5 Nursing Diagnosis Peritonitis

Peritonitis is an inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. Peritonitis may be localised or generalised, and may result from infection (often due to rupture of a hollow organ as may occur in abdominal trauma or appendicitis) or from a non-infectious process.


Treatment


Depending on the severity of the patient's state, the management of peritonitis may include:

• General supportive measures such as vigorous intravenous rehydration and correction of electrolyte disturbances.
• Antibiotics are usually administered intravenously, but they may also be infused directly into the peritoneum. The empiric choice of broad-spectrum antibiotics often consist of multiple drugs, and should be targeted against the most likely agents, depending on the cause of peritonitis (see above); once one or more agents are actually isolated, therapy will of course be targeted on them.
• Surgery (laparotomy) is needed to perform a full exploration and lavage of the peritoneum, as well as to correct any gross anatomical damage that may have caused peritonitis. The exception is spontaneous bacterial peritonitis, which does not always benefit from surgery and may be treated with antibiotics in the first instance.

5 Nursing Diagnosis Nursing Care Plan for Peritonitis

1. Acute Pain Nursing Care Plan for Peritonitis

2.Imbalanced Nutrition Less Than Body Requirements Nursing Care Plan for Peritonitis

3. Risk for Infection Nursing Care Plan for Peritonitis

4. Deficient Fluid Volume Nursing Care Plan for Peritonitis

5.Ineffective Breathing Pattern Nursing Care Plan for Peritonitis

Source : http://nanda-list.blogspot.com/2011/12/nursing-care-plan-for-peritonitis-5.html

Peritonitis Definition and Clinical Manifestations

Peritonitis Definition

Peritonitis is inflammation of the peritoneum - the serous membrane lining the abdominal cavity and covers the viscera is dangerous complications that can occur in acute or chronic form or set of signs and symptoms, including tenderness and pain on palpation loose, defans muscular, and general signs of inflammation. Patients with peritonitis may experience symptoms of acute, mild illness and limited, or severe and systemic disease with septic shock.

Infectious peritonitis, are divided over the causes perimer (spontaneous peritonitis), secondary (associated with pathological processes in visceral organs), or tertiary cause (recurrent or persistent infection after adequate initial therapy). Infection of the abdomen are grouped into pertitonitis infection (common) and abdominal abscesses (local peritonitis infection is relatively difficult to enforce and very dependent of the underlying disease. The cause of peritonitis is spontaneous bacterial peritonitis due to chronic liver disease.

Other causes of secondary peritonitis is perforated appendicitis, peptic and duodenal ulcer perforation, perforation of the colon due to diverdikulitis, volvulus and cancer, and ascending colon strangulation. The cause of iatrogenic trauma generally comes from the upper gastrointestinal tract including pancreas, bile ducts and colon sometimes also can occur from trauma endoscopy. Stitching operation that is leaking is a common cause of peritonitis.

After surgery, abdominal effective for non-infectious etiology, incidence of secondary peritonitis (due to rupture of suture surgery should be less than 2%. Surgery for inflammatory diseases (eg appendicitis, divetikulitis, cholecystitis) without risk of perforation is less than 10% of secondary peritonitis and peritoneal abscess. Risk occurrence of secondary peritonitis and abscess higher with the involvement of the duodenum, pancreatic colonic perforation, peritoneal contamination, perioperative shock, and the passive transfusion.

Peritonitis Clinical Manifestations

The presence of blood or fluid in the peritoneum cavity will provide signs of stimulation peritoneum. Peritoneum stimuli cause tenderness and muscular defans, liver dullness may disappear due to free air under the diaphragm. Decreased peristaltic lost due to temporary paralysis of the intestines.

In case of bacterial peritonitis, the patient's body temperature will rise and there is tachycardia, hypotension and the patient seemed lethargic and shock. This stimulation causes pain on any movement that causes the shift of peritoneum. Pain is a subjective form of pain when the patient moves such as roads, breathing, coughing, or straining. Pain is a pain if the objective is moved such as palpation, tenderness loose, psoas test, or other tests.

