Nursing Care for Peritonitis

Dina Dewi SLI

Nursing Program of Medical faculty
Brawijaya Univ.
 What is Pertonitis ??
Peritonitis is an
inflammation of the
membrane which lines the
inside of the abdomen &
all the internal
organs.(Encyclopedia of
medicine,2002)
 Types
 Primary :
Meaning that it occur spontaneously
 Diffuse bacterial infection without loss of integrity of GI tract
 Often occurs in adolescents girls
 Streptococcus Pneumonia
 Secondary :
Meaning that it result from other condition
 Acute peritoneal infection resulting :
• GI perforation
• Anastomotic dehiscence
• Infected pancreatitic chronic
 Often involved multiple organism (aerobes & anaerobes)
 Commonest organisms are E.coli & Bacteriodes Fragilis
 Etiology
 Primary :
o Blood Infection
o Liver Disease (cirrhosis )
o Accumulated Fluid in abdomen
 Secondary:
o Spillage of bacteria, enzymes or bile into
the peritoneum
o Tears can occur as a result of infected
internal organ (ruptured appendicitis,
abdominal surgery complication )
 Phatophysiology
Inflammation of abdominal
organ

Inflammation of over lying

peritoneum

Fibrous exudate form on peritoneal

surface

Fibrin wall forms around lesion Abscess /adhesions

Clinical Manifestation (Sign/ Symptom)
 Swelling & tenderness in the abdomen
 Fever & Chills
 Loss appetite
 Nausea & Vomiting
 Increasing breathing & Heart rate
 Shallow breaths
 Low blood Pressure
 Limited Urine Production
 Inability to pass gas or feces
 Board like (perut seperti papan)
Assessment & Diagnostic Finding
 Physical Assessment
 Feel & press the abdomen to detect any
Swelling & Tenderness
 Bowel sound
 Difficulty breathing
 Low Blood Pressure
 Signs of Dehydration
 Diagnostic Tests
 WBC : elevated to 20.000/mm³
 High Neutrophil count
 Blood Culture
 Parasyntesis : identifies microorganism
 CT-Scan
 Chest X-rays
 Electrolyte balance & Renal Status
 ABG
 Complication
 Pre/without operative :
Sepsis
Shock
Intestinal obstruction
 Post Operative :
 Wound evisceration
 Abscess formation
 Medical Management
 Fluid, Colloid & electrolyte replacement
 Analgesic
 Antibiotic therapy
 Surgical
 Nutrition & Dietary Suplement
 Diagnosa Keperawatan
1. Risiko Tinggi infeksi (Septikemia) b.d tidak
adekuaynya pertahanan primer
2. Kekurangan Volume cairan b.d Perpindahan
cairan dari ekstraseluler, intraseluler &
interstisial yang berlebihan
3. Gangguan kebutuhan nutrisi kurang dari
kebutuhan b.d pengeluaran berlebihan (mual
muntah), disfungsi usus
4. Gangguan rasa nyaman : nyeri b.d iritasi
kimia peritoneum perifer
5. Ansietas b.d ancaman kematian/ perubahan
status kesehatan.
 Rencana intervensi Dx.1
1. Kaji tanda-tanda vital
2. Catat perubahan status mental
3. Catat warna kulit
4. Pertahankan teknik aseptik
Kolaborasi :
5. Perhatikan hasil Px darah, urine, kultur luka
6. Bnatu aspirasi peritoneal
7. Berkan anti mikrobial
 Rencana Intervensi Dx.2
1. Pertahankan masukan & haluaran cairan
2. Ukur BJ urine
3. Observasi kulit dan membra mukosa
Kolaborasi
4. Perhatikan hasil Lab. : Hb/Ht, Elektrolit,
protein, BUN, kreatinin
5. Berikan Plasma cairan
6. Pertahankan puasa & aspirasi NGT
 Rencana intervensi Dx. 3
1. Observasi haluaran NGT
2. Auskultasi bising usus
3. Timbang BB
4. Berikan diet sesuai toleransi
Kolaborasi
5. Berkan Hiperalimentasi