Appendicitis
-Inflammation of the appendix, a narrow blind tube that extends from the inferior part of the
cecum.
-**Most common reason for emergency abdominal surgery
-When the appendix becomes inflamed or infected, rupture may occur within a matter of hours,
leading to peritonitis and sepsis.
Etiology & Patho
-Most common in individuals 10-30 years of age
-Common cause of appendicitis is obstruction of the lumen by a fecalith (accumulated
feces).
-Obstruction results in distention; venous engorgement; & the accumulation of mucous
& bacteria, which can lead to gangrene, perforation, & peritonitis.
-Low fiber diet & high intake of refined carbs are risk factors
Clinical Manifestations
-Typically begins with dull periumbilical pain, followed by anorexia, nausea & vomiting
-Pain is persistent & continuous, eventually shifting to the RLQ & localizing at
McBurney’s point (halfway between the umbilicus & right iliac crest)
-Low grade fever may develop
-Further assessment reveals localized tenderness, rigidity, rebound tenderness,
& muscle guarding
-Coughing, sneezing, & deep inhalation worsen pain
-Elevated WBC count
-Pt in side lying position with abdominal guarding & legs flexed
-Constipation or diarrhea
-Older adults may report less severe pain, slight fever, & discomfort in the right iliac
fossa
Diagnostic Studies & Interprofessional Care
-Pt examination includes complete history, physical exam, & a differential WBC count
-Most pt’s have a mildly to moderately elevated WBC count
-Urinalysis is done to rule out genitourinary conditions that mimic appendicitis
-CT scan is the preferred diagnostic procedure
-Ultrasound & MRI are also used
-Leukocyte count greater than 10,000/mm 3, neutrophil count greater than 75%;
abdominal radiographs, ultrasound studies, and CT scans may reveal right lower quadrant
density or localized distention of the bowel.
-If there is a delay in the diagnosis & treatment, the appendix can rupture & the resulting
peritonitis can be fatal
-Treatment of appendicitis is an immediate appendectomy (removal of appendix)
,-If inflammation is localized, surgery should be done as soon as diagnosis is made
-Antibiotics & fluid resuscitation are started before surgery
-If appendix has ruptured & there is evidence of peritonitis or an abscess, giving
parenteral fluids & antibiotic therapy for 6-8 hours before the appendectomy helps
prevent dehydration & sepsis
Nursing Management: Appendicitis
-Management focuses on preventing fluid volume deficit, relieving pain, & preventing
complications
-Keep the pt NPO until the HCP evaluates the pt
-Monitor vitals & perform ongoing assessment to detect any deterioration
-Administer IV fluids, analgesics, & antiemetics as ordered
-Provide comfort measures
Primary Nursing Diagnosis
-Primary Preoperative Nursing Diagnosis
-Pain (acute) related to inflammation
-Primary Postoperative Nursing Diagnosis
-Risk for infection related to the surgical incision
Other Diagnoses that may occur in Nursing Care Plans For Appendicitis
-Imbalanced nutrition: Less than body requirements
-Impaired skin integrity
-Ineffective tissue perfusion: GI
-Risk for deficient fluid volume
-Risk for injury
Medical Management
An appendectomy (surgical removal of the appendix) is the preferred method of
management for acute appendicitis if the inflammation is localized. An open
appendectomy is completed with a transverse right lower quadrant incision, usually at the
McBurney point. A laparoscopic appendectomy may be used in females of childbearing
age, those in whom the diagnosis is in question, and for obese patients. If the
appendix has ruptured and there is evidence of peritonitis or an abscess, conservative
treatment consisting of antibiotics and intravenous (IV) fluids is given 6 to 8 hours prior
to an appendectomy. Generally, an appendectomy is performed within 24 to 48 hours
after the onset of symptoms under either general or spinal anesthesia. Preoperative
management includes IV hydration, antipyretics,antibiotics, and, after definitive
diagnosis, analgesics.
Complications of Appendectomy
,-The major complication is perforation of the appendix, which can lead to
peritonitis or an abscess.
