Question

A 43 year old male was admitted last night with a diagnosis of spontaneous bacterial peritonitis, ascites, and abdominal pain. He was diagnosed with pancreatic cancer in February 2020 and had surgery to remove the tumor in March. He completed his last round of chemotherapy 3 weeks ago. He has a fever, high WBC, and has had nausea/vomiting with a decreased appetite for 3 days.

The signs and symptoms the patient is experiencing. Please explain the physiology for the signs/symptoms.

Signs & Symptoms :  

Fever

Abdominal pain

Ascites

Nausea/Vomiting

explain the Probable Physiological Cause (Pathophysiology) of the signs and symptoms above.

Below concisely explain the pathophysiology of major admitting diagnosis Spontaneous Bacterial Peritonitis: (Discuss the probable cause, risk factors, and signs and symptoms of diseases.

Laboratory Values:
The Abnormal Lab value is listed for your patient. Please list the normal range for the lab value and then answer the following questions for each lab: What are the most likely causes for the abnormalities based on this patient’s diagnosis? What assessments and interventions will you implement in light of these abnormalities?

Abnormal Lab Value

Normal Range
Most likely cause
Assessment/ interventions for each.

WBC 54.4 H

RBC 3.46L

HGB 11.0L

PLT Count 126L

Neutrophil % 90%

Lymphocyte % 8L

Monocyte % 2L

Total Protein 6.0L

Magnesium 1.4L

Sodium 130L

Potassium 3.1L

Calcium 8.1 L

Glucose 168H

     Nursing Diagnosis List: Complete the table with 10 nursing diagnoses, their priority for this patient, and their cause and defining characteristics.

Priority (High, Medium, Low)

Nursing Diagnosis
Related To (cause)
AEB (defining Characteristics)
*include abnormal labs, physical assessment findings, medical and health history

Answer 1

Answers

This 43 year-old-patient is admitted last night with a diagnosis of spontaneous bacterial peritonitis, ascities and abdominal pain. Also he had a pancreatic cancer in february 2020 and removed the tumor in march 2020. He has completed his chemotherpy 3 weeks ago. Now he has fever, high WBC, nausea and vomitting with decreased appetite for 3 days.

Spontaneous bacterial peritonitis is an acute bacterial infectiion of ascitic acid in the peritoneum. This infection is an inflammatory process within the peritoneal cavity. Inflammation may extend throughout the peritoneoum and may cause severe abscess. Ascites is an abnormal increase of fluid in the abdomen.

Physiology and pathophysiology of signs and symptoms:

The main pathophysiology of bacterial peritonitis is the transfer of bacterias from one organ to other organ. The bacterial transfer is done by intestinal bacterial overgrowth, structural and functional of instestinal mucosal barrier, deficiency of the immune system, certain bacterial infections, ascities, chirrosis, pancreatic disorders, etc. One of the cause for developing bacterial peritonitis is the disturbance of gut with overgrowth and extraintestinal spreading of organism, mainly Escherichia coli. Cirrhosis also cause bacterial overgrowth because of decreasing the mobility of intestines. Ascites caused by the disruption in the pressure forces between intravascular and extravascular fluid spaces, which causes fluid retention. Fluid retention causes pressure on other internal organs results signs and symptoms like abdominal pain, enlargement of abdomen, nausea and vomitting, back pain, difficulty in sitting and walking, etc. The main pathophysiology of ascites includes elevated hydostatic pressure, decreased osmotic pressure, liver parenchymal diseases, hepatic congestion, congestive heart failure, etc.

Normal range of lab values are following below:

WBC: 3.5 - 10.5 x 109/L

RBC: 4.7 - 6.1 million cells/mcL

HB: 13 - 17 g/dL

Platelet count: 150 - 450 x 109 L

Percentage of Neutrophils: 40% - 60 %

Percentage of Lymphocytes: 20%- 40%

Percentage of monocytes: 2% - 8%

Total protein: 6.3 - 8.0 g/dL

Magnesium: 1.5 - 3.0 mEq/L

Sodium: 135 -147 mEq/L

Pottassium: 3.5 - 5.5 mEq/L

Calcium: 8.5 - 10.2 mg/dL

Glucose: 80 - 120 mg/dL

Nursing care management and assessment:

Peritonitis generally decreases intestinal mobility and causes intestinal distention with gas, If this symptoms become severe the obstruction of intestine occurs. This may cause death of the patient. So monitoring of patient is the main task for nursing care assesment. Obtain pulmonary artery pressure and venous pressure frequently. Monitor fluid volume level of patient by measuring urine output hourly. Determine fluid balance of the body every 6-8 hours. ECG monitoring for cardiac patients and patients with electrolyte disturbances. Check the patient's consciousness, skin colour, temperature, pulses and all vital signs. Check the patient abdominal rigidity, tenderness, distention and bowel sounds. Review the blood and urine analysis, mainly the sodium and pottassium level, WBC, HB, PT. Replace sodium and pottassium, if needed. Keep the patient NPO in case of surgical procedures or evaluation by a surgeon before going any procedures. Provide nutritional support as needed. Administer certain medicines such as antibiotics and other drugs as per the doctors orders.