Peritonitis Nursing Care Plans

Peritonitis Nursing Care Plans

Peritonitis is the acute or chronic inflammation of the peritoneum, the membrane that lines the abdominal cavity and covers the visceral organs. Inflammation may extend throughout the peritoneum or may be localized as an abscess. Peritonitis commonly decreases intestinal motility and causes intestinal distention with gas. mortality is 10% with death usually a result of bowel obstruction.

The peritoneum is sterile, despite the GI tract normally contains bacteria. When bacteria invade the peritoneum due to an inflammation or perforation of the GI tract peritonitis usually occurs. Bacterial invasion usually results from appendicitis, diverticulitis, peptic ulcer, ulcerative colitis, volvulus, abdominal neoplasms, or a stab wound. It may also be associated with peritoneal dialysis.

Nursing Care Plans

Early treatment of GI inflammation conditions and preoperative and postoperative therapy help prevent peritonitis. Patient care includes monitoring and measures to prevent complications and the spread of infection. Here are 6 peritonitis nursing care plans.

1. Risk for Infection

Nursing Diagnosis

Infection, risk for (septicemia)

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

Achieve timely healing; be free of purulent drainage or erythema; be afebrile.
Verbalize understanding of the individual causative/risk factor(s).

Nursing Interventions	Rationale
Note individual risk factors. Abdominal trauma, acute appendicitis, peritoneal dialysis are common risk factors.	Influences choice of interventions.
Assess vital signs frequently, noting unresolved or progressing hypotension, decreased pulse pressure, tachycardia, fever, tachypnea.	Signs of impending septic shock. Circulating endotoxins eventually produce vasodilation, shift of fluid from circulation, and a low cardiac output state.
Note changes in mental status: confusion, stupor, altered LOC.	Hypoxemia, hypotension, and acidosis can cause deteriorating mental status.
Note skin color, temperature, moisture.	Warm, flushed, dry skin is early sign of septicemia. Later manifestations include cool, clammy, pale skin and cyanosis as shock becomes refractory.
Monitor urine output.	Oliguria develops as a result of decreased renal perfusion, circulating toxins, effects of antibiotics.
Maintain strict aseptic technique in care of abdominal drains, incisions and/or open wounds, dressings, and invasive sites. Cleanse with appropriate solution.	Prevents access or limits spread of infecting organisms and cross-contamination.
Perform and teach proper hand washing technique.	Reduces risk of cross-contamination and/or spread of infection.
Observe drainage from wounds and/or drains.	Provides information about status of infection.
Maintain sterile technique when catheterizing patient, and provide catheter care and encourage perineal cleansing on a routine basis.	Prevents access, limits bacterial growth in 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 immuno compromised patient.
Obtain specimens and monitor results of serial blood, urine, wound cultures.	Identifies causative microorganisms and helps in assessing effectiveness of antimicrobial regimen.
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), 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 inflammation that is poorly localized or diffused.
Prepare for surgical intervention if indicated.	Surgery may be 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.

2. Deficient Fluid Volume

Nursing Diagnosis:

Deficient Fluid Volume [mixed]

May be related to

Fluid shifts from extracellular, intravascular, and interstitial compartments into intestines and/or peritoneal space
Vomiting; medically restricted intake; NG/intestinal aspiration
Fever/hypermetabolic state

Possibly evidenced by

Dry mucous membranes, poor skin turgor, delayed capillary refill, weak peripheral pulses
Diminished urinary output, dark/concentrated urine
Hypotension, tachycardia

Desired Outcomes

Demonstrate improved fluid balance as evidenced by adequate urinary output with normal specific gravity, stable vital signs, moist mucous membranes, good skin turgor, prompt capillary refill, and weight within acceptable range.

