What assessment findings would the nurse expect when caring for a patient diagnosed with peritonitis?

Choice A rationale Decreased urinary output, or oliguria, is a possible finding but not a universal, core symptom of peritonitis. Peritonitis is an inflammation of the peritoneum, often caused by a ruptured organ or infection. The inflammatory response can lead to a fluid shift into the peritoneal cavity (third spacing), causing hypovolemia and potentially decreased urinary output. However, it is a secondary effect of the fluid shifts, not a primary sign. Choice B rationale A distended, rigid abdomen is a hallmark sign of peritonitis. The inflammation and irritation of the peritoneal lining cause reflex muscle guarding, leading to a tense and rigid abdominal wall. This is often described as a "board-like" abdomen. The distention is caused by paralytic ileus, where intestinal motility ceases, and the accumulation of fluid, gas, and pus within the peritoneal cavity. Choice C rationale Abdominal pain is the most common and severe symptom of peritonitis. The peritoneum is rich in nerve endings, and its inflammation causes intense, diffuse, or localized pain that is often constant and worsens with any movement, coughing, or palpation. The location of the pain can help pinpoint the underlying cause. Choice D rationale Bradycardia, or a slow heart rate, is an uncommon finding in peritonitis. In response to the systemic inflammatory response and hypovolemia, the body typically mounts a compensatory response that includes tachycardia, or an increased heart rate. Tachycardia helps maintain cardiac output and tissue perfusion in the face of fluid loss. Bradycardia might indicate a different underlying issue or a very late stage of septic shock. Choice E rationale Fever is a common systemic sign of peritonitis. It indicates the body's inflammatory and immune response to the infection within the peritoneal cavity. The release of pyrogens from bacteria and inflammatory cells triggers the hypothalamus to raise the body's temperature, leading to a fever. This is a crucial sign of a systemic inflammatory process. Choice F rationale Nausea and vomiting are very common symptoms. The inflammation and irritation of the peritoneum can disrupt normal gastrointestinal motility, leading to paralytic ileus. The resulting stasis of gastric and intestinal contents causes nausea and vomiting. The body's systemic response to the infection also contributes to these symptoms.