DIPOLOG MEDICAL CENTER COLLEGE FOUNDATION INC.

College of Nursing

A
CASE STUDY
OF
PERITONITIS

Submitted by:
SHARMAINE S. CAGANG
BSN III - KING

Submitted to:
MR. HAROLD S. NABOR, USRN
INSTRUCTOR
 CONTENTS

A. Introduction

B. Terminologies

C. Anatomy and Physiology

D. Pathophysiology

E. Nursing Care Plan

F. Discharge Instructions (Methods) Style

G. Drug Study

H. Readings r/t Digestive cases / Articles Summary and Reaction

I. General Evaluation Labs / Diagnostic Tests

 A. INTRODUCTION
Description

 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.

Clinical Manifestations
 The early clinical manifestations of peritonitis frequently are the symptoms of the
disorder causing the condition. At first, a diffuse type of pain is felt. The pain
tends to become constant, localized, and more intense near the site of the
inflammation. Movement usually aggravates it. The affected area of the abdomen
becomes extremely tender and distended, and the muscles become rigid.
Rebound tenderness and paralytic ileus may be present. Usually, nausea and
vomiting occur and peristalsis is diminished. The temperature and pulse rate
increase, and there is almost always an elevation of the leukocyte count.

Complications
 Frequently, the inflammation is not localized and the whole abdominal cavity
becomes involved in a generalized sepsis. Sepsis is the major cause of death
from peritonitis. Shock may result from septicemia or hypovolemia. The
inflammatory process may cause intestinal obstruction, primarily from the
development of bowel adhesions. The two most common postoperative
complications are wound evisceration and abscess formation.
 B. TERMINOLOGIES

Diapedesis - the passage of blood cells through the intact walls of the capillaries, typically
accompanying inflammation.
Gangrene - a dangerous and potentially fatal condition that happens when the blood flow
to a large area of tissue is cut off. 
Peritonitis - a redness and swelling (inflammation) of the lining of your belly or abdomen.
Rebound tenderness - a clinical sign in which there is pain upon removal of pressure
rather than application of pressure to the abdomen. 
Wound evisceration - the uncontrolled exteriorization of intra-abdominal contents through
the dehisced surgical wound outside of the abdominal cavity. 
 C. ANATOMY AND PHYSIOLOGY

THE PERITONEUM
 The peritoneum is a continuous membrane which lines the abdominal cavity and
covers the abdominal organs (abdominal viscera).

 It acts to support the viscera, and provides pathways for blood vessels and

lymph to travel to and from the viscera.

 Parietal peritoneum – an outer layer which adheres to the anterior and posterior
abdominal walls.

 Visceral peritoneum – an inner layer which lines the abdominal organs. It's made
when parietal peritoneum reflects from the abdominal wall to the viscera. 

PERITONEAL CAVITY
 The peritoneal cavity is a potential space found between the parietal and visceral
layers of the peritoneum. The cavity is filled with a small amount of serous
peritoneal fluid secreted by the mesothelial cells which line the
peritoneum. Peritoneal fluid enables the peritoneal layers to slide against each
other with little friction while following the subtle movements of the abdominopelvic
organs.

