WARD TEACHING

ON
APPENDICITIS
SUBMITTED TO: SUBMITTED BY:
MRS. V. SAILAJA V. SIRISHA
M.Sc.(N) M.Sc. (N) 1st YEAR
LECTURER GCON, VSP
GCON, VSP
 NAME OF THE SUBJECT: MEDICAL SURGICAL NURSING

NAME OF THE TOPIC: APPENDICITIS

NAME OF THE STUDENT TEACHER: MISS V. SIRISHA

NAME OF THE SUPERVISIOR: MRS. V. SAILAJA MADAM

GROUP: M.S.C [N] 1ST YEAR

VENUE: SURGICAL WARD

DATE AND TIME: 07-11-2023

METHOD OF TEACHING: DISCUSSION

A.V AIDS: FLASH CARDS, CHARTS

MEDIUM OF INSTRUCTION: ENGLISH

SUPERVISED BY: MRS. V. SAILAJA MADAM

M.S.C [N] LECTURER
GENERAL OBJECTIVES:

The students will be able to gain in depth knowledge regarding the appendicitis and able to create awareness on managing of the
appendicitis.

SPECIFIC OBJECTIVES:

By the end of the microteaching the students will be able to

➢ Define the Appendicitis.

➢ Enlist the causes and risk factors of Appendicitis.

➢ List out the types of Appendicitis.

➢ Explain the Pathophysiology of Appendicitis.

➢ Discuss the clinical manifestations of Appendicitis.

➢ Describe the diagnostic evaluation of the Appendicitis.

➢ Explain about medical, surgical, nursing management of Appendicitis.

➢ Enumerate the complications and prevention of Appendicitis.

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2min INTRODUCTION: Lecture method

Appendicitis is an inflammation of the appendix, a

finger-shaped pouch that projects from colon on the
lower right side of abdomen. Appendicitis causes pain in
lower right abdomen.
However, in most people, pain begins around the navel
and then moves.
As inflammation worsens, appendicitis pain typically
increases and eventually becomes severe.
Although anyone can develop appendicitis, most often it
occurs in people between the ages of 10 and 30.

Define the DEFINITION

Appendicitis.
❖ Appendicitis is an inflammation of appendix that
develops most common in adolescents and
young adults.
Define
❖ Appendicitis is acute inflammation of the Appendicitis?
appendix, and is the most common cause for
acute, severe abdominal pain.

❖ The abdomen is most tender at McBurney's point

- one third of the distance from the right anterior
superior iliac spine to the umbilicus. This
corresponds to the location of the base of the
appendix.
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Enlist the 3min CAUSES: Enlist the causes of What are the
causes of ❖ Acute appendicitis seems to be the end result of appendicitis through causes of
appendicitis a primary obstruction of the appendix. discussion method appendicitis?
❖ Once this obstruction occurs, the appendix
becomes filled with mucus and swells. This
continued production of mucus leads to
increased pressures within the lumen and the
walls of the appendix.
❖ The increased pressure results in thrombosis
and occlusion of the small vessels, and stasis of
lymphatic flow Faecal impaction and/or a
faecality’s layered buildup of calcium salts and
faecal debris around a piece of faecal material
within the appendix
❖ The appendix contains lymphoid (immune
system) tissue that can become inflamed as a
result of infection or inflammatory bowel disease
(IBD)
❖ Parasites Examples: Schistosomes species,
pinworms, Strongyloidiasis,
❖ Tumour’s, Foreign Material
❖ A wide variety of foreign objects can become
lodged in the appendix. Some of these include:
shotgun pellets, intrauterine devices, tongue
studs, and activated charcoal Trauma, intestinal
worms,lymphadenitis
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List out the 2min List out the types of What are the
types of TYPES: appendicitis through types of
appendicitis lecture method. appendicitis?
❖ Acute Appendicitis:

❖ Acute appendicitis, as its name implies, develops

very fast, usually in a span of several days or
hours. It is easier to detect and requires prompt
medical treatment, usually surgery.

❖ Acute appendicitis occurs when the vermiform

appendix is completely obstructed, either
because of a bacterial infection, faces or other
types of blockages.

❖ Infection may also cause swelling of the lymph

nodes, which then adds pressure on the
appendix, cutting off its blood supply.

