NURSING CARE STUDY OF A PATIENT WITH PERITONITIS

BY

NAME: …………………………………………….

MATRIC NUMBER: ……………………………...

INDEX NO: ……………………………………….

DEPARTMENT OF NURSING SCIENCES

FACULTY OF HEALTH SCIENCES

ABIA STATE UNIVERSITY, UTURU

NOVEMBER, 2022
 NURSING CARE STUDY OF PATIENT WITH PERITONITIS

BY

NAME: …………………………………………….

MATRIC NUMBER: ……………………………...

INDEX NO: ……………………………………….

DEPARTMENT OF NURSING SCIENCES

FACULTY OF HEALTH SCIENCES

ABIA STATE UNIVERSITY, UTURU

IN PARTAIL FULFILMENT OF THE REQUIREMENTS OF NURSING AND

MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF ‘‘REGISTERED

NURSE” CERTIFICATE

NOVEMBER, 2022.
 APPROVAL/ CERTIFICATION PAGE

This is to certify that the client care by ………………………………………………… with

index number …………………………………………………………………..has been examined

and approved for the award of Registered Nurse Certificate.

…………………...... ………………………..

(Supervisor) Date

…………………...... ………………………..

Dr. Mrs. Emonye O. P Date

…………………...... ………………………..

External Examiner Date

 ACKNOWLEDGEMENT

I must sincerely acknowledge God Almighty for his infinite grace and mercy to complete this

case study. I am particularly grateful to my supervisor …………………………. for her guidance

and corrections throughout the course of this work.

A big thank you to all my colleagues which in one way or another contributed to the success of

this work.

God bless you all.

 Table of Content

Cover Page i

Title Page ii

Approval/Certification iii

Acknowledgment iv

Introduction 1

Patient’s Bio Data 1

Disease History 2

Anatomy and Physiology of the Lungs 3

Comprehensive Literature Review 4

Incidence 4

Causes 4

Pathophysiology 5

Clinical Manifestations 5

Diagnostic Investigation 6
Application of the Nursing Process 7

Nursing History 7

Nursing Management 8

Nursing Diagnoses 9

Nursing Care Plan 10

Pharmacological Review of Drugs Used 12

Progress and Discharge Summary 14

Conclusion 14

Implication of the Study 14

Importance of the Study 15

Inferences Drawn from the Study 15

Suggestions 15

Recommendations ` 15

References 16
Aims and Objectives

• To determine the definition of peritonitis.

• To determine the incidence, causes, risk factors, signs and symptoms, peritonitis

• To determine the medical management of peritonitis

INTRODUCTION

Peritonitis is a serious medical condition characterized by inflammation of the peritoneum,

which is the thin tissue lining the inner wall of the abdomen and covering the abdominal organs.

It is usually caused by a bacterial or fungal infection, although other factors such as chemical

irritation, injury, or certain medical procedures can also lead to peritonitis.

The peritoneum normally helps protect and lubricate the abdominal organs, allowing them to

move smoothly against each other. However, when the peritoneum becomes infected or

inflamed, it can lead to significant pain discomfort, and potential complications.

There are two main types of peritonitis: primary and secondary. Primary peritonitis, also known

as spontaneous peritonitis, occurs in individuals with underlying liver disease or ascites (the

buildup of fluid in the abdomen). Secondary peritonitis is more common and usually results from

a perforated organ, such as a ruptured appendix, a perforated stomach ulcer, or a burst

diverticulum.
Patients Bio Data

Name of Patient: Mrs. D. P

Age: 29 yrs

Sex: Female

Diagnoses Peritonitis

Ward Female Medical Ward

Religion: Christianity

Occupation: Trader

Nationality Nigeria

State of Origin Abia State

Address: Umualangwa Isialangwa

Next of Kin: Mr. D. I

Address of Next of Kin: Umualangwa Isialangwa

Family History: Mrs. D. P is a native of Umualangwa Isialangwa South Abia State. She is a

trader who sells baby’s wear at New Market rd Aba. She is married to Mr. D. I and they live in a

two bed room flat with her family; 3 children, a boy and two girls.

Socio-History: Mrs. D. P frequently travels especially for her sales. She belongs to a social club

called Umuada Ngwa. They attend the St. Joseph’s Catholic Church.
Disease History

Mrs. D. P was apparently well until 3 weeks ago when she started having abdominal pain which

she took an OTC analgesic (Paracetamol) to reduce the pain. She also experienced alteration in

bowel movement which lasted for days.

Past medical history: Patient was previously diagnosed with peptic ulcer a year ago . She also

was diagnosed of anaemia in pregnancy during her first pregnancy.

