8.PERITONITIS.pptx medicalsurgical nursing

adult health nursing

1. PERITONITIS

2. PERITONITIS Appendicitis and diverticulitis may both lead to peritonitis, and all of them are acute inflammatory intestinal disorders. DEFINITION : Peritonitis is the  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.

3. PERITONITIS

4. CAUSES OF PERITONITIS Peritonitis can be caused by internal and external factors. 1.Injury : Trauma like  gunshot wounds or stab wounds  could lead to peritonitis. 2.Inflammation :  An inflammation that extends from an organ outside the peritoneal area such as the kidneys could cause peritonitis. 3.Bacteria :  The most common bacteria are Escherichia coli, Klebsiella, Proteus, Pseudomonas, and Streptococcus.

5. PATHOPHYSIOLOGY 1.Leakage :  Peritonitis is caused by leakage of contents from abdominal organs into the abdominal cavity. 2.Proliferation :  Bacterial proliferation occurs. 3.Edema :   Edema of the tissues occurs, and exudation of fluid develops in a short time. 4.Invasion :  Fluid in the peritoneal cavity becomes turbid with increasing amounts of protein, white blood cells, cellular debris, and blood. 5.Response : The immediate response of the intestinal tract is  hypermotility , soon followed by paralytic ileus with an accumulation of air and fluid in the bowel.

6. CLINICAL MANIFESTATIONS Symptoms depend on the extent and location of the inflammation. 1.Pain : At first, there is diffuse pain, which tends to become constant, localized, and more intense over the site of the pathologic process. 2.Tenderness :  The affected area of the abdomen becomes extremely tender and distended, the muscles become rigid, and movement could aggravate it further. 3.Altered vital signs :  A temperature of  37.8C to 38.3C  can be expected along with an  increased pulse rate .

7. COMPLICATIONS The abdominal cavity shows widespread infection that can lead to complications. 1.Sepsis.  Sepsis is the major cause of death from peritonitis. 2.Shock.  Shock may result from  septicemia  or hypovolemia 3.Intestinal obstruction.  The inflammatory process may cause intestinal obstruction, primarily from the development of bowel adhesions.

8. Assessment and Diagnostic Findings Assessing and diagnosing peritonitis involves the following: 1.Increased WBC : The white blood cell count is almost always elevated. 2.Serum electrolyte studies : Serum electrolyte studies may reveal altered levels of potassium, sodium, and chloride. 3.Abdominal X ray : An abdominal X - ray may show air and fluid levels as well as distended bowel loops.

9. Assessment and Diagnostic Findings 4.Abdominal ultrasound :  Abdominal ultrasound may reveal abscesses and fluid collections. 5.CT scan : A CT scan of the abdomen may reveal abscess formation. 6. MRI : MRI may be used for diagnosis of intra-abdominal abscesses.

10. 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( which has 0.9% NACL)  is prescribed. 2.Analgesics :  Analgesics are prescribed for pain. 3.Intubation and suction :  Intestinal intubation and suction assist in relieving abdominal distention and in promoting intestinal function.

11. MEDICAL MANAGEMENT 4.Oxygen therapy :   Oxygen therapy by nasal cannula or mask generally promotes adequate oxygenation. 5.Antibiotic therapy.   Antibiotic therapy is initiated early in the treatment of peritonitis

12. Surgical Management Surgical objectives include removing the infected material and correcting the cause. 1.Excision.   Surgical treatment is directed towards excision, especially if the appendix is involved. 2.Resection.  Resection of the intestines may be done with or without anastomosis. 3.Fecal diversion.   A fecal diversion may need to be created with extensive sepsis.

13. Nursing Diagnosis Based on assessment data, the diagnoses appropriate for the patient are: Acute pain  related to peritoneal irritation. Deficient fluid volume  related to massive shifting of fluids towards the intestinal lumen and depletion in the vascular space. Risk for shock  related to septicemia or hypovolemia.

14. Nursing Interventions Nursing interventions focus on the following: 1.Blood pressure monitoring  The patient’s blood pressure is monitored by arterial line if shock is present. 2.Medications.   Administration of analgesic and anti emetics can be done as prescribed. 3.Pain management . Analgesics and positioning could help in decreasing pain.

15. Nursing Interventions 4.I&O monitoring.   Accurate recording of all intake and output could help in the assessment of fluid replacement. 5. IV fluids :  The nurse administers and closely monitors IV fluids. 6.Drainage monitoring.  The nurse must monitor and record the character of the drainage postoperatively.