The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer?
A. Bradycardia
B. Numbness in the legs
C. Nausea and vomiting
D. A rigid, board-like abdomen
Correct Answer: D. A rigid, board-like abdomen
Perforation of an ulcer is a surgical emergency and is characterized by sudden, sharp, intolerable severe pain beginning in the mid epigastric area and spreading over the abdomen, which becomes rigid and board-like. Perforated peptic ulcer (PPU) is a serious complication of PUD and patients with PPU often present with an acute abdomen that carries a high risk for morbidity and mortality. The lifetime prevalence of perforation in patients with PUD is about 5%. PPU carries mortality ranging from 1.3% to 20%.
Option A: Tachycardia may occur as hypovolemic shock develops. The classic triad of sudden onset of abdominal pain, tachycardia, and abdominal rigidity is the hallmark of perforated peptic ulcers. Early diagnosis, prompt resuscitation, and urgent surgical intervention are essential to improve outcomes.
Option B: Numbness in the legs is not an associated finding. Symptoms of PUD include abdominal pain, upper abdominal discomfort, bloatedness, and feeling of fullness. When PUD worsens and eventually perforates, gastric juice and gas enter the peritoneal cavity leading to chemical peritonitis.
Option C: Nausea and vomiting may occur. Sudden onset of abdominal pain or acute deterioration of the ongoing abdominal pain is typical of PPU. Typically the pain never completely subsides despite usual premedical remedies and forces the patient to seek medical attention.
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