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56 Cards in this Set
- Front
- Back
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What is peritonitis?
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acute inflammation of visceral/parietal peritoneum and endothelial lining of abdominal cavity, or peritoneum...LIFE-THREATENING
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How is peritonitis classified?
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primary or secondary
localized or generalized |
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How much transudate does the peritoneal cavity normally contain and why?
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50 ml
prevents friction in abdominal cavity during peristalsis |
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What happens when the peritoneal cavity is contaminated by bacteria?
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inflammatory reaction occurs...immune reaction attempts to wall off area...if it fails, then inflammation spreads, causing massive contamination, resulting in diffuse peritonitis
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As peritonitis is developing, how does the body respond to the infectious process?
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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 |
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Peritonitis may cause third spacing which may result in?
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decreased circulatory volume
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How might decreased circulatory volume due to third spacing affect kidneys?
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may cause insufficient perfusion of kidneys, leading to renal failure with electrolyte imbalance
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What happens to peristalsis in response to severe peritoneal infection?
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slows or stops so bowel becomes distended with gas and fluid
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What happens to the fluid that normally flows to the small bowel and colon for reabsorption?
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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
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How might peritonitis affect respiratory?
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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
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What is primary peritonitis?
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acute bacterial infection that develops as a result of contaminatino of peritoneum through vascular system
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A type of primary peritonitis is?
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tuberculous peritonitis...arises from a tuberculin infection originating elsewhere in the body
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What is secondary peritonitis?
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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
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What is peritonitis caused by?
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contamination of peritoneal cavity by bacteria or chemicals
bacterial invasion via: an ascending infection through the reproductive tract salpingitis (fallopian tube inflammation) septic abortion |
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Bacteria gain entry into peritoneum by?
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perforation or from an external penetrating wound
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Most common causes of bacterial peritonitis are?
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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) |
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Bacteria responsible for peritonitis?
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E. coli
Streptococcus Staphylococcus Pneumococcus Gonococcus |
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Chemical peritonitis arises from?
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leakage of bile
pancreatic anzymes gastric acid |
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When assessing for peritontitis, found out if patient has?
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history of abdominal pain?
is pain localized? is pain generalized? history of low-grade fever? recent spikes in temperature? |
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What do the physical findings of peritonitis depend on?
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stage of disease
ability of body to localize process by walling off infection whether inflammation has progressed to generalized peritonitis |
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What physical findings might the nurse observe?
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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 |
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Cardinal signs of peritonitis are?
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abdominal pain
tenderness |
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The abdomen with localized peritonitis is?
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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)
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The abdomen with generalized peritonitis has?
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widespread tenderness
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Abdominal wall rigidity is a classic finding, sometimes referred to as a?
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"board-like" abdomen
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What response might the heart have to the high fever associated with the infectious process of peritonitis?
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tachycardia
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Upon assessing, ask the patient if he has dry _______ _________ and low ________ ________.
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mucous membranes
urine output |
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Urine output may be low because?
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fluid accumulates in:
peritoneal cavity GI tract connective tissues ...which results in a fluid deficit in the vascular space |
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How is the WBC affected?
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elevated to 20,000/mm3 with high neutrophil count
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What type of tests might hcp order?
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blood culture studies
fluid and electrolyte studies renal status studies arterial blood gases abdominal x-rays abdominal sonogram peritoneal lavage |
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Why are blood culture studies done?
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to determine whether septicemia has occurred..
to identify causative organism |
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What type of fluid and electrolyte and kidney studies are run?
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electrolytes
BUN creatinine hemoglobin hematocrit |
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Why are arterial blood gases obtained?
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to assess respiratory function and acid-base balance
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Why are abdominal x-rays obtained?
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to assess for free air or fluid in abdominal cavity, which indicates perforation..
may show dilation, edema, and inflammation of small and large intestines |
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How does a physician perform a peritoneal lavage?
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by instilling 1 L of fluid through a peritoneal dialysis catheter
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Lavage fluid positive for peritonitis is characterized by the following?
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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 |
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Nonsurgical management of peritonitis includes?
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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 |
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Surgical management of peritonitis?
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abdominal surgery (typically exploratory laparotomy) focusing on:
controlling contamination removing foreign material from peritoneal cavity draining collected fluid |
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An exploratory laparotomy removes or repairs the?
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inflamed or perforated organ
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An appendectomy is performed for an?
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inflamed appendix
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A colon resection, with or without colostomy, is performed for a perforated?
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diverticulum or colon secondary to a tumor
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Before abdominal cavity is closed, the surgeon irrigates the peritoneum with?
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antibiotic solutions.
also several catheters may be inserted to drain the cavity and provide a route for irrigation postop |
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Because patients may have multisystem complications, nurse should monitor what on hourly basis?
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LOC
VS respiratory status (resp. rate and breath sounds) fluid and electrolyte status (I&O and lab values) |
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Why should nurse position patient in semi-Fowler's position?
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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 |
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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 |
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Incisions caused by the abdominal surgery necessitate meticulous care involving ________ ________
or _______ as ordered by surgeon. |
manual irrigation
packing |
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If the surgeon requests peritoneal irrigation through a drain, maintain strict ________ technique by using a catheter-tipped _______.
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sterile
syringe |
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Determine that client is not retaining irrigant by ensuring absence of ________ ________or ______ and by monitoring irrigant _____ and _______.
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abdominal distention
pain intake and output |
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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?
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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 |
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Uncomplicated peritonitis case means hospitalization for less than a _______.
Depends on response to __________ and ____ _______. |
week
antibiotics IV fluids |
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Complicated cases which involve sepsis or shock, may require _______ ________ or
_________ which requires hospitalization for longer than a week. |
mechanical ventilation
hemodialysis |
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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? |
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When patient is discharged, instruct him to handwash, on how to change dressings, and to dress wounds ________ to avoid ________.
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separately
cross-contamination |
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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 |
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As far as lifting goes, patient is instructed not to lift anything for ____ _____ following surgery.
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SIX WEEKS
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Upon discharge, the patient healing by second and third intention may require what materials?
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dressings
solution catheter-tipped syringes to irrigate wound |
