The nurse is assessing a patient with peritonitis. What findings should they expect? (Select all that apply)

Choice A reason: Frequent bowel movements are not typical in peritonitis. Inflammation of the peritoneal cavity causes ileus, reducing bowel motility and leading to constipation or obstipation. Peristalsis slows due to irritation, and the body diverts energy to combat infection, making diarrhea unlikely unless another condition, like gastroenteritis, is present, which is not indicated here.

Choice B reason: A rigid abdomen is a classic sign of peritonitis due to peritoneal inflammation causing muscle guarding and rigidity. The peritoneal irritation from infection or chemical irritants (e.g., bile, gastric contents) triggers involuntary abdominal wall contraction to protect inflamed tissues, resulting in a board-like abdomen, often with severe pain.

Choice C reason: Decreased urinary output occurs in peritonitis due to systemic inflammation and potential hypovolemia from fluid shifts into the peritoneal cavity (third-spacing). The kidneys receive reduced perfusion, activating the renin-angiotensin-aldosterone system, leading to oliguria. This reflects the body’s attempt to conserve fluid in response to systemic stress and inflammation.

Choice D reason: Inability to pass stools is expected in peritonitis due to paralytic ileus, where intestinal motility ceases from inflammation. Peritoneal irritation disrupts normal peristalsis, causing bowel obstruction symptoms like constipation or obstipation. This results from the body’s inflammatory response inhibiting gastrointestinal function, leading to stool retention.

Choice E reason: Hyperactive bowel sounds are not typical in peritonitis. The condition causes paralytic ileus, reducing or absent bowel sounds due to decreased peristalsis from peritoneal inflammation. Hyperactive sounds may occur in early mechanical obstruction but not in peritonitis, where inflammation halts bowel motility, leading to hypoactive or absent sounds.