Past surgical history: none

Treatment taken so far: Mrs. D.P presented to the Hospital at about 14 days ago with

complaints of abdominal pain and fever. She stated to have been taking paracetamol since the

pain began.
 ANATOMY AND PHYSIOLOGY OF THE PERITONEUM

ANATOMY OF THE PERITONEUM

Definition: The peritoneum is the largest serous membrane of the body. It is a closed sac

containing a small amount of serous fluid. Within the abdominal cavity. It is richly supplied

with blood and lymph vessels and contains many lymph nodes.

Layers of the peritoneum; the peritoneum has two layers:

The parietal layer of the peritoneum, which lines the abdominal wall.

The visceral layer of the peritoneum, which covers the organs (visceral) within the abdominal

and pelvic cavities. The peritoneum lines the anterior abdominal wall.

The two layers of the peritoneum are in close contact and friction between them is prevented by

the present of serous fluid secreted by the peritoneal cavity. A similar arrangement is seen in

with the membrane covering the lungs, and the pleural. In the male, the peritoneal cavity is

completely closed but, in the female, the uterine tube open into it and the ovaries are the only

structures inside. The arrangement of the peritoneum is such that the organs area invaginated

(pushed into the membrane forming a pouch) into the closed sac at least partly covered by the

visceral layer and attached securely within the abdominal cavity. This means that; pelvic organs

are covered only on their superior surface and the stomach and intestine, deeply invaginated

from behind, are most completely surrounded by peritoneum and have double fold (the

mesentery) that attaches to the posterior abdominal wall.

The fold of peritoneum enclosing the stomach extended beyond the greater curvature of the

stomach and hangs down in front of the abdominal organs like an apron. This is the greater

omentrum which stores fat that provides both insulation and long-term energy store.

 The pancreas, spleen, kidney and adrenal glands are invaginated form behind only their

anterior surfaces are covered and are therefore retroperitoneal (lie behind the peritoneum)

 The liver is invaginated from the peritoneum, which attaches it to the inferior surfaces of

the diaphragm

 The main blood vessels and nerves pass close to the posterior abdominal wall and send

branches to the posterior abdominal wall and send branches of the organs between folds

of peritoneum.

Functions of the peritoneum.

It provides a physical barrier to local spread of infection, and can isolate an infective focus such

as appendicitis, preventing involvement of other abdominal structures. (Waugh & Grant, 2014).
 COMPREHENSIVE LITERATURE OF PERITONITIS

Peritonitis is the inflammation of the peritoneum. The tissues that lines the inner wall of the

abdominal covers and supports most of the abdominal organism (Ferri & Fred, 2017)

Causes of peritonitis

Arfania, (2018), stated that the following are causes of peritonitis:

 Perforation of the intestinal

 Pancreatitis

 Stomach Ulcer

 Pelvic inflammation disease

 Surgery

 Trauma to the abdomen such as an injury from a kidney or gunshot wound

 Non-infectious causes of peritonitis include:

 Irritates such as bile, or foreign substances in the abdomen such as barium.

Types of peritonitis

Darley. (2015) categorized peritonitis into the flowing types:

 Primary Peritonitis also called spontaneous bacterial peritonitis (SBP) occurs as a

spontaneous bacterial infection of ascetic fluid. This occurs most commonly in the adult

patient with liver failure.

 Secondary peritonitis occurs secondary to perforation of abdominal organs wit spillage

that infects the serous peritoneum. The common causes include a perforated appendix.
 perforated peptic Ulcer, perforated sigmoid colon caused by severe diverticulitis,

volvulus of the colon and strangulation of the small intestine. The major focus of this

section is on secondary peritonitis.

 Tertiary Peritonitis occurs as a result of supra infection in a patient who immune

compromised tuberculosis peritonitis in a patient with AIDS is an example of tertiary

peritonitis.

CLINICAL MANIFESTATIONS

Symptoms depend on the location and extent of inflammation:

 At first pain is diffused but then becomes constant localized and more intense over the

site of the pathologic process (site of maximum peritoneal irritation).

 The affected area of the abdomen becomes extremely tender and distended, and the

muscles becomes rigid. Anorexia, nausea and vomiting.

 Fever with temperature of 37.8°C to 38.3°c with an increases pulse rate.

 Sinus tachycardia

 Difficulty passing gas or having a bowel movement.

 Chills, excessive thirst and fatigue. (Baum, 2014)

PATHOPHYSIOLOGY

Peritonitis is the inflammation of the peritoneum, which is the serous membrane lining the

abdominal cavity and covering the viscera. It can be presented with symptoms of abdominal

pain, fever, diffused, abdominal rigidity.