D. PATHOPHYSIOLOGY
 E. NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Independent: Independent:
Subjective: Deficient Fluid After 8 hours of 1. Monitor vital signs, 1. Aids in evaluating degree of After 8 hours of
Volume may be nursing noting presence of fluid deficit or effectiveness of nursing interventions,
“I’ve been related to Fluid interventions, the hypotension (including fluid replacement therapy and the goal was met.
experiencing shifts from patient will postural changes), response to medications. The patient
abdominal pain extracellular, demonstrate tachycardia, 2. Reflects overall hydration demonstrates
and I feel intravascular, improved fluid tachypnea, fever. status. Urine output may be improved fluid
nauseous.” As and interstitial balance as Measure central diminished because balance as
verbalized by compartments evidenced by venous pressure of hypovolemia and decreased evidenced by
the patient. into intestines adequate urinary (CVP) if available. renal perfusion, but weight may adequate urinary
and/or output with 2. Maintain accurate still increase, reflecting tissue output with normal
peritoneal normal specific I&O and correlate with edema or ascites accumulation. specific gravity,
Objective:
space; gravity, stable daily weights. Include Gastric suction losses may be stable vital signs,
vomiting; vital signs, moist measured losses. large, and a great deal of fluid moist mucous
-dry mucous
medically mucous Include measurements can be sequestered in the membranes, good
membranes
restricted membranes, good from gastric suction, bowel and peritoneal space skin turgor, prompt
-poor skin turgor intake; skin turgor, drains, dressings, (ascites). capillary refill, and
-weak peripheral NG/intestinal a prompt capillary 3. Reflects hydration status and weight within
Hemovacs,
pulses spiration; fever; refill, and weight diaphoresis, and changes in renal function, acceptable range.
hypermetabolic within acceptable abdominal girth for which may warn of
V/S taken as state range. third spacing of fluid. developing acute renal
follows: 3. Measure urine failure in response to
specific gravity. hypovolemia and effect of
Temp: 36.5°C 4. Observe skin or toxins. Many antibiotics also
PR: 49 bpm mucous membrane have nephrotoxic effects that
RR: 14 cpm dryness, turgor. Note may further
BP: 110/80 peripheral and sacral affect kidney function and urine
mmHg edema. output.
5. Eliminate noxious 4. Hypovolemia, fluid shifts,
sights and smells from and nutritional deficits
environment. Limit contribute to poor skin turgor,
intake of ice chips. taut edematous tissues.
6. Change position 5. Reduces gastric stimulation
frequently, provide and vomiting response.
frequent skin care, and Excessive use of ice chips
maintain dry or wrinkle- during gastric aspiration can
free bedding. increase gastric washout
7. Monitor laboratory of electrolytes.
studies: Hb/ Hct, 6. Edematous tissue with
electrolytes, protein, compromised circulation
albumin, BUN, Cr. is prone to breakdown.
8. Maintain NPO with 7. Provides information about
nasogastric or hydration, organ function.
intestinal aspiration. Varied alterations with
Dependent: significant consequences to
9. Administer plasma systemic function are possible
or blood, fluids, as a result of fluid shifts,
electrolytes, diuretics a hypovolemia, hypoxemia,
s indicated. circulating toxins, and necrotic
tissue products.
8. Reduces hyperactivity of
bowel and diarrhea losses.
Dependent:
9. Replenishes circulating
volume and electrolyte
balance. Colloids (plasma,
blood) help move water back
into intravascular compartment
by increasing osmotic pressure
gradient. Diuretics may be used
to assist in excretion of toxins
and to enhance renal function.
 F. DISCHARGE INSTRUCTIONS (METHODS) STYLE

Seek care immediately if:

o You have severe pain in your abdomen that keeps you from being
comfortable.
o You have severe tenderness in your abdomen.
o You have severe abdominal pain after you have an accident or are
injured.
o You are receiving peritoneal dialysis and the dialysis fluid is cloudy or has
flecks or clumps.

Contact your healthcare provider if:

o You have a fever.
o You have questions or concerns about your condition or care.

Medicines:
o Medicines may be given to fight a bacterial infection or to reduce pain.
Ask your healthcare provider how to take prescription pain medicine
safely. You may also need medicines to relieve nausea or to stop
vomiting.
o Take your medicine as directed. Contact your healthcare provider if you
think your medicine is not helping or if you have side effects. Tell him or
her if you are allergic to any medicine. Keep a list of the medicines,
vitamins, and herbs you take. Include the amounts, and when and why
you take them. Bring the list or the pill bottles to follow-up visits. Carry
your medicine list with you in case of an emergency.