Appendicitis Can Be Chronic (But It's a Rare Condition)

❖ Chronic appendicitis is an inflammation that can

last for a long time. This is rare according to a
report published in Therapeutic Advances in
Gastroenterology, it only occurs in only 1.5
percent of recorded acute appendicitis cases.
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❖ Basically, chronic appendicitis means that the

appendiceal lumen is only partially obstructed,
causing inflammation. The inflammation worsens
over time, causing internal pressure to buildup.

Stump Appendicitis:

❖ A Rare Appendectomy Side Effect In most

instances of appendicitis, an appendectomy is
the usual procedure recommended, and it works
by completely taking out the appendix to prevent
it from rupturing.

❖ If the appendix has already ruptured, additional

treatment measures are performed during an
appendectomy, as the infection needs to be
prevented from spreading.
Discuss the 3min
Discuss the clinical
clinical CLINICAL MANIFESTATIONS: manifestations of
manifestations Appendicitis.
of Appendicitis. ❖ Local tenderness is elicited at McBurney's
point when pressure is applied.

❖ Rebound tenderness (ie, production or

intensification of pain when pressure is
released) may be present.
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Explain the 2min Symptoms Explain the signs and What are the
signs and ❖ Abdominal pain >95% symptoms of signs and
symptoms of appendicitis through symptoms of
appendicitis ❖ Anorexia >70% discussion method. appendicitis?
through
discussion ❖ Constipation 4-16%
method.
❖ Diarrhoea 4-16%

❖ Fever 10-20%

❖ Migration of pain to right lower quadrant 50-60%

❖ Nausea Vomiting >65%

Signs

❖ Abdominal tenderness >95%

❖ Right lower quadrant tenderness >90%
❖ Rebound tenderness 30-70%
❖ Rectal tenderness 30-40%
❖ Cervical motion tenderness 30%
❖ Rigidity 10%Psoas sign 3-5%
❖ Obturator sign 5-10%
❖ Rovsing's sign 5%
❖ Palpable mass <5%
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Rovsing's sign:
Palpating in the left lower quadrant causes pain in the
right lower quadrant.

Obturator's sign:
Internal rotation of the hip causes pain, suggesting the
possibility of an inflamed appendix located in the pelvis
Dunphy's sign: Increased pain in the right lower
quadrant with coughing.

Iliopsoas sign:
Extending the right hip causes pain along posterolateral
back and hip, suggesting Retrocecal appendicitis.
Sikorsky (Rosenstein)'s sign: Increased pain in the right
iliac region as the person is being examined lies on
his/her left side.
3min
Describe the Diagnosis:
diagnostic Describe the diagnostic What is the
evaluation of the ❖ Diagnosis is based on results of a complete evaluation of the diagnostic
Appendicitis. physical examination and on laboratory and x-ray Appendicitis through evaluation of
findings. lecture method. the
Appendicitis?
❖ The complete blood cell count demonstrates an
elevated white blood cell count.

❖ The leukocyte count may exceed 10,000

cells/mm3, and the neutrophil
count may exceed 75%.
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2min Ultrasound studies
❖ A peristaltic, non- compressible, dilated

❖ appendix (>6 mm outer diameter)

