peritonitis dictation report sample on patient

Medication

Here are six (6) nursing care plans (NCP) and nursing diagnosis for patients with peritonitis: 1. Risk for Infection 1. Risk for Infection 2. Deficient Fluid Volume 3. Acute Pain 4. Risk for Imbalanced Nutrition: Less Than Body Requirements 5. Anxiety/Fear 6. Deficient Knowledge 7. Other Possible Nursing Care Plans Not applicable.

Procedures

The doctor will also listen to and feel your abdomen to look for signs of peritonitis, including pain to touch, and a firm, “board-like” consistency. Examination can be impossible for some patients with severe pain.

Nutrition

Pain to palpation is the most characteristic sign of peritonitis, to both deep and superficial touch. Initially there is voluntary guarding; subsequently the muscular wall undergoes an involuntary and severe spasm. Bowel sounds may or may not be present, and they may resemble an early ileus.

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In patients who have peritonitis secondary to perforated diverticulitis, the decision to perform a primary anastomosis should be based on an individual basis, according to the patient's stability and the surgeon's judgment [100–103]. More recently, primary colonic anastomosis has been advocated in the setting of acute trauma of the colon [104–111].

What are the nursing care plans for patients with peritonitis?

What does a doctor look for in a peritonitis exam?

What are the signs and symptoms of peritonitis?

When is primary colonic anastomosis indicated in the treatment of peritonitis?

What is the conclusion of peritonitis?

In conclusion, peritonitis was independently associated with a higher risk of all-cause, infection-related and cardiovascular mortality, in those patients on peritoneal dialysis longer than 2 years who experienced a peritonitis.

How do you test for peritonitis?

How is peritonitis diagnosed?X-rays. Imaging tests that make pictures of your body's tissues, bones, and organs.Blood, fluid, and urine tests. These tests are done to find out what is causing the infection.CT scans (computed tomography scans). ... MRI. ... Surgery.

What is the most common cause of peritonitis?

In most cases, the cause is a rupture (perforation) within the abdominal wall. Though it's rare, the condition can develop without an abdominal rupture. Common causes of ruptures that lead to peritonitis include: Medical procedures, such as peritoneal dialysis.

What is the pathophysiology of peritonitis?

Peritonitis is most often caused by introduction of an infection into the otherwise sterile peritoneal environment through organ perforation, but it may also result from other irritants, such as foreign bodies, bile from a perforated gall bladder or a lacerated liver, or gastric acid from a perforated ulcer.

Who can diagnose peritonitis?

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.

What is the most specific exam finding for diagnosing peritonitis?

Rigidity (involuntary contraction of the abdominal muscles) is the most specific exam finding for diagnosing peritonitis.

Who is at risk for peritonitis?

Peritonitis is the major complication of peritoneal dialysis. According to previous reports, the risk factors for peritonitis include age, gender, smoking, diabetes, low education level, depression, low residual renal function, and low serum albumin level [13-17].

What is the most common complication of peritonitis?

Aggressive fluid resuscitation and early surgical intervention are the mainstay of therapy of peritonitis. Enterocutaneous fistulas, surgical site infection, sepsis, and multiorgan failure are the commonest complications seen in surgical settings.

How many stages of peritonitis are there?

Peritonitis is divided into three stages. The division is based on the defensive and inhibitory mechanisms of the host.

What are the complications of peritonitis?

Complications of peritonitis include tertiary peritonitis, infection or dehiscence of the surgical site, enterocutaneous fistula, abdominal compartment syndrome, and enteric insufficiency.

Which bacteria can cause peritonitis?

Escherichia coli, streptococci (mostly pneumococci), and Klebsiella cause most episodes of spontaneous bacterial peritonitis in patients who are not receiving selective intestinal decontamination (Garcia-Tsao 1992).

What is the difference between primary and secondary peritonitis?

The two main types of peritonitis are primary spontaneous peritonitis, an infection that develops in the peritoneum; and secondary peritonitis, which usually develops when an injury or infection in the abdominal cavity allows infectious organisms into the peritoneum. Both types of peritonitis are life-threatening.

What are the symptoms of peritonitis?

Fatigue. Diarrhea. Nausea or vomiting. Racing heart rate. Abnormal breathing. Some patients (especially those with cirrhosis) might not show any symptoms at all, which can make it difficult to detect and treat quickly. If you show any signs of peritonitis, go to the emergency room or call an ambulance right away.

How do you know if you have peritonitis?

Pain can be so intense that individuals resort to curling up in a ball as they try to stay as still as possible. The most common symptom is sudden, extreme abdominal pain that gets worse when you touch the affected area or move around.

What is the term for a condition where fluid builds up in the abdominal cavity?

Spontaneous bacterial peritonitis (SBP), or primary peritonitis, is when body fluid builds up in the abdominal cavity (a condition called ascites ) and results in inflammation. Unlike with secondary peritonitis, where the peritoneal inflammation is often due to an identifiable infection, SBP is an infection of the ascites and enclosing peritoneum without a clear source.

What causes peritonitis in the abdomen?

