Peritonitis

� Briefly summaries the main topic and focus of each study and include a very summary
of the study�s methodology, results, and discussion (i.e. where the authors explain the
reasons for their findings and research conclusions) for the articles;
� discuss how each article explicitly and specifically explains the behavioral and
psychological responses that the patient in your case study is experiencing in response to
their illness.


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Peritonitis is a health condition that involves the inflammation of peritoneum (thin
protective tissue layer that underlie the abdomen). This health condition is caused by infection
which spreads around the body. It requires immediate treatment to prevent fatal complications
from arising. In patients who have undergone surgical treatment, autonomic responses, mood
swings and psychological coping responses are common. This paper explores 3 different journal
study articles that explain patient’s behavioral and psychological responses to this illness. This
study focuses on behavioral and psychosocial responses following surgical responses.
Boer, K. R., Mahler, C. W., Unlu, C., Lamme, B., Vroom, M. B., Sprangers, M. A., …
Boermeester, M. A. (2007). Long-term prevalence of post-traumatic stress disorder
symptoms in patients after secondary peritonitis. Critical Care, 11(1), R30.
Introduction/Literature review: This study investigates the behavioral response following
secondary peritonitis. This is because numerous hospital admissions and intensive care unit
(ICU) can be physically, emotionally and financially exhaustive. Patients who survive critical
illness report critical poor quality of live and symptomology (PTSD) such as numbing, anxiety,
loss of avoidant and intrusive recollections. The study suggests that the behavioral interventions
are vital in patients with secondary peritonitis.
Methodology: This is a retrospective cohort in patients diagnosed with secondary peritonitis.
The study comprises of 278 patients who had undergone surgery for secondary peritonitis, where
131 of them were long term survivors. The patients were interviewed Post-traumatic Stress
Syndrome 10-question inventory (PTSS-10).

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Study/ Results: The study indicates that in a cohort of 100 patients diagnosed with secondary
peritonitis, 86% of them presented with post traumatic stress disorder. PTSD related symptoms
were also present in 4.3 times higher in older male patients.
Discussion/explanation: The study indicates that 25% patients who have received surgical
treatment for peritonitis are likely to be emotionally and physically upset due to surgical-related
trauma, which could exacerbate illness behavior. The study suggests that patterns of behavior are
seen as a product of socio-cultural conditioning and coping strategies. The study suggests that
healthcare providers should recognize patient’s responses to various health procedures associated
with pain and anxiety. Other symptoms such as impaired appetite, lack of energy and disturbed
sleep can occur due to illness. In addition, some treatments can affect patient’s mood. These
conditions can also be aggravated by other environmental factors such as financial strain of lack
of physical and emotional support.
Application to the case study: The study findings contribute to the body of research that
demonstrates that psychosocial responses in patients are associated with the socio-cultural
factors. The suggests that the healthcare providers should incorporate psychosocial interventions
in routine care so as to help patients such as Mr. Jacobs to manage stress associated with their
new lifestyles of dependency, helplessness and pain. It is important for the healthcare providers
to identify and be aware of this hidden morbidity among the patients diagnosed with secondary
peritonitis.
Jennifer Finnegan-John and Veronica J. Thomas, “The Psychosocial Experience of
Patients with End-Stage Renal Disease and Its Impact on Quality of Life: Findings from a

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Needs Assessment to Shape a Service,” ISRN Nephrology, vol. 2013, Article ID 308986, 8
pages, 2013. doi:10.5402/2013/308986
Introduction/Literature review: This study investigates the psychosocial experiences in patients
with end stage renal disease. The study conducts needs assessment on renal patients to explore
their psychological, spiritual and social needs. The study objective was to investigate behavioral
responses and to conduct needs assessment so as to develop a comprehensive health psychology
that can run concurrently with renal counseling.
Methodology: The study design is prospective qualitative. The study population consisted of 50
patients with end stage renal disease. The mean age of the participants was 55 years and 40% of
them were from black and minority ethnic group. The study utilized series of semi- structured
face to face interviews in renal patients and their carers in order to explore their behavioral and
psychological responses and how the disease impacted their quality of life.
Study/ Results: The study findings indicated that depressive symptoms and disruptive behaviors
are common in renal patients. This is associated with the psychological burden associated with
the disease. Most of the patients in the study had feelings associated with depression and
anxiety.
Discussion/explanation: This retrospective study indicates that depression and anxiety is a
common behavioral response in patient diagnosed with renal disease. The study suggests that
about 25% of patients who are diagnosed with the disease suffer from psychological burden.
This behavioral response is associated with emotional numbness, avoidance of social activities
and events. It is also associated difficulty in sleeping, disruptive and reckless behavior and is
easily irritated. The study states that these are body responses to stress or perceived threat.

