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Use Clinic reasoning Cycle: Process to make sure we are making correct clinical judgement.

Clinical Reasoning Cycle (Levett-Jones, 2018) as a framework to plan and evaluate person-centred care
Consider the person’s situation
Collect, process and present related health information
Identify and prioritise at least three (3) nursing problems/issues based on the health assessment data that you have identified for the person at the centre of care.
Establish goals for priority of nursing care related to the nursing problem/issues identified
Discuss the nursing care of the person; link it to assessment data and history.
Evaluate your nursing care strategies to justify the nursing care provided
Reflect on the person’s outcomes

Causes and Symptoms of Peritonitis

The case study is about Ms. Melody King who has Peritonitis due to her ruptured appendix. The disease occurs when an individual’s peritoneum undergoes inflammation (See et al., 2017). Peritoneum covers the interior section of the abdomen. Abdominal organs depend on the tissue for support and protection. The essay applies clinical reasoning cycle to offer person-centered care to the patient. The three priority problems in the case study include: treatment to rectify the abdominal pain, raised White Blood Cells (WBC) and nausea.

The reasoning cycle begins by considering the situation of the patient (Liaw et al., 2018). Ms. Melody is a Peritonitis patient, and her condition arises from the rapture of the appendix. The second point in the cycle involves the collection of relevant information about the patient. The patient has a history of depression and asthma. She has elevated temperature and low blood pressure. The paper will process the data, identify the problems and establish the goals of treatment. The essay will also discuss the actions and evaluate the outcome.

Ms. Melody King is a 36-year old who has been presented to the emergency department. She has a ruptured appendix which has caused peritonitis. Her condition has caused severe abdominal pain, and she requires surgery to remove the ruptured appendix. Ms. King has a past medical history of depression and asthma. Her current medications include Seretide, Ventolin, and sertraline. She has elevated temperature readings and is also complaining of nausea.


A healthy peritoneum is a glistering and a grayish organ before infection. However, peritonitis infection makes peritoneum to become dull within two to four hours (Sato et al., 2017). The healthy abdominal lining has little thick fluid and a scarce serous. The progression of the disease makes the exudates to turn into a creamy and suppurative liquid. Dehydrated peritonitis patients register incidences of inspissations. The amount of exudates fluctuates depending on the patient. The fluid can occupy the entire peritoneum or reside in the Viscera and Omentum. Inflammation occurs due to neutrophil infiltration. The elevation in the fluid levels explains the raised WBC in the pathology results.

Causes of Peritonitis

Peritonitis occurs due to peritoneum inflammation (Danvath, & Matta, 2016). The peritoneum is a membrane that covers the inner wall of the abdomen. Therefore, the peritoneum protects the abdominal organs from chemical and physical injury. The inflammation occurs due to fungal or bacterial infection. A rupture in the abdomen causes the disease. Some medical conditions also cause the disease. The disease requires urgent treatment to rectify the abdominal problem. The treatment is through surgery or administration of antibiotics. The symptoms of the disease include abdominal pain and nausea (Ramachandra, 2017). The patient feels fatigued and thirsty. Moreover, the condition leads to diarrhea and bloating. In some cases, the patient finds difficulty in defecation.

Treatment of Peritonitis

Causes of Abdominal Rupture

The abdomen can rapture due to pancreatitis. The complication causes the inflammation of the pancreas. The swelling is due to further infection of the pancreas (Metcalfe et al., 2016). Peritonitis occurs when the bacteria that cause pancreatitis moves to the abdomen. Trauma is the second cause of the rupture. The injury allows chemicals or bacteria to move into the peritoneum from other body organs. Diverticulitis causes abdominal separation by allowing waste from the intestines to gain access to the abdominal cavity.

Medical procedures also cause peritonitis. A process like peritoneal dialysis uses catheters to get rid of waste materials from the blood (Roumelioti et al., 2016). Physicians apply the procedure when the kidney cannot clean the blood. The process of dialysis can lead to an infection due to contaminated equipment, unclear surrounding or poor hygiene. Complications during gastrointestinal surgery also cause peritonitis.

Three Nursing Problems (Priorities)

The patient has Peritonitis caused by the ruptured abdomen. Her first problem is abdominal pain which is a symptom of the disease. The second priority area is the feeling of nausea. Thirdly, the treatment efforts should lower the raised White Blood Cells. The three areas are symptoms from diagnosis of Peritonitis.

Goals for the Priority Areas

The patient reported for surgery to remove the ruptured abdomen. The first goal is to carry out a diagnosis process on the patient. Secondly, the physician should suggest appropriate medications such as antibiotics to reduce the abdominal pain. Surgical treatment also lowers the amounts of White Blood Cells (WBC). Successful diagnosis and treatment manage the complication. The outcome should be a lower WBC, reduced abdominal pain and nausea.  The procedure should take two weeks.

