Appendicitis
•Inflammation of the appendix
•Occurs as a result of obstruction of the lumen of the appendix by hardened fecal material, microorganisms, parasites or tumors.
•Can lead to perforation & peritonitis
Appendicitis: Etiology
•Occurs at any age & affects both sexes; most common in teenagers & young adults: 10-30 yrs
•Most common condition requiring surgery
•Decreased incidence & death rate because of use of antibiotics
•Fatal if untreated r/t delayed treatment & complications
•Cause is poorly understood
•Dietary habits may be involved
•Children with high fiber diets have lower incidence
•Pinworms have NOT been shown to be a cause
Appendicitis: Pathophysiology
•Obstruction of outflow of mucus secretions is blocked & pressure builds within the lumen resulting in compression of blood vessels.
•Resulting ischemia is followed by necrosis of lining & bacterial invasion.
•Inflammation of the appendix spreads rapidly throughout abdomen - peritonitis
Appendicitis: Subjective Data Collection
•Subjective symptoms
•Abdominal pain in RLQ (McBurney’s point)
•Anorexia
•Nausea & vomiting
•Increased tenderness in area
•NOTE: sudden cessation of abdominal pain indicates rupture or infarction of appendix
Appendicitis: Objective Data Collection
•Vomiting
•Abdominal rigidity
•Retractions: respirations
•Severe abdominal spasms
•Rebound tenderness (if in left side, indicates rupture or infarction of appendix)
•Constipation
•Low grade fever (99-102)
•Decreased bowel sounds
•Tachycardia
•Elevated WBC count: 12,000-15,000 mm3
Appendicitis: Diagnosis
•History
•Pain, often generalized, periumbilical, but usually descends to McBurney's point; aggravated by movement Fever 99.5-101.5 (higher is viral or perforated)
•Physical exam
•X-ray
•Labs
•WBC count elevated
•Routine UA
•US used mostly
•Evaluation similar symptoms: gastritis, colitis, diverticulitis, pancreatitis, renal colic, bladder infection, ovarian cyst, & uterine disease
Appendicitis Management
•Surgery (appendectomy)
•If ruptured:
•Rehydration
•Antibiotics 6-8 hrs before appendectomy
Appendicitis Management: Ruptured Appendix
•Preoperative
•IV fluids & electrolytes
•IV systemic antibiotics
•NG suction to decompress the abdomen
•Postoperative
•IV fluids, antibiotics for 7-10 days
•NG suction
Appendicitis: Nursing
•Acute pain r/t infection, rupture
•Risk for fluid volume deficit r/t NPO, anorexia, fever
•Hyperthermia r/t infection
•Anxiety r/t infection, immediate surgery, pain
•Peritonitis
•Postoperative complications: atelectasis, pneumonia, DVT
Acute Pain r/t abdominal infection
•Use ice packs to abdomen as prescribed – do not apply heat.
•Keep client NPO
•Place client in Fowler’s position to minimize tension on incision & abdominal organs
•Administer analgesia as ordered postoperatively
•Sedatives may be given
Risk for fluid volume deficit r/t NPO, anorexia, fever
•Maintain bedrest
•Administration of & monitor IV fluids to prevent dehydration
•Administer oral fluids postoperatively when tolerated when bowel sounds are present
Anxiety r/t infection, immediate surgery, pain
•Prepare for surgery, explain, teach, consents
•Teach about incisional care
•Also, short acting narcotics should be used for pain management
Appendicitis Evaluation
•Client reports increased comfort
•Client remains free of infection or avoidable complications
•Client demonstrates an understanding of disease process, nature of surgery, & postoperative care
