718 Peritonitis peritoneum and the somatic nerves supplying the parietal pentoneum. Peritoneal pain is almost always increased by pressure or tension of the peritoneum, such as coughing, sneezing, and palpation. Ask whether abdominal pain is generalized or localized. Inflamed diaphragmatic peritonitis can cause shoulder pain as well.

PHYSICAL EXAMINATION. Visually inspect the abdomen for size and shape. Peritonitis leads to abdominal distension. When assessing the GI system, auscultate before palpation. Bowel sounds are decreased or absent. Palpation reveals abdominal rigidity and elicits rebound tenderness with guarding. The patient may keep movement to a minimum to reduce the pain. Well-localized pain may cause rigidity of the abdominal muscles. The patient is generally in a knee-flexed position with shallow respirations in an attempt to minimize pain.

Check the patient for signs of dehydration, such as a dry and swollen tongue, dry mucous membranes, and thirst. High fever may result in rapid heart rate. The patient may experience hiccups in cases of diaphragmatic peritonitis. Observe the patient for pallor, excessive sweating, or cold skin, which are signs of electrolyte and fluid loss.

PSYCHOSOCIAL. Patients with peritonitis have often been coping with a serious illness or traumatic injury to the abdomen and may already be weary of discomfort and pain. Besides dealing with intensified pain and new complications, the patient with peritonitis is also at risk for life-threatening complications such as shock, renal problems, and respiratory problems. Assess the patient's and family's anxiety and feelings of powerlessness about the illness and potential complications.

Diagnostic Highlights


Normal Result

Abnormality with Condition


White blood

Adult males and


Detects the presence of an

cell (WBC)


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