Peritonitis Nursing Care Plan
Peritoneal infection needing antibiotics, fluid support and abdominal assessment.
Quick answer
A Peritonitis nursing care plan centers on restore circulating volume and prevent septic shock; achieve source control — surgery is usually required; deliver antibiotics promptly after cultures. Priority nursing diagnoses are Acute pain, Deficient fluid volume, Risk for infection, Hyperthermia. The plan below gives assessment cues, measurable goals, 5 intervention sets with rationales, and patient teaching.
Overview
Peritonitis is inflammation of the peritoneum, usually from bacterial contamination after perforation of a hollow organ — a ruptured appendix, perforated ulcer, diverticulum or bowel — or from peritoneal dialysis catheter contamination. It is a surgical emergency: fluid and bacteria pour into the peritoneal cavity, huge volumes third-space out of circulation, and untreated the patient progresses to septic shock and multi-organ failure.
The classic presentation is severe, constant abdominal pain with a board-like rigid abdomen, rebound tenderness, absent bowel sounds, fever, tachycardia and a patient who lies still with knees flexed because any movement hurts. Paralytic ileus follows quickly, adding distention and vomiting.
Management is fluid resuscitation, broad-spectrum antibiotics, NPO status with nasogastric decompression, pain control and source control in the operating room. Nursing care centers on early recognition, hemodynamic monitoring, and vigilance for the deterioration into sepsis.
Key numbers to know
Hallmark
Board-like rigid abdomen with rebound tenderness and absent bowel sounds.
Position
Patients instinctively lie still with knees flexed; movement and coughing worsen pain.
Fluid loss
Several liters can third-space into the peritoneal cavity, causing hypovolemic shock despite no visible bleeding.
Sudden pain relief
In a perforating ulcer, brief relief after rupture is deceptive — deterioration follows.
Dialysis-associated
Cloudy peritoneal dialysis effluent with abdominal pain means peritonitis until proven otherwise; send fluid for cell count and culture.
Nursing priorities
- Restore circulating volume and prevent septic shock.
- Achieve source control — surgery is usually required.
- Deliver antibiotics promptly after cultures.
- Rest the bowel with NPO status and decompression.
- Control severe pain without masking deterioration.
- Monitor for organ dysfunction: renal, respiratory and cardiovascular.
Nursing assessment
Subjective data
- Severe, constant, diffuse abdominal pain worsened by any movement
- Nausea, vomiting and inability to pass flatus
- Chills, weakness and thirst
- Anxiety and a sense of impending doom
Objective data
- Rigid, board-like abdomen with guarding and rebound tenderness
- Absent or markedly diminished bowel sounds and increasing distention
- Fever, tachycardia, tachypnea and hypotension
- Shallow breathing because deep breaths hurt
- Decreased urine output, dry mucous membranes and rising BUN/creatinine
- Leukocytosis with left shift, elevated lactate, free air on upright imaging
- Cloudy effluent in a peritoneal dialysis patient
Related factors
- Perforation of a hollow viscus with spillage of intestinal contents
- Peritoneal dialysis catheter contamination
- Postoperative anastomotic leak or wound contamination
- Massive fluid shift into the peritoneal cavity
- Inflammatory mediators producing systemic vasodilation
Key nursing diagnoses
Goals and expected outcomes
- The client will maintain adequate perfusion with stable blood pressure, heart rate under 100 and urine output above 0.5 mL/kg/hr.
- The client will report pain reduced to an agreed level.
- The client will remain free of septic shock and organ failure.
- The client will regain bowel function with return of bowel sounds and flatus.
- The client will have a clean, healing surgical site without infection.
Nursing interventions and rationales
1. Recognizing and escalating early
- Assess the abdomen at least every 4 hours in at-risk patients: contour, rigidity, tenderness, bowel sounds and girth.
- Report a new rigid abdomen, rebound tenderness or absent bowel sounds immediately — do not wait for a fever.
- Track vital sign trends; a rising heart rate with a narrowing pulse pressure precedes hypotension.
- Obtain cultures, lactate and imaging as ordered without delaying antibiotics.
2. Restoring volume and perfusion
- Establish large-bore IV access and give isotonic crystalloid as prescribed, titrated to blood pressure, urine output and lactate clearance.
- Monitor hourly urine output with an indwelling catheter in the unstable patient.
- Replace electrolytes and monitor renal function; acute kidney injury develops quickly.
- Administer vasopressors in a monitored setting if hypotension persists after adequate fluid.
3. Resting the bowel and controlling infection
- Keep the patient NPO and maintain nasogastric suction; verify placement and patency and record output.
- Give broad-spectrum IV antibiotics on schedule after cultures; timing matters more than choice at the bedside.
- Monitor temperature trend, white count and lactate as response indicators.