Nursing Interventions	Rationale
Monitor vital signs, noting presence of hypotension (including postural changes), tachycardia, tachypnea, fever. Measure central venous pressure (CVP) if available.	Aids in evaluating degree of fluid deficit or effectiveness of fluid replacement therapy and response to medications.
Maintain accurate I&O and correlate with daily weights. Include measured losses. Include measurements from gastric suction, drains, dressings, Hemovacs, diaphoresis, and abdominal girth for third spacing of fluid.	Reflects overall hydration status. Urine output may be diminished because of hypovolemia and decreased renal perfusion, but weight may still increase, reflecting tissue edema or ascites accumulation. Gastric suction losses may be large, and a great deal of fluid can be sequestered in the bowel and peritoneal space (ascites).
Measure urine specific gravity.	Reflects hydration status and changes in renal function, which may warn of developing acute renal failure in response to hypovolemia and effect of toxins. Many antibiotics also have nephrotoxic effects that may further affect kidney function and urine output.
Observe skin or mucous membrane dryness, turgor. Note peripheral and sacral edema.	Hypovolemia, fluid shifts, and nutritional deficits contribute to poor skin turgor, taut edematous tissues.
Eliminate noxious sights and smells from 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 laboratory studies: Hb/ Hct, electrolytes, protein, albumin, BUN, Cr.	Provides information about hydration, organ function. Varied alterations with significant consequences to systemic function are possible as a result of fluid shifts, hypovolemia, hypoxemia, circulating toxins, and necrotic tissue products.
Administer plasma or blood, fluids, electrolytes, diuretics as indicated.	Replenishes circulating volume and electrolyte balance. Colloids (plasma, blood) help move water back into intravascular compartment by increasing osmotic pressure gradient. Diuretics may be used to assist in excretion of toxins and to enhance renal function.
Maintain NPO with nasogastric or intestinal aspiration.	Reduces hyperactivity of bowel and diarrhea losses.

3. Acute Pain

May be related to

Chemical irritation of the parietal peritoneum (toxins)
Trauma to tissues
Accumulation of fluid in abdominal/peritoneal cavity (abdominal distension)

Possibly evidenced by

Verbalizations of pain
Muscle guarding, rebound tenderness
Facial mask of pain, self-focus
Distraction behavior, autonomic/emotional responses (anxiety)

Desired Outcomes

Report pain is relieved/controlled.
Demonstrate use of relaxation skills, other methods to promote comfort.

Nursing Interventions	Rationale
Investigate pain reports, noting location, duration, intensity(0–10 scale), and characteristics (dull, sharp, constant).	Changes in location or intensity are not uncommon but may reflect developing complications. Pain tends to become constant, more intense, and diffuse over the entire abdomen as inflammatory process accelerates; pain may localize if an abscess develops.
Maintain semi-Fowler’s position as indicated.	Facilitates fluid or wound drainage by gravity, reducing diaphragmatic irritation and/or abdominal tension, and thereby reducing pain.
Move patient slowly and deliberately, splinting painful area.	Reduces muscle tension and guarding, which may help minimize pain of movement.
Provide comfort measures: massage, back rubs, deep breathing. Instruct in relaxation and visualization exercises. Provide diversional activities.	Promotes relaxation and may enhance patient’s coping abilities by refocusing attention.
Provide frequent oral care. Remove noxious environmental stimuli.	Reduces nausea and vomiting, which can increase intra-abdominal pressure and pain.
Administer medications as indicated:
Analgesics, narcotics;	Reduce metabolic rate and intestinal irritation from circulating or local toxins, which aids in pain relief and promotes healing. Pain is usually severe and may require narcotic pain control. Analgesics may be withheld during initial diagnostic process because they can mask signs and symptoms.
Antiemetics: hydroxyzine (Vistaril);	Reduce nausea and vomiting, which can increase abdominal pain.
Antipyretics: acetaminophen (Tylenol).	Reduce discomfort associated with fever.

4. Risk for Imbalanced Nutrition

Nursing Diagnosis

Risk for Imbalanced Nutrition: less than body requirements

Risk factors may include

Nausea/vomiting, intestinal dysfunction
Metabolic abnormalities; increased metabolic needs

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

Maintain usual weight and positive nitrogen balance.

