UNIT 8 PERONTINITIS and FISTULA

Question 1

What is Peritonitis?

Answer 1

Peritonitis is a life-threatening, acute inflammation and infection of the visceral/parietal peritoneum and endothelial lining of the abdominal cavity.

Question 2

Signs and Symptoms of Peritonitis?

Answer 2

S/S –
* Based on location and extent – i.e. peptic ulcer
perforation – sudden, sharp mid-epigastric pain;
perforated appendix – abdominal pain worsen with
activity & pain relief when hips are flexed.
* Symptoms of cause come first – i.e. fever, increase
WBC, tachycardia, & hypotension.
* Abdominal distention, and bloating.
* Rigid, and board-like abdomen.
* N/V, and hypoactive to no bowel sounds.

• Rigid, board-like abdomen (classic)
• Abdominal pain (localized, poorly localized, or referred to the shoulder or chest)
• Distended abdomen
• Nausea, anorexia, vomiting
• Diminishing bowel sounds
• Inability to pass flatus or feces
• Rebound tenderness in the abdomen
• High fever
• Tachycardia
• Dehydration from high fever (poor skin turgor)
• Decreased urine output
• Hiccups
• Possible compromise in respiratory status

Question 3

What is the cause of Peritonitis?

Answer 3

Life threatening
* Causes –
* Usually from bacteria in the GI (i.e. perforated
appendix, diverticulitis or peptic ulcer) and female
reproductive system
* External trauma – i.e. penetrating wounds
* Abdominal procedures and peritoneal dialysis

Question 4

Where would a pt complain of pIN WITH when experiencing pERITONITIS?

Answer 4

epigastric pain with PUD

Question 5

Symptoms of Peritonitis

Answer 5

Monitor for signs and symptoms of shock.
* Monitor for signs and symptoms of sepsis.
* Monitor for intestinal obstruction.
* Fluid replacement.
* Insertion of nasogastric tube (NGT).
* Drug therapy – i.e. Famotidine, Acetaminophen.
* Monitor gastrointestinal functioning.
* Paracentesis or drains.
* Pain management.
* Surgery – i.e. exploratory laparotomy. *Post-op care.
* Antibiotics
* NGT, surgery
* IVF

Question 6

What is the best position to place a pt with active peritonitis?

A. High fowlers
B.Trensdelengdug
C. Semi fowlers
D. Prone

Answer 6

C. Semi fowlers

Monitor the patient’s level of consciousness, vital signs, respiratory status (respiratory rate and breath sounds), and intake and output at least hourly immediately after abdominal surgery. Maintain the patient in a semi-Fowler position to promote drainage of peritoneal contents into the lower region of the abdominal cavity. This position also helps increase lung expansion.

Question 7

NCLEX Examination Challenge 52.1
Safe and Effective Care Environment
A client had an exploratory laparotomy to treat the cause of peritonitis and has a large incision that is closed with staples and two abdominal drains. Which finding(s) would the nurse report immediately to the surgeon? Select all that apply.
A. Serosanguineous drainage
B. Increased abdominal distention
C. Fever and chills
D. Pain level 2 on a scale of 0 to 10
E. Passing flatus

Question 8

What should you monitor a ppt for when diagnosed with Peritonitis?

Answer 8

Monitor for signs and symptoms of shock.
* Monitor for signs and symptoms of sepsis.
* Monitor for intestinal obstruction.
* Fluid replacement.
* Insertion of nasogastric tube (NGT).
* Drug therapy – i.e. Famotidine, Acetaminophen.
* Monitor gastrointestinal functioning.
* Paracentesis or drains.
* Pain management.
* Surgery – i.e. exploratory laparotomy. *Post-op care.
* Antibiotics
* NGT, surgery
* IVF

Question 9

Which of the following is a sign of Peritonitis or shock?

A. hypotension
B. bradycardia
C. hypoglycemia
D. constricted pupils

Answer 9

A. hypotension

Question 10

What is a fistula

Answer 10

Abnormal opening (tract) between two organs or structures.
teaching
* Diet high calories, high protein
* High risk for sepsis