- For dialysis-associated peritonitis, send effluent for cell count, Gram stain and culture and follow the unit protocol for intraperitoneal antibiotics.
4. Managing pain and positioning
- Give IV analgesia as ordered; withholding pain relief to 'preserve the exam' is outdated once the surgeon has assessed the patient.
- Position semi-Fowler with knees slightly flexed to relax the abdominal wall and localize drainage in the pelvis.
- Support the abdomen during coughing and turning with a pillow.
- Reassess pain quality — a change from localized to diffuse, or new shoulder-tip pain, is significant.
5. Perioperative and postoperative care
- Prepare the patient for laparotomy or laparoscopy: consent, site marking, labs, type and screen and preoperative antibiotics.
- Postoperatively, monitor the incision, drains and drainage character, and record volumes.
- Encourage incentive spirometry and early ambulation to prevent atelectasis and VTE, using premedication so it is achievable.
- Advance diet only after bowel sounds, flatus and provider clearance.
- Watch for abscess formation: recurring fever, persistent leukocytosis and localized tenderness after initial improvement.
Patient and family teaching
- Report fever, increasing abdominal pain, wound redness or drainage, or vomiting after discharge.
- Resume activity gradually and avoid heavy lifting for the period your surgeon specifies.
- Complete the entire antibiotic course even after you feel well.
- For peritoneal dialysis, use strict aseptic technique at every exchange and report cloudy fluid at once.
- Keep follow-up appointments so drains and healing can be assessed.
How to build this plan
- 1Assess the patient. Collect subjective and objective data through interview, physical assessment, labs and chart review. Complete, accurate data is the foundation of every later step.
- 2Analyze and cluster the data. Group related cues, compare them with normal findings, and identify patterns that point to actual or potential problems.
- 3Formulate nursing diagnoses. Write the problem statement using a recognized diagnostic label plus related factors and evidence (problem related to cause as evidenced by signs).
- 4Set priorities. Rank diagnoses as high, medium or low using ABCs, Maslow's hierarchy and the patient's own stated priorities. Life-threatening problems come first.
- 5Establish goals and outcomes. Write SMART, patient-centered outcomes: specific, measurable, attainable, realistic and time-bound (short-term and long-term).
- 6Select nursing interventions. Choose independent, dependent and collaborative actions that are safe, evidence-based and matched to the outcome.
- 7Provide rationales. State the scientific reason each intervention works. Rationales are what turn a task list into clinical reasoning.
- 8Evaluate the plan. Compare the patient's actual response with the expected outcome: met, partially met or not met — then continue, revise or discontinue.
- 9Document and communicate. Record the plan and the patient's response in the health record so the whole team works from the same information.
Summarized for study use. Always follow your school's or facility's approved care plan format and current clinical policy.
Practice Peritonitis questions
These concepts are tested on the ATI proctored exams below — every set has answers and rationales.
More Gastrointestinal care plans
Plans that share these nursing diagnoses
Care plan writing guides
Common questions
What are the nursing diagnoses for Peritonitis?
Priority nursing diagnoses for Peritonitis: Acute pain; Deficient fluid volume; Risk for infection; Hyperthermia.
What are the nursing interventions for Peritonitis?
Assess the abdomen at least every 4 hours in at-risk patients: contour, rigidity, tenderness, bowel sounds and girth. Report a new rigid abdomen, rebound tenderness or absent bowel sounds immediately — do not wait for a fever. Track vital sign trends; a rising heart rate with a narrowing pulse pressure precedes hypotension. Obtain cultures, lactate and imaging as ordered without delaying antibiotics. Establish large-bore IV access and give isotonic crystalloid as prescribed, titrated to blood pressure, urine output and lactate clearance. Monitor hourly urine output with an indwelling catheter in the unstable patient.
What are the nursing care goals for Peritonitis?
The client will maintain adequate perfusion with stable blood pressure, heart rate under 100 and urine output above 0.5 mL/kg/hr. The client will report pain reduced to an agreed level. The client will remain free of septic shock and organ failure. The client will regain bowel function with return of bowel sounds and flatus. The client will have a clean, healing surgical site without infection.
What should you assess in a patient with Peritonitis?
Severe, constant, diffuse abdominal pain worsened by any movement; Nausea, vomiting and inability to pass flatus; Chills, weakness and thirst; Anxiety and a sense of impending doom; Rigid, board-like abdomen with guarding and rebound tenderness; Absent or markedly diminished bowel sounds and increasing distention; Fever, tachycardia, tachypnea and hypotension; Shallow breathing because deep breaths hurt; Decreased urine output, dry mucous membranes and rising BUN/creatinine; Leukocytosis with left shift, elevated lactate, free air on upright imaging; Cloudy effluent in a peritoneal dialysis patient