Follow up with your healthcare provider as directed:

 Write down your questions so you remember to ask them during your visits.
 G. DRUG STUDY

Mechanism of
Drug Indications Contraindications Side effects Nursing considerations
Action
Generic Name: Undergoes To treat Breastfeeding, CNS: Aseptic meningitis  Use cautiously in patients
intracellular systemic hypersensitivity to (parenteral form), ataxia, with central nervous system
Metronidazole
chemical reduction anaerobic metronidazole or its confusion, depression, diseases.
Brand Name: during anaerobic infections components, dizziness,  Give I.V. drug by slow
metabolism. After caused by trichomoniasis during encephalopathy, fever, infusion over 1 hour; don’t
Flagyl
metronidazole is Bacteroides first trimester of headache, incoordination, give by direct I.V. injection.
Classification: reduced, it damages fragilis, pregnancy insomnia, irritability,  Discontinue primary I.V.
DNA’s helical Clostridium lightheadedness, infusion during
Antibiotic
structure and breaks difficile, peripheral neuropathy, metronidazole infusion.
its strands, which Clostridium seizures (high doses),  Monitor patient with severe
inhibits bacterial perfringens, syncope, weakness, liver disease because
nucleic acid Eubacterium, vertigo slowed metronidazole
synthesis and Fusobacterium, EENT: Dry mouth, metabolism may cause drug
causes cell death. Peptococcus, lacrimation (topical form), to accumulate in body and
Peptostreptoco metallic taste, nasal increase the risk of adverse
ccus,and congestion, optic effects.
Veillonella neuropathy, pharyngitis  If skin irritation occurs, apply
species GI: Abdominal cramps or topical metronidazole gel
pain, anorexia, diarrhea, less frequently or
nausea, pancreatitis, discontinue it, as ordered.
vomiting  Monitor CBC and culture and
GU: Dark urine, vaginal sensitivity tests if therapy
candidiasis (oral, lasts longer than 10 days or
parenteral, and topical if second course of treatment
forms); burning or is needed.
irritation of sexual  Monitor patient’s neurologic
partner’s penis, candidal status throughout
cervicitis or vaginitis, metronidazole therapy. If
dysuria, dryness of vagina abnormal neurologic signs
or vulva, urinary and symptoms occur, notify
frequency, vulvitis prescriber and expect to
(vaginal form) discontinue drug
 HEME: Leukopenia MS:
Back pain, dysarthria
SKIN: Burning or stinging
sensation, dry skin
(topical form); erythema,
flushing, pruritus, rash,
Stevens-Johnson
syndrome, toxic epidermal
necrolysis, urticaria (oral
and parenteral forms)
Other: Injection-site
edema, pain, or
tenderness