Nursing Care (Taking Action)

The initial nursing care step involves the diagnosis of Ms. Melody King. The physician should examine the medical history before conducting physical examinations. The patient has a history of depression and asthma. Ms. King was taking Ventolin, Seretide, and sertraline. The increased amounts of fluids in the abdominal cavity can also cause the infection. The raised WBC is due to high liquid amounts in the abdomen (Tantiyavarong et al., 2016). The first exam is the blood tests. The physician withdraws the patient’s blood to check for WBC count. The patient has raised WBC showing that she has peritonitis.

Nurses should use imaging tests to gauge whether Mr. Melody King has peritonitis or otherwise. Caregivers should use X-rays to examine whether Mr. King has holes in their gastrointestinal tract. A positive test shows perforations in the GIT. CT-scan and Ultrasound are also useful for checking the condition of the patient’s tract (Cochon, Esin, & Baez, 2016). The care provider can also use a needle to extract fluid samples from the peritoneum. The test of peritoneal fluid indicates an elevation in the amount of WBC for the peritonitis patients. A close examination of the fluid can also indicates bacterial growth in the peritoneum. The bacteria can perforate the intestinal linings and lead to peritonitis. Positive results from the diagnosis should lead to treatment.

Nursing Care

The first treatment option is through surgery. From the assessment results, Ms. Melody was presented in the emergency department laparoscopic surgery. The operation targeted the removal of the ruptured appendix. The intervention reduces nausea and abdominal pain. Furthermore, the levels of WBC return to the reasonable standards. Surgical procedures have three primary objectives. Firstly, the operation removes the defective tissue (Angenete et al., 2016). Secondly, the process treats the factors that lead to the development of the infection. Thirdly, surgery prevents the spreading of the disease to other organs such as the colon and the stomach (Cirocchi et al., 2015). Surgery also corrects any anatomical damage.

Nurses should also offer antibiotics as another viable remedy for peritonitis other than surgery. The medication counters the infection and stops its spreading to the unaffected organs (Piano et al., 2016). Different types of antibiotics are available to treat various forms of peritonitis. Severe infections call for long periods of antibiotic therapy. Other medications include issuance of supplementary oxygen and pain medications. Blood transfusion and intravenous fluids also treat the disease. The covering of grams negative and positive organisms is also an essential remedy for peritonitis. Cefotetan, cefoxitin, and cephalosporins are useful covers of the anaerobic and grams bacteria (Friedrich et al., 2016). Intravenous rehydration also treats the infection. The caregivers must correct electrolyte disturbances during the nursing care.

The nurses should also train the patient on prevention tactics. Ms. King has a medical history of depression and asthma. Therefore, the nurse should also advise the patient on the prevention mechanisms towards the two diseases. The patient should recognize and avoid the triggers of asthma (Ritz, Bobb, & Griffiths, 2014). The physician should encourage the family members to monitor the patient's activities to prevent depression. Ms. Melody should also take the prescribed drugs to prevent asthma and depression. However, there is no close link between peritonitis and the two infections. Therefore, nursing care involves the diagnosis and treatment of peritonitis. Caregivers should also advise patients on the management of the past medical history.

Evaluation of Outcome

Surgery is the best way of treating peritonitis. Successful operations remove the ruptured appendix. Therefore, nausea and abdominal pain seize. Laparoscopy also lowers the count of White Blood Cells (Marano et al., 2017). The proper intake of antibiotics also relieves the victim of abdominal pain. The patient should also use other medications to treat the infection. The patient has a history of asthma and depression. The family members should ensure that the patient observes strict medicines of the two complications. Prevention of the diseases lowers the severity of peritonitis.

Learning Points

Reflection and New Learning  

There are a lot of learning points from the management of peritonitis. The first lesson is that the elevation of the WBC is an indication of the infection. Secondly, nausea and abdominal pain are the dominant symptoms of the disease. Surgery to remove the ruptured appendix is essential in treating the disease. Antibiotics and other medications also lower the abdominal pain due to peritonitis (Piraino, 2017). The nurse must conduct a proper diagnosis before the treatment process. X-rays and CT-scans are useful in checking for holes in the gastrointestinal tract. An individual who shows a raised WBC has high chances of peritonitis.


Ms. Melody King is a 36-year old who has peritonitis due to the ruptured abdomen. Clinical Reasoning Cycle is useful in providing a person-centered treatment to the patient. The first step is to consider the situation of the patient. The action involves documenting the facts about Ms. King. The patient reports to the emergency department to undergo surgery. The operation intends to remove the ruptured abdomen. The second step is to collect information about the patient. The stage discusses the pathology and the causes of the infection.

