Patient Suffering from Peritonitis - Case Study Example

Peritonitis Name Course Tutor Date Peggy, a patient with peritonitis has travelled a long distance to be reviewed hence an indicator of the commitment to health with support of her husband. On observation she is noted to be having a drop in blood pressure and an elevated pulse. The sensation in the extremities, the gait and the cold clammy skin are all indicators of distorted circulatory system more so due to their onset after insertion of the sub-clavian catheter. It is thus necessary for the nurse to review and observe the patient to ensure the heart is not affected or the catheter is not causing any occlusion. It is thus necessary to address issues related to the hemodialysis, catheter sites and the patients clinical situation so as to provide a complete nursing care and to avert all risks that may arise. Among the clinical issues to be decided on will include; hemodialysis process, infection prevention and family involvement in the therapy. Hemodialysis is aimed at achieving the functions of the kidneys hence it is an important procedure for Peggy who is a chronic renal failure victim (Bullock et al 2011). This is in consideration of the effects of the excretory products and the by-products of urea have on the body cells and more so on brain cells. In the brain the easily cause confusion and set precedence from psychosis while on other cells it causes retention of cellular fluid which results in rapture, prevents supply of relevant nutrients causing exhaustion and cellular malaise. Renal failure is a condition that results in the kidneys failing to filter the glomerular filtrate adequately. It can be of sudden onset or occurring over a period. Though both cases have predisposing factors and underlying causes; acute renal failure is reversible while chronic renal failure is an end on its own hence cannot be reversed. Forrester & Griffiths (2010) indicate that the managements of both renal diseases vary hence our interest narrows to chronic renal failure. Among the significant causes of renal insufficiency include severe infections, acute bleeding and chronic diseases such as lies diabetes mellitus. Therefore the nurses should address the hemodialysis to ensure it is done regularly and the systemic toxins and excretory products are cleared. Rapid hemodialysis should be avoided as it risks the cells due to the sudden clearance of toxins hence they lack adequate time to adjust and adapt considerably to the new extra cellular conditions. Therefore, there is need to ensure that adequate time is taken to expel the toxins from the blood. The access site should be carefully monitored and protected from infection when dressing it and infection prevention techniques should be followed and applied. The frequency of hemodialysis should also be considered to ensure the toxins are not allowed to accumulate to dangerous levels. When this is done, it will ensure the duration of the dialysis sessions are reduced and the patient is able to live a more comfortable and balanced life with minimized disease interruptions (Chang & Johnson 2008). The nurse therefore has a major role to play in assisting Peggy cope with her current health status and the modifications needed for him to improve her life. This will require a strict diet change and monitoring of the urinary output depending on the percentage of the nephrones functioning. Monitoring of the weight gain is significant as it indicates the frequency of and the amount of excretory products produced thus determining the frequency of the dialysis and the duration too (Brown 2010). Another issue of importance is infection prevention. The patient is already suffering from peritonitis which can easily spread to other parts of the body. Peritonitis is an infection of the peritoneum; a membrane covering the abdominal contents such as the intestine forming a cavity. The cavity is filled with a fluid, the peritoneal fluid which circulates in the area and is drained by the lymphatic system (Lee & Bishop 2010). When infected, the peritoneal fluid easily transmits the infection to other regions through the lymphatic system hence mortality resulting from this infection is high if appropriate measures are not taken in time. According to Bryant and Knights (2011) peritonitis requires adequate and appropriate measure to prevent its spread to other parts of the body thus the instituting of the tench off catheter was to help in draining of the infective fluid from the peritoneum. Since the peritoneal cavity has to have some fluid at all times, it is therefore the duty of the nurse to ensure that adequate rehydration was achieved. With the removal of the catheter, the peritoneal fluid remains in situ hence increased chances for further infections. This is therefore necessary for adequate treatment regime to be instituted to prevent overload of infection which could easily overwhelm the whole system. It is therefore necessary to start the patient on strong antibiotics to curb the infection and prevent its spread (Goldman & Schafer 2011). Such antibiotics will have to be administered systemically hence the use for the venous line. Due to the already struggling immune system of the patient, other potential infection points such as the venous site should be handled aseptically to ensure minimum contamination. The nurse is therefore to uphold hygiene and explain to the patient why it is important. More so, the patient should be encouraged to take the medications and keep track to ensure they receive the medication as scheduled. To assist in the clearance of the peritoneal fluid, the nurse should provide the patient with necessary fluid infusion taking into account the renal state to avoid compromise and fluid overload (Brown 2010). The nurse is also to monitor and assess urinary output and discharge from the peritoneum for amount, color and smell for relevant correction as needed. The family is an important aspect of treatment of any individual hence its impact is readily needed and felt in the care process. The psychological aspect of any condition is significant to the outcome of treatment received. It has been noted that most individuals have a special connection to their environment, specific people or objects. Inclusion of such has been associated to produce positive results in therapy hence the widespread use of the psychological aspect in therapy to augment the healing process (Hunter 2012). When the family and special persons are included in the therapy it also provides a close link to the patient in addition to educating the family on the condition. In view of this, the nurse has a major role to plan with the family and to endeavor to continually include them in the treatment and care of the patient. A family that has been well involved in the care process is normally well prepared and adapted to the possible eventuality of the condition. Family involvement lessens anxiety and the extra work to the nurse of explaining how the outcome and decisions during the care were arrived at (Hunter 2012). The nurse will plan and define to the family their role in the care and help them achieve the objective of the therapy for the wellbeing of the patient. The community is an important entity of any therapy as they are the homes to the patients. Any condition that affects an individual definitely affects the community as they all have their specific roles to play. The involvement of Peggy’s relatives in her treatment is to a small extend involvement of the immediate community members but unless the larger community is involved and informed on the condition, the disease will continue to affect them. It is therefore necessary to involve the greater community by dissemination of information on peritonitis and its complication so as to prevent it from occurring at all. The community should also be sensitized on the basic care of individuals with catheters to prevent infections and dislodging of the catheters in order to minimize complications and reduce hospital stay for these patients. The community is also entitled not to discriminate against such individuals; rather, they should assimilate them in their normal lives hence providing a positive atmosphere for healing and rehabilitation. The patients are also encouraged to form support groups to assist them in seeking health care and educating the members on lifestyle and the community on the condition (Taal & Chertow 2011). It is therefore relevant to conclude that in the therapy of a patient suffering from any condition, no single remedy is applicable hence a collection of therapies is necessary to completely alleviate a condition. The inclusion of psychotherapy in drug treatment is necessary in addition to a rehabilitation program as the patient will not always remain in hospital; they have to be able to continue with their normal lives. While hemodialysis is an important remedy to Peggy, infection control should be insisted on and maintained at the highest possible standards to reduce the length of treatment and minimize complications. It is hence necessary that the patient be cared for and all necessary adjustments to be made for anything thing or therapy that would improve her health. References Brown, P. 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 Forrester, K., & Griffiths, D. (2010). Essentials of law for health professionals; Sydney: Elsevier Australia. 
 Goldman L, & Schafer AI, (2011). Cecil Medicine; Philadelphia, PA: Saunders Elsevier Hunter, S. (2012). Miller’s Nursing for wellness in older adults; Wolters Kluwer/ Lippincott: London Lee, G., & Bishop, P. (2010). Microbiology and infection control for health professionals;Frenchs Forest, NSW: Prentice Hall. 
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