Appendicitis Fadi Jehad Zaben RN MSN Indroduction The

Appendicitis Fadi Jehad Zaben RN MSN

Indroduction: • The appendix is a small fingerlike appendage about 10 cm (4 in) long, attached to the cecum just below the ileocecal valve. • No definite functions can be assigned to it in humans. • The appendix fills with food and empties as regularly as does the cecum. • It is prone to become obstructed and is particularly vulnerable to infection (appendicitis) because it is small.

Facts about Appendicitis: • Appendicitis is the most common cause of acute inflammation in the right lower quadrant of the abdominal cavity. • About 7% of the population will have appendicitis at some time in their lives. • Males are affected more than females and teenagers more than adults. • It occurs most frequently between the age of 10 and 30. • It is more prevalent in countries in which people consume a diet low in fiber and high in refined carbohydrates.

Definition: Appendicitis is inflammation of the vermiform appendix caused by an obstruction attributable to infection, structure, fecal mass, foreign body, or tumor.

Pathophysiology of Appendicitis: • The appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith, tumor, or foreign body. • The inflammatory process increases intraluminal pressure, initiating a progressively severe, generalized or periumbilical pain that become localized to the right lower quadrant of the abdomen within few hour. • The inflamed appendix fills with pus.

Pathophysiology of Appendicitis:

Risk Factors: • Age. • Gender.

Clinical Manifestations: 1. Generalized or localized abdominal pain in the epigastric or periumbilical areas and upper right abdomen. 2. The pain localizes in the right lower quadrant and intensity increases with 2 to 12 hours. 3. Anorexia, moderate malaise, mild fever, nausea and vomiting. 4. Usually constipation occurs ; occasionally diarrhea. 5. Rovsing’s Sign: which pressure on the left lower quadrant of the abdomen causes pain in the right lower quadrant. 6. Rebound tenderness, involuntary guarding, generalized abdominal rigidity.

Diagnostic Evaluation: q. Physical examination consistent with clinical manifestations. q. WBC count reveal moderate leukocytosis (10, 000 to 16, 000/mm 3). q. Urinalysis rule out urinary disorders. q. Abdominal x-ray may visualize shadow consistent with fecal in appendix; perforation will reveal free air. q. Abdominal ultrasound or CT scan visualize appendix and rule out other conditions, such as diverticulitis and crohn’s disease. q. Focused appendiceal CT can quickly evaluate for appendicitis.

Treatment and Management: 1. Surgery. 2. Parenteral replacement. 3. Medication.

Continue……… Surgery: Appendectomy: It is a surgery to remove of the appendix. It is the effective treatment. It is performed if appendicitis is diagnosed as soon as possible to decrease the risk of perforation. Appendectomy may be performed under a general or spinal anesthetics with a low abdominal incisions or by laparoscopy which is recently highly effective method.

Continue……. . Treatment ü Administration of IV fluids and antibiotic to correct or prevent fluid and electrolyte imbalance, dehydration and sepsis until surgery is performed. ü Administration of Antibiotics. ü Analgesics can be administered after the diagnosed is made.

Complications: q Perforation of the appendix: üPeritonitis. üAbscess formation. üPortal pylephlebitis. q If left untreated, appendicitis may progress to abscess, perforation, subsequent peritonitis, and death

Nursing Interventions: Monitor frequently for signs and symptoms of worsening condition, indicating perforation, abscess, or peritonitis (increasing severity of pain, tenderness, rigidity, distention, absent bowel sounds, fever, malaise, and tachycardia). Notify health care provider immediately if pain suddenly ceases, this indicates perforation, which is a medical emergency. Assist patient to position of comfort such as semifowlers with knees are flexed.

Continue………. . Nursing Interventions Apply ice bag to abdomen for comfort. Avoid indiscriminate palpation of the abdomen to avoid increasing the patients discomfort. Promptly prepare patient for surgery once diagnosis is established. Explain signs and symptoms of postoperative complications to report-elevated temperature, nausea and vomiting, or abdominal distention; these may indicate infection. Do not give analgesics/antipyretics to mask fever, and do not administer cathartics because they may cause rupture.

Continue………. . Nursing Interventions Restrict activity that may aggravate pain, such as coughing and ambulation. Instruct patient on turning, coughing, or deep breathing, use of incentive spirometer, and ambulation. Discuss purpose and continued importance of these maneuvers during recovery period. Teach incisional care and avoidance of heavy lifting or driving until advised by the surgeon. Advise avoidance of enemas or harsh laxatives; increased fluids and stool softeners may be used for postoperative constipation.

Discharge Planning: Antibiotics for infection and analgesic agent can be given for pain after the surgery. Within 12 hrs of surgery you may get up and move around. Within 2 -3 week usually can return to normal activities s after laparoscopic surgery. To care wound perform dressing changes and irrigations as prescribe avoid taking laxative or applying heat to abdomen when abdominal pain of unknown cause is experienced. Reinforce need for follow-up appointment with the surgeon and to call the physician if the pain increase at the incision site.

Continue……………Discharge Planning Document bowel sounds and the passing of flatus or bowel movements (these are signs of the return of peristalsis. Watch for surgical complications such as continuing pain or fever, which indicate an abscess. Stitches removed between fifth and seventh day. Liquid or soft diet until the infection subsides Soft diet is low in fiber and easily breaks down in the gastrointestinal tract.

Nursing Responsibilities: Relieving Pain. Preventing Fluid Volume Deficit. Reducing Anxiety. Eliminating Infection. Maintaining Skin Integrity. Attaining Optimal Nutrition

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