Nursing Interventions	Rationale
Auscultate bowel sounds, noting absent or hyperactive sounds.	Although bowel sounds are frequently absent, inflammation and irritation of the intestine may be accompanied by intestinal hyperactivity, diminished water absorption, and diarrhea.
Monitor NG tube output. Note presence of vomiting, diarrhea.	Large amounts of gastric aspirant and vomiting and diarrhea suggest bowel obstruction, requiring further evaluation.
Measure abdominal girth.	Provides quantitative evidence of changes in gastric or intestinal distension and/or accumulation of ascites.
Assess abdomen frequently for return to softness, reappearance of normal bowel sounds, and passage of flatus.	Indicates return of normal bowel function and ability to resume oral intake.
Weigh regularly.	Initial losses or gains reflect changes in hydration, but sustained losses suggest nutritional deficit.
Monitor BUN, protein, prealbumin and albumin, glucose, nitrogen balance as indicated.	Reflects organ function and nutritional status and needs.
Advance diet as tolerated. Advance from clear liquids to soft food.	Careful progression of diet when intake is resumed reduces risk of gastric irritation.
Administer TPN as indicated.	Promotes nutrient utilization and positive nitrogen balance in patients who are unable to assimilate nutrients in a normal fashion.

5. Anxiety/Fear

Nursing Diagnosis

Anxiety
Fear

May be related to

Situational crisis
Threat of death/change in health status
Physiological factors, hypermetabolic state

Possibly evidenced by

Increased tension/helplessness
Apprehension, uncertainty, worry, sense of impending doom
Sympathetic stimulation; restlessness; focus on self

Desired Outcomes

Verbalize awareness of feelings and healthy ways to deal with them.
Report anxiety is reduced to a manageable level.
Appear relaxed.

Nursing Interventions	Rationale
Evaluate anxiety level, noting patient’s verbal and nonverbal response. Encourage free expression of emotions.	Apprehension may be escalated by severe pain, increasingly ill feeling, urgency of diagnostic procedures, and possibility of surgery.
Provide information regarding disease process and anticipated treatment.	Knowing what to expect can reduce anxiety.
Schedule adequate rest and uninterrupted periods for sleep.	Limits fatigue, conserves energy, and can enhance coping ability.

6. Deficient Knowledge

Nursing Diagnosis:

Knowledge, deficient [Learning Need] regarding condition, prognosis, treatment, self-care, and discharge needs

May be related to

Lack of exposure/recall
Information misinterpretation
Unfamiliarity with information resources

Possibly evidenced by

Questioning; request for information
Statement of misconception
Inaccurate follow-through of instruction

Desired Outcomes

Verbalize understanding of disease process and potential complications.
Identify relationship of signs/symptoms to the disease process and correlate symptoms with causative factors.
Verbalize understanding of therapeutic needs.
Correctly perform necessary procedures and explain reasons for actions.

Nursing Interventions	Rationale
Review underlying disease process and recovery expectations.	Provides knowledge base from which patient 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 medication regimen, schedule, and possible side effects.	Antibiotics may be continued after discharge, depending on length of stay.
Recommend gradual resumption of usual activities as tolerated, allowing for adequate rest.	Prevents fatigue, enhances feeling of well-being.
Review activity restrictions or limitations: avoid heavy lifting, constipation.	Avoids unnecessary increase of intra-abdominal pressure and muscle tension.
Demonstrate aseptic dressing change, wound care.	Reduces risk of contamination. Provides opportunity to evaluate healing process.
Emphasize importance of medical follow-up.	Necessary to monitor resolution of infection and resumption of usual activities.

Other Possible Nursing Care Plans

Fatigue—decreased metabolic energy production, increased energy requirements to perform ADLs, states of discomfort.
Pain, acute—chemical irritation of the peritoneum, prolonged healing process.

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