Care for a Peritonitis Patient

This case study discusses the care for a peritonitis patient, including the use of the Clinical Reasoning Cycle and the goals of treatment. The patient has a medical history of asthma and depression. Clinical observation indicates that the patient has low blood pressure, high heart rate, and elevated temperatures. The patient also has an elevated respiratory rate. The goals of treatment should involve eliminating depression and pain. Additionally, appropriate remedies are required to restore the blood pressure to normal. Taking antidepressants help to curb the major depressive disorder. Taking plenty of water helps to raise the blood pressure. Implementing the above actions help restore the health of the patient. Apart from surgery, antibiotic treatment can help to manage peritonitis. The rupture of the peritoneum allows bacteria to enter the abdomen leading to peritonitis.

Running head: CARE FOR A PERITONITIS PATIENT 1
Care for a Peritonitis Patient
Student’s Name
Institutional Affiliation

CARE FOR A PERITONITIS PATIENT 2
Introduction
The case study presents a 36-year-old Melody King having peritonitis. Her condition
resulted from a ruptured appendix. Peritonitis occurs due to the inflammation of an individual’s
peritoneum (Dever, & Sheikh, 2015). The peritoneum is a membrane that covers the inner walls
of the abdomen; thereby, protecting its organs from mechanical injury. This essay will use the
Clinical Reasoning Cycle to provide legal, ethical, person-centered, and evidence-based care for
Ms. Melody. Clinical Reasoning Cycle is a process that nurses and other health specialists can
rely on to provide quality care to patients (Levett-Jones, 2013). The cycle has eight steps with the
first one requiring caregivers to examine the situation of the patient. The second and third steps
involve collecting and processing a patient's information. The fourth and fifth steps include the
identification of issues and establishing treatment goals. The sixth, seventh, and eighth steps
involve taking action, evaluating the outcome, and reflection. This paper will discuss all the steps
in the cycle.
Clinical Reasoning cycle
Consider the Patient’s Situation
Ms. Melody King visited the Emergency Department after 2-3 days of severe abdominal
pain. The pain originated from the right lower quadrant of her abdomen. Ms. Melody has a
medical history of major depressive disorder and asthma. Her current compliant and prescribed
medications include Sertraline, Seretide, and Ventolin. Upon observation by the caregivers, the
patient had a blood pressure of 95/45mmHg. She also recorded temperatures of 38.3ºC and a
heart rate (HR) of 120 beats per minute. The patient also recorded a respiratory rate (RR) 22
beats per minute. Moreover, the patient’s oxygen saturation rate (SpO2) was 95%. Peritonitis
made the patient experience a severe centralized abdominal pain (Kim et al., 2017). According to

CARE FOR A PERITONITIS PATIENT 3
abdominal pain scale, the patient's pain is ranked 7-8 out of 10. The other symptom of
complication recorded by the patient was increasing nausea. Physical examination indicated that
the patient had a generalized abdominal guarding and a distended abdomen. Pathological
findings suggested that the patient had raised levels of White Blood Cells (WBC) and C -
reactive protein (CRP).
Collect Information
The case study indicates that Ms. Melody reported to the Emergency Department to
undergo an emergency laparoscopic surgery. The operation intended to remove the ruptured
appendix. Apart from removing the ruptured appendix, a surgical remedy should treat the cause
of the complication. Surgical treatment should also prevent the spread of the infection to other
parts of the body like colon and stomach (Thornellet al., 2016). Caregivers should prescribe
antibiotics to curb the spread of peritonitis symptoms in other areas. The duration and the type of
antibiotic prescribed should depend on the nature of the condition. The patient records a lower
blood pressure than the normal range. Caregivers should prescribe medications to stabilize the
blood pressure. The patient should also take antidepressants to manage her major depressive
disorder. Her temperatures are also slightly higher than the normal, a condition that requires
close monitoring and correction.
Process Information
The patient records higher than average temperatures due to her condition. The normal
temperature of an individual under room temperature is 37ºC. High and rising body temperatures
are indications of a medical emergency. Therefore, the emergency should alert the specialists to
conduct surgery and remove the ruptured appendix. The average blood pressure should range
from 120/80mmHg to 140/90mmHg (Lüscher, 2018). However, the patient records 95/45mmHg

