9 Peritonitis Nursing Care Plans

Peritonitis is a surgical emergency wearing a medical mask. The peritoneum is inflamed, the gut is shutting down, and septic shock is one missed assessment away. Your priorities are infection control, fluid resuscitation, pain relief, and prepping the patient for the OR when surgery is the answer.

What is Peritonitis?

Peritonitis is acute or chronic inflammation of the peritoneum, the membrane lining the abdominal cavity and covering the visceral organs. It may spread throughout the peritoneum or localize as an abscess. It slows intestinal motility and distends the gut with gas. Mortality is 10%, with death usually from bowel obstruction.

The peritoneum is normally sterile even though the GI tract carries bacteria. Peritonitis occurs when bacteria invade after inflammation or perforation of the GI tract, usually from appendicitis, diverticulitis, peptic ulcer, ulcerative colitis, volvulus, abdominal neoplasms, or a stab wound. It can also follow peritoneal dialysis.

Nursing Care Plans and Management

Treating GI inflammation early and managing patients carefully before and after surgery helps prevent peritonitis. Care centers on preventing complications and the spread of infection.

Nursing Problem Priorities

• Give appropriate antibiotics to control infection.
• Manage pain and discomfort.
• Monitor and stabilize vital signs.
• Start fluid resuscitation and maintain hydration.
• Prepare for surgery if needed.
• Provide supportive care to prevent complications.
• Watch for sepsis and manage it.
• Teach medication adherence and followup.

Nursing Assessment

See assessment cues under Nursing Interventions and Actions.

Nursing Diagnosis

Form the nursing diagnosis from your assessment and clinical judgment. The label matters less than matching the plan to what the patient in front of you actually needs.

Nursing Goals

• The client will heal on time, free of purulent drainage or erythema, and afebrile.
• The client will verbalize the causative and risk factors.
• The client will show improved fluid balance: adequate urine output with normal specific gravity, stable vital signs, moist mucous membranes, good skin turgor, prompt capillary refill, and acceptable weight.
• The client will report relief or control of pain.
• The client will use relaxation skills and other comfort methods.
• The client will maintain usual weight and positive nitrogen balance.
• The client will verbalize feelings and healthy ways to handle them, and appear relaxed with anxiety at a manageable level.
• The client will verbalize understanding of the disease process, complications, and therapeutic needs, and correctly perform necessary procedures.

Nursing Interventions and Actions

1. Infection Control and Risk Reduction

Compromised skin and mucosal barriers, weakened immunity, and invasive procedures all let pathogens into the abdomen, where peritonitis can spiral into serious complications.

Note individual risk factors. Abdominal trauma, acute appendicitis, and peritoneal dialysis are common risk factors that guide your interventions.

Assess vital signs frequently, noting unresolved or progressing hypotension, decreased pulse pressure, tachycardia, fever, and tachypnea. Signs of impending septic shock. Circulating endotoxins cause vasodilation, fluid shift out of circulation, and low cardiac output.

Note changes in mental status: confusion, stupor, altered LOC. Hypoxemia, hypotension, and acidosis deteriorate mental status.

Note skin color, temperature, and moisture. Warm, flushed, dry skin is an early sign of septicemia. Cool, clammy, pale skin and cyanosis come later as shock turns refractory.

Monitor urine output. Oliguria develops from decreased renal perfusion, circulating toxins, and antibiotic effects.

Observe drainage from wounds and drains. Shows the status of infection.

Obtain specimens and monitor serial blood, urine, and wound cultures. Identifies organisms and gauges the antimicrobial regimen.

Maintain strict aseptic technique with abdominal drains, incisions, open wounds, dressings, and invasive sites. Cleanse with an appropriate solution. Limits the spread of organisms and cross-contamination.

Perform and teach proper handwashing. Reduces cross-contamination.

Use sterile technique when catheterizing, provide catheter care, and encourage routine perineal cleansing. Limits bacterial growth in the urinary tract.

Monitor or restrict visitors and staff as appropriate. Provide protective isolation if indicated. Reduces secondary infection in an immunocompromised patient.