Mechanism of
Drug Indications Contraindications Side effects Nursing considerations
Action
Generic Name: Inhibits the Used to treat Hypersensitivity to CNS: Abnormal gait,  Obtain culture and sensitivity
enzyme DNA Infections of ciprofloxacin, agitation, anxiety, ataxia, test results, as ordered,
Ciprofloxacin
gyrase, which is the gastro- quinolones, or their cerebral thrombosis, before giving ciprofloxacin.
Brand Name: responsible for intestinal tract components, confusion,  Use drug cautiously in
the unwinding and intra- myasthenia gravis depersonalization, patients with CNS disorders
Cipro, Cipro I.V.,
and supercoiling abdominal depression, dizziness, and disorders that may
Cipro XR, Proquin XR of bacterial DNA infections drowsiness, fever, predispose patient to
before it hallucinations, headache, seizures, such as history of
Classification: replicates. By increased intracranial epilepsy or conditions that
Antibiotic inhibiting this pressure including may lower the seizure
enzyme, pseudotumor cerebri, threshold, such as history of
ciprofloxacin insomnia, irritability, severe cerebral
causes bacterial lethargy, light-headedness, arteriosclerosis, reduced
cells to die malaise, manic reaction, cerebral blood flow, altered
migraine, nervousness, brain structure, or stroke.
nightmares, paranoia, Take seizure precautions. If a
paresthesia, peripheral seizure occurs, expect
neuropathy, phobia, ciprofloxacin to be
restlessness, seizures, discontinued immediately.
status epilepticus, suicidal  Use drug cautiously in
ideation, syncope, tremor, patients who may be more
toxic psychosis, susceptible to drug’s effect on
unresponsiveness, QT interval, such as those
weakness taking Class IA or III
CV: Angina, atrial flutter, antiarrhythmics; those with
cardiopulmonary arrest, uncorrected hypokalemia or
cardiovascular collapse, hypomagnesemia; or in the
hypertension, MI, presence of a history of QT-
orthostatic hypotension, interval prolongation,
palpitations, phlebitis, torsades de pointes or
tachycardia, torsades de cardiac disease such as heart
pointes, vasculitis, failure.
ventricular ectopy  are that E.R. and immediate-
EENT: Oral candidiasis release tablets aren’t
GI: Abdominal pain, interchangeable and that
anorexia, constipation, Proquin XR and Cipro XR
diarrhea, dysphagia, aren’t interchangeable.
elevated liver enzymes,  Patient should be well
flatulence, GI bleeding, hydrated during therapy to
hepatic failure or necrosis, help prevent alkaline urine,
hepatitis, indigestion, which may lead to crystalluria
intestinal perforation, and nephrotoxicity.
jaundice, nausea,  Assess patient’s hepatic,
pancreatitis, renal, and hematologic
pseudomembranous colitis, functions periodically, as
vomiting ordered. Report any
GU: Acute renal failure or abnormalities, including signs
insufficiency, crystalluria, and symptoms of dysfunction,
hematuria, increased serum to prescriber. For example,
creatinine level, interstitial severe liver toxicity has
nephritis, nephrotoxicity, occurred with ciprofloxacin
renal calculi, renal failure, use (within 1 to 39 days of
urine retention, vaginal therapy) and has been
candidiasis associated more frequently
HEME: Agranulocytosis, with hypersensitivity
aplasitc or hemolytic reactions. If dysfunction
anemia, bone marrow occurs, expect drug to be
depression, leukopenia, discontinued and provide
lymphadenopathy, supportive care, as ordered
pancytopenia, and needed
thrombocytopenia  Assess patient routinely for
MS: Arthralgia, myalgia, signs of rash or other
tendinitis, tendon rupture hypersensitivity reactions,
RESP: Allergic pneumonitis even after patient has
SKIN: Acute generalized received multiple doses. Stop
exanthematous pustulosis drug at first sign of rash,
(AGEP), erythema jaundice, or other sign of
multiforme, exfoliative hypersensitivity, and notify
dermatitis, photosensitivity, prescriber immediately. Be
rash, Stevens-Johnson prepared to provide
syndrome, toxic epidermal supportive emergency care.
necrolysis, urticaria  Monitor patient closely for
