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A patient is experiencing lower left quadrant pain with guarding, as well as abdominal distention and rigidity. KUB reveals free air in the abdominal
cavity. Vital signs are:
BP 76/40
HR 130
RR 32
T 101.7 F (38.7C)
A nurse would suspect
Suggested Answer: A
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The clinical presentation of lower left quadrant pain with guarding, abdominal distention, rigidity, and free air in the abdominal cavity on a KUB (kidney, ureter, and bladder) radiograph strongly suggests a perforated bowel. The presence of free air indicates that there is a breach in the gastrointestinal tract, allowing air to escape into the peritoneal cavity. The patient's vital signs, including hypotension (BP 76/40), tachycardia (HR 130), tachypnea (RR 32), and fever (T 101.7F), are consistent with sepsis and shock, which are common complications of bowel perforation. Reference: CCRN Exam Handbook, AACN, page 30, section on Gastrointestinal.
31 comments · newest first
JU
Junita
10 months ago
Definitely a perforation, the guarding is a big clue!
DA
Dallas
11 months ago
Free air? That’s pretty serious, not sure about the other options.
MI
Micheline
11 months ago
Wait, could it be appendicitis instead?
LA
Laurene
11 months ago
Totally agree, those vital signs are concerning.
CL
Clemencia
11 months ago
Sounds like a perforated bowel to me.
AF
Afton
12 months ago
I thought paralytic ileus could cause distention too, but the free air makes me lean towards perforation.
BE
Belen
12 months ago
I practiced a similar question about appendicitis, but this case seems more severe with the guarding and free air.
JA
Janessa
12 months ago
I'm not entirely sure, but I feel like the vital signs suggest shock, which could align with a perforated bowel, right?
TR
Truman
1 year ago
I remember studying about abdominal pain and guarding, and I think free air in the cavity usually indicates perforation.
PA
Paris
1 year ago
Yikes, this patient is in rough shape with those vital signs. I'm going to go with perforated bowel since that seems to fit the clinical presentation the best. Gotta act fast on this one.
VE
Veronica
1 year ago
The free air and abdominal distention and rigidity make me think perforated bowel is the most likely diagnosis. I'll focus on that as my primary answer, but I'll also make sure to review the other options just in case.
AL
Alesia
1 year ago
Hmm, I'm a little unsure here. The symptoms could also point to appendicitis or even pancreatitis. I'll need to carefully weigh the evidence before selecting an answer.
FE
Felix
1 year ago
Okay, this looks like a classic case of a perforated bowel based on the free air in the abdomen and the patient's vital signs. I'm pretty confident this is the right answer.
LA
Lacresha
2 years ago
I don't think so, the free air in the abdominal cavity suggests perforated bowel.
MI
Minna
2 years ago
I'm just going to go with option A and hope for the best. Perforated bowel sounds dramatic, but at least it's not something boring like appendicitis. Who wants to be the nurse that misses a major abdominal catastrophe, am I right?
EV
Evangelina
2 years ago
User 3: Definitely need to act fast on this one.
AD
Adolph
2 years ago
User 2: Yeah, that sounds serious.
CH
Charlie
2 years ago
User 1: I think it's perforated bowel.
AN
Anglea
2 years ago
But could it also be acute pancreatitis?
NA
Nakita
2 years ago
This is a tough one, but I'm leaning towards paralytic ileus. The distention and rigidity could be due to a blockage in the intestines. Plus, the nurse would definitely suspect this, right? It's the most obscure answer, so it must be correct.
SH
Shelia
2 years ago
Hmm, I'm not so sure. The combination of symptoms makes me think it could be acute pancreatitis. The fever and low blood pressure are concerning, though. I'll go with that just to be different.
LA
Laine
2 years ago
I suspect acute pancreatitis.
LA
Laila
2 years ago
I believe it might be appendicitis.
CE
Cecilia
2 years ago
I'm leaning towards paralytic ileus.
SA
Santos
2 years ago
I think it's a perforated bowel.
AZ
Azzie
2 years ago
I agree, the symptoms and vital signs point towards that.
IR
Irma
2 years ago
I'm going with appendicitis. The lower left quadrant pain and guarding are classic signs. Maybe the patient just had a big meal and that's why there's distention and rigidity.
PA
Pamella
2 years ago
Definitely a perforated bowel. The free air in the abdomen and the patient's vital signs point to a serious abdominal emergency. This is a no-brainer.
CH
Chauncey
2 years ago
Definitely a perforated bowel. The free air in the abdomen and the patient's vital signs point to a serious abdominal emergency. This is a no-brainer.
LA
Lashon
2 years ago
A) perforated bowel.
FI
Filiberto
2 years ago
I think the patient might have a perforated bowel.