NIGHTINGALE COLLEGE
DIRECT-FOCUSED CARE: CONCEPT MAPPING ASSIGNMENT WORKSHEET
NURSING PROCESS TEMPLATE:
Assessment (Recognizing Cues) Vital Signs: Fever (temperature >100.4°F or 38°C), tachycardia (heart rate >100
Which client information is relevant? What bpm), and hypotension (systolic blood pressure <90 mmHg) suggest systemic
infection and sometimes sepsis. Pain or metabolic acidosis may increase
client data is most important? Which client respiratory rate; in severe sepsis, the oxygen saturation may decrease (Li et al.,
information is of immediate concern? Consider 2022; Mayo Clinic, 2023).
signs and symptoms, lab work, client
statements, H & P, and others. Consider Abdominal Symptoms: Severe constant abdominal pain that worsens when you
subjective and objective data. move is a hallmark sign of peritonitis. Abdominal guarding with rebound
tenderness and rigidity, which means inflamed peritoneum, may be present in the
patient. Absent or hypoactive bowel sounds as well as nausea, vomiting, and
bloating may also occur (Al Sahlawi et al., 2020; Johns Hopkins Medicine,
2024).
Patient Medical History: A 45-year-old female with a history of peritoneal
dialysis for end-stage renal disease. States diffuse abdominal pain worsened over
the last 24 hours with a gradual onset. Complained of fever, nausea, and fatigue.
Cloudy peritoneal dialysis effluent and mild hypotension have been experienced.
No history of gastrointestinal perforation in the past, but a year ago had an
episode of peritonitis. Not known to have any allergies but has type 2 diabetes,
which puts a person at higher risk of infections (NHS Choices, 2019; Mayo
Clinic, 2023).
Analysis (Analyzing Cues)
A clinical condition that this set of cues corresponds to is acute peritonitis, which
Which client conditions are consistent with the
is characterized by infection and inflammation of the peritoneal cavity. The
cues? Do the cues support a particular client
patient’s symptoms, including severe abdominal pain, guarding, rigidity, nausea,
condition? What cues are a cause for concern? vomiting, fever, and hypotension, indicate a systemic inflammatory response,
What other information would help to establish possibly leading to sepsis. The presence of cloudy peritoneal dialysis effluent
the significance of a cue? further supports a diagnosis of peritoneal dialysis-associated peritonitis (PDAP).
This diagnosis is further reinforced by the elevated white blood cell count,
increased C-reactive protein (CRP), elevated procalcitonin levels, and cloudy
peritoneal fluid analysis with WBC >100 cells/µL and neutrophil predominance,
which strongly indicate an infectious process. Gram-positive cocci seen on Gram
stain suggest bacterial peritonitis, likely caused by coagulase-negative
staphylococci or Staphylococcus aureus, which are common in PDAP cases (Li et
al., 2022; Al Sahlawi et al., 2020).
Analysis (Prioritizing Hypotheses) Such a patient is likely due to an acute peritonitis, i.e., a severe
inflammatory response within the peritoneal cavity that usually arises from
What explanations are most likely? What is the bacterial contamination. Severe abdominal pain, guarding, rigidity, fever,
most serious explanation? What is the priority hypotension, and cloudy peritoneal fluid all suggest peritoneal dialysis-
order for safe and effective care? In order of associated peritonitis (PDAP) or some other infectious peritonitis.
priority, identify the top 3 client conditions. Peritonitis is not treated; it can cause sepsis, circulatory collapse, and
multiorgan failure (Li et al., 2022; Al Sahlawi et al., 2020). The most
serious explanation is sepsis and septic shock resulting from peritonitis
spreading systemically and causing severe hypotension, organ dysfunction,
and potential multi-organ failure. Intervention is necessary as soon as
possible to avoid irreparable damage and fatal outcomes (Mayo Clinic,
2023; Johns Hopkins Medicine, 2024). There are three priorities in order to
ensure safe and effective care: preventing septic shock and stabilizing
hemodynamics, controlling the infection and removing the source, and
managing pain and preventing complications.
This study source was downloaded by 100000900412927 from CourseHero.com on 09-18-2025 07:12:45 GMT -05:00 Page 1 of 5
https://www.coursehero.com/file/251599200/Peritonitis-Concept-Mapdocx/
, Planning (Generate Solutions)
What are the desirable outcomes? What
interventions can achieve these outcomes? What
should be avoided? (SMART Planning- specific,
measurable, attainable, realistic/relevant, time-
restricted- Goal setting)
Implementation (Take actions) *Administer broad-spectrum IV antibiotics (e.g., vancomycin and
How should the intervention or combination of ceftazidime) within 1 hour to control infection and prevent septic
interventions be performed, requested, progression. Adjust based on culture results (Li et al., 2022).
communicated, taught, etc.? What are the *Initiate IV fluid resuscitation using normal saline or lactated
priority interventions? (Mark with asterisk) Ringer’s to maintain blood pressure and prevent shock. If needed,
administer vasopressors (Mayo Clinic, 2023).