Processing of information and identification of the issues are the next steps in the Clinical Reasoning cycle.  The caregiver then establishes goals of tackling the priority areas. The critical issues in the case study are the symptoms which include abdominal pain, nausea, and raised WBC. The care provider then takes action to rectify the problems. The effect refers to the nursing care involving diagnosis and treatment. Evaluation and reflection are the last steps in the cycle.


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Cirocchi, R., Trastulli, S., Vettoretto, N., Milani, D., Cavaliere, D., Renzi, C., ... & Arezzo, A. (2015). Laparoscopic peritoneal lavage: a definitive treatment for diverticular peritonitis or a “bridge” to elective laparoscopic sigmoidectomy?: a systematic review. Medicine, 94(1).

Cochon, L., Esin, J., & Baez, A. A. (2016). Bayesian comparative model of CT scan and ultrasonography in the assessment of acute appendicitis: results from the Acute Care Diagnostic Collaboration project. The American journal of emergency medicine, 34(11), 2070-2073.

Danvath, K., & Matta, S. (2016). Clinical study and management of benign gastrointestinal perforations. J. Evid. Based Med Health, 3(37), 1844-8.

Clinical Reasoning Cycle

Friedrich, K., Nüssle, S., Rehlen, T., Stremmel, W., Mischnik, A., & Eisenbach, C. (2016). Microbiology and resistance in first episodes of spontaneous bacterial peritonitis: implications for management and prognosis. Journal of Gastroenterology and Hepatology, 31(6), 1191-1195.

Liaw, S. Y., Rashasegaran, A., Wong, L. F., Deneen, C. C., Cooper, S., Levett-Jones, T., ... & Ignacio, J. (2018). Development and psychometric testing of a Clinical Reasoning Evaluation Simulation Tool (CREST) for assessing nursing students' abilities to recognize and respond to clinical deterioration. Nurse education today, 62, 74-79.

Marano, A., Giuffrida, M. C., Giraudo, G., Pellegrino, L., & Borghi, F. (2017). Management of Peritonitis After Minimally Invasive Colorectal Surgery: Can We Stick to Laparoscopy?. Journal of Laparoendoscopic & Advanced Surgical Techniques, 27(4), 342-347.

Metcalfe, D., Sugand, K., Thrumurthy, S. G., Thompson, M. M., Holt, P. J., & Karthikesalingam, A. P. (2016). Diagnosis of ruptured abdominal aortic aneurysm: a multicentre cohort study. European Journal of Emergency Medicine, 23(5), 386-390.

Piano, S., Fasolato, S., Salinas, F., Romano, A., Tonon, M., Morando, F., ... & Palù, G. (2016). The empirical antibiotic treatment of nosocomial spontaneous bacterial peritonitis: Results of a randomized, controlled clinical trial. Hepatology, 63(4), 1299-1309.

Piraino, B. (2017). Effective Treatment of PD Peritonitis. Clinical Journal of the American Society of Nephrology, 12(12), 1919-1921.

Ramachandra, M. L. (2017). Age, sex incidence with signs and symptoms of peritonitis. International Journal of Research in Medical Sciences, 2(3), 916-919.

Ritz, T., Bobb, C., & Griffiths, C. (2014, September). Predicting asthma control: the role of psychological triggers. In Allergy and asthma proceedings (Vol. 35, No. 5, pp. 390-397). OceanSide Publications, Inc.

Roumelioti, M. E., Argyropoulos, C., Pankratz, V. S., Jhamb, M., Bender, F. H., Buysse, D. J., ... & Unruh, M. L. (2016). Objective and subjective sleep disorders in automated peritoneal dialysis. Canadian Journal of kidney health and disease, 3(1), 6.

Sato, K., Tazawa, H., Fujisaki, S., Fukuhara, S., Imaoka, K., Hirata, Y., ... & Sakimoto, H. (2017). Acute diffuse peritonitis due to spontaneous rupture of a primary gastrointestinal stromal tumor of the jejunum: A case report. International journal of surgery case reports, 39, 288-292.

See, E., Johnson, D., Hawley, C., Pascoe, E., Darssan, D., Clayton, P., ... & Cho, Y. (2017). SP493 Early Peritonitis and its outcome in incident Peritoneal dialysis Patients. Nephrology Dialysis Transplantation, 32(suppl_3), iii294-iii294.

Tantiyavarong, P., Traitanon, O., Chuengsaman, P., Patumanond, J., & Tasanarong, A. (2016). Dialysate white blood cell change after initial antibiotic treatment represented the patterns of response in peritoneal dialysis-related peritonitis. International Journal of Nephrology, 2016. 65(7) p.

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