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Peritonitis
Peritonitis is inflammation of the peritoneum, the serous membrane lining the
abdominal cavity and covering the viscera. Usually, it is a result of bacterial
infection; the organisms come from diseases of the GI tract or, in women,
from the internal reproductive organs (eg, fallopian tube).
Peritonitis can also result from external sources such as injury or trauma (eg,
gunshot wound, stab wound) or an inflammation
that extends from an organ outside the peritoneal area, such as the kidney.
Other common causes of peritonitis are appendicitis, perforated ulcer,
diverticulitis, and bowel perforation (Fig. 38-5). Peritonitis may also be
associated with abdominal surgical procedures and peritoneal
dialysis. The most common bacteria implicated are Escherichia coli,
Klebsiella,
. Inflammation and paralytic ileus are the direct effects of the infection.
Pathophysiology
Peritonitis is caused by leakage of contents from abdominal
organs into the abdominal cavity, usually as a result of inflammation,
infection, ischemia, trauma, or tumor perforation. Bacterial proliferation
occurs. Edema of the tissues results, and exudation of fluid develops in a
short time. Fluid in the peritoneal cavity becomes turbid with increasing
amounts of protein, white blood cells, cellular debris,
Nursing Management.
Intensive care is often needed. The patient’s blood pressure is monitored by
arterial line if shock is present. urine output are monitored frequently. In
addition, ongoing assessment of pain, GI function, and fluid and electrolyte
balance is important. The nurse reports the nature of the pain, its location in
the abdomen, and any changes in location.
Administering analgesic medication and positioning he patient for comfort are
helpful in decreasing pain. The patient is placed on the side with knees flexed;
this position decreases tension on the abdominal organs. Accurate recording
of all intake and output and central venous pressures and pulmonary artery
pressures assist in calculating fluid replacement. The nurse administers and
closely monitors IV fluids. Nasogastric intubation may be necessary.
Signs that indicate that peritonitis is subsiding include a decrease in
Temperature and pulse rate, softening of the abdomen, return of peristaltic
sounds, passing of flatus, and bowel movements. The nurse increases fluid
and food intake gradually and reduces parenteral fluids as prescribed.
.Drains are frequently inserted during the surgical procedure, and the nurse
must monitor and record the character of the drainage postoperatively. Care
must be taken when moving and turning the patient to prevent the drains from
being dislodged. It is also important for the nurse to prepare the patient and
family for discharge by teaching the patient to care for the incision and drains
if the patient will be sent home with the drains still in place.
medical management.
The administration of several liters of an isotonic solution is prescribed.
Hypovolemia occurs because massive amounts of fluid and electrolytes
move from the intestinal lumen into the peritoneal cavity and deplete the
fluid in the vascular space.
Analgesics are prescribed for pain. Antiemetic are administered as
prescribed for nausea and vomiting. Intestinal intubation and suction
assist in relieving abdominal distention
and in promoting intestinal function. Fluid in the abdominal cavity can
cause pressure that restricts expansion of the lungs and causes respiratory
distress. Oxygen therapy by nasal cannula or mask generally promotes
adequate oxygenation, but airway intubation and ventilatory assistance
may be required if peritonitis leads to septic shock
Complications
The inflammation is most commonly not localized, and the
entire abdominal cavity shows evidence of widespread infection.
Sepsis is the major cause of death from peritonitis.
Shock may result from septicemia or hypovolemia. The inflammatory
process may cause intestinal obstruction, primarily from the development
of bowel adhesions.