# A nurse is assessing a 45-year-old patient admitted with acute abdominal pain. Which assessment finding should the nurse prioritize for immediate reporting to the healthcare provider?

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## 문제

A nurse is assessing a 45-year-old patient admitted with acute abdominal pain. Which assessment finding should the nurse prioritize for immediate reporting to the healthcare provider?

## 보기

1. Rigid abdomen with rebound tenderness **✔ 정답**
2. Hyperactive bowel sounds in all four quadrants
3. Nausea and vomiting for the past 6 hours
4. Temperature of 100.2°F (37.9°C)

**정답: 1**

## 해설

Rigid abdomen with rebound tenderness indicates peritonitis, a surgical emergency. Other findings (hyperactive sounds, nausea/vomiting, low-grade fever) are less urgent.

## 심화 해설

Clinical Reasoning and Prioritization

The assessment finding that demands immediate reporting is a rigid abdomen with rebound tenderness. This combination represents a classic peritoneal sign indicative of an acute surgical abdomen, which requires urgent intervention to prevent life-threatening deterioration.

Pathophysiology and Clinical Significance

When an intra-abdominal catastrophe occurs—such as a perforated viscus, strangulated bowel obstruction, or severe inflammatory process—the parietal peritoneum becomes irritated. This triggers involuntary guarding, leading to a board-like, rigid abdominal wall. Rebound tenderness (pain upon sudden release of palpation pressure) is a hallmark of peritoneal inflammation. These findings signal a progression from a localized problem to a diffuse, systemic crisis.

The provided literature directly supports the gravity of this presentation. A rigid, tender abdomen is the clinical manifestation of conditions such as pneumoperitoneum from a perforated peptic ulcer, where free air and gastric contents spill into the peritoneal cavity, causing chemical and bacterial peritonitis [2]. Similarly, a strangulated small bowel obstruction—whether from an internal hernia, a migrated device, or intussusception—compromises mesenteric blood flow [1][3]. As ischemia progresses to necrosis and eventual perforation, the patient transitions from crampy, intermittent pain to constant, severe pain with peritoneal signs. This marks the critical window where delay in surgical exploration directly correlates with increased mortality due to sepsis and hemodynamic instability [1][3].

Analysis of Alternative Options

-   Hyperactive bowel sounds in all four quadrants: This finding is characteristic of early mechanical bowel obstruction, as the intestine attempts to overcome the blockage with increased peristalsis [3]. While clinically significant and requiring prompt investigation, it does not represent the immediate, life-threatening peritoneal insult that rigidity with rebound tenderness does.

-   Nausea and vomiting for the past 6 hours: These are non-specific symptoms common to many acute abdominal conditions, including simple gastroenteritis or early obstruction. They reflect the activation of the emetic reflex due to visceral distension or irritation but do not independently indicate a surgical emergency.

-   Temperature of 100.2°F (37.9°C): A low-grade fever is a systemic response to inflammation and can be seen in uncomplicated conditions like acute appendicitis or even a viral illness . It is a supportive finding, not a primary indicator of a perforated or ischemic crisis. The presence of a rigid, tender abdomen with this mild temperature elevation would be highly concerning for a contained perforation or early peritonitis before a significant systemic inflammatory response has fully mounted.

The nurse’s priority is to recognize that a rigid, tender abdomen is a late and ominous sign of an acute surgical pathology, such as the perforations and strangulated obstructions described in the supporting evidence [1][2][3]. This finding must be communicated instantly to the healthcare provider to facilitate emergency surgical evaluation and intervention.References (research sources)

- [1]Recurrent Jejunojejunal Intussusception of the Common Limb in a Patient With Roux-en-Y Gastric Bypass: A Report of an Unusual Case and Literature Review.Research articleNavalón Calzada A, Chavéz Cadena OG, Reyes Rementeria B, Turrent Pinedo R. (2026) · DOI: 10.7759/cureus.109400

- [2]Diagnosis of Pneumoperitoneum Using POCUS.Research articleMaya Jaramillo MP, Ocampo AC. (2026) · DOI: 10.24908/pocusj.v11i01.19753

- [3]Strangulated Small Bowel Obstruction Caused by a Migrated Ring-Shaped Intrauterine Device: Two Case Reports and a Literature Review.Case reportLu Y, Zhu J, Wang Z, Shi X, Jiang X, Shang D, Zhang Q, Li S. (2026) · DOI: 10.12659/ajcr.952535

## 임상 시나리오

Recognizing an Acute Surgical AbdomenPrioritizing Peritoneal Signs in Clinical Assessment
A rigid, board-like abdomen with rebound tenderness is the hallmark of peritonitis and indicates an acute surgical abdomen. This finding must be reported immediately.

Rebound tenderness is elicited by pressing deeply and then suddenly releasing the abdominal wall. Pain on release signals parietal peritoneal inflammation. Involuntary guarding, where muscles remain tense throughout the respiratory cycle, confirms the rigidity.

Common underlying causes include a perforated peptic ulcer, strangulated bowel obstruction, or ruptured appendix. As ischemia progresses to necrosis, pain changes from intermittent cramping to constant, severe pain with peritoneal signs.

CautionDo not delay reporting for less specific findings like nausea, vomiting, or low-grade fever. A rigid abdomen with rebound tenderness signifies a life-threatening crisis requiring urgent surgical evaluation.

## 핵심 개념

- **Rebound tenderness** — Pain upon sudden release of palpation pressure, indicating peritoneal inflammation.
- **Peritonitis** — Inflammation of the peritoneum, often caused by infection or perforation, presenting with a rigid, tender abdomen.
- **Acute surgical abdomen** — An acute abdominal condition requiring urgent surgical intervention to prevent life-threatening deterioration.
- **Guarding** — Involuntary tensing of abdominal muscles to protect inflamed organs, contributing to a rigid abdominal wall.

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