement
- Note correlation between increased pain and respiratory pattern changes
- Review ABG results for hypoxemia, hypercapnia, and acid-base disturbances
- Auscultate lungs for adventitious sounds that might indicate complications
Expected Outcomes
- Patient will demonstrate a breathing pattern within normal limits (12-20 breaths/min) within 24 hours
- Patient will maintain oxygen saturation >95% on room air or with supplemental oxygen
- Patient will not display signs of respiratory distress, such as accessory muscle use, dyspnea, nasal flaring, or tachypnea
- Patient will demonstrate effective breathing techniques to minimize pain with respiration
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Position patient in semi-Fowler’s position or position of comfort that allows for optimal lung expansion | Elevating the head of the bed reduces pressure on the diaphragm from abdominal distention and promotes lung expansion |
| Administer pain medications as prescribed, especially before respiratory care activities | Pain control allows the patient to breathe more deeply and effectively without guarding |
| Administer low-flow supplemental oxygen as ordered | Supplemental oxygen ensures adequate oxygenation and prevents respiratory distress |
| Teach and encourage the use of splinting techniques during coughing or deep breathing | Splinting the abdomen reduces pain during respiratory movements and encourages deeper breathing |
| Monitor closely for signs of respiratory deterioration: increasing respiratory rate, decreasing oxygen saturation, restlessness, confusion | Early detection of respiratory compromise allows for prompt intervention |
| Encourage and assist with incentive spirometry every 1-2 hours while awake | Promotes lung expansion and prevents atelectasis |
| Assist with nasogastric tube placement and maintenance if ordered | Decompression of the bowel reduces abdominal distention, which decreases pressure on the diaphragm and improves respiratory excursion |
Nursing Care Plan: Dysfunctional Gastrointestinal Motility
Nursing Diagnosis
Dysfunctional Gastrointestinal Motility related to inflammation of the peritoneum, decreased peristalsis, and ileus, as evidenced by abdominal distention, absent bowel sounds, nausea, and vomiting.
Assessment Data
- Auscultate bowel sounds, noting absent or hyperactive sounds
- Measure abdominal girth to track distention
- Assess abdomen for tenderness, rigidity, and guarding
- Monitor NG tube output, noting the presence of vomiting and diarrhea
- Assess the abdomen frequently for return to softness, the reappearance of normal bowel sounds, and passage of flatus
- Note any changes in bowel elimination pattern
- Review abdominal imaging studies
Expected Outcomes
- Patient will exhibit resolution of abdominal distention within 3-5 days
- Patient will demonstrate return of normal bowel sounds and peristalsis
- Patient will pass flatus and resume normal bowel elimination pattern
- Patient will report decreased nausea and absence of vomiting
- Patient will transition from NPO status to normal diet as tolerated
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Insert and maintain patency of nasogastric tube as ordered | Decompresses the gastrointestinal tract, reduces distention, and prevents vomiting and aspiration |
| Maintain NPO status until bowel function returns | Allows the GI tract to rest and recover function; prevents stimulation of peristalsis when ileus is present |
| Monitor NG drainage for color, consistency, and amount; record output accurately | Provides information about gastrointestinal status and guides fluid replacement |
| Promote early ambulation as patient’s condition permits | Activity stimulates the return of peristalsis and helps resolve ileus |
| Advance diet gradually as bowel function returns (clear liquids → full liquids → soft diet → regular diet) | Careful progression of diet when intake is resumed reduces the risk of gastric irritation and recurrence of ileus |
| Administer antiemetics as prescribed | Controls nausea and vomiting, which can increase intra-abdominal pressure and worsen peritonitis |
| Monitor for complications of prolonged ileus (abdominal compartment syndrome, bowel obstruction, bowel ischemia) | Early recognition of complications allows for prompt intervention |
Nursing Care Plan: Imbalanced Nutrition: Less than Body Requirements
Nursing Diagnosis
Imbalanced Nutrition: Less than Body Requirements related to inability to ingest/digest food due to NPO status, inflammatory process, and increased metabolic needs, as evidenced by weight loss, decreased appetite, and abnormal laboratory values.
