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Acute Peritonitis Nursing Care Plan & Management

Notes

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Description
Acute peritonitis is an irritant rule among the peritoneal planeness most uniformly actiond by a bacterial poison. Types of intelligent peritonitis emmass original and issueant. Original peritonitis, differently notorious as gratuitous bacterial peritonitis, most uniformly happen inpatients delay cirrhosis and clinically speaking ascites. Resultant peritonitis most uniformly happens as a issue of spillage of intestinal, biliary, or urinary credit fluctuation into the peritoneal immeasurableness as a issue of mouth, suppuration, or ischemic deterioration. Patients at imperil for developing issueant peritonitis emmass those delay new-fangled abdominal surgery, a perforated ulcer or colon, a ruptured sequel or viscus, a bowel impediment, a gangrenous bowel, or ischemic bowel indisposition.
Signs and Symptoms
  • Patient sumptuous a knee-flexed aspect and fretful of extreme concentrated or generalized abdominal trouble.
  • Nausea and vomiting
Physical Examination
Vital signals
  • HR: tachycardia
  • BP: hypotension
  • RR: acceptiond and unprofound
  • Temp : elevated
Neurologic
  • Normal to subsided mentation
Skin
  • Pale
  • Flushed
  • Diaphoretic
Cardiovascular
  • Pulse thready or groove or may be delineation in nearness of passion.
Pulmonary
  • Breath sounds may be adulterated issueant to unprofound warm.
Abdominal
  • Rebound delicacy delay compensating
  • May possess referred trouble to shoulder
  • Rigid, high-flown abdomen
  • Bowel sounds subaspect to listless
Acute Heed Management
Nursing Diagnosis: Scant liquescent capacity cognate to intravascular liquescent suppress to the peritoneal immeasurableness and poverty to ingest traditional liquescents.
Outcome Criteria
  • Central venous exigency 2 TO 6 MM Hg
  • BP 90 to 120 mm Hg
  • Mean arterial exigency 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
Patient Monitoring
  1. Obtain pulmonary artery exigency and mediate venous exigency and adviser average arterial exigency hourly or past frequently if the resigned’s hemodynamic foundation is impermanent.
  2. Not the resigned’s reply to all therapy.
  3. Monitor liquescent capacity foundation by measuring urine output hourly and appraise nasogastric and other fleshy parchage.
  4. Determine liquescent neutralize whole 8 hours.
  5. Continuously adviser ECG fir dysrhythmias issueing from electrolyte disturbances.
Patient Assessment
  1. Assess web perfusion. Music smooth of memory, peel perversion and region, pulses, and capillary furnish.
  2. Assess hydration foundation: music peel turgor on living thigh or forehead, situation of buccal membranes, and harvest of edema or crackles.
  3. Assess the resigned’s abdomen for separation of rectilinearity, reverbetrounce delicacy, and distention. Auscultate bowel sounds.
Diagnostic Assessment
  1. Review serum sodium and potassium smooths, which may behove depleted delay nasogastric suctioning or liquescent suppresss.
  2. Review serial WBC enumetrounce and differentiated to evaluate the plan of exercise.
Patient Management
  1. Administer crystalloid or colloid breachs to correct intravascular capacity.
  2. Replace potassium as ordered; validate deferred urine output anteriorly government.
  3. Keep the resigned NPO during intelligent sight and anteriorly evaluation by a surgeon.
  4. Provide nutritional buttress as implied; most resigned get utility from postpyloric delivery of forthcoming enteral nutrients at a minimal hourly trounce to hinder v=bacterial transresiduum and sepsis.
  5. Administer antibiotics as prescribed following divert cultures obtained.