It can be caused by leakages of contents from abdominal cavity, usually as a result of

inflammation, infection, ischemia, trauma, or tumor perforation. This leads to oedema of the

tissues ends exudation of fluid developing in a short time. Fluid in the peritoneal cavity becomes

turbid with increasing amounts of protein, white blood cells, cellular debris and blood.

There is immediate response to the intestinal tract to be hyper motile and soon flowed by

paralytic ileus with an accumulation of air and fluid in the bowel.

The predisposing factors may include weakened immune system, history of peritonitis, and

pelvic inflammatory diseases.

Prompt intravenous antibiotic are needed to treat the infection and if it is not properly managed

or treated can lead to complication like peritoneal abscess, sepsis may develop which may lead to

death.

Assessment and Diagnostic findings

Salunsky. (2016); stated that the following investigations or test are recommended to confirm

peritonitis in a person

 A history taken: the history of the patient is taken in order to know the cause of the

illness, this include present and past medical history, family and social history, surgical

history.

 Head of toe examination: this will help ascertain the symptoms associated with the illness

which includes palpation, auscultation and inspection of the abdominal cavity.

  Blood test: a sample of blood is taken and sent to a laboratory to check for a high white

blood cell count. A blood culture may also be performed to determine if there are

bacterial in the blood.

 Imaging tests: the doctor may want to use an x-ray to check for holes or other

perforations in the gastrointestinal tract. Ultra sound may also be used in some cases, the

doctor may use a computerized tomography (CT) scan instead of an x-ray.

 Peritoneal fluid analysis: using a thin needle, the doctor may take the sample of the fluid

in the peritoneum (paracentesis) especially if the person received peritoneal dialysis or

have fluid in the abdomen from liver disease. If one has peritonitis examination of this

fluid may show on increase while blood cell count, which typically indicates an infection

or inflammation. A culture may also reveal the presence of bacteria.

Predisposing Factors

 Previous history of peritonitis

 History of alcohol perforated colon

 Stomach ulcer

 Liver disease

 Ruptured appendix

 Fluid accumulation in the abdomen

 Weakened immune system

 Pelvic inflammation disease

 Infection of the gall bladder, intestine or stomach. (Potter, 2013)

MANAGEMENT OF PERITONITIS
The goal in the management of peritonitis is to fight the infection and further complications; the

managements include: medical management, surgical management and nursing management.

MEDICAL MANAGEMENT

 Antibiotics: the patient is likely to be given a course of antibiotics medications to fight

the infection and prevent it from the antibiotics thereby depends on the severity of the

condition and the kind of peritonitis that is involved.

 Analgesics to relieve pain

 IV fluids and electrolytes

 Rectal tube to facilitate passage of gas

 Abdominal Paracentesis

Other treatments: depending on the signs and symptoms, the treatment while in the hospital may

include pain medications (analgesic), intravenous (IV) fluid, supplemental oxygen and in some

cases, a blood transfusion. (Fennel, 2016)

Surgical Management

The surgical management is exploratory laparotomy which is needed to perform full exploration

and lavage of the peritoneum, as well as to correct any gross anatomical is spontaneous bacterial

peritonitis, which does not always benefit from surgery and may be treated with antibiotics in the

first instance.

COMPLICATIONS

 Dehydration
  Sepsis

 Septic shock and death

 Multiple organ infection and other failure

 Hepatorenal syndrome (liver disease leading to increasing renal failure)

 Hepatic encephalopathy (MC David, 2014).

PREVENTION

The prevention of peritonitis includes the following:

1. Early diagnosis and management can help prevent peritonitis

2. Preventing underlying causes (for example; trauma, ulcers, alcohol and pelvic

inflammation disease)

3. Individual that are obtaining peritoneal dialysis should be very careful about hand and

finger nail cleanliness to avoid contamination to the dialysis catheter.

4. Preventive measures of the antimicrobial have been used to reduce the risk of peritonitis;

however, if this technique is used it may generate antibiotics resistant organism (Khanna,

2014).
 APPLICATION OF THE NURSING PROCESS NURSING HISTORY

Nursing History

Mrs. D. P was brought into the ward (Batley) from the accident and emergency ward in the

company of a health worker and a relative at about 2: 30 pm.

On arrival, they were welcomed into the ward. Patient was familiarized with the ward by the

nurse on duty explaining all the ward routines and a visitation card handed over to them. Patients

anxiety was relieved by answering all her questions.