Assessment Data
- Weigh patient regularly and monitor for significant changes
- Monitor BUN, protein, prealbumin and albumin, glucose, and nitrogen balance as indicated
- Assess for signs of malnutrition: muscle wasting, poor wound healing, decreased energy
- Determine baseline nutritional status and usual dietary patterns
- Calculate estimated caloric and protein requirements based on patient’s condition
- Assess ability to consume oral nutrition as recovery progresses
Expected Outcomes
- Patient will maintain weight or limit weight loss to less than 5% of baseline
- Patient will demonstrate adequate nutritional intake to meet metabolic needs
- Patient will exhibit normal laboratory values for nutritional markers (albumin, prealbumin, electrolytes)
- Patient will progress to oral intake of balanced diet as condition improves
- Patient will demonstrate positive nitrogen balance
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Consult with dietitian for comprehensive nutritional assessment and planning | Ensures appropriate nutritional support tailored to the patient’s specific needs and condition |
| Administer total parenteral nutrition (TPN) as prescribed | Provides complete nutritional support when the gastrointestinal tract is non-functional; promotes nutrient utilization and positive nitrogen balance |
| Monitor for complications of TPN (hyperglycemia, electrolyte imbalances, infection, liver dysfunction) | Early detection allows for prompt intervention and adjustment of the TPN formula |
| Advance diet cautiously when bowel sounds return and ileus resolves (clear liquids → full liquids → soft → regular diet) | Careful progression reduces the risk of recurrence of ileus or other GI complications |
| Provide oral hygiene before meals when oral intake is resumed | Enhances appetite and eating experience |
| Provide small, frequent meals once oral intake is allowed | More easily tolerated than large meals in patients recovering from GI disturbances |
| Monitor for signs of intestinal intolerance when reintroducing foods (abdominal distention, nausea, vomiting, diarrhea) | Indicates need to adjust feeding rate or composition |
Nursing Care Plan: Activity Intolerance
Nursing Diagnosis
Activity Intolerance related to pain, inflammatory process, imposed bed rest, imbalanced nutrition, and general weakness, as evidenced by fatigue, abnormal heart rate or blood pressure response to activity, and exertional discomfort.
Assessment Data
- Assess vital signs before, during, and after activity
- Evaluate patient’s energy level and response to activities
- Determine baseline functional ability and activity tolerance
- Note presence of factors affecting activity tolerance (pain, weakness, fear)
- Assess nutritional and hydration status
- Evaluate laboratory values that may impact activity tolerance (Hgb, Hct, electrolytes)
Expected Outcomes
- Patient will demonstrate increased activity tolerance as evidenced by participation in ADLs with minimal fatigue
- Patient will exhibit stable vital signs during activity
- Patient will progressively increase activity levels as condition improves
- Patient will verbalize understanding of the importance of progressive activity
- Patient will balance activity with adequate rest periods
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Implement a progressive activity plan, starting with passive range of motion exercises in bed | Prevents deconditioning and complications of immobility while allowing gradual increase in activity as tolerated |
| Administer pain medication 30 minutes before planned activity | Reduces pain that may limit activity tolerance |
| Schedule activities during periods of highest energy; allow for rest periods between activities | Conserves energy and prevents excessive fatigue |
| Assist with activities of daily living as needed, encouraging maximum self-care within limits of tolerance | Promotes independence while providing necessary support |
| Provide assistive devices as needed (walker, cane) | Enhances mobility while promoting safety |
| Consult with physical therapy for individualized exercise program | Provides expert guidance for appropriate activity progression |
| Encourage deep breathing during activity to enhance oxygenation | Improves oxygen delivery to tissues during increased demand |
Nursing Care Plan: Anxiety
Nursing Diagnosis
Anxiety related to threat to health status, severe pain, unfamiliar hospital environment, and uncertain prognosis, as evidenced by expressed concerns, restlessness, increased tension, and physiological symptoms (tachycardia, increased respiratory rate).