Causes. Peritonitis occurs when body fluids like blood or pus pool in the abdominal cavity. Why this happens, however, can vary. The two primary causes of peritonitis are spontaneous bacterial peritonitis (also called primary peritonitis) and secondary peritonitis.

What test is used to test for peritonitis?

Depending on the results of the physical exam, your healthcare provider might also recommend getting lab tests, such as a white blood cell count, urinalysis, or cultures, to look for signs of infection. A common diagnostic test used to detect peritonitis involves taking a sample of the fluid in your abdomen to test it for infection.

Why do you need surgery for peritonitis?

For secondary peritonitis, surgery is sometimes necessary to eliminate the source of infection. This is especially true if the peritonitis is the result of a swollen or burst appendix, sores caused by stomach or intestinal ulcers, or inflamed or perforated diverticula (tiny pouches in the colon).

What to do if you have peritonitis?

If you show any signs of peritonitis, go to the emergency room or call an ambulance right away. Sudden abdominal pain may have other causes, but medical attention is required to determine the issue and start treatment. In serious cases, peritonitis can cause life-threatening issues like shock, sepsis, hypothermia, internal bleeding, ...

How to manage tertiary peritonitis?

The management of tertiary peritonitis should be done in the ICU, and should be performed by a multidisciplinary team. The patient will require metabolic and nutritional support, as well as hemodynamic and respiratory care; early physical therapy is ideal. An opportune and timely decision to adjust antibiotics according to the most recent culture report of blood and of the abdominal cavity should be made in conjunction with the surgeon and the intensivist. From the surgical viewpoint, the decision for on-demand relaparotomy should be made in advance, and decisions for reoperation should not be delayed. If the decision has been made for management with an open abdomen with planned laparotomy using a mesh, then it should be decided when to suspend the repeated lavages of the abdominal cavity, because these can cause more damage than benefit after the fifth or sixth procedure. Antimicrobial therapy should not exceed 14 days, except in patients who have fungal infections [34–38].

What is primary peritonitis?

Primary peritonitis is an inflammation of the peritoneum by an extraperitoneal source , frequently occurring from hematogens dissemination. It occurs in children and adults, and can endanger life, particularly in patients who have cirrhosis or in children who have nephrosis. Primary or spontaneous peritonitis relates to the deterioration of the immune defenses of the guest. It is generally produced by a single micro-organism, and the main pathogens in adults are the coliforms. In fact, 70% of these infections they are caused by Escherichia coli, 10% to 20% by gram-positive cocci, and 10% by anaerobes. The management includes antibiotics and fluid resuscitation. Occasionally the patient may have to undergo surgery, usually as a diagnostic laparotomy characterized by finding purulent material with gram-positive cultures without obvious perforation or abscesses in solid organs [1,24].

Why is peritonitis so serious?

This type of intra-abdominal infection is usually serious because of the delay in diagnosis, especially in patients who have multiple injuries and associated traumatic brain injury. Patients who suffer a penetrating trauma by sharp weapon or by firearm, with an acute abdomen, are operated on immediately and the injury is controlled. Generally, the intra-abdominal infection secondary to contamination seen in penetrating traumatism is a function of the time lapsed between the injury and the surgery. Only a third of the patients who have penetrating trauma of the colon have contamination of the cavity peritoneal that requires treatment with antibiotics [26–28].

What is the systemic response of bacterial peritonitis?

The systemic response of to a severe bacterial peritonitis will then include the liberation of catecholamines, and an increase of the secretion of hormones adrenocorticoids, as well as the secretion of aldosterone and antidiuretic hormone. The hemodynamic alterations that are observed in patients who have peritonitis have several causes. The hypovolemia decrease the extracellular volume by the massive shift of fluids toward the peritoneal cavity, producing a decrease in cardiac index, increase of the resistance vascular peripheral, and oxygen consumption increase in the periphery. IL-2 and IL-8 favor cell recruitment; this stimulus of the cell abduction is so profound that pancytopenia can be observed some 4 to 6 hours after the initial stimulus. It has been difficult, however, to show the direct correlation between the magnitude of the septic answer and the concentration of circulating cytokines [20–23].

What is the effect of fibrinogen on septic foci?

As a consequence of this inflammation there is production of fibrinogen in the septic foci, with fast formation of fibrin, creating a mesh of fibrin that temporarily reduces and blocks the reabsorption of fluid from peritoneal cavity and “traps” bacteria. This phenomenon may generate the formation of an abscess. In addition, the omentum migrates toward the inflamed area and aids in delivering mediators and cells to facilitate the abscess formation. The most common location is the subphrenic areas.

What is the initial response of the peritoneum against the bacterial contamination?

The initial response of the peritoneum against the bacterial contamination is characterized by hyperemia and increased exudates of fluid with phagocytes into the peritoneal cavity. In this initial stage these are predominately macrophages. Neutrophils arrive within 2 to 4 hours, and become the predominant cells of the peritoneal cavity by the first 48 to 72 hours. These cells release great amount of cytokines such as interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF), leukotriens, platelet activating factor, C3A and C5A, that promotes even more local inflammation. The combined effect of these mediators contributes to observed inflammatory response during peritonitis. As there is destruction of the bacteria, the lipo-polysacharids of gram-negative Enterobacteriaconstitute a powerful stimulus for further generation of inflammatory cytokines [18,19].