Nursing Heed Plan

Peritonitis Nursing Heed Plan

Nursing Diagnosis
  • Infection, imperil for (septicemia)
Risk contents may embody
  • Indeferred original defenses (tamed peel, traumatized web, altered peristalsis)
  • Indeferred issueant defenses (immunosuppression)
  • Invasive procedures
Possibly tokend by
  • Not pertinent. A imperil identicality is not tokend by signals and symptoms, as the bearing has not happenred and nursing intercessions are directed at hinderion.
Desired Outcomes
  • Achieve seasonable heartinessful; be unreserved of festering parchage or erythema; be afebrile.
  • Verbalize agreement of the identical efficient/imperil content(s).
Nursing Interventions
  • Note identical imperil contents. Abdominal trauma, intelligent appendicitis, peritoneal dialysis are vile imperil contents.
    • Rationale: Influences cherished of intercessions.
  • Assess living signals frequently, noting unresolved or progressing hypotension, subsided pulse exigency, tachycardia, passion, tachypnea.
    • Rationale: Signs of hovering septic surprise. Circulating endotoxins ultimately product vasodilation, suppress of liquescent from publicity, and a low cardiac output narrate.
  • Note modifys in intellectual foundation: indistinctness, oblivion, altered LOC.
    • Rationale: Hypoxemia, hypotension, and acidosis can action deteriorating intellectual foundation.
  • Note peel perversion, region, humidity.
    • Rationale: Warm, flushed, dry peel is forthcoming signalal of septicemia. Later manifestations emmass timid, clammy, livid peel and cyanosis as surprise behoves recalcitrant.
  • Monitor urine output.
    • Rationale: Oliguria develops as a issue of subsided renal perfusion, circulating toxins, amiables of antibiotics.
  • Maintain exact aseptic technique in heed of abdominal parchs, incisions and/or notorious troubles, dressings, and invasive sites. Cleanse delay divert breach.
    • Rationale: Prevents mode or limits open of infecting organisms and cross-contamination.
  • Perform and tell suited operative washing technique.
    • Rationale: Reduces imperil of cross-contamination and/or open of poison.
  • Observe parchage from troubles and/or parchs.
    • Rationale: Provides notification encircling foundation of poison.
  • Maintain barren technique when catheterizing resigned, and get catheter heed and permit perineal lustration on a gradation cause.
    • Rationale: Prevents mode, limits bacterial augmentation in urinary credit.
  • Monitor and/or reexact visitors and staff as divert. Get protective segregation if implied.
    • Rationale: Reduces imperil of scylla to and/or merit of issueant poison in immuno concerned resigned.
  • Obtain specimens and adviser amiables of serial lineage, urine, trouble cultures.
    • Rationale: Identifies efficient microorganisms and succors in assessing usefulness of antimicrobial sustenance.
  • Assist delay peritoneal endeavor, if implied.
    • Rationale: May be issueed to suppress liquescent and to establish infecting organisms so divert antibiotic therapy can be launched.
  • Administer antimicrobials: gentamicin (Garamycin), amikacin (Amikin), clindamycin (Cleocin), via IV/peritoneal lavage.
    • Rationale: Therapy is directed at anaerobic bacteria and aerobic Gram-negative bacilli. Lavage may be used to suppress necrotic offal and use inflammation that is sick concentrated or copiousd.
  • Prepare for surgical intercession if implied.
    • Rationale: Surgery may be usement of cherished (curative) in intelligent, concentrated peritonitis, e.g., to parch concentrated ulcer; suppress peritoneal exudates, ruptured sequel or gallbladder; plicate perforated ulcer; or resect bowel.

Nursing Diagnosis:
  • Deficient Liquescent Capacity [mixed]
May be cognate to
  • Fluid suppresss from extracellular, intravascular, and interstitial allotments into civils and/or peritoneal immeasurableness
  • Vomiting; medically limited intake; NG/intestinal endeavor
  • Fever/hypermetabolic narrate
Possibly tokend by
  • Dry mucous membranes, scanty peel turgor, delayed capillary furnish, inconclusive peripheral pulses
  • Diminished urinary output, dark/concentrated urine
  • Hypotension, tachycardia
Desired Outcomes
  • Demonsttrounce correctd liquescent neutralize as tokend by deferred urinary output delay natural particular starch, steady living signals, lively mucous membranes, amiable peel turgor, responsive capillary furnish, and signification among jocular class.
Nursing Interventions
  • Monitor living signals, noting nearness of hypotightness (including postural modifys), tachycardia, tachypnea, passion. Appraise mediate venous exigency (CVP) if profitable.
    • Rationale: Aids in evaluating aspect of liquescent demand or usefulness of liquescent regaining therapy and reply to medications.
  • Maintain accutrounce I&O and correlate delay daily significations. Emmass appraised losses. Emmass appraisements from gastric suction, parchs, dressings, Hemovacs, diaphoresis, and abdominal band for third spacing of liquescent.
    • Rationale: Reflects adjustall hydration foundation. Urine output may be adulterated beaction of hypovolemia and subsided renal perfusion, but signification may stagnant acception, meditation web edema or ascites fund. Gastric suction losses may be big, and a gigantic market of liquescent can be private in the bowel and peritoneal immeasurableness (ascites).
  • Measure urine particular starch.
    • Rationale: Reflects hydration foundation and modifys in renal duty, which may monish of developing intelligent renal demand in reply to hypovolemia and issue of toxins. Many antibiotics too possess nephrotoxic amiables that may raise assume genus duty and urine output.
  • Observe peel or mucous membrane thirst, turgor. Music peripheral and sacral edema.
    • Rationale: Hypovolemia, liquescent suppresss, and nutritional demands give to scanty peel turgor, taut edematous webs.
  • Eliminate morbific sights and smells from environment. Limit intake of ice chips.
    • Rationale: Reduces gastric stimulation and vomiting reply. Excessive use of ice chips during gastric endeavor can acception gastric washout of electrolytes.
  • Change aspect frequently, get reiterated peel heed, and maintain dry or wrinkle-unreserved bedding.
    • Rationale: Edematous web delay concerned publicity is disposed to breakdown.
  • Monitor laboratory studies: Hb/ Hct, electrolytes, protein, albumin, BUN, Cr.
    • Rationale: Provides notification encircling hydration, organ duty. Varied alterations delay speaking consequences to systemic duty are virtual as a issue of liquescent suppresss, hypovolemia, hypoxemia, circulating toxins, and necrotic web products.
  • Administer plasma or lineage, liquescents, electrolytes, diuretics as implied.
    • Rationale: Replenishes circulating capacity and electrolyte neutralize. Colloids (plasma, lineage) succor advance steep tail into intravascular allotment by increasing osmotic exigency gradient.Diuretics may be used to aid in sweating of toxins and to augment renal duty.
  • Maintain NPO delay nasogastric or intestinal endeavor.
    • Rationale: Reduces hyperprinciple of bowel and diarrhea losses.

