# A 65-year-old client is admitted to the emergency department with complaints of severe left lower quadrant abdominal pain that started 6 hours ago. The client reports nausea, vomiting, and a low-grade fever. Which assessment finding would be most significant for the nurse to report immediately to the healthcare provider?

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## 문제

A 65-year-old client is admitted to the emergency department with complaints of severe left lower quadrant abdominal pain that started 6 hours ago. The client reports nausea, vomiting, and a low-grade fever. Which assessment finding would be most significant for the nurse to report immediately to the healthcare provider?

## 보기

1. Complaint of cramping abdominal pain rated 6/10 on the pain scale
2. Rigid abdomen with rebound tenderness **✔ 정답**
3. Temperature of 100.8°F (38.2°C) with mild leukocytosis
4. Nausea and vomiting with decreased oral intake for 12 hours

**정답: 2**

## 해설

A rigid abdomen with rebound tenderness indicates peritonitis, which is a life-threatening complication of diverticulitis that requires immediate surgical intervention. Peritonitis occurs when intestinal contents leak into the abdominal cavity due to diverticular perforation, with abdominal rigidity and rebound tenderness being typical signs. Immediate surgical intervention is necessary. Incorrect answer analysis: 1) Crampy abdominal pain rated 6/10 is a common symptom of diverticulitis but is not an emergency requiring immediate reporting. 3) A low-grade fever of 100.8°F and mild leukocytosis are expected in diverticulitis but are not life-threatening on their own. 4) Nausea, vomiting, and decreased oral intake over 12 hours pose a risk of dehydration but are less urgent than peritonitis.

## 심화 해설

Clinical Reasoning and Prioritization

The client presents with acute left lower quadrant abdominal pain accompanied by nausea, vomiting, and fever. In the context of an acute abdomen, the nurse must rapidly differentiate between findings that are expected in the disease process and those that signal a life-threatening complication. The most significant finding to report immediately is a rigid abdomen with rebound tenderness.

Pathophysiology and Clinical Significance

A rigid, board-like abdomen with rebound tenderness is a classic peritoneal sign indicating peritonitis, which is the inflammation of the peritoneal lining. Rebound tenderness—pain upon sudden release of pressure rather than during palpation—occurs because the inflamed peritoneal layers are stretched and irritated by the sudden movement. This finding strongly suggests that the underlying pathological process, such as complicated diverticulitis (common in the left lower quadrant in older adults) or a perforated viscus, has progressed beyond localized inflammation to involve the entire peritoneal cavity.

In cases of hollow organ perforation, as described in the context of spontaneous cecal perforation [4], intestinal contents spill into the sterile peritoneal cavity, causing chemical and subsequently bacterial peritonitis. This progression leads to third-spacing of fluids, sepsis, and hemodynamic instability. The finding of a rigid abdomen is a surgical emergency and requires immediate notification of the healthcare provider for urgent surgical evaluation and intervention, as delays directly increase morbidity and mortality.

Analysis of Other Options

- Option 1: A complaint of cramping abdominal pain rated 6/10 is an expected symptom in many acute abdominal conditions. While pain management is a nursing priority, this finding alone does not indicate a new, life-threatening development that requires immediate escalation over peritoneal signs.

- Option 3: A temperature of 100.8°F (38.2°C) with mild leukocytosis reflects a systemic inflammatory response, which is an anticipated finding in acute diverticulitis or appendicitis. These values support the diagnosis but do not carry the same immediate urgency as physical examination findings indicating a perforation.

- Option 4: Nausea and vomiting with decreased oral intake explain the client's fluid volume deficit risk but are common, non-specific symptoms of an acute abdomen. They are not the priority assessment finding when a potential surgical emergency is evolving.

Triage and Nursing Implications

In conventional nurse-only triage models, the rapid identification of such high-acuity physical assessment findings is critical for timely intervention. Studies on team triage for acute surgical conditions like appendicitis and cholecystitis highlight the importance of accelerating the time to diagnosis and treatment . The nurse at the bedside is pivotal in recognizing the transition from a localized inflammatory process to a generalized peritoneal crisis. A rigid abdomen with rebound tenderness is a late and ominous sign that necessitates immediate surgical consultation, making it the most significant finding to report.References (research sources)

- [4]Spontaneous Cecal Perforation During Pregnancy.Research articleAlshoubi A, Kim M, Hauter W, Khan W, Shah H. (2024) · DOI: 10.7759/cureus.55862

## 임상 시나리오

Recognizing the Acute Surgical AbdomenPrioritizing peritoneal signs in nursing assessment
A rigid, board-like abdomen with rebound tenderness is a hallmark of peritonitis. This finding suggests a perforated viscus or complicated infection and is a surgical emergency.

In an older adult with left lower quadrant pain, consider complicated diverticulitis as a common cause. The progression from localized inflammation to generalized peritonitis can lead to sepsis and hemodynamic instability.

CautionDo not delay reporting. A rigid abdomen with rebound tenderness takes priority over vital sign changes or pain levels. Immediate notification of the healthcare provider is required for potential emergency surgery.

## 핵심 개념

- **Diverticulitis** — A condition in which pouches (diverticula) formed in the wall of the large intestine become inflamed and infected. Common symptoms include left lower abdominal pain, fever, and vomiting.
- **Peritonitis** — Inflammation of the peritoneum (the membrane lining the abdominal cavity and covering the organs). It is mainly caused by intestinal perforation and is a life-threatening condition that can lead to abdominal rigidity, rebound tenderness, fever, and sepsis.
- **Rebound Tenderness** — Pain felt when suddenly releasing hand pressure from the abdomen. It is an important sign of peritoneal irritation and inflammation.
- **Rigid Abdomen** — Abdominal muscles are rigidly tense. This is a protective mechanism seen in patients with peritonitis, described as 'board-like' stiffness.
- **Paralytic Ileus** — A condition where the bowel's motor function is paralyzed, stopping the movement of contents. It occurs due to peritonitis and other causes, accompanied by decreased or absent bowel sounds, bloating, and vomiting.

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