Peritonitis
Surgical treatment for peritonitits
*focus to control/remove the contamination* -exploratory laparotomy (remove/repair inflamed/perforated organ) -colon resection with/without colostomy -draining of peritoneal fluid following surgery
Non-surgical treatment for peritonitis
-NPO -NG tube to suction (decompress stomach) -IV fluids -antibiotics -analgesics -symptomatic treatment (oxygen, electrolytes)
Clinical manifestations for peritonitis
-abdominal pain -Blumberg's sign/rebound tenderness -fever -tachycardia -tachypnea -rigid abdomen -decreased peristalsis -abdominal distention -inability to pass gas/stool -anorexia -N/V -possible compromise in respiratory status (hurts to move/breathe)
Nursing problems and interventions for peritonitis
-acute pain -fluid volume deficit -potential complications -anxiety -knowledge deficit
Causes of primary peritonitis
-blood borne organisms -genital tract organisms -cirrhosis with ascites
What are complications of peritonitis?
-dehydration -oliguria/renal failure -hypovolemic shock -sepsis -intra-abdominal abcess formation -paralytic ileus -bowel obstruction -ARDS (acute respiratory distress syndrome)
Nursing assessment of peritonitis
-pain (location) -vitals -LOC -respiratory status -bowels -abdominal distention -abdominal guarding -nausea -fever -s/s of dehydration/hypovolemic shock
Causes of secondary peritonitis
-peritoneal dialysis -perforation -ruptured appendicitis -trauma to abdominal organs -ruptured diverticulitis -ischemic bowel disorder -pancreatitis -post operative complication
Goals and interventions for peritonitis
-resolution of inflammation -relief of abdominal pain -freedom from complications -normal nutritional status -learning needs evaluation
How is peritonitis diagnosed?
-x-ray (assess for free air/fluid/perforation -ultrasound -CT scan -peritoneal aspiration -blood culture -oxygen saturation, acid-base balance -labs (inc WBC, CBC, CMP, BUN, creatinine)
Peritonitis
acute/chronic inflammation of the visceral/parietal peritoneum and endothelial lining of the abdominal cavity; potentially life threatening
What does peritoneal fluid contain?
anti-inflammatory properties, antibodies, immunoglobulins, and white blood cells
Secondary peritonitis
more common; caused by issue in another body region
Primary peritonitis
occurs when disease causing organisms gain entry into the peritoneal cavity causing irritation and chemical peritonitis; bacteria then gain entry and bacterial peritonitis develops in a few hours
What is paralytic ileus?
peristalsis slows or stops in response to the peritoneal inflammation and distention of the intestinal lumen with fluid occurs; also called adynamic bowel
Peritoneal cavity
potential space between the parietal peritoneum and visceral peritoneum; two membranes that separate the organs in the abdominal cavity
Peritoneal fluid
present in between the visceral and parietal membrane; about 50mL of sterile peritoneal fluid; acts as lubrication
Intraperitoneal organs
stomach first 5 cm and 4th part of the duodenum jejunum ileum cecum appendix transverse colon sigmoid colon upper 3rd of the rectum liver spleen tail of the pancreas
Peritoneal cavity Image
two membranes that separate the organs in the abdominal cavity
What happens if inflammatory response fails in primary peritonitis?
widespread inflammation and massive fluid shifts and edema, also causes adhesion as the body attempts to wall off the infection