CARE FOR A PERITONITIS PATIENT 4
which is lower than the normal range. Like high body temperature, low blood pressure is an
indication of a medical emergency. The standard heart rate ranges from 60-100 beats/minute
while the patient has a high HR of 120 beats/minute (Shaffer, McCraty, & Zerr, 2014). A high
heart rate indicates an abnormal cardiovascular function. Therefore, caregivers should find a
remedy to return the HR to normal. The average respiratory rate (RR) ranges from 12-20
breaths/minute while the patient has a high record of 22 breaths/minute (Galiè et al., 2015). The
patient requires oxygen therapy to stabilize her RR.
Identify the Problems
The patient has a wide range of complications due to her numerous symptoms like low
BP, high RR, HR, and temperature readings. The low blood pressure can interfere with the
patient's recovery post surgery. Caregivers should advise the patient to drink large volumes of
water to help in bring her BP to be normal (MacRae, Laing, & Partsch, 2016). A recent study has
indicated that wearing compression stocking can assist in raising the blood pressure. The WBC
counts should reduce after surgical operations. However, pathological findings indicate that the
patient has an elevated number of WBC. Therefore, an elevation in WBC count can be an
indication of other medical complications. The patient also experiences severe abdominal pain
which is a common symptom of peritonitis. Caregivers should prescribe pain relievers to lower
the extent of the pain (Lambert, 2014). The patient has a medical history of depression which can
increase the severity of peritonitis symptoms like nausea and pain. Therefore, the patient should
use antidepressants to curb the major depressive disorder (Leong, 2014).
Establish Goals
The nursing goals intend to restore proper health of the patient after surgery. The first
goal is to eliminate depression and asthma within two months. According to recent research,

CARE FOR A PERITONITIS PATIENT 5
reducing the symptoms of depression lowers the physical manifestations of complications
(Correll, Detraux, De Lepeleire, & De Hert, 2015). The second goal is to reduce the abdominal
pain as a result of peritonitis infection. Eliminating abdominal pain can take three weeks and will
make the patient comfortable. The third goal is to bring the BP, HR, RR, and temperature to the
normal ranges. Bringing the mentioned ranges to be normal can take four months. The above
goals assist the patient to regain normal health after the operation.
Take Actions
The first goal involves managing depression and asthma. Taking antidepressants assist in
managing the major depressive disorder. The second action targets, reducing the severe
abdominal pain in the right lower quadrant of the patient's abdomen. Caregivers should prescribe
antibiotics to alleviate the pain. The patient also records low blood pressure. Caregivers should
recommend the patient to drink plenty of water to raise her blood pressure. Taking sufficient salt
in food can also stabilize her blood pressure (Cogswell, Mugavero, Bowman, & Frieden, 2016).
Ms. Melody has also recorded an elevated heart rate (HR) and respiratory rates (RR). The high
RR and HR are due to anxiety as a result of Peritonitis infection. Care providers should prescribe
antidepressants to lower the levels of stress. The patient also has raised temperature readings due
to symptoms like pain and nausea. Managing the symptoms will restore the body temperature to
the usual reading. Therefore, caregivers should monitor and control pain and nausea. An
elevation in WBC count and CRP is another area that requires immediate medical action.
Elevation in white blood cell count can result in gallbladder stones, liver diseases among other
complications (Krishnan et al., 2017). The patient should undergo a CT scan to establish the
exact cause of raised WBC count. Afterward, the caregiver should suggest an appropriate
remedy to lower the number.

CARE FOR A PERITONITIS PATIENT 6
Evaluate outcome
Taking antidepressants according to the doctor's prescription made Ms. Melody to
experience a reduction in depression symptoms. Drinking plenty of water also restored the blood
pressure of the patient to normal. The patient also started taking meals with sufficient salt, a
move that assisted in bringing her BP to be normal. Taking antibiotics helped to reduce the
severity of the abdominal pain (Di Saverio et al., 2014). Managing anxiety helped to bring HR
and HR back to normal. Additionally, managing peritonitis symptoms like pain and nausea
helped to bring temperature readings back to normal.
Reflection on the process and new learning
Laparoscopic surgery is an efficient remedy for peritonitis as it removes the ruptured
appendix; thereby, reducing abdominal pain (Angenete et al., 2016). A medical history of
depression and asthma facilitate the severity of physical complications. However, antibiotic
medication can help to curb the spread of peritonitis to other organs like the stomach and colon.
Surgery can lead to the loss of a lot of blood. Therefore, a blood transfusion is necessary after the
surgical operation. From the observation, taking plenty water help in raising the BP of an
individual. Additionally, taking food with sufficient salt also increases the blood pressure. I also
learned about the symptoms of peritonitis. Apart from abdominal pain, other symptoms include
nausea, thirst, fatigue, and fever. A ruptured appendix allows bacteria into the peritoneum;
hence, causing peritonitis. Therefore, an emergency surgical procedure is necessary to remove a
ruptured appendix in case of peritonitis infection.
Conclusion
The case study presents a patient having peritonitis due to a ruptured appendix. The
clinical reasoning cycle is essential in providing person-centered, ethical, legal, and evidence-

CARE FOR A PERITONITIS PATIENT 7
based care to Ms. Melody. The patient has a medical history of asthma and depression. Clinical
observation indicates that the patient has low blood pressure, high heart rate, and elevated
temperatures. The patient also has an elevated reparatory rate. The goals of treatment should
involve eliminating depression and pain. Additionally, appropriate remedies are required to
restore the blood pressure to normal. Taking antidepressants help to curb the major depressive
disorder. Taking plenty of water helps to raise the blood pressure. Apart from depression,
antidepressants also help to lower anxiety. Implementing the above actions help restore the
health of the patient. Apart from surgery, antibiotic treatment can help to manage peritonitis. The
rupture of the peritoneum allows bacteria to enter the abdomen leading to peritonitis.

