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56 Cards in this Set

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What is peritonitis?
acute inflammation of visceral/parietal peritoneum and endothelial lining of abdominal cavity, or peritoneum...LIFE-THREATENING
How is peritonitis classified?
primary or secondary
localized or generalized
How much transudate does the peritoneal cavity normally contain and why?
50 ml
prevents friction in abdominal cavity during
peristalsis
What happens when the peritoneal cavity is contaminated by bacteria?
inflammatory reaction occurs...immune reaction attempts to wall off area...if it fails, then inflammation spreads, causing massive contamination, resulting in diffuse peritonitis
As peritonitis is developing, how does the body respond to the infectious process?
by shunting extra blood to the area of inflammation...
fluid is shifted from ECF to peritoneal cavity, connective tissues and GI tract...this is called THIRD SPACING...the shift of fluid out of vascular space may result in decreased circulatory volume
Peritonitis may cause third spacing which may result in?
decreased circulatory volume
How might decreased circulatory volume due to third spacing affect kidneys?
may cause insufficient perfusion of kidneys, leading to renal failure with electrolyte imbalance
What happens to peristalsis in response to severe peritoneal infection?
slows or stops so bowel becomes distended with gas and fluid
What happens to the fluid that normally flows to the small bowel and colon for reabsorption?
accumulates in intestine in volumes of 7 to 8 L daily...this fluid can be full of toxins and bacteria...which may enter bloodstream from peritoneal area, leading to bacteremia or septicemia
How might peritonitis affect respiratory?
there is increased abdominal pressure against the diaphragm from intestinal distention and fluid shifts to peritoneal cavity...the pain can interfere with ventilatory efforts ...patient has increased oxygen demands because of infectious process
What is primary peritonitis?
acute bacterial infection that develops as a result of contaminatino of peritoneum through vascular system
A type of primary peritonitis is?
tuberculous peritonitis...arises from a tuberculin infection originating elsewhere in the body
What is secondary peritonitis?
caused by bacterial invasion as a result of an acute abdominal disorder...may develop as a result of a gangrenous bowel, perforation of viscera by blunt or penetrating trauma or bile leakage
What is peritonitis caused by?
contamination of peritoneal cavity by bacteria or chemicals

bacterial invasion via:
an ascending infection through the reproductive
tract
salpingitis (fallopian tube
inflammation)
septic abortion
Bacteria gain entry into peritoneum by?
perforation or from an external penetrating wound
Most common causes of bacterial peritonitis are?
appendicitis and perforations asociated with:
peptic ulcer disease
diverticulitis
gangrenous gallbladder
bowel obstruction

other causes:
perforating tumors
ulcerative colitis
foreign bodies (from trauma)
leakage
contamination during
surgical procedure
infection by skin pathogens in clients undergoing
continuous ambulatory peritoneal dialysis (CAPD)
Bacteria responsible for peritonitis?
E. coli
Streptococcus
Staphylococcus
Pneumococcus
Gonococcus
Chemical peritonitis arises from?
leakage of bile
pancreatic anzymes
gastric acid
When assessing for peritontitis, found out if patient has?
history of abdominal pain?
is pain localized?
is pain generalized?
history of low-grade fever?
recent spikes in temperature?
What do the physical findings of peritonitis depend on?
stage of disease
ability of body to localize
process by walling off
infection
whether inflammation has
progressed to generalized
peritonitis
What physical findings might the nurse observe?
patient acutely ill
lying still
possibly knees flexed
movement guarded
signs of pain by facial
grimacing upon coughing or
movement of any type
progressive abdominal
distention
bowel sounds may disappear
with progression of
inflammation
nausea and vomiting possible
hiccups possible as a result
of diaphragmatic breathing
irritation
respiratory status
compromised possibly
Cardinal signs of peritonitis are?
abdominal pain
tenderness
The abdomen with localized peritonitis is?
tender on palpation in a well-defined area of abdomen with REBOUND TENDERNESS in the area (rebound tenderness is one thing that separates peritonitis from gastroenteritis)
The abdomen with generalized peritonitis has?
widespread tenderness
Abdominal wall rigidity is a classic finding, sometimes referred to as a?
"board-like" abdomen
What response might the heart have to the high fever associated with the infectious process of peritonitis?
tachycardia
Upon assessing, ask the patient if he has dry _______ _________ and low ________ ________.
mucous membranes
urine output
Urine output may be low because?
fluid accumulates in:
peritoneal cavity
GI tract
connective tissues
...which results in a fluid deficit in the vascular space
How is the WBC affected?
elevated to 20,000/mm3 with high neutrophil count
What type of tests might hcp order?
blood culture studies
fluid and electrolyte
studies
renal status studies
arterial blood gases
abdominal x-rays
abdominal sonogram
peritoneal lavage
Why are blood culture studies done?
to determine whether septicemia has occurred..
to identify causative organism
What type of fluid and electrolyte and kidney studies are run?
electrolytes
BUN
creatinine
hemoglobin
hematocrit
Why are arterial blood gases obtained?
to assess respiratory function and acid-base balance
Why are abdominal x-rays obtained?
to assess for free air or fluid in abdominal cavity, which indicates perforation..
may show dilation, edema, and inflammation of small and large intestines
How does a physician perform a peritoneal lavage?
by instilling 1 L of fluid through a peritoneal dialysis catheter
Lavage fluid positive for peritonitis is characterized by the following?
more than 500 WBCs/mL of fluid..
more than 50,000 rbcs/mL...
presence of bacteria on a Gram stain...
bile stained green fluid may indicate a ruptured gallbladder or perforated intestine, which can lead to chemical peritonitis
Nonsurgical management of peritonitis includes?
IV fluids
broad-spectrum antibiotics
monitor daily weight and
I&O
NG tube
NPO status
administer oxygen
pain management with IV
analgesics (morphine in PCA
pump)
possible surgical consult
Surgical management of peritonitis?
abdominal surgery (typically exploratory laparotomy) focusing on:
controlling contamination
removing foreign material
from peritoneal cavity
draining collected fluid
An exploratory laparotomy removes or repairs the?
inflamed or perforated organ
An appendectomy is performed for an?
inflamed appendix
A colon resection, with or without colostomy, is performed for a perforated?
diverticulum or colon secondary to a tumor
Before abdominal cavity is closed, the surgeon irrigates the peritoneum with?
antibiotic solutions.

