Which of the following aspects is the priority focus of nursing management for a client with peritonitis?
A. Fluid and electrolyte balance
B. Gastric irrigation
C. Pain management
D. Psychosocial issues
Correct Answer: A. Fluid and electrolyte balance
Peritonitis can advance to shock and circulatory failure, so fluid and electrolyte balance is the priority focus of nursing management. Maintain accurate I&O and correlate with daily weights. Include measured losses. Include measurements from gastric suction, drains, dressings, Hemovacs, diaphoresis, and abdominal girth for third spacing of fluid.
Option B: Gastric irrigation may be needed periodically to ensure patency of the nasogastric tube. Nasogastric tubes used for suction or drainage will be irrigated at least every 2 hours and when needed (PRN) as per patient reports of abdominal discomfort, nausea or vomiting, leaking from the tube, gastric distention, or gastric distress.
Option C: Although pain management is important for comfort, focusing on fluid and electrolyte imbalance will maintain hemodynamic stability. Maintain semi-Fowler’s position as indicated; facilitates fluid or wound drainage by gravity, reducing diaphragmatic irritation and/or abdominal tension, and thereby reducing pain.
Option D: Although psychosocial care will address concerns such as anxiety, focusing on fluid and electrolyte imbalance will maintain hemodynamic stability. Evaluate anxiety level, noting patient’s verbal and nonverbal response. Encourage free expression of emotions. The apprehension may be escalated by severe pain, increasingly ill-feeling, the urgency of diagnostic procedures, and the possibility of surgery.
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