-Perforation generally occurs 24 hours after onset of pain, symptoms include fever
(37.7°C [100°F] or greater), toxic appearance, and continued pain and tenderness
Pharmacologic Intervention
-Crystalloid intravenous fluids an isotonic solutions such as normal saline solution or
lactated Ringer’s solution 100–500 mL/hr of IV, depending on volume state of the
patient, is used to replaces fluids and electrolytes lost through fever and vomiting;
replacement continues until urine output is 1 cc/kg of body weight and electrolytes are
replaced
-Antibiotics (broad-spectrum antibiotic coverage) to control local and systemic infection
and reduces the incidence of postoperative wound infection
-Other Drugs: Analgesics.
Nursing Intervention
-Preoperative interventions
1. Maintain NPO status.
2. Administer fluids intravenously to prevent dehydration.
3. Monitor for changes in level of pain.
4. Monitor for signs of ruptured appendix and peritonitis
5. Position right-side lying or low to semi fowler position to promote comfort.
6. Monitor bowel sounds.
7. Apply ice packs to abdomen every hour for 20-30 minutes as prescribed.
8. Administer antibiotics as prescribed
9. Avoid the application of heat in the abdomen.
10. Avoid laxatives or enema.
-Postoperative interventions
1. Monitor temperature for signs of infection.
2. Assess incision for signs of infection such as redness, swelling and pain.
3. Maintain NPO status until bowel function has returned.
4. Advance diet gradually or as tolerated or as prescribed when bowel sound return.
5. If rupture of appendix occurred, expect a Penrose drain to be inserted, or the
incision
maybe left to heal inside out.
6. Expect that drainage from the Penrose drain maybe profuse for the first 2 hours.
Documentation Guidelines
-Location, intensity, frequency, and duration of pain
-Response to pain medication, ice applications, and position changes
-Patient’s ability to ambulate and tolerate food
, -Appearance of abdominal incision (color, temperature, intactness, drainage)
-Gas can be a cause of increased pain. Pt may need to ambulate to relieve gas
Discharge & Home Healthcare Guidelines
-MEDICATIONS. Be sure the patient understands any pain medication prescribed,
including doses, route, action, and side effects. Make certain the patient understands that
he or she should avoid operating a motor vehicle or heavy machinery while taking such
Medication.
-INCISION. Sutures are generally removed in the physician’s office in 5 to 7 days.
Explain the need to keep the surgical wound clean and dry. Teach the patient to observe
the wound and report to the physician any increased swelling, redness, drainage, odor, or
separation of the wound edges. Also instruct the patient to notify the doctor if a fever
develops. The patient needs to know these may be symptoms of wound infection. Explain
that the patient should avoid heavy lifting and should question the physician about when
lifting can be resumed.
-COMPLICATIONS. Instruct the patient that a possible complication of appendicitis is
peritonitis. Discuss with the patient symptoms that indicate peritonitis, including sharp
abdominal pains, fever, nausea and vomiting, and increased pulse and respiration. The
patient must know to seek medical attention immediately should these symptoms occur.
-NUTRITION. Instruct the patient that diet can be advanced to her or his normal food
pattern as long as no gastrointestinal distress is experienced
Chapter 39: Nutritional Problems
-Nutritional Problems
-Nutrition is the sum of processes by which one takes in and uses nutrients. Nutrition is
important for energy, growth, and maintenance and repair of body tissues.
-Nutritional problems can occur in all age groups, cultures, ethnic groups, and
socioeconomic classes and across all educational levels.
-The essential components of the basic food groups are carbohydrates, fats, proteins,
vitamins, and minerals.
-The daily caloric requirements of a person are influenced by body type, age, gender,
medication usage, physical activity, and the presence or absence of disease.
-Malnutrition
-Malnutrition is a deficit, excess, or imbalance of the essential components of a balanced
diet.
-Undernutrition describes a state of poor intake as a result of inadequate diet or diseases
that interfere with normal appetite and assimilation of ingested food.
-Overnutrition refers to the ingestion of more food than is required for body needs, as in
obesity.
