Peritonitis: Nursing and Interprofessional Management

Peritonitis: Interprofessional and Nursing Management

• Peritonitis is inflammation of the peritoneum resulting from bacteria or irritating chemicals.
• Initially, chemical peritonitis progresses to bacterial peritonitis.
• Manifestations include severe, continuous abdominal pain, rebound tenderness, rigidity, spasm, shallow breathing, abdominal distension, fever, tachycardia, nausea/vomiting, appetite loss, and altered bowel habits.
• A universal sign is tenderness over the involved area (localized vs. generalized).
• It can lead to hypovolemic shock, sepsis, paralytic ileus, intra-abdominal abscess, and ARDS.
• Diagnostic studies include CBC (WBC, H&H), CMP (electrolytes, organ function), peritoneal aspiration, abdominal X-ray, and US/CT scan.
• Preoperative care includes NPO status, NG suction, IV fluids, antibiotics, and analgesia.
• Mild cases or patients with poor surgical risk receive NPO, NG suction, IV fluids, ABX, analgesia, and antiemetics.
• Surgical intervention involves locating the source, draining purulent fluid, and repairing damaged organs.
• Postoperative care includes NPO, NG suction, blood monitoring, parenteral nutrition, antibiotics, sedatives, opioids, and antiemetics.
• Implementation includes IV fluids and antibiotics, pain management through analgesia and positioning, anxiety relief, VS monitoring, antiemetics, NPO with NG tube, and drain care.

Small vs. Large Bowel Obstructions

• Intestinal obstruction is the inability to pass intestinal contents through the intestinal tract.
• It can be partial (some contents pass) or complete (total occlusion, requires surgery).
• Simple obstructions have an intact blood supply, while strangulated obstructions do not.
• Fluid, gas, and intestinal contents back up proximally, leading to bowel distention, fluid absorption, and stimulated intestinal secretion.
• Increased pressure in the bowel lumen leads to capillary permeability and extravasation of fluids/electrolytes into the peritoneal cavity.
• This decreases circulating blood volume, causing hypotension and hypovolemic shock.
• Eventually, intestinal muscle fatigues and peristalsis stops, leading to distention and poor perfusion.
• Prolonged ischemia leads to necrosis and gangrene, which can result in perforation.
• Perforation requires immediate treatment to avoid severe infection, septic shock, and death.
• Clinical manifestations depend on cause, location, and type of obstruction.
• SBO is most commonly due to surgical adhesions, while LBO is most commonly due to CRC or diverticular disease.
• SBO: rapid onset, frequent copious vomiting, colicky intermittent pain in mid-upper abdomen, may produce stool at first, minimal abdominal distention.
• LBO: gradual onset, vomiting is rare, persistent crampy lower abdominal pain, no stool (obstipation), complete obstruction is more noticeable abdominal distention.
• Diagnostic studies include abdominal X-rays, CT scan, contrast enema for HIP, sigmoidoscopy or colonoscopy for LBO, and blood tests (CBC, CMP).
• The goal is to regain intestinal patency, dependent on cause.
• Emergency surgery is for strangulation or perforation, and resection of obstructed bowel with anastomosis.
• Partial or total colostomy/ileostomy is for obstruction, necrosis, or perforation.
• Colonoscopy can remove polyps, dilate strictures, laser destruction, and remove tumors.
• Conservative management is preferred for paralytic ileus and adhesion-related obstructions.
• Nursing management ensures early recognition of deterioration and monitoring of pain characteristics, vomiting, bowel function, and abdominal assessment.
• Strict I/O and assessment for acid-base imbalances are crucial.

Bowel Resection and Ostomy Surgery

• Bowel Resection is indicated for removing cancer, repairing perforation/fistula/traumatic injury, relieving obstruction/stricture, or treating abscess/inflammatory disease/hemorrhage.
• An ostomy is a surgically created opening on the abdomen for fecal elimination.
• Stoma is the outermost visible part, with the bowel brought to the outside and sutured in place.
• Names are allocated to location and type.
• Care is performed by adhesive systems of skin barriers and pouches
• Transparent pouches are used to visualize stomas
• Changing a failed pouch immediately
• Pouches should be emptied when 1/3 full
• Charcoal filters are used to deodorize and irrigate for regulation
• Education for both patient and caregivers is key for diet, resources and problems
• Patients can usually resume ADLs after 6–8 weeks
• Patients may experience emotions such as grief, anger, depression
• It is important to discuss body image and self-esteem
• Provide education on ostomy function and care.
• Teach patients to remove old skin barriers, cleanse skin and apply new materials
• Teach patients how to apply, empty and remove pouches
• Stress the importance of emptying the pouch ones it is approximately 1/2 full
• Explain how to obtain ostomy supplies
• Elaborate of what signs to look for that may signify a problem.
• Diet: To prevent obstruction in ileostomy, patients should avoid corn, nuts, raisins, skins, fruits with casings
• Sexual Function: Possible vascular disruption, Males concern with ejaculation, Females with arousal and orgasm
• Ostomy: Pouching and security alternatives and care
• Can be temporary or permanent; A "takedown procedure" to reverse output can take place.
• End stomas are mostly permanent; double-barrel stomas are more often temporary
• Prior care involves prep, education, pre-op site selection.
• Care should be taken to assess of any possible complications, edema, redness, drainage or fever
• Monitor stoma characteristics and ensure that the pouch is clear
• Ileostomy output is in minimal form.
• Output volume, color and consistency should be constantly charted
• There should be an overall maintenance of anal function and pain control.
• Kegel exercises and skincare are also imperative.

Gallbladder Disorders

• Cholelithiasis: stones in the gallbladder.
• Bile salts form to make stones.
• Cholecystitis: inflammation of the gallbladder, typically associated with gallstones.
• Cholelithiasis is the most common form of biliaty system disease.