Appendicitis Definition The appendix is a small fingerlike

Appendicitis

Definition • The appendix is a small, finger-like appendage attached to the cecum just below the ileo-cecal valve. • It empties into the colon inefficiently and its lumen is small; it is prone to becoming obstructed and is vulnerable to infection (appendicitis). • It is the most common cause of acute inflammation in RLQ of the abdominal cavity and the most common cause of emergency abdominal surgery.

Definition (cont’d) • Appendicitis results from obstruction, inflammation, and infection of the appendix. • Obstruction leads to hypoxia, leading to gangrene and/or perforation of the appendix. Perforation can result in the formation of an abscess and/or peritonitis. • Appendicitis is not preventable, therefore early detection is important.

Diagnostic Procedures and Nursing Interventions • Diagnosis is based on a complete physical examination and laboratory and imaging tests. • WBCs count and differential: (10, 000 to 18, 000/mm 3) , 20, 000/mm 3 may indicate peritonitis. • Abdominal US may show an enlarged appendix. • Abdominal CT may be diagnostic if symptoms are recurrent or prolonged. (Check allergies and renal function ? ? ? ) • Urinalysis • Pregnancy test, PID? ?

Therapeutic Procedures and Nursing Interventions • Surgical management includes an appendectomy : ▫ With laparoscope or ▫ an open approach

Assessments Monitor for signs and symptoms: ▫ Mild or cramping, epigastric or periumbilical pain (initial) ▫ Constant, intense RLQ pain (later) ▫ Rebound tenderness (pain after deep pressure is applied and released) over Mc. Burney’s point (located halfway between the umbilicus and anterior iliac spine) ▫ Pain that decreases with a decrease in right hip flexion or increases with coughing and movement may indicate perforation with peritonitis.

Clinical Manifestations • Low grade fever, nausea, and sometimes vomiting; • loss of appetite is common; constipation can occur. • At Mc. Burney’s point , local tenderness with pressure and some rigidity of the lower portion of the right rectus muscle. • Rovsing’s sign (palpating left lower quadrant, causes pain in right lower quadrant) • Muscle rigidity, tense positioning, guarding may indicate perforation with peritonitis. • If appendix ruptures, pain becomes more diffuse; abdominal distention develops from paralytic ileus, and condition worsens.

NANDA Nursing Diagnoses • Acute pain • Risk for infection • Risk for deficient fluid volume • Deficient knowledge • Anxiety

Nursing Interventions • Preoperative • Upon admission, maintain NPO status due to the possibility of emergency surgery. • Administer IV fluids as prescribed. • Encourage semi-Fowler’s position to contain abdominal drainage in the lower abdomen. • Avoid laxatives/enemas or application of heat to the abdomen, which could cause perforation.

Postoperative • Administer opioid analgesia (usually morphine sulfate) as ordered. • Administer IV antibiotics as ordered (surgical prophylaxis, perforation). • For peritonitis, monitor nasogastric (NG) tube drainage. • For perforation or abscess, monitor surgical drains.

Complications and Nursing Implications • Peritonitis due to perforation – Perforation is a lifethreatening emergency. • The risk of perforation is greatest 48 hr following the onset of appendicitis pain. • Carefully assess the client for: ▫ ▫ ▫ Fever of 38. 2° C or higher. Acutely ill appearance. Board-like abdomen Decreased urinary output. Septicemia. • Treatment includes administration of broad spectrum IV antibiotics. .