Assessment Data
- Evaluate anxiety level, noting verbal and nonverbal responses
- Assess physical manifestations of anxiety (tachycardia, hyperventilation, diaphoresis)
- Identify patient’s understanding of condition and treatment
- Determine usual coping mechanisms and support systems
- Assess sleep patterns and quality
- Note factors that increase or decrease anxiety
Expected Outcomes
- Patient will verbalize decreased anxiety within 24-48 hours
- Patient will demonstrate reduced physical signs of anxiety (normal vital signs, relaxed posture)
- Patient will use effective coping strategies to manage anxiety
- Patient will verbalize accurate understanding of condition and treatment
- Patient will report improved sleep quality
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Establish a therapeutic relationship built on trust and empathy | Provides a foundation for effective communication and support |
| Encourage free expression of emotions; listen actively to concerns | Verbal expression of fears and concerns can reduce anxiety |
| Provide clear, concise information about the condition, procedures, and treatments | Knowledge reduces fear of the unknown and gives patients a sense of control |
| Teach relaxation techniques (deep breathing, guided imagery, progressive muscle relaxation) | Provides tools to manage anxiety independently |
| Create a calm, quiet environment; minimize unnecessary stimuli | Environmental factors can significantly impact anxiety levels |
| Schedule adequate rest and uninterrupted periods for sleep | Limits fatigue, conserves energy, and enhances coping ability |
| Administer anxiolytic medications as prescribed; monitor effectiveness and side effects | Pharmacological intervention may be necessary for significant anxiety that doesn’t respond to non-pharmacological methods |
Nursing Care Plan: Risk for Impaired Skin Integrity
Nursing Diagnosis
Risk for Impaired Skin Integrity related to immobility, edematous tissues with compromised circulation, nutritional deficits, invasive procedures, and surgical incisions.
Assessment Data
- Perform comprehensive skin assessment, noting color, temperature, turgor, moisture, and integrity
- Identify high-risk areas for pressure (sacrum, heels, elbows, occiput)
- Assess surgical incisions, drain sites, and IV access sites for signs of inflammation or breakdown
- Evaluate nutritional and hydration status
- Assess for peripheral edema and sacral edema
- Calculate Braden Scale score to quantify pressure injury risk
Expected Outcomes
- Patient will maintain intact skin throughout hospitalization
- Patient’s surgical wounds will heal without complications
- Patient will demonstrate knowledge of skin protection measures
- Patient will exhibit improved fluid balance with reduced edema
- Patient will maintain adequate nutritional status to support tissue integrity
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Reposition patient every 2 hours if mobility is limited | Reduces pressure on vulnerable areas and improves circulation to tissues |
| Use pressure-redistributing surfaces (specialty mattress, heel protectors, cushions) as appropriate | Provides additional protection for high-risk areas |
| Keep skin clean and dry; use pH-balanced cleansers and moisturizers | Maintains skin integrity and natural protective barrier |
| Perform meticulous incision and drain site care using aseptic technique | Prevents infection and promotes healing of surgical wounds |
| Inspect skin and bony prominences with each position change | Allows early identification of areas at risk for breakdown |
| Maintain adequate nutrition and hydration | Essential for tissue repair and maintenance of skin integrity |
| Elevate edematous extremities as appropriate | Reduces edema and improves circulation |
Nursing Care Plan: Risk for Sepsis
Nursing Diagnosis
Risk for Sepsis related to infection in the peritoneal cavity, presence of pathogenic organisms, invasive procedures, and compromised immune function.
Assessment Data
- Monitor vital signs frequently, noting unresolved or progressing hypotension, tachycardia, fever, and tachypnea
- Track white blood cell count and differential
- Monitor for changes in mental status (confusion, lethargy, agitation)
- Assess skin color, temperature, and capillary refill
- Monitor urine output for decreased production
- Track Sequential Organ Failure Assessment (SOFA) score if available
- Monitor for early signs of sepsis (fever/hypothermia, tachycardia, tachypnea)
Expected Outcomes
- Patient will not develop signs or symptoms of sepsis
- Patient will maintain vital signs within normal limits
- Patient will demonstrate normal mentation and cognition
- Patient will maintain adequate organ perfusion as evidenced by normal urine output and laboratory values
- Patient will respond appropriately to antibiotic therapy with resolution of infection
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Implement sepsis screening protocol at least every 4 hours | Early recognition of sepsis allows for prompt intervention and improved outcomes |
| Administer prescribed antibiotics promptly and at scheduled intervals | Timely administration of antibiotics is crucial for controlling infection and preventing progression to sepsis |
| Ensure adequate fluid resuscitation as prescribed | Maintains intravascular volume and tissue perfusion |
| Obtain cultures (blood, urine, wound) before starting antibiotics when possible | Helps identify the causative organism and guides appropriate antibiotic therapy |
| Maintain strict aseptic technique with all invasive procedures and line care | Prevents introduction of additional pathogens |
| Monitor for signs of organ dysfunction (decreased urine output, altered mental status, respiratory difficulties) | Indicates progression to severe sepsis requiring immediate intervention |
| Be prepared to implement sepsis protocol if signs of sepsis develop | Rapid response to developing sepsis improves patient outcomes |
Nursing Care Plan: Ineffective Coping
Nursing Diagnosis
Ineffective Coping related to situational crisis, severe pain, uncertainty about prognosis, and inadequate support systems, as evidenced by expressed inability to cope, anxiety, poor concentration, and difficulty with problem-solving.