Assist with peritoneal aspiration if indicated. Removes fluid and identifies organisms so the right antibiotic can start.

Administer antimicrobials: gentamicin (Garamycin), amikacin (Amikin), and clindamycin (Cleocin) via IV or peritoneal lavage. Therapy targets anaerobic bacteria and aerobic Gram-negative bacilli. Lavage removes necrotic debris and treats diffuse inflammation.

Prepare for surgery if indicated. Surgery can be curative in acute, localized peritonitis: drain an abscess, remove exudate, remove a ruptured appendix or gallbladder, plicate a perforated ulcer, or resect bowel.

2. Enhancing Fluid Volume

Monitor vital signs, noting hypotension (including postural changes), tachycardia, tachypnea, and fever. Measure CVP if available. Evaluates fluid deficit, replacement effectiveness, and response to medications.

Observe skin and mucous membrane dryness and turgor. Note peripheral and sacral edema. Hypovolemia, fluid shifts, and nutritional deficits cause poor turgor and taut edematous tissue.

Maintain accurate I&O and correlate with daily weights. Include gastric suction, drains, dressings, Hemovacs, diaphoresis, and abdominal girth for third-spacing. Reflects hydration. Urine output may fall with hypovolemia while weight rises with tissue edema or ascites. Large gastric losses and bowel and peritoneal sequestration are common.

Measure urine specific gravity. Reflects hydration and renal function, warning of acute renal failure. Many antibiotics are nephrotoxic and can further affect kidney function.

Monitor Hb/Hct, electrolytes, protein, albumin, BUN, and creatinine. Tracks hydration and organ function through fluid shifts, hypovolemia, hypoxemia, and circulating toxins.

Eliminate noxious sights and smells. Limit ice chips. Reduces gastric stimulation and vomiting. Excess ice chips during gastric aspiration wash out electrolytes.

Reposition frequently, give skin care, and keep bedding dry and wrinkle-free. Edematous tissue with poor circulation breaks down easily.

Administer plasma, blood, fluids, electrolytes, and diuretics as indicated. Replenishes volume and electrolytes. Colloids pull water back into the intravascular space; diuretics aid toxin excretion and renal function.

Maintain NPO with nasogastric or intestinal aspiration. Reduces bowel hyperactivity and diarrhea losses.

3. Relieving Pain and Discomfort

Investigate pain reports, noting location, duration, intensity (0 to 10 scale), and quality (dull, sharp, constant). Pain becomes constant, intense, and diffuse as inflammation accelerates, and may localize if an abscess forms. Changing location or intensity can signal developing complications.

Maintain semi-Fowler's position as indicated. Drains fluid by gravity, reducing diaphragmatic irritation and abdominal tension.

Move the patient slowly and deliberately, splinting the painful area. Reduces muscle tension and guarding.

Provide comfort measures: massage, back rubs, deep breathing, relaxation, visualization, and diversion. Promotes relaxation and refocuses attention.

Provide frequent oral care and remove noxious stimuli. Reduces nausea and vomiting, which raise intra-abdominal pressure and pain.

Administer medications as indicated. See Pharmacologic Management.

4. Reducing Anxiety and Fear

Evaluate anxiety, noting verbal and nonverbal responses. Encourage free expression of emotions. Severe pain, worsening illness, urgent diagnostics, and the prospect of surgery all heighten apprehension.

Provide information about the disease and anticipated treatment. Knowing what to expect reduces anxiety.

Schedule adequate rest and uninterrupted sleep. Limits fatigue, conserves energy, and improves coping.

5. Improving Nutritional Status

Auscultate bowel sounds, noting absent or hyperactive sounds. Bowel sounds are often absent, but intestinal irritation can cause hyperactivity, poor water absorption, and diarrhea.

Monitor NG tube output. Note vomiting and diarrhea. Large gastric aspirate with vomiting and diarrhea suggests bowel obstruction needing evaluation.

Measure abdominal girth. Quantifies gastric or intestinal distension and ascites.