RESP: Bronchospasm, diarrhea, which may reflect
pulmonary embolism, pseudomembranous colitis. If
respiratory arrest Other: it occurs, notify prescriber
Acidosis, anaphylaxis, and expect to withhold drug
angioedema, serum and treat diarrhea.
sickness-like reaction  Assess patient for evidence
of peripheral neuropathy.
Notify prescriber and expect
to stop drug if patient
complains of burning,
numbness, pain, tingling, or
weakness in extremities or if
physical examination reveals
deficits in light touch, pain,
temperature, position sense,
vibratory sensation, or motor
strength.
 Mechanism of
Drug Indications Contraindications Side effects Nursing considerations
Action
Generic Name: Inhibits protein To treat serious History of regional CNS: Fatigue, headache  Expect to obtain a specimen
synthesis in respiratory tract enteritis, ulcerative CV: Hypotension, for culture and sensitivity
Clindamycin
susceptible infections colitis, or antibiotic- thrombophlebitis (after I.V. testing before giving first
Brand Name: bacteria by caused by associated colitis; injection) dose.
binding to the anaerobes such hypersensitivity to EENT: Glossitis, metallic or  Use clindamycin cautiously
Cleocin, Cleocin T,
50S subunits of as occur with clindamycin or unpleasant taste (with high in patients who have a
Evoclin, and bacterial anaerobic lincomycin I.V. doses), stomatitis history of asthma, significant
ribosomes and pneumonitis, GI: Abdominal pain, allergies, or GI disease; in
Clindesse
preventing empyema, and diarrhea, esophagitis, those with renal or hepatic
Classification: peptide bond lung abscess nausea, dysfunction; and in elderly or
formation, which and those pseudomembranous colitis, atopic patients.
Antibiotic
causes bacterial caused by vomiting  Store oral solution for up to 2
cells to die. pneumococci, GU: Cervicitis, vaginitis, weeks at room temperature
staphylococci, and vulvar irritation (with or reconstituted parenteral
and vaginal form) solution for up to 24 hours at
streptococci; HEME: Agranulocytosis, room temperature.
serious skin eosinophilia, leukopenia,  Give I.V. dose by infusion
and softtissue neutropenia, only; don’t give bolus dose.
infections thrombocytopenic purpura Dilute 300 mg of clindamycin
caused by SKIN: Irritation, pruritus, in 50 ml of diluent and give
anaerobes, rash, urticaria over 10 minutes. Dilute 600
staphylococci, Other: Anaphylaxis; mg of clindamycin in 100 ml
and induration, pain, or sterile of diluent and give over
streptococci; abscess after injection; 20 minutes. Dilute 900 mg of
septicemia superinfection clindamycin in 100 ml of
caused by diluent and give over
anaerobes; 30 minutes
intra-abdominal  Give I.M. injection deep into
infections large muscle mass, such as
caused by the gluteus maximus. Rotate
anaerobes such injection sites, and avoid
as occur with giving more than 600 mg by
intra-abdominal I.M. injection.
abscess and  Check I.V. site often for
 peritonitis; phlebitis and irritation.
infections of the  For topical foam, wash the
female pelvis affected area with mild soap,
and genital tract let it dry fully, and then apply
caused by foam to entire affected area.
anaerobes such Be aware that if irritation or
as occur with dermatitis develops, notify
endometritis, prescriber as foam will need
nongonococcal to be discontinued.
tubo-ovarian  Monitor results of liver
abscess, pelvic function tests, CBC, and
cellulitis, and platelet counts during
postsurgical prolonged therapy.
vaginal cuff  Observe patient for signs
infection; bone and symptoms of
and joint superinfection, such as
infections vaginal itching and sore
caused by mouth, which may occur 2 to
Staphylococcus 9 days after therapy begins.
aureus; as  Assess patient’s bowel
adjunct therapy pattern daily; severe
in chronic bone diarrhea may indicate
and joint pseudomembranous colitis
infections caused by Clostridium
difficile. If diarrhea occurs,
notify prescriber and expect
to withhold clindamycin and
treat with fluids, electrolytes,
protein, and an antibiotic
effective against C. difficile.