Clinical diagnosis of peritonitis enforced by the presence of abdominal pain (Acute abdomen) with a dull pain and obscure location (visceral peritoneum) that more and more obvious location (parietal peritoneum). Relative signs of peritonitis with severe infection is high fever or sepsis patients who could be hypothermia, tachycardia, dehydration to be hypotensive. Severe abdominal pain which usually has a punctum maximum specific place as a source of infection.

The walls of the stomach will feel tight because the mechanism of anticipation patient unconsciously to avoid palpation painful or tense because of irritation of the peritoneum.

Nursing Care Plan for Peritonitis Nursing Diagnosis Risk for Infection

Nursing Diagnosis Risk for Infection Nursing Care Plan

Definition: At increased risk for being invaded by pathogenic organisms
Related Factors: See Risk Factors.

Risk Factors:

Invasive procedures; insufficient knowledge regarding avoidance of exposure to pathogens; trauma; tissue destruction and increased environmental exposure; rupture of amniotic membranes; pharmaceutical agents (e.g., immunosuppressants); malnutrition; increased environmental exposure to pathogens; immunosuppression; inadequate acquired immunity; inadequate secondary defenses (e.g., decreased hemoglobin, leukopenia, suppressed inflammatory response); inadequate primary defenses (e.g., broken skin, traumatized tissue, decrease in ciliary action, stasis of body fluids, change in pH secretions, altered peristalsis); chronic disease.

NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

Immune Status
Knowledge: Infection Control
Risk Control
Risk Detection

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

Infection Control
Infection Protection

Client Outcomes

Remains free from symptoms of infection
States symptoms of infection of which to be aware
Demonstrates appropriate care of infection-prone site
Maintains white blood cell count and differential within normal limits
Demonstrates appropriate hygienic measures such as hand washing, oral care, and perineal care.

Nursing Interventions Risk for Infection for Peritonitis

Independent:

1. Note the example of individual risk factors abdominal trauma, acute appendicitis, peritoneal dialysis.
Rational: Affects choice of interventions

2. Assess vital signs with frequent, noted no improvement or continuing hypotension, decreased pulse pressure, tachycardia, fever, tachypnea.
Rationale: Signs of septic shock, endotoxin circulation causes vasodilation, loss of fluid from the circulation, and low cardiac output status.

3. Note the change in mental status (eg, confusion, fainting).
Rational: Hypoxaemia, hypotension, and acidosis can cause irregularities in mental status.

4. Note the color, temperature, humidity.
Rational: Warm, redness, dry skin is an early sign of septicemia. Further manifestations include cold, pale skin moist and cyanosis as a sign of shock.

5. Monitor urine output.
Rational: Oliguria occurred as a result of reduced renal perfusion, the toxin in the circulation affects the antibiotic.

6. Maintain strict aseptic technique in the treatment of abdominal drain, wound incision / open, and the invasive side.
Rationale: Prevent the spread and limit the spread of infectious organisms / cross contamination.

7. Observations on wound drainage.
Rationale: Provides information about the status of infection.

8. Maintain sterile technique when the patient is placed catheters, and catheter care provided / or perineal hygiene routine.
Rasonal: Preventing the spread, limiting the growth of bacteria in the urinary tract.

9. Supervise / limit visitors and staff as needed. Provide insulation protection when indicated.
Rational: Reduce the risk of exposure to / add a secondary infection in patients who experienced immune pressure.


Collaboration:

1. Take for example / watch the results of serial blood, urine, wound cultures.
Rationale: Identifying microorganisms and assist in assessing the effectiveness of antimicrobial program.

2. Assist in the peritoneal aspiration, if indicated.
Rational: Guide to drain fluids and to identify infectious organisms so that appropriate antibiotics but can be given.

3. Prepare for surgical intervention when indicated
Rationale: Treatment of choice (curative) in acute peritonitis or local, for example a local abscess drainage, peritoneal exudate throw, throw rupturapendiks / gall bladder, cope with perforated ulcer, or bowel resection.

 Reference : http://careplannursing.blogspot.com/2011/12/risk-for-infection-nursing-care-plan.html