Nursing Diagnosis
  • Acute trouble
May be cognate to
  • Chemical effeminacy of the parietal peritoneum (toxins)
  • Trauma to webs
  • Accumulation of liquescent in abdominal/peritoneal planeness (abdominal distension)
Possibly tokend by
  • Verbalizations of trouble
  • Muscle compensating, reverbetrounce delicacy
  • Facial hide of trouble, self-focus
  • Distrexercise demeanor, autonomic/emotional replys (anxiety)
Desired Outcomes
  • Report trouble is relieved/controlled.
  • Demonsttrounce use of recreation skills, other methods to advance self-satisfaction.
Nursing Interventions
  • Investigate trouble reports, noting residuum, term, ardor(0–10 flake), and characteristics (dull, discerning, regular).
    • Rationale: Changes in residuum or ardor are not unvile but may exhibit developing complications. Trouble tends to behove regular, past determined, and copious adjust the perfect abdomen as irritant rule accelerates; trouble may concentreprove if an ulcer develops.
  • Maintain semi-Fowler’s aspect as implied.
    • Rationale: Facilitates liquescent or trouble parchage by starch, reducing diaphragmatic effeminacy and/or abdominal tightness, and thereby reducing trouble.
  • Move resigned unwillingly and deliberately, splinting troubleful area.
    • Rationale: Reduces muscle tightness and compensating, which may succor minimize trouble of advancement.
  • Provide self-satisfaction appraises: massage, tail rubs, profound warm. Instruct in recreation and visualization exercises. Get diversional activities.
    • Rationale: Promotes recreation and may augment resigned’s coping abilities by refocusing observation.
  • Provide reiterated traditional heed. Suppress morbific environintellectual stimuli.
    • Rationale: Reduces sea-sickness and vomiting, which can acception intra-abdominal exigency and trouble.
Administer medications as implied:
  • Analgesics, anodynes;
    • Rationale: Reduce metabolic trounce and intestinal effeminacy from circulating or persomal toxins, which aids in trouble exemption and advances heartinessful. Trouble is customaryly extreme and may demand anodyne trouble administer. Analgesics may be delayheld during primal feature rule beaction they can hide signals and symptoms.
  • Antiemetics: hydroxyzine (Vistaril);
    • Rationale: Reduce sea-sickness and vomiting, which can acception abdominal trouble.
  • Antipyretics: acetaminophen (Tylenol).
    • Rationale: Reduce disself-satisfaction associated delay passion.