Drug Mechanism of Indications Contraindications Side effects Nursing considerations

Action
Generic Name: Interferes with To reduce Hypersensitivity to CNS: Anxiety, CNS  Use levofloxacin cautiously
bacterial cell incidence or levofloxacin, other stimulation, dizziness, in patients with renal
Levofloxacin
replication by progression of fluoroquinolones, or fever, headache, increased insufficiency. Monitor renal
Brand Name: inhibiting the inhalation their components; ICP, insomnia, light- function as appropriate
bacterial enzyme anthrax after myasthenia gravis headedness, nervousness, during treatment.
Levaquin
DNA gyrase, exposure to paranoia, peripheral  Use drug cautiously in
Classification: which is aerosolized neuropathy, psychosis, patients with CNS disorders,
essential for Bacillus seizures, sleep disturbance, such as epilepsy, that may
Antibiotic
replication and anthracis; to suicidal ideation lower the seizure threshold.
repair of treat plague, CV: Arrhythmias, Also use cautiously in
bacterial DNA. including leukocytoclastic vasculitis, patients taking
pneumonic and prolonged QT interval, corticosteroids, especially
septicemic torsades de pointes, elderly patients, because of
plague, caused vasculitis, vasodilation increased risk of tendon
by Yersinia EENT: Blurred vision, rupture.
pestis; to decreased visual acuity,  Expect to obtain culture and
provide diplopia, dysphonia, sensitivity tests before
prophylaxis for scotoma, taste perversion, levofloxacin treatment
plague tinnitus begins.
ENDO: Hyperglycemia,  Know that levofloxacin
hypoglycemia therapy should begin as
GI: Abdominal pain, acute soon as possible after
hepatic necrosis or failure, suspected or confirmed
anorexia, constipation, exposure to Y. pestis.
diarrhea, flatulence,  Avoid giving drug within 2
hepatitis, hepatotoxicity, hours of antacids.
indigestion, jaundice,  Give parenteral form over 60
nausea, to 90 minutes, depending on
pseudomembranous colitis, dosage, because bolus or
vomiting rapid I.V. delivery may cause
GU: Acute renal failure or hypotension
insufficiency, crystalluria,  Monitor blood glucose level,
interstitial nephritis, vaginal especially in diabetic patient
candidiasis who takes an oral
HEME: Agranulocytosis, antidiabetic or uses insulin,
aplastic anemia, because levofloxacin may
eosinophilia, hemolytic alter blood glucose level. If
anemia, leukopenia, so, notify prescriber, stop
pancytopenia, drug immediately if patient
thrombocytopenia has hypoglycemia, and
MS: Arthralgia, arthritis, provide prescribed
back pain, gait abnormality, treatment.
myalgia, rhabdomyolysis,  Notify prescriber if patient
tendon or muscle rupture, has symptoms of peripheral
tendinopathy neuropathy (pain; burning;
RESP: Allergic pneumonitis tingling; numbness;
SKIN: Photosensitivity, weakness; altered
pruritus, rash, Stevens- sensations of light touch,
Johnson syndrome, toxic pain, temperature, position
epidermal necrolysis, sense, or vibration sense),
urticaria which could be permanent;
Other: Anaphylaxis, or CNS abnormalities
angioedema, multiorgan (seizures, psychosis,
failure, serum sickness increased ICP, or CNS
stimulation), which may lead
to more serious adverse
reactions, such as suicidal
ideation. In each case,
expect to discontinue
levofloxacin. Monitor QT
interval if needed. If it
lengthens, notify prescriber
at once and stop drug.
Patients with hypokalemia,
significant bradycardia, or
cardiomyopathy and those
receiving a class IA or III
antiarrhythmic shouldn’t
receive levofloxacin.
 Mechanism of
Drug Indications Contraindications Side effects Nursing considerations
Action
Generic Name: Interferes with To treat infections of the Calcium-containing CNS: Chills, fever,  Use ceftriaxone
bacterial cell wall lower respiratory tract, I.V. solutions; headache, cautiously in patients
Ceftriaxone
synthesis by skin, soft tissue, urinary hyperbilirubinemic hypertonia, who are hypersensitive
Brand Name: inhibiting cross- tract, bones, and joints; neonates; reversible to penicillins because
linking of sinusitis; intra-abdominal hypersensitivity to hyperactivity, cross-sensitivity has
Rocephin
peptidoglycan infections; and septicemia ceftriaxone, other seizures occurred in about 1% to
Classification: strands. caused by anaerobes cephalosporins, or CV: Edema 3% of such patients.
Peptidoglycan (including Bacteroides their components; EENT: Glossitis,  If possible, obtain culture
Antibiotic
makes the cell bivius, Bacteroides neonates who are 28 hearing loss, and sensitivity results, as
membrane rigid fragilis, Bacteroides days old or less if stomatitis ordered, before giving
and protective. melaninogenicus, and they’re expected to GI: Abdominal drug.
Without it, Peptostreptococcus need cramps, cholestasis,  Protect powder from
bacterial cells species), gramnegative calciumcontaining diarrhea, elevated light.
rupture and die. organisms (including solutions, including liver function test  For I.V. use, reconstitute
Citrobacter species, parenteral nutrition. results, gallbladder with an appropriate
Enterobacter aerogenes, Cefotaxime is a dysfunction, hepatic diluent, such as sterile
Escherichia coli, better choice of failure, water for injection or
Haemophilus influenzae, therapy for neonates. hepatomegaly, sodium chloride for
Klebsiella species, nausea, oral injection, as follows: for
Neisseria species, candidiasis, 250-mg vial, add 2.4 ml;
Proteus mirabilis, Proteus pancreatitis, for 500-mg vial, add 4.8
vulgaris, Providencia pseudolithiasis, ml; for 1-g vial, add 9.6
species, Salmonella pseudomembranous ml; and for 2-g vial, add
species, Serratia colitis, vomiting 19.2 ml to yield 100
