Perforated peptic ulcer is a surgical emergency. The classic presentation is:

• Sudden, severe, generalized abdominal pain
• Board-like rigidity (involuntary guarding) — contents spill into peritoneal cavity causing chemical peritonitis
• Rebound tenderness (positive Blumberg's sign)
• Absent bowel sounds
• Tachycardia, hypotension (shock)
• Free air under diaphragm on chest X-ray (pathognomonic)

Priority nursing actions:

1. Keep patient NPO immediately
2. Insert IV lines — large-bore cannulas
3. IV fluids to maintain hemodynamic stability
4. Insert urinary catheter — monitor urine output hourly
5. IV antibiotics as ordered
6. Prepare for emergency laparotomy
7. Do NOT give analgesics until surgeon has assessed (may mask signs)