also several catheters may be inserted to drain the cavity and provide a route for irrigation postop
Because patients may have multisystem complications, nurse should monitor what on hourly basis?
LOC
VS
respiratory status (resp.
rate and breath sounds)
fluid and electrolyte status
(I&O and lab values)
Why should nurse position patient in semi-Fowler's position?
to promote drainage of
peritoneal contents in
inferior region of abdominal
cavity

also facilitates adequate
respiratory excursion
because diaphragm and
abdominal contents are
impinging on respiratory
muscles
The client is likely to have ________ incisions and drains
post-op. Incisions are allowed to heal by _____ or _____ intention because contamination impedes healing by ______ intention.
multiple

second
third
first
Incisions caused by the abdominal surgery necessitate meticulous care involving ________ ________
or _______ as ordered by surgeon.
manual irrigation
packing
If the surgeon requests peritoneal irrigation through a drain, maintain strict ________ technique by using a catheter-tipped _______.
sterile

syringe
Determine that client is not retaining irrigant by ensuring absence of ________ ________or ______ and by monitoring irrigant _____ and _______.
abdominal distention
pain
intake and output
Because of the loss of fluids from the extracellular space to the peritoneal cavity, plus fluid volume deficit occurring as a result of NG suctioning and NPO status, what does the nurse need to do?
start IV fluid replacement and maintenance...based on BUN, electrolyte, serum creatinine values, NS or balanced saline solution with potassium may need to be administered...
nurse needs to be also assessing the following:
fluid volume
VS
urine output
skin turgor
mucous membrane integrity
WEIGHT (very important)

also assess edema from third spacing
Uncomplicated peritonitis case means hospitalization for less than a _______.
Depends on response to __________ and ____ _______.
week

antibiotics
IV fluids
Complicated cases which involve sepsis or shock, may require _______ ________ or
_________ which requires hospitalization for longer than a week.
mechanical ventilation
hemodialysis
For discharge and home care, assess patient for _______ _______ and _______ care.

Symptoms patient should be looking for include?
activity intolerance
incision

unusual or foul-smelling
drainage?
swelling, redness, or
warmth or bleeding from
the incision site?
temperature higher than 101F?
abdominal pain?
When patient is discharged, instruct him to handwash, on how to change dressings, and to dress wounds ________ to avoid ________.
separately
cross-contamination
When patient is discharged, physician may give him a rx
for an oral ______ ______ and possibly an ______
opioid analgesic (stool
softener may be required
with this rx)
antibiotic
As far as lifting goes, patient is instructed not to lift anything for ____ _____ following surgery.
SIX WEEKS
Upon discharge, the patient healing by second and third intention may require what materials?
dressings
solution
catheter-tipped syringes to
irrigate wound