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Application to the case study: The study indicates that depression and anxiety is a behavioral
response that goes beyond the mental health. Based on this study, Mr. Jacob’s behavioral
responses (irritability, social isolation and binge drinking) could be associated with the emotional
burden of the disease. This research is interesting because it suggests that healthcare providers
should engage with psychiatrists to help them better manage their improved outcome health.
Mckercher, C.M., Venn, A.J., Blizzard, L., Nelson, M., Palmer, A., Sshby, M., Scott, J., and
Jose. M.D. (2012). Psychosocial factors in adults with chronic kidney disease:
characteristics of pilot participants in the Tasmanian Chronic Kidney Disease study. BMC
Nephrology, 14:83
Introduction/Literature review: This study investigates behavioral and psychosocial responses
in patient diagnosed with chronic illness. The literature links health outcomes with depression,
anxiety and dispositional tendency described by aggression, cynicism attitudes and
anger/irritability. The study also indicates that hostility, anger and depression are related with
renal failure experiences. According to this study, these psychosocial responses are controlled by
biomedical risk factors, and are associated with most aspects of immune function.
Methodology: This study design is quantitative. The study consisted of 105 patients above 18
years diagnosed with stage 4 CKD and was not under dialysis. The measures used in this study
include depression (9- item patient Health questionnaire) and Beck Anxiety Inventory to
investigate behavioral responses with disease progression and patient’s quality of life.
Study/ Results: The study findings indicated that hostility and patient’s behavioral responses to
chronic disease are correlated with their plasma levels of CRP. The study findings indicated that

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the cycle of inflammation levels influence depressive behavior, indicating that depression is
problematic indicator of patients under chronic pain.
Discussion/explanation: The longitudinal study findings indicated that there is a relationship
between the CRP levels and psychosocial factors. The study also states that hormonal changes
also induce inflammatory processes which in turn influence psychosocial responses. For
instance, pain initiates systemic stress which activates neuro-endocrinological pathways
(hypothalamic-pituitary-adrenal axis) leading to the secretion of stress hormone. Accumulation
of stress hormone is associated with hostility and depressive symptoms. The study also suggests
that genetic predispositions play a major role in both inflammation and hostility.
Application to the case study: The study findings contribute to the body of research that
demonstrates that psychosocial responses in patients are associated with systemic inflammation.
This indicates that the Mr. Jacob’s depressive behavior (irritability, social isolation and binge
drinking) is associated with elevated levels of the systemic inflammation. This research is
interesting because it suggests that healthcare providers should reduce systemic inflammation so
as to improve patient’s ability to improve pain, and to help them cope with the illness-induced
stress in their lives.

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References
Boer, K. R., Mahler, C. W., Unlu, C., Lamme, B., Vroom, M. B., Sprangers, M. A., …
Boermeester, M. A. (2007). Long-term prevalence of post-traumatic stress disorder
symptoms in patients after secondary peritonitis. Critical Care, 11(1), R30.
Jennifer Finnegan-John and Veronica J. Thomas, “The Psychosocial Experience of Patients with
End-Stage Renal Disease and Its Impact on Quality of Life: Findings from a Needs
Assessment to Shape a Service,” ISRN Nephrology, vol. 2013, Article ID 308986, 8
pages, 2013.
Mckercher, C.M., Venn, A.J., Blizzard, L., Nelson, M., Palmer, A., Sshby, M., Scott, J., and
Jose. M.D. (2012). Psychosocial factors in adults with chronic kidney disease:
characteristics of pilot participants in the Tasmanian Chronic Kidney Disease study. BMC
Nephrology,

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