NURSING

1. PERITONITIS
Presented by
Monika Devi
Msc(N)
HCN, SRHU

2. INTRODUCTION
 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.

3. PERITONITIS

4. CONT…
 Peritonitis commonly decreases intestinal
motility and causes intestinal distention with
gas. mortality is 10% with death usually a
result of bowel obstruction.
 Causative organism is pyogenic bacteria
 E –COLI
 Aerobic and anaerobic streptococcus and
staphylococcus.

5. DEFINITION
 Peritonitis is the inflammation of the
peritoneum, the serous membrane lining
the abdominal cavity and covering the
viscera.

6. CAUSES
Peritonitis may be caused by internal as well as
external factors likes :-
 Injury
 Trauma
 Gun shoot wound
 Stab wound

7. CONT…
Other causes
 Inflammation
 Bacteria
 Perforation of gastrointestinal organs
 Dialysis (peritoneal dialysis)

8. PATHOPHYSIOLOGY
Leakage:- peritonitis is caused by leakage of contents from abdominal
cavity
Proliferation :- Bacterial proliferation occur
Edema :- occurs and exudation of fluid develops in a short time
Invasion :- Fluid in the peritoneal cavity becomes turbid with increasing
amounts of protein, WBC, cellular debris and blood.
Response :- the immediate response of the intestinal tract is
hypermotality. Soon followed by paralytic ilius with an accumulation of
air and fluid in the bowel.

9. CLINICAL MANIFESTATION
 Swelling & tenderness in the abdomen
 Fever & Chills
 Loss of Appetite
 Nausea & Vomiting
 Pain

10. CONT…
 Breathing & Heart Rates
 Shallow Breaths
 Low BP
 Limited Urine Production
 Inability to pass gas or feces

11. ASSESSMENT AND DIAGNOSTIC
FINDING
 Increased WBC. The white blood cell count is
almost always elevated.
 Serum electrolyte studies. Serum electrolyte
studies may reveal altered levels
of potassium, sodium, and chloride.
 Abdominal x-ray. An abdominal xray may show air
and fluid levels as well as distended bowel loops.

12. ASSESSMENT AND DIAGNOSTIC
FINDING
 Abdominal ultrasound. Abdominal ultrasound may
reveal abscesses and fluid collections.
 CT scan. A CT scan of the abdomen may reveal
abscess formation.
 MRI. MRI may be used for diagnosis of intra-
abdominal abscesses.

13. COMPLICATIONS
 Sepsis
 Shock
 Intestinal obstruction

14. MEDICAL MANAGEMENT
Fluid colloid and electrolyte replacement is the
major focus of medical management.
1.Fluid :- the administration of several liters of an
isotonic solution is prescribed.
2.Analgesics :- are prescribed for pain

15. CONT…
3. Intubation and suction :- to relieving abdominal
distention and in promoting intestinal function.
4. Oxygen therapy:- generally promotes adequate
oxygenation.
5. Antibiotic therapy :- is initiated early in the
treatment of peritonitis.

16. SURGICAL MANAGEMENT
 Exploratory laprotomy
 Excision
 Resection
 Fecal diversion

18. NURSING MANAGEMENT
Intensive care is often needed for patients with
peritonitis.
Nursing Assessment
Assessment should be ongoing and precise.
 Pain. Pain should be assessed continuously and
should be acted upon.
 GI function. GI function should be monitored to
assess response to interventions.
 Fluid and electrolyte. F&E should be balanced.

19. NURSING DIAGNOSIS
1. Acute pain related to peritoneal irritation.
Goal
To reduce the level of pain.

20. CONT…
2. Deficient fluid volume related to massive shifting
of fluids towards the intestinal lumen and depletion
in the vascular space.
Goal
Restore fluid and electrolyte balance.

21. CONT….
3. Risk for shock related to septicemia or hypovolemia.
Goal
Prevent complications.

22. NURSING INTERVENTION
 Nursing intervention focus on the following :-
Blood pressure monitoring :- by arterial line if
shock is present.
 Medications :- analgesic and antiemetic can be
administration as prescribed.
 Pain management ;- analgesic and positioning
could help in decrease pain.

23. CONT…
 Input and output monitoring ;- accurate
according to all intake and output could help in
the assessment of fluid replacement.
 I/v fluid ;- administers and closely monitors I/v
fluids .
 Drainage monitoring ;- monitor and record the
character of the drainage post operatively.

24. SUMMARY

25. REFERENCES
 PHIPPS’ Medical-surgical Nursing Health And Illness
Perspectives Eighth Edition . Page No 1013,1248-1249.
 Lewis’s Medical –Surgical Nursing , Assessment And
Management Of Clinical Problems Second Edition. Page No
1020-1021.
 Brunner And Suddarth's Medical –Surgical Nursing ,Twelfth
Edition .Page No 1080-1081,1311.

26. THANK YOU