Bacterial or chemical inflammation (see Causes of peritonitis)
Causes of peritonitis
Typically the cause of peritonitis depends on the type of peritonitis the patient is experiencing.
Primary peritonitis (spontaneous bacterial peritonitis or SBP )
Invasion of bacteria from the gut wall or mesenteric lymphatics
Complication of any disease state, but most commonly patients with cirrhosis who are debilitated
Gram-negative: Escherichia coli, Klebsiella pneumonia, Pseudomonas, Proteus
Gram-positive: Streptococcus pneumoniae, other Streptococcus species, and Staphylococcus species
Perforated gastric or duodenal ulcer
Perforated colon secondary to diverticulitis, volvulus, or cancer
Strangulation of small bowel
Gram-negative: E. coli, Enterobacter, Proteus, Pseudomonas
Gram-positive: streptococci, staphylococci
Anaerobic: Bacteroides, Clostridia
Most common in immunocompromised patients and those with significant pre-existing conditions
Tuberculosis (rare in U.S.)
Patients with human immunodeficiency virus infection
GI tract perforation (from appendicitis, diverticulitis, peptic ulcer, or ulcerative colitis)
Ruptured ectopic pregnancy
Broad-spectrum I.V. antibiotics based on the infecting organism, such as cefotaxime sodium, amoxicillin-clavulanate potassium, cefoxitin sodium, cefotetan, ticarcillin disodium-clavanulate potassium, piperacillin sodium -tazobactam sodium, ampicillin-sulbactam, imipenem, vancomycin hydrochloride and gentamicin (peritoneal instillation), and ofloxacin
Metronidazole for fungal infection
Diuretics, such as furosemide, to reduce ascitic fluid
Fluid and electrolyte replacements
Analgesics for pain; antiemetics for nausea and vomiting
Initiate I.V. access if one is not already in place, maintain I.V. site and ensure patency, and administer I.V. fluids and electrolytes as ordered. Provide I.V. site care according to facility policy.
Give prescribed drugs; administer I.V. antibiotics as ordered.
Encourage the patient to express his feelings and concerns; provide emotional support and comfort measures.
Institute cardiac monitoring as indicated. If hemodynamically unstable, anticipate the need for hemodynamic monitoring.
Provide NG tube care, ensure patency of NG tube, and note the color and characteristics of the drainage.
Maintain NPO status, auscultate bowel sounds, evaluate abdomen for tenderness and rigidity, and begin oral intake as indicated by return of bowel sounds and passage of flatus and stool.
Assist the patient in assuming a position of comfort; elevate the head of the bed to assist with pain relief and promote maximum chest expansion.
Prepare the patient and the family for possible surgery, including what to expect after surgery, such as equipment, monitoring, drainage devices, and wound care.
disorder, possible underlying cause, diagnosis, and treatment, including the possibility of surgery if necessary
prescribed medication therapy, including the drug name, dosage, frequency of administration, and duration of therapy
need to continue oral antibiotics for a specified number of days even if the patient is feeling better to ensure complete resolution of infection
possible adverse effects of medication, such as nausea, vomiting, gastric distress, and rash
preoperative and postoperative measures, such as coughing and deep-breathing techniques, leg exercises, position changes, incentive spirometry, and monitoring
signs and symptoms of infection
incisional/drainage site care, including signs and symptoms of infection and dressing changes as appropriate
dietary and activity limitations (depending on type of surgery)
importance of follow-up care as indicated.