Assess the abdomen for return to softness, normal bowel sounds, and passage of flatus. Indicates returning bowel function and readiness for oral intake.

Weigh regularly. Early swings reflect hydration; sustained losses suggest nutritional deficit.

Monitor BUN, protein, prealbumin and albumin, glucose, and nitrogen balance. Reflects organ function and nutritional needs.

Advance diet as tolerated, from clear liquids to soft food. Careful progression reduces gastric irritation.

Administer TPN as indicated. Supports nutrient use and positive nitrogen balance when the patient cannot absorb normally.

6. Patient Education and Health Teaching

Review the underlying disease and recovery expectations. Gives patients a base for informed choices.

Identify signs needing medical evaluation: recurrent abdominal pain and distension, vomiting, fever, chills, or purulent drainage, swelling, or erythema of the incision. Early recognition prevents more serious illness.

Discuss the medication regimen, schedule, and side effects. Antibiotics may continue after discharge depending on length of stay.

Recommend gradual return to usual activity with adequate rest. Prevents fatigue and supports well-being.

Review activity limits: avoid heavy lifting and constipation. Prevents unnecessary increases in intra-abdominal pressure and muscle tension.

Demonstrate aseptic dressing change and wound care. Reduces contamination and lets you evaluate healing.

Emphasize medical followup. Monitors resolution of infection and return to activity.

7. Pharmacologic Management

Analgesics, narcotics. Reduce metabolic rate and intestinal irritation from toxins, aiding pain relief and healing. Pain is usually severe and may need narcotic control. Analgesics may be withheld during initial diagnosis because they mask signs and symptoms.

Antiemetics: hydroxyzine (Vistaril). Reduce nausea and vomiting that increase abdominal pain.

Antipyretics: acetaminophen (Tylenol). Reduce discomfort from fever.

8. Diagnostic and Laboratory Procedures

Complete Blood Count (CBC). Elevated WBC, especially with a left shift, points to infection or inflammation. Red cell count and hemoglobin help assess overall status and identify anemia from underlying conditions or blood loss.

Blood Cultures. Identify bacteria in the bloodstream. Positive cultures confirm septic peritonitis and guide antibiotic therapy.

Ascitic Fluid Analysis. Analyzing peritoneal fluid identifies the cause and type of infection (bacterial, fungal, tuberculous) or non-infectious causes such as malignancy or pancreatitis. Parameters include cell count, differential, protein, glucose, lactate dehydrogenase (LDH), and cultures.

Imaging Studies. Abdominal ultrasound, CT, or X-ray visualize the organs and detect the cause, such as appendicitis, diverticulitis, or GI perforation, and assess infection extent, abscesses, and fluid collections.

Peritoneal Fluid Gram Stain. Quickly identifies the presence and type of bacteria, guiding antibiotic choice before cultures return.

C-reactive Protein (CRP). Rises with inflammation. Elevated CRP indicates severity and helps monitor response and antibiotic duration.

Liver Function Tests (LFTs). Elevated ALT, AST, or bilirubin may point to liver disease or bile duct obstruction as a cause.

Renal Function Tests. BUN and creatinine assess kidney function and detect acute kidney injury (AKI) from the condition or sepsis.

9. Monitoring for Complications

Complications arise from the underlying cause, such as infection, trauma, or a perforated organ. Regular monitoring allows early detection and timely intervention.

Assess vital signs regularly. Temperature, heart rate, blood pressure, and respiratory rate flag worsening infection, sepsis, or systemic inflammatory response syndrome (SIRS).

Assess abdominal pain and tenderness. Changes in severity or location may indicate worsening peritonitis, bowel perforation, or abscess.

Monitor for signs of infection. Fever, chills, rising WBC, or purulent drainage signal worsening infection and may require antibiotic changes or further diagnostics.

Assess fluid balance. Intake and output track hydration and renal function. Peritonitis patients are at risk of fluid imbalance from fluid shifts, inflammation, and sepsis.

Assess nutritional status. Malnutrition compromises immunity and delays healing. Weight, intake, and labs (albumin, prealbumin) guide nutritional support.