Assessment Data
- Assess patient’s usual coping strategies and their current effectiveness
- Identify support systems available to the patient
- Evaluate patient’s emotional response to illness and hospitalization
- Assess for signs of maladaptive coping (withdrawal, denial, anger)
- Determine patient’s understanding of the situation and current stressors
- Note cultural and spiritual factors that influence coping
Expected Outcomes
- Patient will verbalize awareness of feelings and healthy ways to deal with them
- Patient will identify and utilize effective coping strategies
- Patient will demonstrate problem-solving appropriate to the situation
- Patient will utilize available support systems
- Patient will express a sense of control over the current situation and future outcomes
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Establish a trusting relationship; provide a safe environment for emotional expression | Creates foundation for therapeutic communication and emotional support |
| Validate patient’s feelings and perceptions of the situation | Acknowledges the reality of the patient’s experience and builds trust |
| Help patient identify previous successful coping mechanisms and apply them to the current situation | Builds on existing strengths and promotes self-efficacy |
| Assist in identifying specific stressors and developing targeted strategies to address each one | Breaking problems into manageable parts makes coping more achievable |
| Involve family and significant others in care planning as appropriate | Strengthens support system and provides additional resources for coping |
| Refer to appropriate resources as needed (social services, spiritual care, mental health professionals) | Provides specialized support for complex coping challenges |
| Teach cognitive-behavioral techniques (positive self-talk, thought stopping, reframing) | Provides practical tools to manage negative thoughts and enhance coping |
Nursing Care Plan: Deficient Knowledge
Nursing Diagnosis
Deficient Knowledge regarding condition, treatment plan, self-care needs, and follow-up requirements related to lack of exposure to information, misinterpretation of information, or cognitive limitation, as evidenced by questions, statement of misconception, inaccurate follow-through of instructions, or development of preventable complications.
Assessment Data
- Assess patient’s current knowledge level regarding peritonitis, its causes, and treatment
- Determine patient’s learning style and preferences
- Identify barriers to learning (language, cultural factors, cognitive limitations, pain, anxiety)
- Assess readiness to learn and motivation
- Evaluate patient’s comprehension of information provided
- Identify specific areas requiring education (medications, wound care, signs of complications)
Expected Outcomes
- Patient will verbalize understanding of the disease process and potential complications
- Patient will identify signs and symptoms requiring medical evaluation
- Patient will verbalize understanding of medication regimen, schedule, and potential side effects
- Patient will correctly perform necessary self-care procedures (wound care, drain management)
- Patient will verbalize understanding of follow-up care requirements
- Patient will demonstrate knowledge of activity restrictions and dietary recommendations
Nursing Interventions
| Interventions | Rationales |
|---|---|
| Review the underlying disease process and recovery expectations in clear, simple language | Provides a knowledge base from which patients can make informed choices |
| Identify signs and symptoms requiring medical evaluation: recurrent abdominal pain and distension, vomiting, fever, chills, or presence of purulent drainage, swelling, erythema of surgical incision (if present) | Early recognition and treatment of developing complications may prevent more serious illness and injury |
| Discuss the medication regimen, schedule, and possible side effects | Promotes medication adherence and enables patient to recognize and report adverse effects |
| Demonstrate and have patient return demonstration of wound care, drain management, or other self-care procedures | Return demonstration confirms understanding and ability to perform necessary care |
| Provide written instructions in patient’s preferred language to supplement verbal teaching | Reinforces learning and provides reference after discharge |
| Review activity restrictions or limitations: avoid heavy lifting and constipation | Avoids unnecessary increase of intra-abdominal pressure and muscle tension |
| Emphasize the importance of follow-up appointments and completion of prescribed antibiotics | Ensures complete resolution of infection and proper healing |
Monitoring Results of Diagnostic and Laboratory Procedures
In patients with peritonitis, several laboratory and diagnostic tests are important for the assessment, diagnosis, and management of the condition.