Patients history was taken and vital signs at that time (3 pm) read; temperature 36.4 0 C, pulse 82

b/m, respiration 24 b/m, SpO2 96%, blood pressure 110/70 b/m, random blood sugar 128mg/dl.

Patient passed urine of about 400mls.

She was reviewed by Doctor E. and the following drugs were prescribed;

 IV normal saline 500mls hourly x 5/7

 IV dextrose water 500mls 8 hourly x 3/7

 IV ceftriaxole 9 tandox 12 hourly x 3/7

 IM paracetamol 8 hourly daily x 3/7

 IM omeprazole 4mg daily x 3/7

 IV flagyl 1500mg 8 hourly x 3/7

 IM pentazocin 30mg 8 hourly x 5/7

 IV gentamicin 80mg

NURSING MANAGEMENT FOR MRS. D.P

 Admission: admit patient into a female medical ward on a well-made bed. Explain ward

procedures to the patient and patient's relatives; take admission vital signs, urine testing

and random blood sugar

 Position: place the patient in a comfortable position, this help to alley patient's anxiety.

 Observation: observe patients vital signs, restlessness, input and output report finding

and carry out the appropriate nursing interventions and document.

 Drugs: administer prescribed antibiotics and isotonic solution as well as the analgesic to

relieve pain.

 Diet: encourage adequate diet to promote the formation of proteins and enzymes to aid

tissue repairs including fruits, vegetables and adequate fluid intake.

 Rest: proper rest and sleep is encouraged to conserve energy.

 Bladder and bowel control: monitor patient's bowel pattern and urine elimination. Teach

proper way of cleaning the perinea area after defecation, maintain the input and output

chart

 Investigation: encourage patients and relatives to do all order investigations and prepare

the patient adequately for the investigations.

 Health education: educate patient on the causes of peritonitis, preventions and

complications if not properly treated→ Special nursing care: take patients vital signs,
 empty urine bag, encourage warm bath, ventilation, intake of fluid, exposing and tepid

sponging patient when febrile.

 Advice: patient should be advices to take her medications religiously as prescribed and to

report in case of any abnormalities or relapse.

 Follow up: Encourage and ensure the patient always go her check up at the appointed

time, this help to ascertain that she is free from the illness to help avoid further

complications.

NURSING DIAGNOSES FOR MRS. D.P

1. Hyperthermia related to ineffective thermo-regulator evidenced by increased temperature

of 38.80 C.

2. Acute pain related to inflammation of the peritoneum evidenced by patient’s

verbalization.

3. Anxiety related to deficit knowledge of outcome of illness evidenced by patient’s

inquisitiveness.
 NURSING CARE PLAN FOR MRS. D.P WITH PERITONITIS

S/N Nursing Diagnosis Nursing Objectives Nursing Intervention Scientific Rationale Evaluation

1. Hyperthermia related to Patients temperature 1. Expose the patient 1. Exposure will reduce the Patients

ineffective thermo- will reduce by 10 C 2. Fan the patient or open temperature by radiation. temperature

regulator evidenced by within 45 – 60 the windows 2. Reduces temperature by return to

increased temperature of minutes of nursing 3. Tepid sponge or sprinkle convection normal 370C

38.80 C. intervention. the patient with water. 3. Helps to reduce the after 45 min of

4. Encourage intake of cool temperature by nursing

fluid conduction and intervention

5. Give prescribed evaporation

antipyretic 4. Decreases temperature &

prevent dehydration

5. Drug acts on the heat

regulatory center in the

hypothalamus & help

eliminate the excess heat

 through the skin by

increasing vasodilation

and sweating.

2. Acute pain related to Patient will verbalize 1. Assess the patients level 1. To ascertain baseline Patient

inflammation of the reduced pain within of pain data verbalized

peritoneum evidenced by 30 min – 60 min of 2. Position the patient 2. Helps to reduce the reduced pain

patient’s verbalization. nursing intervention. properly pain after 30 min of

3. Provide diversional 3. Diverts patient nursing

therapy attention from feeling intervention.

the pain

3. Anxiety related to deficit Patients anxiety will 1. Asses the level of 1. Helps ascertain that Patient

knowledge of outcome of be allayed within 1 – anxiety baseline data verbalized a

illness evidenced by 2 hours of nursing 2. Encourage patient to 2. It reduces anxiety reduction in

patient’s inquisitiveness. intervention ask questions and try 3. Helps to relax and anxiety after 1

to answer the question calm the patient hour of nursing

3. Explain the disease 4. Helps reassure and

 condition to the relax patient intervention.

patient 5. This is to allay

4. Introduce others that anxiety, has a muscle

had recovered from relaxant effect to relax

such sickness to her tensed muscle.