*Manage pain with IV analgesics (e.g., acetaminophen, opioids if
necessary) to reduce discomfort. Use semi-Fowler’s positioning to
relieve abdominal pressure (Johns Hopkins Medicine, 2024).
*Patient & Caregiver Education: Teach signs of worsening
infection, including persistent fever, increasing abdominal pain,
and signs of sepsis. Educate on proper catheter hygiene to prevent
recurrence (NHS Choices, 2019).
*Reinforce dietary and lifestyle changes: Encourage adequate
hydration and proper nutrition to support recovery. Advise
peritoneal dialysis patients to maintain strict aseptic technique
during exchanges (Al Sahlawi et al., 2020).
Before the assessment, the client had severe abdominal pain, guarding,
Evaluation (Evaluating Outcomes) hypotension (BP 88/56 mmHg), an active peritoneal infection (cloudy peritoneal
What signs point to dialysis effluent), and fever (101.5°F). Elevated CRP levels and raised WBC
improving/declining/unchanged status? What count (18,000/mm³) indicated systemic inflammation on laboratory tests. The
interventions were effective? Are there other client was at risk of developing sepsis and multi-organ failure without immediate
interventions that could be more effective? Did treatment (Li et al., 2022).
the client’s care outlook or status improve?
After interventions, IV analgesics were successful in reducing the client’s pain
from 8/10 to 4/10, and antibiotics reduced the client’s fever to 99.2°F. BP
stabilized to 110/70, stabilizing so as to not shock. Targeted antibiotic therapy,
based on peritoneal fluid cultures and markers of peritoneal infection (WBC,
CRP), started to fall. Proper catheter care and early indications of peritonitis
recurrence were explained to the patient. Although the patient’s immediate
condition improved, it is necessary to maintain surveillance and compliance with
peritoneal hygiene due to reinfection. It may need to be further evaluated to see if
the catheter needs to be taken out to completely rid of the infection (Mayo Clinic,
2023; Johns Hopkins Medicine, 2024).
This study source was downloaded by 100000900412927 from CourseHero.com on 09-18-2025 07:12:45 GMT -05:00 Page 2 of 5
https://www.coursehero.com/file/251599200/Peritonitis-Concept-Mapdocx/
DIRECT-FOCUSED CARE: CONCEPT MAPPING ASSIGNMENT WORKSHEET
NURSING PROCESS TEMPLATE:
Assessment (Recognizing Cues) Vital Signs: Fever (temperature >100.4°F or 38°C), tachycardia (heart rate >100
Which client information is relevant? What bpm), and hypotension (systolic blood pressure <90 mmHg) suggest systemic
infection and sometimes sepsis. Pain or metabolic acidosis may increase
client data is most important? Which client respiratory rate; in severe sepsis, the oxygen saturation may decrease (Li et al.,
information is of immediate concern? Consider 2022; Mayo Clinic, 2023).
signs and symptoms, lab work, client
statements, H & P, and others. Consider Abdominal Symptoms: Severe constant abdominal pain that worsens when you
subjective and objective data. move is a hallmark sign of peritonitis. Abdominal guarding with rebound
tenderness and rigidity, which means inflamed peritoneum, may be present in the
patient. Absent or hypoactive bowel sounds as well as nausea, vomiting, and
bloating may also occur (Al Sahlawi et al., 2020; Johns Hopkins Medicine,
2024).
Patient Medical History: A 45-year-old female with a history of peritoneal
dialysis for end-stage renal disease. States diffuse abdominal pain worsened over
the last 24 hours with a gradual onset. Complained of fever, nausea, and fatigue.
Cloudy peritoneal dialysis effluent and mild hypotension have been experienced.
No history of gastrointestinal perforation in the past, but a year ago had an
episode of peritonitis. Not known to have any allergies but has type 2 diabetes,
which puts a person at higher risk of infections (NHS Choices, 2019; Mayo
Clinic, 2023).
Analysis (Analyzing Cues)
A clinical condition that this set of cues corresponds to is acute peritonitis, which
Which client conditions are consistent with the
is characterized by infection and inflammation of the peritoneal cavity. The
cues? Do the cues support a particular client
patient’s symptoms, including severe abdominal pain, guarding, rigidity, nausea,
condition? What cues are a cause for concern? vomiting, fever, and hypotension, indicate a systemic inflammatory response,
What other information would help to establish possibly leading to sepsis. The presence of cloudy peritoneal dialysis effluent
the significance of a cue? further supports a diagnosis of peritoneal dialysis-associated peritonitis (PDAP).