What is the peritoneum made of?

The peritoneum is a single layer of mesothelial cells resting on a basal membrane, and a bed of conjunctive tissue formed by adipose cells, macrophages, fibroblasts, lymphocytes, and some elastic fibers of collagen. The abdominal cavity is covered by the parietal peritoneum and it turns into the visceral peritoneum to cover the abdominal viscera. The total surface of the peritoneum is approximately 1.7 m2. In normal conditions it is sterile, and it contains 50 mL of yellow fluid, which contains a few macrophages; mesothelial cells generally and lymphocytes. Most of the peritoneal membrane behaves like a passive barrier, semipermeable to the bidirectional diffusion of water and most solutes. The total surface of interchange of the peritoneal cavity is approximately 1 m2. Unlike liquids and most solutes, larger particles are eliminated through the larger orifices that exist between the specialized mesothelial cells that cover the lymphatic conduits on the diaphragmatic surface of the peritoneal cavity. These intracellular orifices correspond to fenestrations of the basal membrane, and together serve as conduits of the peritoneal cavity to the underlying lymphatic drainage system of the diaphragm, called “lakes” or “lagoons.” The reabsorption of particles or bacteria is only possible in the subdiaphragmatic peritoneal surface through numerous stomas or intracellular lagoons, to which a network of lymphatic vessels flows into the diaphragmatic lacunas. These lacunas have a diameter of 8 to 12 microns, subject to variations depending on the diaphragmatic movements and the changes of thoraco-abdominal pressure. Smaller particles, such as bacteria that by general are approximately 2 microns in diameter, are readily absorbed through diaphragmatic lacunes into the thoracic duct. Intra-peritoneal fluid and exudates circulate constantly in the cavity toward the decanting zones via gravity, and toward the subphrenic spaces by the suction caused by diaphragmatic contraction. This works like a suction pump. It accelerates the flow during inspiration, and diminishes or restrains it during expiration, and it is probably the most important mechanism in charge of the “defensive” cleansing of the peritoneum [1,4].

How many nursing care plans are there for peritonitis?

Here are six (6) nursing care plans (NCP) and nursing diagnosis for patients with peritonitis:

What causes peritoneal peritonitis?

When bacteria invade the peritoneum due to an inflammation or perforation of the GI tract peritonitis usually occur s. Bacterial invasion usually results from appendicitis, diverticulitis, peptic ulcer, ulcerative colitis, volvulus, abdominal neoplasms, or a stab wound. It may also be associated with peritoneal dialysis.

What is peritoneal inflammation?

Peritonitis is the acute or chronic inflammation of the peritoneum, the membrane that lines the abdominal cavity and covers the visceral organs. Inflammation may extend throughout the peritoneum or may be localized as an abscess. Peritonitis commonly decreases intestinal motility and causes intestinal distention ...

What antibiotics are used to remove fluid from the peritoneum?

Administer antimicrobials: gentamicin (Garamycin), amikacin (Amikin), clindamycin (Cleocin), via IV/peritoneal lavage.

What are the signs of septic shock?

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

Is a risk diagnosis evidenced by signs and symptoms?

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.

Is surgery a cure for peritonitis?

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. 1. Risk for Infection. 1.

Where was the longitudinal incision made?

A longitudinal incision was then made in the mid thigh medially, which entered the subcutaneous cavity. The blood was under extreme pressure and was not coagulated and very runny. All the blood was evacuated. The incision was extended for a total distance of 30 cm along the thigh.

What is the procedure for a postoperative wound infection?

PROCEDURE PERFORMED: Incision and drainage of complex postoperative wound infection.

How was the anteromedial right leg treated?

General anesthesia was administered. He was then prepped and draped in the usual sterile fashion. Skin was incised sharply with a scalpel over the fluctuant mass in the anteromedial right leg. Copious amount of purulence was drained; this was suctioned. The wound was probed. The fibrous bands were broken up. The skin incision was extended both superiorly as well as inferiorly. Hemostasis was achieved with electrocautery. The wound was then packed with Betadine-soaked gauze. A dry dressing was placed around this followed by an Ace wrap. The patient tolerated the procedure well. He was extubated and transported to the recovery area in stable condition.

What was used to clean the abscess cavity?

Loculations were broken up inside the abscess cavity with digital inspection, and there was no evidence of any significant tracking of purulence up or down any muscle or fascial planes. Copious irrigation was then used to clean the abscess cavity. Cautery was used as needed to provide for hemostasis.

Is the fascia intact after pulsatile lavage?

The fascia was intact. After evacuation of the hematoma and irrigation with pulsatile lavage, bacitracin solution was used followed by gentle debridement back to excellent fresh tissue with excellent color and bleeding response. There was no necrosis, no obvious pus.

What Is Peritonitis?

Pathophysiology

Causes

Clinical Manifestations

Complications

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Assessment and Diagnostic Findings

Medical Management

Surgical Management

Practice Quiz: Peritonitis

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