welcome to nursing school explained in this video on peritonitis peritonitis meaning inflammation of the peritoneum and remember that the peritoneal cavity basically includes all of the organs of the abdomen all of the digestive and genital urinary organs that you can basically think of so causes that lead to inflammation of the peritoneum can be either localized or systemic so when we think systemic infection or inflammation we always have to think of sepsis but any kind of gi or gu infection can also lead to peridot peritonitis as well as cirrhosis with acids so now because of all the leakage of the fluid into the abdominal cavity into the peritoneum the ascites fluid that's been escaping from the blood vessels really causing this third spacing can be inflamed then lead to peritonitis and then really any kind of abdominal condition you can think about any kind of abdominal itis so appendicitis diverticulitis pancreatitis any of the inflammations of the abdominal organs can lead to peritonitis which is basically that just those localized infections now getting worse spreading into that peritoneal cavity also abdominal trauma for example so if there is let's say a car accident and the patient's bladder ruptures so now the urine leaks all over the peritoneum causing inflammation and peritonitis and then there are certain other risk factors such as intestinal perforation from let's say a small bowel obstruction or any of the inflammatory inflammatory bowel disorders crohn's disease or ulcerative colitis that can cause that toxic mega colon and the intestine to burst and also peritoneal dialysis when the exchange of the fluids and electrolytes happens through that peritoneal cavity if the fluid gets infected or we are not extra careful or something happens to the dialysis catheter now we have inflammation of the peritoneum or it can be a post-op leak so any kind of abdominal even exploratory surgery that you can imagine can lead to peritonitis and a telltale sign of peritonitis is severe abdominal pain so now let's say you are taking care of a patient who is admitted after an appendicitis and now they are just getting abdominal pain that is much more severe as you would expect for a patient with with appendicitis to have so this abdominal pain will definitely be severe which is why we have to monitor our patients very carefully there will be rebound tenderness so the tenderness will not occur and when you palpate when you press on the patient's abdomen but when you release that pressure is that rebound tenderness the patient's abdomen will be distended because of the inflammation of this entire peritoneal cavity certainly they are going to have a fever and then they might get a little bit shocky on you with hypotension tachycardia and increased respiratory rate because this can lead to sepsis this is a significant infection that the body is fighting certainly as with any abdominal disorders nausea and vomiting can be an associated sign and symptom and then there will be decreased bowel sounds as the peritoneum is getting fuller and fuller with fluid there will be less movement for the intestine to do its job and then so the bowel sounds will be decreased so most importantly will be the abdominal pain distension and these decreased bowel sounds complication from peritonitis is hypovolemic shock because the fluids escape the vascular system in the digestive system the patient will be shocky and then lose their blood pressure leading to hypobolemic shock if it was from a localized infection such as appendicitis diverticulitis it can lead to a systemic infection like sepsis there can be an abscess that's formed it can lead to paralytic illness where the intestine now completely ceases to work um it can further lead to ards and then if we're not careful the patient can die from peritonitis so this is a very serious complication or condition in terms of diagnostic tests we'll certainly check their cbc and cmp monitor the fluids and electrolytes see what their h is doing we will most definitely need to obtain blood cultures because now we're afraid if it was a localized infection that it's now becoming systemic and then the best way to obtain a culture from the peritoneum is by peritoneal aspiration so basically placing a needle in and of course the provider will do that a needle into the peritoneal cavity aspirating some of the fluid saving enough for culture so we know what we're treating with our antibiotics and then most definitely imaging such as x-ray ultrasound and ct scan will be helpful in determining the extent of the peritonitis and maybe the origin and to see if any of these other complications specifically abscess and paralytic iliacs are developing as for treatment certainly we need to treat the patient with antibiotics but that's why it's so important to get these cultures from the blood and that peritoneal fluid so that we know we are treating the patient with the correct antibiotics according to the culture and sensitivity report the patient will need a an ng tube because we need to let the digestive system rest so there will be npo and they will need an ng to to help deflate the stomach help get rid of some of the digestive bile and digestive fluid that will accumulate we will need to manage the fluids and the electrolytes because as you know when we're dealing with gi tract issues we can lose sodium and potassium and a lot of proteins and we'll need to very carefully manage that and then especially if the patient will be npo we'll need to make sure that they stay hydrated they will certainly need anti-ammetics because of this nausea and vomiting that's really associated with any kind of gi disorder and then they might need surgery to locate and treat if there is a leak let's say from a perforated appendicitis or diverticulitis or pancreatitis and to locate where the problem area is and then treat it by putting it back together and then certainly pain management because the patient will have significant abdominal pain now as for nursing care we need to trend their vital signs and that is super important in any of these itis any of these gi is conditions you can think about because this is the only way we can detect this early along with our nursing assessment of the patient's abdomen so that we can see are they having more abdominal pain rebound tenderness and distension and maybe are their bowel sounds getting less and less active to prevent these complications we'll need to manage their fluids and electrolytes as i mentioned up here they will need iv fluids depending on whatever their fluid and electrolyte results will show and most certainly we need to administer those iv antibiotics keep the patient in po and if this is something surgical or the hospitalization is expected to be fairly long even if it's just you know npo for 48 hours we really should consider putting the patient on tpn because we want to keep the digestive system addressed but they will need the nutrition because this is a significant impact on their body and we want to make sure we provide them the appropriate nutrients that they need to heal and get over this episode of peritonitis so thank you for watching this video please also watch the videos on all these other disorders that are already in my gi playlist and i hope to see you soon here on nursing school explained thanks for watching