5. Give prescribed

anxiolytic e.g

diazepam.

PHARMACOLOGICAL REVIEW OF THE DRUGS USED

1. Ceftriazone

2. Flagyl

3. Pentazocin
Name of drug Group Indication Dosage Route of Side effects Contraindications Nursing
administration responsibility
Ceftriazone Antibiotics Infectious 1 – 2g Intramuscular, Diarrhea, History of Use with

fever, daily or Intravenous abdominal hypersensitivity to caution if

gonococcal 500 mg pain, sore penicillin patient is

infection, twice mouth, body hypersensitive

Urinary tract daily rashes to penicicllin

infection, Instruct the

meningitis patient not to

drink alcohol

and to takje the

full course of

the drug to

maintain

therapeutic

blood level.

Flagyl Antimicrobia Amoebic 400 – Orally, GIT Pregnancy, CNS Do not

(Mteronidazole) l dysentery, suppository and disturbances, disease, blood administer or

 appendicitis, 800mg intravenously urticarial, dyscrasias, pregnant

diverticulitis, dizziness, encephalopathy and women with

septic headache, and hypertensivity hypersensitivity

abortion. hypersensitivity Avoid intake of

reaction. alcohol within

24 hours of

flagyl intake

Pentazocin Non- opoid Acute or 40 – Orally, Dizziness, Hypersensitivity Ambulatory

analgesic chronic pain, 80mg intramuscular, nausea, reacvtion, patient should

burns, pre daily intravenous and vomiting, and pregnancy and be warned to

anaesthetic subcutaneous. hallucination hypertension avoid operating

medication machineries

Patients should

avoid

movement for

15 minutes

after receiving
the drug
Progress and Discharge Summary

Mrs. D. P reported to the hospital on 2nd August, 2022 and was admitted with a diagnosis of

peritonitis She was admitted to the FMW for proper treatment and care. Patient was successfully

managed without secondary illnesses arising. She was undergone the medication i.e. IV

pentazocin, and tab flagyl. Her general conditions was much improve throughout the treatment

procedure being hospitalized. She was reviewed by the doctor, prior to discharge.

Conclusion

Patient was admitted and received good nursing and medical management prior to discharge.

Patient was fully recovered and was discharged.

Implication

Peritonitis is the inflammation of the peritoneum, the tisuue that lines the inner wall of the

abdomen. Peritonitis is usually caused by infection from bacteria of fungi , left unilateral and can

spread into the blood and to other organs resulting in organ failure or death. Signs and symptoms

can include fever, chills, ascites, nausea and vomiting and abdominal distension. Traetment

begins with treating the underlying cause and then the infection to destroy the bacteria.

Importance of the Study

1. To gain insight on the nursing and medical care of patients with peritonitis

2. To have a detailed knowledge of the nursing process

3. To improve skill and professionalism

4. To gain more clinical experience

Suggestions

Health education should be given to the individuals and community on the causes, risk factors

and prevention of peritonitis

 REFERENCES

ArfaniaD. Evereff, E.D, Nolph, K.D., Rubin, J. (2018). "Uncommon causes of peritonitis in
patient undergoing peritoneal dialysis". Archives of internal medicine 141 (1): 61-64.

Baum, M. Powell, D, Calvin S. (2014) "Clinical Manifestation of Peritonitis" 102(6): 12-17.

Daley, J.W.; Vigneux, A., Willumsen, J; (2015). "Types of Peritonitis" 426(2):66-70

FennelR,S.' Orak, JGarin, E.H. (2019). "Medical management of peritonitis"Archives of (3): 18-
20. Waugh & Grant, A; (2014). "Anatomy and Physiology in Health illness"

Internal Medicine, 620(4): 20-24. Khanna, R. (2014)"Prevention of Peritonitis during continuous

ambulatory peritoneal dialysis"

Muleyalous, R; Opas, L.M(2016)"Treatment of peritonitis in Patient". Mason Publishing.

U.S.A.. New York. 265-272.

Laroches & Gharding, (2016)"Definition of Peritonitis". 456(2)-66-70

Potters, D.E., M.CDavid, T.K., Ramirez, J.A. (2013). "Peritoneal dialysis in Children". Church
Hill Living stone, Edwinburgh; (19) 356-367.

Salunsky, I, B. Hall, T. (2016). "Diagnostic Investigations of Peritonitis. In a Dong

Thapnoprovonce Mekong Delta Region of Vietnam