Acute peritonitis is an inflammatory process within the peritoneal cavity most commonly caused by a bacterial infection. Types of acute peritonitis include primary and secondary. Primary peritonitis, otherwise known as spontaneous bacterial peritonitis, most commonly occur in patients with cirrhosis and clinically significant ascites. Secondary peritonitis most commonly occurs as a result of spillage of intestinal, biliary, or urinary tract contents into the peritoneal space as a result of perforation, suppuration, or ischemic injury. Patients at risk for developing secondary peritonitis include those with recent abdominal surgery, a perforated ulcer or colon, a ruptured appendix or viscus, a bowel obstruction, a gangrenous bowel, or ischemic bowel disease.
Signs and Symptoms
- Patient assuming a knee-flexed position and complaining of severe localized or generalized abdominal pain.
- Nausea and vomiting
- HR: tachycardia
- BP: hypotension
- RR: increased and shallow
- Temp : elevated
- Normal to decreased mentation
- Pulse thready or wear or may be bounding in presence of fever.
- Breath sounds may be diminished secondary to shallow breathing.
- Rebound tenderness with guarding
- May have referred pain to shoulder
- Rigid, distended abdomen
- Bowel sounds decrease to absent
Acute Care Management
Nursing Diagnosis: Deficient fluid volume related to intravascular fluid shift to the peritoneal space and inability to ingest oral fluids.
- Central venous pressure 2 TO 6 MM Hg
- BP 90 to 120 mm Hg
- Mean arterial pressure 70 to 105 mm Hg
- Pulmonary artery systolic 15 to 30 mm Hg
- Pulmonary artery diastolic 5 to 15 mm Hg
- HR 60 to 100 beats/min
- Urine output 30 ml/hr
- Obtain pulmonary artery pressure and central venous pressure and monitor mean arterial pressure hourly or more frequently if the patient’s hemodynamic status is unstable.
- Not the patient’s response to all therapy.
- Monitor fluid volume status by measuring urine output hourly and measure nasogastric and other bodily drainage.
- Determine fluid balance every 8 hours.
- Continuously monitor ECG fir dysrhythmias resulting from electrolyte disturbances.
- Assess tissue perfusion. Note level of consciousness, skin color and temperature, pulses, and capillary refill.
- Assess hydration status: note skin turgor on inner thigh or forehead, condition of buccal membranes, and development of edema or crackles.
- Assess the patient’s abdomen for resolution of rigidity, rebound tenderness, and distention. Auscultate bowel sounds.
- Review serum sodium and potassium levels, which may become depleted with nasogastric suctioning or fluid shifts.
- Review serial WBC count and differentiated to evaluate the course of action.
- Administer crystalloid or colloid solutions to improve intravascular volume.
- Replace potassium as ordered; validate adequate urine output before administration.
- Keep the patient NPO during acute phase and before evaluation by a surgeon.
- Provide nutritional support as indicated; most patient will benefit from postpyloric delivery of early enteral nutrients at a minimal hourly rate to prevent v=bacterial translocation and sepsis.
- Administer antibiotics as prescribed after appropriate cultures obtained.