marcescens, Shigella, GU: Elevated BUN mg/ml. For piggyback
and some strains of level, nephrotoxicity, bottles, reconstitute with
Pseudomonas oliguria, renal 10 ml of diluent indicated
aeruginosa), and gram- failure, vaginal above for 1-g bottle and
positive organisms candidiasis 20 ml for 2-g bottle. After
(including Staphylococcus HEME: Aplastic reconstitution, further
aureus, Streptococcus anemia, dilute to 50 to 100 ml
pneumoniae, and eosinophilia, with diluent indicated
Streptococcus pyogenes) hemolytic anemia, above and infuse over
hemorrhage, 30 minutes. Never use a
hypoprothrombinemi diluent that contains
a, neutropenia, calcium, such as
thrombocytopenia, Ringer’s solution or
unusual bleeding Hartmann’s solution,
MS: Arthralgia because a precipitate
RESP: Allergic can form and may be
pneumonitis, fatal if injected.
dyspnea  For I.M. administration,
SKIN: Allergic reconstitute with an
dermatitis, appropriate diluent, such
ecchymosis, as sterile water for
erythema, erythema injection or sodium
multiforme, chloride for injection, as
exanthema, pruritus, follows: for 250-mg vial,
rash, Stevens- add 0.9 ml; for 500-mg
Johnson syndrome, vial, add 1.8 ml; for 1-g
toxic epidermal vial, add 3.6 ml; and for
necrolysis, urticaria 2-g vial, add 7.2 ml to
Other: Anaphylaxis; make a 250-mg/ml
drug fever; concentration. Shake
injectionsite pain, well. Inject deep into
redness, and large muscle mass, such
swelling; serum as the gluteus maximus.
sickness;  Monitor BUN and serum
superinfection creatinine levels to detect
early signs of
nephrotoxicity. Also
monitor fluid intake and
output; decreasing urine
output may indicate
nephrotoxicity.
 Monitor patient for
allergic reactions
throughout ceftriaxone
 therapy and after drug is
discontinued. Notify
prescriber and stop drug,
as ordered, at first sign of
an allergic reaction. Be
prepared to provide
supportive care,
including epinephrine
administration and other
emergency measures, as
indicated and ordered.
 Assess CBC, hematocrit,
and serum AST, ALT,
bilirubin, LD, and alkaline
phosphatase levels
during long-term therapy.
If abnormalities occur,
notify prescriber. Drug
may need to be
discontinued.
 Assess bowel pattern
daily; severe diarrhea
may indicate
pseudomembranous
colitis caused by
Clostridium difficile. If
diarrhea occurs, notify
prescriber and expect to
treat with fluids,
electrolytes, protein, and
an antibiotic effective
against C. difficile.
Ceftriaxone therapy may
be withheld also.
 Drug Mechanism of Action Indications Contraindications Side effects Nursing considerations
Generic Name: Interferes with bacterial cell To provide Hypersensitivity to CNS: Chills, fever,  Impaired renal
wall synthesis by inhibiting perioperative cephalosporins or headache, seizures function, a history of GI
Cefutaxime
cross-linking of prophylaxis their components CV: Edema disease (especially
Brand Name: peptidoglycan strands. EENT: Hearing loss colitis), or
Peptidoglycan makes cell GI: Abdominal cramps, hypersensitivity to
Claforan
membranes rigid and cholestasis, diarrhea, penicillin because
Classification: protective. Without it, elevated liver function crosssensitivity has
bacterial cells rupture and test results, hepatic occurred in about 10%
Antibiotic
die. failure, hepatitis, of such patients.
hepatomegaly, jaundice,  If possible, obtain
nausea, oral candidiasis, culture and sensitivity
pseudomembranous test results, as ordered,
colitis, vomiting before giving drug.
GU: Elevated BUN level,  For I.V. use,
nephrotoxicity, renal reconstitute each 0.5-,
failure, vaginal 1-, or 2-g vial with 10
candidiasis ml of sterile water for
HEME: Eosinophilia, injection. Shake to
hemolytic anemia, dissolve.
hypoprothrombinemia,  For intermittent I.V.
neutropenia, infusion, further dilute
thrombocytopenia, in 50 to 100 ml of D5W
unusual bleeding or normal saline
MS: Arthralgia solution.
RESP: Dyspnea  For I.M. use,
SKIN: Ecchymosis, reconstitute each 500-
erythema, erythema mg vial with 2 ml sterile
multiforme, pruritus, water for injection
rash, Stevens-Johnson or bacteriostatic water
syndrome, toxic for injection; each 1-g
epidermal necrolysis vial with 3 ml diluent;
Other: Anaphylaxis; and each 2-g vial with
injection-site pain, 5 ml diluent. Shake to
redness, and swelling; dissolve.
superinfection  Give cefotaxime by I.V.
injection over 3 to 5
minutes through tubing
of a free-flowing
compatible I.V.
solution. Temporarily
stop other solutions
being given through
same I.V. site.
 Discard unused drug
after 24 hours if stored
at room temperature, 5
days if refrigerated.
 Protect cefotaxime
powder and solution
from light and heat.
 Monitor I.V. sites for
signs of phlebitis or
extravasation. Rotate
I.V. sites every
72 hours.
 Monitor BUN and
serum creatinine levels
and fluid intake and
output for signs of
nephrotoxicity.
 Be aware that allergic
reaction may occur a
few days after
cefotaxime therapy
starts.
 Assess bowel pattern
daily; severe diarrhea
may indicate
pseudomembranous
 colitis caused by
Clostridium difficile. If
diarrhea occurs, notify
prescriber and expect
to withhold cefotaxime
and treat with fluids,
electrolytes, protein,
and an antibiotic
effective against C.
difficile.
 Assess patient for
pharyngitis,
ecchymosis, bleeding,
and arthralgia, which
may indicate a blood
dyscrasia. Monitor
CBC, PT, and bleeding
time, as ordered.
 Monitor patient closely
for superinfection. If
evidence appears,
notify prescriber and
expect to stop drug and
provide care.
 Be aware that
cephalosporins, such
as cefotaxime, may
produce a positive
direct Coombs’ test.
H. READINGS R/T DIGESTIVE CASES / ARTICLES SUMMARY AND
REACTIONS
 I. GENERAL EVALUATION INCLUDING LABORATORY OR DIAGNOSTIC
TESTS