Nursing Diagnosis
  • Risk for Imbalanced Nutrition:  less than mass demandments
Risk contents may embody
  • Nausea/vomiting, intestinal dysfunction
  • Metabolic abnormalities; acceptiond metabolic needs
Possibly tokend by
  • Not pertinent. A imperil identicality is not tokend by signals and symptoms, as the bearing has not happenred and nursing intercessions are directed at hinderion.
Desired Outcomes
  • Maintain customary signification and confident nitrogen neutralize.
Nursing Interventions
  • Auscultate bowel sounds, noting listless or hyperactive sounds.
    • Rationale: Although bowel sounds are frequently listless, inflammation and effeminacy of the civil may be accompanied by intestinal hyperactivity, adulterated steep aridity, and diarrhea.
  • Monitor NG tube output. Music nearness of vomiting, diarrhea.
    • Rationale: Large amounts of gastric petitioner and vomiting and diarrhea intimate bowel impediment, requiring raise evaluation.
  • Measure abdominal band.
    • Rationale: Provides vital token of modifys in gastric or intestinal distightness and/or fund of ascites.
  • Assess abdomen frequently for give-back to unmanlyness, repose of natural bowel sounds, and road of flatus.
    • Rationale: Indicates give-back of natural bowel duty and power to begin-again traditional intake.
  • Weigh frequently.
    • Rationale: Initial losses or gains exhibit modifys in hydration, but sustained losses intimate nutritional demand.
  • Monitor BUN, protein, prealbumin and albumin, glucose, nitrogen neutralize as implied.
    • Rationale: Reflects organ duty and nutritional foundation and needs.
  • Advance victuals as tolerated. Advance from acquitted liquids to unmanly foundation.
    • Rationale: Careful series of victuals when intake is begin-againd subjects imperil of gastric effeminacy.
  • Administer TPN as implied.
    • Rationale: Promotes nutrient utilization and confident nitrogen neutralize in resigneds who are incompetent to compare nutrients in a natural ceremony.

Nursing Diagnosis
  • Anxiety
  • Fear
May be cognate to
  • Situational crisis
  • Threat of death/modify in heartiness foundation
  • Physiological contents, hypermetabolic narrate
Possibly tokend by
  • Increased tightness/helplessness
  • Apprehension, conjecture, molest, memory of hovering doom
  • Sympathetic stimulation; quietlessness; rendezvous on self
Desired Outcomes
  • Verbalize awareness of impressions and heartinessy ways to market delay them.
  • Report stoppagefulness is cheap to a easy smooth.
  • Appear relaxed.
Nursing Interventions
  • Evaluate stoppagefulness smooth, noting resigned’s unwritten and nonunwritten reply. Permit unreserved countenance of emotions.
    • Rationale: Apprehension may be escalated by extreme trouble, increasingly ill impression, conjuncture of feature procedures, and possibility of surgery.
  • Provide notification concerning indisaspect rule and anticipated usement.
    • Rationale: Knowing what to look-for can subject stoppagefulness.
  • Schedule deferred quiet and perpetual periods for snooze.
    • Rationale: Limits weary, conserves distillation, and can augment coping power.

Nursing Diagnosis
  • Knowledge, scant [Learning Need] concerning situation, prognosis, usement, self-care, and dismiss needs
May be cognate to
  • Lack of scylla/recall
  • Information misinterpretation
  • Unfamiliarity delay notification resources
Possibly tokend by
  • Questioning; demand for notification
  • Statement of misconception
  • Inaccutrounce follow-through of instruction
Desired Outcomes
  • Verbalize agreement of indisaspect rule and virtual complications.
  • Identify intercommunity of signals/symptoms to the indisaspect rule and correlate symptoms delay efficient contents.
  • Verbalize agreement of curative needs.
  • Correctly execute compulsory procedures and illustrate reasons for exercises.
Nursing Interventions
  • Review underlying indisaspect rule and revival look-forations.
    • Rationale: Provides cognizance disesteemed from which resigned can shape informed cherisheds.
  • Identify signals and symptoms requiring medical evaluation: reiterated abdominal trouble and distension, vomiting, passion, chills, or nearness of festering parchage, turgescence, erythema of surgical incision (if confer-upon).
    • Rationale: Early memory and usement of developing complications may hinder past thoughtful sickness and deterioration.
  • Discuss medication sustenance, register, and virtual aspect amiables.
    • Rationale: Antibiotics may be continued following dismiss, depending on elongation of alight.
  • Recommend gradational foreclosure of customary activities as tolerated, allowing for deferred quiet.
    • Rationale: Prevents weary, augments impression of well-being.
  • Review principle limitions or limitations: avoid impenetrable lifting, constipation.
    • Rationale: Avoids uncompulsory acception of intra-abdominal exigency and muscle tightness.
  • Demonsttrounce aseptic dressing modify, trouble heed.
    • Rationale: Reduces imperil of contamination. Provides turn to evaluate heartinessful rule.
  • Emphasize signification of medical follow-up.
    • Rationale: Necessary to adviser separation of poison and foreclosure of customary activities.

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