-Inflammation of the appendix, a narrow blind tube that extends from the inferior part of the
cecum.
-**Most common reason for emergency abdominal surgery
-When the appendix becomes inflamed or infected, rupture may occur within a matter of hours,
leading to peritonitis and sepsis.
Etiology & Patho
-Most common in individuals 10-30 years of age
-Common cause of appendicitis is obstruction of the lumen by a fecalith (accumulated
feces).
-Obstruction results in distention; venous engorgement; & the accumulation of mucous
& bacteria, which can lead to gangrene, perforation, & peritonitis.
-Low fiber diet & high intake of refined carbs are risk factors
Clinical Manifestations
-Typically begins with dull periumbilical pain, followed by anorexia, nausea & vomiting
-Pain is persistent & continuous, eventually shifting to the RLQ & localizing at
McBurney’s point (halfway between the umbilicus & right iliac crest)
-Low grade fever may develop
-Further assessment reveals localized tenderness, rigidity, rebound tenderness,
& muscle guarding
-Coughing, sneezing, & deep inhalation worsen pain
-Elevated WBC count
-Pt in side lying position with abdominal guarding & legs flexed
-Constipation or diarrhea
-Older adults may report less severe pain, slight fever, & discomfort in the right iliac
fossa
Diagnostic Studies & Interprofessional Care
-Pt examination includes complete history, physical exam, & a differential WBC count
-Most pt’s have a mildly to moderately elevated WBC count
-Urinalysis is done to rule out genitourinary conditions that mimic appendicitis
-CT scan is the preferred diagnostic procedure
-Ultrasound & MRI are also used
-Leukocyte count greater than 10,000/mm 3, neutrophil count greater than 75%;
abdominal radiographs, ultrasound studies, and CT scans may reveal right lower quadrant
density or localized distention of the bowel.
-If there is a delay in the diagnosis & treatment, the appendix can rupture & the resulting
peritonitis can be fatal
-Treatment of appendicitis is an immediate appendectomy (removal of appendix)
,-If inflammation is localized, surgery should be done as soon as diagnosis is made
-Antibiotics & fluid resuscitation are started before surgery
-If appendix has ruptured & there is evidence of peritonitis or an abscess, giving
parenteral fluids & antibiotic therapy for 6-8 hours before the appendectomy helps
prevent dehydration & sepsis
Nursing Management: Appendicitis
-Management focuses on preventing fluid volume deficit, relieving pain, & preventing
complications
-Keep the pt NPO until the HCP evaluates the pt
-Monitor vitals & perform ongoing assessment to detect any deterioration
-Administer IV fluids, analgesics, & antiemetics as ordered
-Provide comfort measures
Primary Nursing Diagnosis
-Primary Preoperative Nursing Diagnosis
-Pain (acute) related to inflammation
-Primary Postoperative Nursing Diagnosis
-Risk for infection related to the surgical incision
Other Diagnoses that may occur in Nursing Care Plans For Appendicitis
-Imbalanced nutrition: Less than body requirements
-Impaired skin integrity
-Ineffective tissue perfusion: GI
-Risk for deficient fluid volume
-Risk for injury
Medical Management
An appendectomy (surgical removal of the appendix) is the preferred method of
management for acute appendicitis if the inflammation is localized. An open
appendectomy is completed with a transverse right lower quadrant incision, usually at the
McBurney point. A laparoscopic appendectomy may be used in females of childbearing
age, those in whom the diagnosis is in question, and for obese patients. If the
appendix has ruptured and there is evidence of peritonitis or an abscess, conservative
treatment consisting of antibiotics and intravenous (IV) fluids is given 6 to 8 hours prior
to an appendectomy. Generally, an appendectomy is performed within 24 to 48 hours
after the onset of symptoms under either general or spinal anesthesia. Preoperative
management includes IV hydration, antipyretics,antibiotics, and, after definitive
diagnosis, analgesics.
Complications of Appendectomy
,-The major complication is perforation of the appendix, which can lead to
peritonitis or an abscess.