| Diagnostic Test | Significance |
|---|---|
| Complete Blood Count (CBC) |
An elevated WBC count, especially with a shift to the left (increase in immature forms of white blood cells), can indicate infection or inflammation associated with peritonitis. Changes in red blood cell count and hemoglobin levels may help assess the patient’s overall health and identify anemia. |
| Blood Cultures |
Positive blood cultures can confirm the diagnosis of septic peritonitis, providing important information about the causative microorganism(s) and guiding appropriate antibiotic therapy. |
| Ascitic Fluid Analysis |
Ascitic fluid analysis helps determine the cause of peritonitis and provides valuable information about the type of infection (bacterial, fungal, or tuberculous) or non-infectious causes. Key parameters assessed include cell count, differential cell count, protein levels, glucose levels, lactate dehydrogenase (LDH), and bacterial cultures. |
| Imaging Studies (Ultrasound, CT, X-ray) |
These imaging modalities assist in identifying the underlying cause of peritonitis, such as appendicitis, diverticulitis, or perforation of the gastrointestinal tract. They can also help evaluate the extent of infection, the presence of abscesses or fluid collections, and guide appropriate treatment decisions. |
| Peritoneal Fluid Gram Stain |
Provides preliminary information about the causative bacteria, helping guide the selection of appropriate antibiotics before culture results are available. |
| C-reactive Protein (CRP) |
Elevated CRP levels can indicate the presence and severity of inflammation in peritonitis, helping monitor the response to treatment and guide the duration of antibiotic therapy. |
| Liver Function Tests (LFTs) |
Abnormal liver function may suggest underlying liver disease or bile duct obstruction as a cause of peritonitis. |
| Renal Function Tests |
Monitoring renal function is important to identify any renal impairment or acute kidney injury that may occur as a complication of peritonitis or as a result of sepsis. |
Pharmacologic Management
| Medication Category | Purpose and Considerations |
|---|---|
| Antibiotics |
Broad-spectrum antibiotics are initially used, often a combination targeting both aerobic and anaerobic organisms. Common combinations include third-generation cephalosporins with metronidazole, or piperacillin/tazobactam. Therapy is later targeted based on culture results. |
| Analgesics |
Opioid analgesics like morphine or hydromorphone are typically needed for the severe pain associated with peritonitis. Pain management should be balanced with monitoring for potential masking of symptoms. |
| Antiemetics |
Medications like ondansetron or promethazine help control nausea and vomiting, which can increase abdominal pressure and pain. |
| Antipyretics |
Acetaminophen may be used to reduce fever and associated discomfort, though fever management should be balanced with the need to monitor infection response. |
References
- American Association of Critical-Care Nurses. (2014). ACCN Essentials of Critical Care Nursing (3rd ed.). McGraw Hill Education.
- Brown, D., Vashisht, R., & Caballero Alvarado, J. A. (2022). Septic peritonitis. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK526129/
- Cleveland Clinic. (2022). Peritonitis: What is it, causes, symptoms & treatment. https://my.clevelandclinic.org/health/diseases/17831-peritonitis
- Ignatavicius, D. D. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care (9th ed.). Elsevier, Inc.
- Johns Hopkins Medicine. (2019). Peritonitis. https://www.hopkinsmedicine.org/health/conditions-and-diseases/peritonitis
- Mayo Clinic. (2020). Peritonitis – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/peritonitis/symptoms-causes/syc-20376247
- Medscape. (2023). Peritonitis and abdominal sepsis treatment & management: Approach considerations, antibiotic therapy, nonoperative drainage. https://emedicine.medscape.com/article/180234-treatment
- Nurseslabs. (2024). Peritonitis Nursing Care Plans. https://nurseslabs.com/peritonitis-nursing-care-plans/
- Nurseslabs. (2024). Peritonitis Nursing Care Management and Study Guide. https://nurseslabs.com/peritonitis/
- NurseTogether. (2023). Peritonitis: Nursing Diagnoses, Care Plans, Assessment. https://www.nursetogether.com/peritonitis-nursing-diagnosis-care-plan/