Final answer:
Management of a patient with ruptured PUD includes emergency surgery to repair the perforation, followed by intensive antibiotic therapy and medical management of RA and PUD contributing factors.
Step-by-step explanation:
When a patient presents with a ruptured peptic ulcer disease (PUD) and there are gastric contents in the peritoneal cavity, the management typically involves emergency surgery to repair the perforation. For a patient with a history of progressive rheumatoid arthritis (RA) who requires nonsteroidal anti-inflammatory drugs (NSAIDs) and occasional steroids, the risk for PUD is increased, and following surgical intervention, careful medical management of both RA and the underlying factors contributing to the PUD is necessary. Intensive antibiotic therapy may also be required to treat potential bacterial peritonitis associated with the contamination of the peritoneal cavity by gastric contents.