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Summary

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Description

The inflammation of the peritoneum, which is the serous membrane lining the abdominal cavity and covering the viscera.

Primary-occurs as a spontaneous bacterial infection of ascitic fluid. common w/ adults with liver failure. Secondary - perforation of abdominal organs with spillage that infects serous peritoneum.

Pathophysiology:

Tertiary- from a suprainfection in a patient who is immunocompromised. EX: tuberculous peritonitis in AIDS patient.

Fluid, colloid, and electrolyte replacement is the major focus of medical management. The administration of several liters of an isotonic solution is prescribed because of hypovolemia.

PERITONITIS Clinical Manifestations: symptoms depend on the location and extent of inflammation. -1st pain comes and goes then becomes constant, localized, and more intense for the site. -aggravated by movement -abd tender, distended, muscles rigid, rebound tenderness may be present. -NV, anorexia, decreased peristalsis -S/S will mimic septic shock

WBC's elevated showing increase count in immature neutrophils. abdominal x-ray may show air and fluid levels as well as distended bowel loops Most common bacteria: Escherichia coli and Klebsiella, Proteus, Pseudomonas, and Streptococcus species

Analgesic medications for pain. Antiemetic for nausea and vomiting.

Medical Management: Intensive care unit for septic shock pt

Nursing Management:

Peritonitis subsiding when: decrease in temperature and pulse rate, soft abdomen, return of peristalsis sounds, passing of flatulence, and bowel movements.

Increase fluid and food gradually and reduce parenteral fluids as prescribed.

Diagnositcs

Intestinal intubation and suction to relieve abdominal distention, and promote intestinal function. Oxygen therapy because of fluid in the abdominal cavity that causes pressure and restricts lung expansion. Antibiotic therapy in large doses of a broad spectrum IV for the specific organism causing the infection. Once cause of infection is determined, appropriate antibiotic therapy will be initiated.

Surgical treatment: excision (appendix), resection with or without anastomosis (intestine), repair (perforation), drainage (abscess)....