Per is Ton It Is

8/3/2019 Per is Ton It Is

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-is an inflammation of the peritoneum, theserous membrane which lines part of the

abdominal cavity and viscera.

-Peritonitis may be localized or generalized, andmay result from infection (often due to rupture

of a hollow organ as may occur in abdominaltrauma or appendicitis) or from a non-infectiousprocess.





There are three types of

Peritonitis :

Spontaneous- this type of peritonitis is caused by aliver or kidney failure.

Secondary-is the inflammation of the peritoneumcaused by another disease.The principal conditionthat causes secondary peritonitis is the spread of aninfection from digestive organs or bowels.

Dialysis associated-is a chronic inflammation of theperitoneum that occurs in persons which receiveperitoneal dislysis.The diagnosis of peritonitis is based on a series ofprocedures .





Perforation of part of the

gastrointestinal tract is the mostcommon cause of peritonitis .

Examples:-perforation of the distal oesophagus

(Boerhaave syndrome)of the stomach

-(peptic ulcer, gastric carcinoma), of theduodenum

-(peptic ulcer), of the remaining intestine



- appendicitis

-diverticulitis

- Meckel diverticulum

-inflammatory bowel disease (IBD)

-carcinoma, meconium peritonitis

The common bacteria that implicated areEscherichia coli, klebsiella, proteus andpseudomonas.



Disruption of the peritoneum ,even in

the absence of perforation of a hollowviscus, may also cause infection simplyby letting micro-organismsinto the

peritoneal cavityExamples:

-trauma

- surgical wound- continuous ambulatory peritoneal

dialysis

- intra-peritoneal chemotherapy



Intra-peritoneal dialysis predisposes toperitoneal infection

Systemic infections (such astuberculosis) may rarely have aperitoneal localisation.



Leakage of sterile body fluids into theperitoneum

Examples:

-blood (e.g. endometriosis, blunt abdominaltrauma)

-gastric juice (e.g. peptic ulcer, gastric

carcinoma)- bile (e.g. liver biopsy)

-urine (pelvic trauma),

-menstruum (e.g. salpingitis)

-pancreatic juice (pancreatitis)



Sterile abdominal surgery normallycauses localised or minimal generalised

peritonitis, which may leave behind aforeign body reaction and/or fibroticadhesions.





LEAKAGE OF CONTENTS FROM ABDOMINAL ORGANS

ABDOMINAL CAVITY RESULTS TO INFLAMMATION,INFECTION,ISCHEMIA,TRAUMA OR TUMOR PERFORATION

BACTERIAL PROLIFERATION

EDEMA OF THE TISSUE AND EXUDATION OF FLUIDDEVELOP IN A SHORT OF TIME

FLUID IN THE PERITONEAL CAVITY BECOMES TURBID

INCREASE AMOU NTS OF PROTEIN ,WBC,CELLULARDEBRIS AND BLOOD

HYPERMOTILITY IN INTESTINAL TRACT , PARALYTIC ILEUS

WITH ACCUMULATION OF AIR AND FLUID IN BOWEL





Fluid , colloid, and electrolyte replacement.

administration of several liters of isotonicsolution is prescribed.

analgesia are prescribed for pain

antiemitics are administered as prescribed fornausea and vomiting.

intestinal intubation and suction assist inrelieving abdominal distention and in promotingintestinal function



Oxygen therapy by nasal cannula ormask

antibiotic therapy





surgery (laparotomy) is needed toperform a full exploration and lavage of

the peritoneum, as well as to correct anygross anatomical damage which mayhave caused peritonitis. The exception is

spontaneous bacterial peritonitis, whichdoes not benefit from surgery.





Blood pressure monitoring

Monitoring of central venous pressure or pulmonaryartery wedge pressure and urine output.

administering of analgesic medication and positioningthe patient for comfort are helpful in decreasing pain.

Worsening client condition may indicate a complication

,and the nurse must prepare for emergency surgery.

Prepare the patient and family for discharge byteaching the patient to care for the incision and drains.



Risk for infection related to inadequate secondarydefenses (immunosuppression)-assess anddocument skin conditions around insertions of pins,wires, and tongs, noting inflammation and drainage.

Note signs and symptoms of sepsis (systemic infection:fever, chills, diaphoresis, altered level ofconsciousness , positive blood culture.

Deficient fluid volume related to chronic

illness/malnutrition and excessive use of hypotonicsolutions(D5W)-evaluate nutritional status, notingcurrent intake, weight, changes, problems with oralintake, use of supplements/tube .Measuringsubcutaneous fats/muscle mass. Administer fluids and

electrolytes



Acute pain related to chemical irritation of parietalperitoneum, trauma tissues and accumulation offluid in abdominal- provide comfort measures (.e.g.touch , repositioning, use of heat/cold packs, nurses

presence), quite environment, and calm activities topromote no pharmacological pain management.Determine client’s acceptable level of pain/ pain control goals.

Risk for imbalanced nutrition: less than bodyrequirements related to nausea and vomiting- useflavoring agents (e.g., lemon and herbs) if salt isrestricted to enhance food satisfaction and stimulantappetite. Prevents/ minimize unpleasant odors/sights.

May have a negative effect on appitite and eating.



Per is Ton It Is

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