❖ Distinct appendiceal wall layers

❖ Peri appendiceal fluid collection/enlargement

CT scans
❖ Dilated appendix with distended lumen (>6 mm
diameter)
❖ Thickened and enhancing wall
❖ Thickening of the caecal apex (up to 80%)
Explain about Explain about medical
MANAGEMENT:
medical management of
management of ❖ Surgery is indicated if appendicitis is diagnosed. Appendicitis through
❖ To correct or prevent fluid and electrolyte
Appendicitis. lecture method
imbalance and dehydration, antibiotics and
intravenous fluids are administered until surgery
is performed.
❖ Analgesics can be administered after the
diagnosis is made. (Morphine sulphate 10 mg/ml)
Antibiotics:
❖ Cefotaxime 250mg, 500mg
❖ Levofloxacin 500 mg
❖ Metronidazole 500mg/100ml, 400 mg tablet
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Explain about 1min Appendectomy: Explain about surgical
surgical (i.e., surgical removal of the appendix) is performed as and
and soon as possible to decrease the risk of perforation. It nursing
nursing may be performed under a general or spinal aesthetic management of
management of with a low abdominal incision or by laparoscopy. Appendicitis.
Appendicitis.
NURSING MANAGEMENT:
❖ Goals include relieving pain, preventing fluid
volume deficit, reducing anxiety, eliminating
infection from the potential or actual disruption of
the GI tract, maintaining skin integrity, and
attaining optimal nutrition.
The nurse prepares the patient for surgery, which
includes an intravenous infusion to replace fluid loss
and promote adequate renal function and antibiotic
therapy to prevent infection.
Pre-Operative care:
❖ Assessment History taking physical
examinations, Regarding pain, nausea vomiting,
abdominal rebound tenderness, Anorexia
❖ Monitor vital signs B.P., Temperature for baseline
data
❖ NPO and I.V. Fluids be started
❖ Naso-gastric aspiration
❖ Monitor for signs of ruptured appendix and
peritonitis
❖ Position right-side lying or low to semi fowler
position to promote comfort.
❖ Auscultate Bowel Sounds
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Administer antibiotics as prescribed
❖ Preparation for surgery i.e., physically &
psychologically, Alley anxiety & fears
❖ Written consent for surgery
❖ Prepare and send the patient for surgery without
delay
❖ OT clothes and pre medications to be given 45
minutes before operation
Post-Operative Nursing care:
❖ Clear airway.
❖ Proper breathing and adequate tissue perfusion
by IVF
❖ Naso-gastric suction to be done regularly to
relieve tension on sutures.
❖ Provide safety & effective care environment to
the patient Care of all drainage tubes.
❖ Care of surgical wounds.
❖ Watch for soakage/bleeding
❖ Daily A.S. dressing and watch for signs of
infections.
❖ Nutritional status maintained by I.V. fluids.
❖ Observe for return of bowel sounds,
❖ Intake and output maintained
❖ Monitor vital signs & fluid, electrolytes balance.
Encourage early ambulation to prevent post
operation complications.
❖ Maintain NPO till bowel sounds return then start
clear fluids orally.
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❖ Medication as per prescription to be given by
using 6 rt of Nursing standards of medication
❖ Drugs - Antibiotics, analgesic & Anticholinergics
i.e., Injection Aciloc as per. prescription
❖ After surgery, the nurse places the patient in a
semi-Fowler position. This position reduces the
tension on the incision and abdominal organs,
helping to reduce pain.
2min Appendicitis Prevention
❖ No prevention.
❖ Reduce risk.
❖ Nutritious diet.
❖ High in Fiber.
❖ Fresh vegetables.
❖ Fresh fruit.
❖ Sprinkling oat bran or wheat germ over breakfast
cereals, yogurt, and salads.
❖ Cooking or baking with whole-wheat flour
whenever possible.
❖ Swapping white rice for brown rice.
❖ Adding kidney beans or other
variations to salads.
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Explain the 3min PATHOPHYSIOLOGY Explain the chart
Pathophysiology Pathophysiology of
of Appendicitis. Obstruction of the appendiceal lumen (inside the Appendicitis through
appendix) chart.

Build-up of mucous in the appendix

Appendix constantly secreting mucous

appendiceal lumen pressure

Ulceration (lesion) of the appendix mucosal lining

oxygen delivery (hypoxia)

blood flow to the appendix

Promotes microbe invasion (ex. bacterial)

Inflammation and swelling of the appendix

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Enumerate the 2min Complications Enumerate the Flash
complications of complications of card
appendicitis. ❖ Wound infection appendicitis through
flash cards.
❖ Intra-abdominal abscess

❖ ileus

❖ Portal pyaemia (Pyle phlebitis)

❖ Faecal fistula

❖ 6. Adhesive intestinal obstruction.

Summary:

An appendix contains supplementary material that is not

an essential part of the text itself but which may be
helpful in providing a more comprehensive
understanding of the research problem or it is
information that is too cumbersome to be included in the
body of the paper.

conclusion:
Appendicitis is inflammation of the appendix that may
lead to an abscess, ileus, peritonitis, or
death, if untreated.
BIBLIOGRAPHY:
1.Bunner and Suddath’s text book of medical surgical nursing, Janice l. Hinkle, Kerry h. chevee, volume-2, 13th edition Wolters
Kluwer publications page no 1265-1270.

2. Dr jog Indravati Prabjot Kaur, Lakhvinder Kaur, text book of adult medical surgical nursing volume -1lotus publications page no
397-401

3. Lewis’s medical surgical nursing assessment and management of clinical problems. Harding, Kwong, Roberts, haggler, reminisce
fourth south Asian edition volume -2 Elsevier publications page no 922-927.

4.Audrey Berman, Shirlee Snyderman text book of fundamentals of nursing 11th edition published by Pearson India education
services private ltd, page no 1205-1206.

5 www.ncbi.nlm.nil.gov6www.Medline plus(gov)