<![CDATA[Background: Structured clinical decision-making is critical in peritonitis with acute kidney injury (AKI), yet application of the SAHAR model in intensive care remains unreported. Objective: To describe the application of the SAHAR model in nursing care for a patient with peritonitis and AKI Methods: A qualitative case study was conducted in an Indonesian hospital. Data were collected through nursing assessment, monitoring, record review, and outcome evaluation, then analyzed using the six SAHAR themes. Results: The SAHAR model guided cue recognition (hypoxemia, hyperkalemia, hemodynamic instability) and prioritization of three nursing diagnoses: impaired gas exchange, risk of shock, and acute pain. Interventions included oxygen therapy, strict fluid balance monitoring, fentanyl analgesia, and electrolyte correction. After 3×24 hours, the patient showed partial clinical improvement, with stable hemodynamics, reduced respiratory rate, and a decreased pain score. Discussion: The SAHAR model's structured approach enabled systematic clinical judgment and timely prioritization of life-threatening conditions. These findings align with previous research on decision-making frameworks in emergency and critical care nursing, demonstrating the model's potential to enhance patient safety and care quality in complex cases such as peritonitis with AKI]]>
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