A nurse is caring for a client with a history of peptic ulcer disease who presents to the emergency department with sudden onset of severe abdominal pain, rigid abdomen, and signs of shock. Which nursing action should be the priority?

The client's presentation—sudden onset of severe abdominal pain, a rigid (board-like) abdomen, and signs of shock—is a classic triad for a perforated peptic ulcer. This is a surgical emergency. The rigid abdomen indicates peritonitis caused by the spillage of gastric or duodenal contents into the sterile peritoneal cavity. The signs of shock are a direct consequence of the massive inflammatory response and fluid shifts (third-spacing) that occur with chemical and subsequent bacterial peritonitis. In the hierarchy of nursing priorities, addressing the underlying, life-threatening cause takes precedence over all other interventions.

According to the WSES guidelines, complicated peptic ulcer disease, particularly perforation, requires a time-sensitive, definitive intervention to control the source of contamination ^[1]. While the guidelines discuss a spectrum of management strategies, the immediate priority for a patient with generalized peritonitis and hemodynamic instability is source control, which is most commonly achieved through surgical intervention. Preparing the client for surgery is the most critical nursing action because it directly facilitates the definitive treatment that will stop the ongoing contamination and reverse the pathophysiological cascade of shock.

The nursing process (Assessment, Analysis, Planning, Implementation, Evaluation) guides this decision. The assessment data points unequivocally to an acute abdomen requiring surgical source control. The priority implementation is therefore to prepare the client for that definitive procedure. The WSES guidelines underscore that successful management of complicated peptic ulcer disease hinges on a multidisciplinary approach where timely recognition and intervention are paramount to reducing mortality ^[1].