To diagnose peritonitis, your doctor will talk with you about your medical history and
perform a physical exam. When peritonitis is associated with peritoneal dialysis, your
signs and symptoms, particularly cloudy dialysis fluid, may be enough for your doctor to
diagnose the condition.

In cases of peritonitis in which the infection may be a result of other medical conditions
(secondary peritonitis) or in which the infection arises from fluid buildup in your
abdominal cavity (spontaneous bacterial peritonitis), your doctor may recommend the
following tests to confirm a diagnosis:

 Blood tests. A sample of your blood may be drawn and sent to a lab to check for a
high white blood cell count. A blood culture also may be performed to determine if
there are bacteria in your blood.

 Imaging tests. Your doctor may want to use an X-ray to check for holes or other
perforations in your gastrointestinal tract. Ultrasound also may be used. In some
cases, your doctor may use a computerized tomography (CT) scan instead of an
X-ray.

 Peritoneal fluid analysis. Using a thin needle, your doctor may take a sample of
the fluid in your peritoneum (paracentesis), especially if you receive peritoneal
dialysis or have fluid in your abdomen from liver disease. If you have peritonitis,
examination of this fluid may show an increased white blood cell count, which
typically indicates an infection or inflammation. A culture of the fluid may also
reveal the presence of bacteria.

The above tests may also be necessary if you're receiving peritoneal dialysis and a
diagnosis of peritonitis is uncertain after a physical exam and an examination of the
dialysis fluid.