This diagnosis is further reinforced by the elevated white blood cell count,
increased C-reactive protein (CRP), elevated procalcitonin levels, and cloudy
peritoneal fluid analysis with WBC >100 cells/µL and neutrophil predominance,
which strongly indicate an infectious process. Gram-positive cocci seen on Gram
stain suggest bacterial peritonitis, likely caused by coagulase-negative
staphylococci or Staphylococcus aureus, which are common in PDAP cases (Li et
al., 2022; Al Sahlawi et al., 2020).
Analysis (Prioritizing Hypotheses) Such a patient is likely due to an acute peritonitis, i.e., a severe
inflammatory response within the peritoneal cavity that usually arises from
What explanations are most likely? What is the bacterial contamination. Severe abdominal pain, guarding, rigidity, fever,
most serious explanation? What is the priority hypotension, and cloudy peritoneal fluid all suggest peritoneal dialysis-
order for safe and effective care? In order of associated peritonitis (PDAP) or some other infectious peritonitis.
priority, identify the top 3 client conditions. Peritonitis is not treated; it can cause sepsis, circulatory collapse, and
multiorgan failure (Li et al., 2022; Al Sahlawi et al., 2020). The most
serious explanation is sepsis and septic shock resulting from peritonitis
spreading systemically and causing severe hypotension, organ dysfunction,
and potential multi-organ failure. Intervention is necessary as soon as
possible to avoid irreparable damage and fatal outcomes (Mayo Clinic,
2023; Johns Hopkins Medicine, 2024). There are three priorities in order to
ensure safe and effective care: preventing septic shock and stabilizing
hemodynamics, controlling the infection and removing the source, and
managing pain and preventing complications.
This study source was downloaded by 100000900412927 from CourseHero.com on 09-18-2025 07:12:45 GMT -05:00 Page 1 of 5
https://www.coursehero.com/file/251599200/Peritonitis-Concept-Mapdocx/
, Planning (Generate Solutions)
What are the desirable outcomes? What
interventions can achieve these outcomes? What
should be avoided? (SMART Planning- specific,
measurable, attainable, realistic/relevant, time-
restricted- Goal setting)
Implementation (Take actions) *Administer broad-spectrum IV antibiotics (e.g., vancomycin and
How should the intervention or combination of ceftazidime) within 1 hour to control infection and prevent septic
interventions be performed, requested, progression. Adjust based on culture results (Li et al., 2022).
communicated, taught, etc.? What are the *Initiate IV fluid resuscitation using normal saline or lactated
priority interventions? (Mark with asterisk) Ringer’s to maintain blood pressure and prevent shock. If needed,
administer vasopressors (Mayo Clinic, 2023).
*Manage pain with IV analgesics (e.g., acetaminophen, opioids if
necessary) to reduce discomfort. Use semi-Fowler’s positioning to
relieve abdominal pressure (Johns Hopkins Medicine, 2024).
*Patient & Caregiver Education: Teach signs of worsening
infection, including persistent fever, increasing abdominal pain,
and signs of sepsis. Educate on proper catheter hygiene to prevent
recurrence (NHS Choices, 2019).
*Reinforce dietary and lifestyle changes: Encourage adequate
hydration and proper nutrition to support recovery. Advise
peritoneal dialysis patients to maintain strict aseptic technique
during exchanges (Al Sahlawi et al., 2020).
Before the assessment, the client had severe abdominal pain, guarding,
Evaluation (Evaluating Outcomes) hypotension (BP 88/56 mmHg), an active peritoneal infection (cloudy peritoneal
What signs point to dialysis effluent), and fever (101.5°F). Elevated CRP levels and raised WBC
improving/declining/unchanged status? What count (18,000/mm³) indicated systemic inflammation on laboratory tests. The
interventions were effective? Are there other client was at risk of developing sepsis and multi-organ failure without immediate
interventions that could be more effective? Did treatment (Li et al., 2022).
the client’s care outlook or status improve?
After interventions, IV analgesics were successful in reducing the client’s pain
from 8/10 to 4/10, and antibiotics reduced the client’s fever to 99.2°F. BP
stabilized to 110/70, stabilizing so as to not shock. Targeted antibiotic therapy,
based on peritoneal fluid cultures and markers of peritoneal infection (WBC,
CRP), started to fall. Proper catheter care and early indications of peritonitis
recurrence were explained to the patient. Although the patient’s immediate
condition improved, it is necessary to maintain surveillance and compliance with
peritoneal hygiene due to reinfection. It may need to be further evaluated to see if
the catheter needs to be taken out to completely rid of the infection (Mayo Clinic,
2023; Johns Hopkins Medicine, 2024).
This study source was downloaded by 100000900412927 from CourseHero.com on 09-18-2025 07:12:45 GMT -05:00 Page 2 of 5
https://www.coursehero.com/file/251599200/Peritonitis-Concept-Mapdocx/
