peritonitis patient report dictation sample

Medication

The guidelines recommend a diagnosis of peritonitis with at least two of the following: Clinical signs and symptoms such as abdominal pain and/or cloudy effluent Dialysis effluent white cell count >100 cells/µL after a dwell time of ≥2 hours and >50% of cells are polymorphonuclear Positive dialysis effluent culture

Procedures

The PD effluent should be tested for cell count, differential, Gram stain, and culture when peritonitis is suspected. Patients with peritonitis usually present with cloudy effluent and abdominal pain.

Nutrition

Peritonitis is the inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera. Usually, it is a result of bacterial infection; the organisms come from diseases of the GI tract, or in women, from the internal reproductive organs.

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• Abdominocentesis is the preferred diagnostic method for confirming peritonitis. • When abdominal fluid cytology reveals degenerative neutrophils and intracellular bacteria, confirming a diagnosis of septic peritonitis, emergency surgical exploration of the abdomen is indicated.

What are the guidelines for the diagnosis of peritonitis?

Which lab tests are performed in the workup of peritonitis?

What is peritonitis?

How is septic peritonitis (hp) diagnosed?

What is the peritoneum of diverticulitis?

Peritonitis is the inflammation of the peritoneum, the serous membrane lining the abdominal cavity and covering the viscera.

What causes peritonitis in the kidneys?

Inflammation. An inflammation that extends from an organ outside the peritoneal area such as the kidne ys could cause peritonitis. Bacteria. The most common bacteria implicated are Escherichia coli, Klebsiella, Proteus, Pseudomonas, and Streptococcus.

What is the best treatment for peritonitis?

Oxygen therapy. Oxygen therapy by nasal cannula or mask generally promotes adequate oxygenation. Antibiotic therapy. Antibiotic therapy is initiated early in the treatment of peritonitis.

What is the immediate response of the intestinal tract?

Response. The immediate response of the intestinal tract is hypermotility, soon followed by paralytic ileus with an accumulation of air and fluid in the bowel.

What is the pathophysiology of peritonitis?

The pathophysiology of peritonitis involves: Leakage. Peritonitis is caused by leakage of contents from abdominal organs into the abdominal cavity. Proliferation. Bacterial proliferation occurs. Edema. Edema of the tissues occurs, and exudation of fluid develops in a short time. Invasion.

What is the major cause of death from peritonitis?

Sepsis. Sepsis is the major cause of death from peritonitis. Shock. Shock may result from septicemia or hypovolemia. Intestinal obstruction. The inflammatory process may cause intestinal obstruction, primarily from the development of bowel adhesions.

What should a nurse do with drains?

The nurse should educate the patient and the family about the care for incisions and drains if the patient will be sent home with the drains still in place. Referral. Referral for home care may be indicated for further monitoring and patient and family teaching.

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 causes oliguria in the kidney?

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.

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 peritoneum sterile?

mortality is 10% with death usually a result of bowel obstruction. The peritoneum is sterile, despite the GI tract normally contains bacteria.

Who is Matt Vera?

Matt Vera, BSN, R.N. Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible.

What is peritoneal dialysis?

Introduction to Peritonitis in Peritoneal Dialysis. Peritonitis is the inflammation of the peritoneum or peritoneal membrane. This type of inflammation typically has an infectious etiology that is mainly caused by bacteria (~80% of cases). Bacterial infections mainly come from contamination during a peritoneal dialysis (PD) session.

How to prevent peritonitis?

In order to prevent peritonitis, both exit-site infections and catheter-tunnel infections must be prevented. The guidelines recommend prophylactic antibiotic therapy right before insertion of the catheter. No single catheter has been shown to have better outcomes than another in regards to peritonitis rates but ISPD does recommend disconnect systems with a “flush before fill” design with continuous ambulatory PD (CAPD). In addition, the guidelines recommend training programs for patients and that they be conducted by health care providers with experience. To prevent exit-sit infections, the guidelines recommend topical antibiotics like mupirocin or gentamicin daily. If an exit-site infection develops, treatment should be prompt and targeted to decrease the risk of peritonitis development.

What is the most common complication of PD?

Peritonitis is a major complication of PD due to the structural changes in the peritoneal membrane that result from PD. Approximately 4% of peritonitis episodes result in death. Since peritonitis is one of the more common complications of PD, it has caused patients to switch from this modality to hemodialysis.

What does cloudy effluent mean?

Cloudy effluent usually represents infectious peritonitis, but there could be differential diagnoses aside from infectious peritonitis, such as chemical peritonitis which is a possible side effect of calcium channel blockers, eosinophilia of the effluent, hemoperitoneum, malignancy, chylous effluent, or specimen taken from a dry abdomen.

How long does it take for WBC to be repeated?

The guidelines recommend repeat WBC count with differential if the effluent yields no growth after 3 days. If the peritonitis has not clinically improved at day 3, special culture techniques that test for mycobacteria, nocardia, legionella, filamentous fungus, or other fastidious bacteria should be considered.

Why should fungi be removed from catheters?

Catheters should be removed immediately once fungi are identified for improved outcomes and reductions in mortality.

How long does it take for a PD patient to show improvement?

Most PD patients with peritonitis will show considerable clinical improvement within 48 hours of initiating therapy.

What Is Peritonitis?

Pathophysiology

Causes

Clinical Manifestations

Complications

Assessment and Diagnostic Findings

Medical Management

Surgical Management

Practice Quiz: Peritonitis

See Also

• Assessing and diagnosing peritonitis involves the following: 1. Increased WBC.The white blood cell count is almost always elevated. 2. Serum electrolyte studies. Serum electrolyte studies may reveal altered levels of potassium, sodium, and chloride. 3. Abdominal xray.An abdominal xray may show air and fluid levels as well as distended bowel loops. ...

See more on nurseslabs.com

Introduction to Peritonitis in Peritoneal Dialysis

Diagnosis of Peritonitis in Peritoneal Dialysis

Identification of Causative Organism

Treatment of Peritonitis as Suggested by The ISPD 2016 Guidelines

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