Nursing care plan peritonitis

I. Pathophysiology
a. Inflammation of the serosal membrane that lines the
abdominal cavity and its viscera
b. Intra-abdominal infection may be localized or generalized,
with or without abscess formation.

II. Classification
a. Categorized as primary, secondary, or tertiary
i. Primary, or bacterial peritonitis, is rare, with the peritoneum
spontaneously infected via the blood and lymphatic
circulation.
ii. Secondary peritonitis is related to a pathological process
in a visceral organ.
iii. Tertiary peritonitis is a persistent or recurrent infection
after adequate initial therapy.
b. Can be acute or chronic in nature

III. Etiology
a. Infectious agents
i. Most common pathogens include gram-negative organisms,
such as Escherichia coli and Klebsiella pneumoniae,
and gram-positive organisms, such as Streptococcus.
ii. Resistant and unusual organisms, such as Enterococcus,
Candida, and Enterobacter, are found in a significant
proportion of tertiary cases.
b. Other sources of inflammation
i. Primary peritonitis: chronic liver disease with ascites
formation most common cause, use of peritoneum for
dialysis
ii. Secondary peritonitis: rupture or perforation of internal
organ or instillation of irritating substance causing
chemical irritation
1. Gastrointestinal (GI) tract: ruptured appendix,
perforated gastric or duodenal ulcer; cholecystitis
with stone perforation; perforated colon caused by
diverticulitis or cancer; pancreatitis, ulcerative colitis,
and Crohn’s disease
2. Ovaries and uterus: pelvic inflammatory disease,
ovarian cyst
3. Traumatic injuries: blunt and penetrating trauma
4. Iatrogenic trauma to GI tract, such as during endoscopic
procedures; inadvertent bowel injury or anastomosis
dehiscence; instrumentation such as occurs with
peritoneal dialysis or percutaneous stent placement
(Peralta et al, 2006)

IV. Statistics (Peralta et al, 2006)
a. Morbidity: As many as 70% of survivors of primary
peritonitis have a recurrent episode within 1 year; dialysisrelated
secondary peritonitis rate is approximately 1 in
24 patient-treatment months (Kean et al, 2000).
b. Mortality: Approximately 10% to 30% in primary
peritonitis, dependent on early versus delayed therapy, and
50% with recurrent episode; in secondary peritonitis rate
of less than 5% with simple abscesses increasing to greater
than 30% to 50% in severe infections, 50% to 70% in
tertiary peritonitis.

Care Setting
The client is admitted to an inpatient acute medical or
surgical unit.

Related Concerns
Appendectomy
Inflammatory bowel disease (IBD): ulcerative colitis, Crohn’s
disease
Pancreatitis
Psychosocial aspects of care
Peritoneal dialysis (PD)
Sepsis/septicemia
Surgical intervention
Total nutritional support: parenteral/enteral feeding
Upper gastrointestinal/esophageal bleeding

Nursing Priorities
1. Control infection.
2. Restore and/or 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 prevented or 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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