What clinical findings would a nurse expect in a client with peritonitis?

Expected Clinical Findings in a Client with Peritonitis

The nurse caring for a client with peritonitis should expect to find abdominal pain, distended rigid abdomen, nausea and vomiting, fever, and decreased urinary output, but not bradycardia.

Primary Clinical Findings

• Abdominal pain and tenderness are present in 74-95% of patients with peritonitis, often accompanied by rebound tenderness and guarding 1
• Abdominal rigidity is a key clinical feature strongly suggesting the presence of peritonitis 1
• Distended abdomen is observed in peritonitis, with isolated abdominal distension seen in 6.6% of patients 1
• Nausea and vomiting are common symptoms, with vomiting reported in 35% of patients with peritonitis 2, 1
• Fever greater than 38.5°C is present in approximately 38% of patients 1
• Decreased urinary output (oliguria) is a sign of hypoperfusion in peritonitis and indicates ongoing sepsis 1

Vital Sign Changes

• Tachycardia (not bradycardia) is observed in 62.5% of patients with peritonitis 1
• Hypotension may develop as peritonitis progresses to septic shock 1
• Tachypnea is a common finding as part of the systemic inflammatory response 2

Additional Clinical Findings

• Decreased bowel sounds are commonly found in peritonitis due to developing ileus 1
• Ileus symptoms such as absence of defecation may be present 1
• Signs of systemic inflammation including altered white blood cell count and chills 2
• Worsening of liver function may be observed, particularly in patients with underlying liver disease 2
• Hepatic encephalopathy may develop as a complication 2, 1

Laboratory Findings

• Leukocytosis with left shift (band neutrophils >20%) is a common laboratory finding 1
• Elevated C-reactive protein (CRP) levels are typically observed 1
• Increased serum creatinine levels (more than 50% above baseline) indicate developing renal dysfunction 1
• Elevated serum lactate levels suggest tissue hypoperfusion 1

Complications to Monitor

• Renal failure is a potential complication that explains the decreased urinary output 1
• Septic shock may develop, particularly in patients with delayed diagnosis 2, 1
• Multi-organ failure can occur as peritonitis progresses 1, 3

Clinical Pitfalls and Considerations

• The classic presentation of "pain out of proportion to physical examination findings" may be present in early peritonitis, making diagnosis challenging 2
• Physical signs of peritonitis may be subtle, requiring a high index of suspicion 2
• Delayed diagnosis and treatment significantly increases mortality rates 1
• The nurse should recognize that bradycardia is NOT an expected finding in peritonitis; instead, tachycardia is the typical cardiovascular response 1