Acute Peritonitis Nursing Care Plan & Management


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 inpatients 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.

Signs and Symptoms
  • Patient assuming a knee-flexed position and complaining of severe localized or generalized abdominal pain.
  • Nausea and vomiting
Physical Examination
Vital signs
  • HR: tachycardia
  • BP: hypotension
  • RR: increased and shallow
  • Temp : elevated
  • Normal to decreased mentation
  • Pale
  • Flushed
  • Diaphoretic
  • Pulse thready or wear or may be bounding in presence of fever.
  • Breath sounds may be diminished secondary to shallow breathing.
  • Rebound tenderness with guarding
  • May have referred pain to shoulder
  • Rigid, distended abdomen
  • Bowel sounds decrease to absent
Acute Care Management

Nursing Diagnosis: Deficient fluid volume related to intravascular fluid shift to the peritoneal space and inability to ingest oral fluids.

Outcome Criteria
  • Central venous pressure 2 TO 6 MM Hg
  • BP 90 to 120 mm Hg
  • Mean arterial pressure 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 pressure and central venous pressure and monitor mean arterial pressure hourly or more frequently if the patient’s hemodynamic status is unstable.
  2. Not the patient’s response to all therapy.
  3. Monitor fluid volume status by measuring urine output hourly and measure nasogastric and other bodily drainage.
  4. Determine fluid balance every 8 hours.
  5. Continuously monitor ECG fir dysrhythmias resulting from electrolyte disturbances.
Patient Assessment
  1. Assess tissue perfusion. Note level of consciousness, skin color and temperature, pulses, and capillary refill.
  2. Assess hydration status: note skin turgor on inner thigh or forehead, condition of buccal membranes, and development of edema or crackles.
  3. Assess the patient’s abdomen for resolution of rigidity, rebound tenderness, and distention. Auscultate bowel sounds.
Diagnostic Assessment
  1. Review serum sodium and potassium levels, which may become depleted with nasogastric suctioning or fluid shifts.
  2. Review serial WBC count and differentiated to evaluate the course of action.
Patient Management
  1. Administer crystalloid or colloid solutions to improve intravascular volume.
  2. Replace potassium as ordered; validate adequate urine output before administration.
  3. Keep the patient NPO during acute phase and before evaluation by a surgeon.
  4. Provide nutritional support as indicated; most patient will benefit from postpyloric delivery of early enteral nutrients at a minimal hourly rate to prevent v=bacterial translocation and sepsis.
  5. Administer antibiotics as prescribed after appropriate cultures obtained.


Nursing Care Plan

Peritonitis Nursing Care Plan

Nursing Diagnosis
  • Infection, risk for (septicemia)
Risk factors may include
  • Inadequate primary defenses (broken skin, traumatized tissue, altered peristalsis)
  • Inadequate secondary defenses (immunosuppression)
  • Invasive procedures
Possibly evidenced by
  • Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
Desired Outcomes
  • Achieve timely healing; be free of purulent drainage or erythema; be afebrile.
  • Verbalize understanding of the individual causative/risk factor(s).
Nursing Interventions
  • Note individual risk factors. Abdominal trauma, acute appendicitis, peritoneal dialysis are common risk factors.
    • Rationale: Influences choice of interventions.
  • Assess vital signs frequently, noting unresolved or progressing hypotension, decreased pulse pressure, tachycardia, fever, tachypnea.
    • Rationale: Signs of impending septic shock. Circulating endotoxins eventually produce vasodilation, shift of fluid from circulation, and a low cardiac output state.
  • Note changes in mental status: confusion, stupor, altered LOC.
    • Rationale: Hypoxemia, hypotension, and acidosis can cause deteriorating mental status.
  • Note skin color, temperature, moisture.
    • Rationale: Warm, flushed, dry skin is early sign of septicemia. Later manifestations include cool, clammy, pale skin and cyanosis as shock becomes refractory.
  • Monitor urine output.
    • Rationale: Oliguria develops as a result of decreased renal perfusion, circulating toxins, effects of antibiotics.
  • Maintain strict aseptic technique in care of abdominal drains, incisions and/or open wounds, dressings, and invasive sites. Cleanse with appropriate solution.
    • Rationale: Prevents access or limits spread of infecting organisms and cross-contamination.
  • Perform and teach proper hand washing technique.
    • Rationale: Reduces risk of cross-contamination and/or spread of infection.
  • Observe drainage from wounds and/or drains.
    • Rationale: Provides information about status of infection.
  • Maintain sterile technique when catheterizing patient, and provide catheter care and encourage perineal cleansing on a routine basis.
    • Rationale: Prevents access, limits bacterial growth in urinary tract.
  • Monitor and/or restrict visitors and staff as appropriate. Provide protective isolation if indicated.
    • Rationale: Reduces risk of exposure to and/or acquisition of secondary infection in immuno compromised patient.
  • Obtain specimens and monitor results of serial blood, urine, wound cultures.
    • Rationale: Identifies causative microorganisms and helps in assessing effectiveness of antimicrobial regimen.
  • Assist with peritoneal aspiration, if indicated.
    • Rationale: May be done to remove fluid and to identify infecting organisms so appropriate antibiotic therapy can be instituted.
  • 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 remove necrotic debris and treat inflammation that is poorly localized or diffused.
  • Prepare for surgical intervention if indicated.
    • Rationale: Surgery may be treatment of choice (curative) in acute, localized peritonitis, e.g., to drain localized abscess; remove peritoneal exudates, ruptured appendix or gallbladder; plicate perforated ulcer; or resect bowel.