CARE FOR A PERITONITIS PATIENT 8
References
Angenete, E., Thornell, A., Burcharth, J., Pommergaard, H. C., Skullman, S., Bisgaard, T., ... &
Rosenberg, J. (2016). Laparoscopic lavage is feasible and safe for the treatment of
perforated diverticulitis with purulent peritonitis: the first results from the randomized
controlled trial DILALA — annals of surgery, 263(1), 117.
Cogswell, M. E., Mugavero, K., Bowman, B. A., & Frieden, T. R. (2016). Dietary sodium and
cardiovascular disease risk—measurement matters. The New England journal of
medicine, 375(6), 580.
Correll, C. U., Detraux, J., De Lepeleire, J., & De Hert, M. (2015). Effects of antipsychotics,
antidepressants and mood stabilizers on risk for physical diseases in people with
schizophrenia, depression and bipolar disorder. World Psychiatry, 14(2), 119-136.
Dever, J. B., & Sheikh, M. Y. (2015). Spontaneous bacterial peritonitis–bacteriology, diagnosis,
treatment, risk factors, and prevention. Alimentary pharmacology & therapeutics, 41(11),
1116-1131.
Di Saverio, S., Sibilio, A., Giorgini, E., Biscardi, A., Villani, S., Coccolini, F., ... & Catena, F.
(2014). The NOTA Study (Non-Operative Treatment for Acute Appendicitis): a
prospective study on the efficacy and safety of antibiotics (amoxicillin and clavulanic
acid) for treating patients with right lower quadrant abdominal pain and long-term
follow-up of conservatively treated suspected appendicitis. Annals of surgery, 260(1),
109-117.
Galiè, N., Humbert, M., Vachiery, J. L., Gibbs, S., Lang, I., Torbicki, A., ... & Ghofrani, A.
(2015). 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary
hypertension: the joint task force for the diagnosis and treatment of pulmonary

CARE FOR A PERITONITIS PATIENT 9
hypertension of the European Society of Cardiology (ESC) and the European Respiratory
Society (ERS): endorsed by: Association for European Paediatric and Congenital
Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).
European heart journal, 37(1), 67-119.
Lambert, L. (2014). A review of over-the-counter pain medication: pain. SA Pharmacist's
Assistant, 14(1), 27-28.
Leong, C. (2014). Antidepressants for depression in patients with dementia: a review of the
literature. The Consultant Pharmacist®, 29(4), 254-263.
Levett-Jones, T. (Ed.), (2013). Clinical reasoning: Learning to think like a nurse. Sydney,
Australia: Pearson Education
Lüscher, T. F. (2018). What is a normal blood pressure?. European heart journal, 39(24), 2233-
2240.
Kim, J. H., Lim, K. S., Min, Y. W., Lee, H., Min, B. H., Rhee, P. L., ... & Paik, S. W. (2017).
Proton pump inhibitors do not increase the risk for recurrent spontaneous bacterial
peritonitis in patients with cirrhosis. Journal of Gastroenterology and Hepatology, 32(5),
1064-1070.
Krishnan, A., Abdullah, T. S., Mounajjed, T., Hartono, S., McConico, A., White, T., ... &
Charlton, M. (2017). Liver and Biliary Tract Physiology/Pathophysiology: A longitudinal
study of the whole body, tissue, and cellular physiology in a mouse model of fibrosing
NASH with high fidelity to the human condition. American Journal of Physiology-
Gastrointestinal and Liver Physiology, 312(6), G666.

CARE FOR A PERITONITIS PATIENT 10
MacRae, B. A., Laing, R. M., & Partsch, H. (2016). General considerations for compression
garments in sports: Applied pressures and body coverage. In Compression Garments in
Sports: Athletic Performance and Recovery (pp. 1-32).
Shaffer, F., McCraty, R., & Zerr, C. L. (2014). A healthy heart is not a metronome: an
integrative review of the heart's anatomy and heart rate variability — frontiers in
psychology, 5, 1040.
Thornell, A., Angenete, E., Bisgaard, T., Bock, D., Burcharth, J., Heath, J., ... & Haglind, E.
(2016). Laparoscopic lavage for perforated diverticulitis with purulent peritonitis: a
randomized trial. Annals of internal medicine, 164(3), 137-145.