-Perforation generally occurs 24 hours after onset of pain, symptoms include fever
(37.7°C [100°F] or greater), toxic appearance, and continued pain and tenderness
Pharmacologic Intervention
-Crystalloid intravenous fluids an isotonic solutions such as normal saline solution or
lactated Ringer’s solution 100–500 mL/hr of IV, depending on volume state of the
patient, is used to replaces fluids and electrolytes lost through fever and vomiting;
replacement continues until urine output is 1 cc/kg of body weight and electrolytes are
replaced
-Antibiotics (broad-spectrum antibiotic coverage) to control local and systemic infection
and reduces the incidence of postoperative wound infection
-Other Drugs: Analgesics.
Nursing Intervention
-Preoperative interventions
1. Maintain NPO status.
2. Administer fluids intravenously to prevent dehydration.
3. Monitor for changes in level of pain.
4. Monitor for signs of ruptured appendix and peritonitis
5. Position right-side lying or low to semi fowler position to promote comfort.
6. Monitor bowel sounds.
7. Apply ice packs to abdomen every hour for 20-30 minutes as prescribed.
8. Administer antibiotics as prescribed
9. Avoid the application of heat in the abdomen.
10. Avoid laxatives or enema.
-Postoperative interventions
1. Monitor temperature for signs of infection.
2. Assess incision for signs of infection such as redness, swelling and pain.
3. Maintain NPO status until bowel function has returned.
4. Advance diet gradually or as tolerated or as prescribed when bowel sound return.
5. If rupture of appendix occurred, expect a Penrose drain to be inserted, or the
incision
maybe left to heal inside out.
6. Expect that drainage from the Penrose drain maybe profuse for the first 2 hours.
Documentation Guidelines
-Location, intensity, frequency, and duration of pain
-Response to pain medication, ice applications, and position changes
-Patient’s ability to ambulate and tolerate food
, -Appearance of abdominal incision (color, temperature, intactness, drainage)
-Gas can be a cause of increased pain. Pt may need to ambulate to relieve gas
Discharge & Home Healthcare Guidelines
-MEDICATIONS. Be sure the patient understands any pain medication prescribed,
including doses, route, action, and side effects. Make certain the patient understands that
he or she should avoid operating a motor vehicle or heavy machinery while taking such
Medication.
-INCISION. Sutures are generally removed in the physician’s office in 5 to 7 days.
Explain the need to keep the surgical wound clean and dry. Teach the patient to observe
the wound and report to the physician any increased swelling, redness, drainage, odor, or
separation of the wound edges. Also instruct the patient to notify the doctor if a fever
develops. The patient needs to know these may be symptoms of wound infection. Explain
that the patient should avoid heavy lifting and should question the physician about when
lifting can be resumed.
-COMPLICATIONS. Instruct the patient that a possible complication of appendicitis is
peritonitis. Discuss with the patient symptoms that indicate peritonitis, including sharp
abdominal pains, fever, nausea and vomiting, and increased pulse and respiration. The
patient must know to seek medical attention immediately should these symptoms occur.
-NUTRITION. Instruct the patient that diet can be advanced to her or his normal food
pattern as long as no gastrointestinal distress is experienced
Chapter 39: Nutritional Problems
-Nutritional Problems
-Nutrition is the sum of processes by which one takes in and uses nutrients. Nutrition is
important for energy, growth, and maintenance and repair of body tissues.
-Nutritional problems can occur in all age groups, cultures, ethnic groups, and
socioeconomic classes and across all educational levels.
-The essential components of the basic food groups are carbohydrates, fats, proteins,
vitamins, and minerals.
-The daily caloric requirements of a person are influenced by body type, age, gender,
medication usage, physical activity, and the presence or absence of disease.
-Malnutrition
-Malnutrition is a deficit, excess, or imbalance of the essential components of a balanced
diet.
-Undernutrition describes a state of poor intake as a result of inadequate diet or diseases
that interfere with normal appetite and assimilation of ingested food.
-Overnutrition refers to the ingestion of more food than is required for body needs, as in
obesity.
