Appendicitis

Jevanette Velacruz BSN 3-B

NCM 116 RLE
Table of Contents.

01. 02. 03.

Definition and Symptoms Pathophysiology Diagnosis
What is appendicitis and It’s structure and how it How it is being diagnose
what are the signs happens

04. 05.
Treatment Nursing Management
The medical and surgical The nursing responsibilities
management
Overview.

The appendix is a normal true

diverticulum of the caecum that is prone
to acute and chronic inflammation.

Acute appendicitis is the most common

surgical emergency. Lifetime risk: 1 in
15 people. Can occur at any age but peak
10 – 30 years. Slightly more common in
males. Acute appendicitis is rare before
age 2 as the appendix is cone shaped
with a larger lumen.
 Appendicitis

is an inflammation of the appendix, a

finger-shaped pouch that projects from
your colon on the lower right side of
your abdomen.

The appendix is a small, vermiforrn

appendage about 8 to 10 cm (3 to 4
inches) long that is attached to the
cecum just below the ileocecal
valve.The appendix fills with by
products of digestion and empties
regularly into the cecum.
 Appendicitis
SIGNS AND SYMPTOMS

Classically periumbilical pain that moves to the right iliac

fossa. Anorexia is an important feature; vomiting is rarely
prominent – pain normally precedes vomiting in the surgical
abdomen. Constipation is usual. Diarrhoea may occur.

Examination

3 classic maneuvers:

● Rovsing sign – peritoneal irritation

● Psoas sign – irritation of psoas muscle
● Obturator sign – irritation of obturator muscle
 Appendicitis
PATHOPHYSIOLOGY

The appendix becomes inflamed and edematous as a result of becoming kinked

or occluded by a fecalith, lymphoid hyperplasia, or rarely, foreign bodies, or
tumors. The inflammatory process increases intraluminal pressure, causing
edema and obstruction of the orifice. Once obstructed, the appendix becomes
ischemic, bacterial overgrowth occurs, and eventually gangrene or perforation
occurs.

Pathophysiology Con’t….
 Appendicitis

DIAGNOSTIC TESTS

● Physical exam to assess your pain. Your doctor may apply gentle pressure on the painful area. When the
pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent peritoneum is
inflamed.

Your doctor may also look for abdominal rigidity and a tendency for you to stiffen your abdominal muscles in
response to pressure over the inflamed appendix (guarding).

Your doctor may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam). Women of
childbearing age may be given a pelvic exam to check for possible gynecological problems that could be causing
the pain.

● Blood test. This allows your doctor to check for a high white blood cell count, which may indicate an infection.
● Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary tract infection or a kidney
stone isn't causing your pain.
● Imaging tests. Your doctor may also recommend an abdominal X-ray, an abdominal ultrasound, computerized
tomography (CT) scan or magnetic resonance imaging (MRI) to help confirm appendicitis or find other causes for
your pain.
 Appendicitis

DIAGNOSTIC TESTS
The Alvarado score for predicting acute appendicitis. The
method relies on a combination of factors derived from
physical signs, symptoms, and laboratory tests and
produces a numerical score used to rule in or rule out
acute appendicitis. It is a well-established and widely-
used clinical decision tool that may help reduce CT
usage. The MDcalc Alvarado Score for Acute
Appendicitis is a useful automated tool to record the
score

Most common real world application of the Alvarado

score:

● triage tool for ruling out appendicitis and

identifying those at higher risk who would benefit
A score of 5 or 6 is compatible with the diagnosis of acute appendicitis, a score of 7 or at most from an admission to a hospital.
8 indicates a probable appendicitis, and a score of 9 or 10 indicates a very probable ● simplified tool to stratify patients for referral for
appendicitis.
surgical consultation.
 Appendicitis

MEDICAL MANAGEMENT
● IV fluids. To correct fluid and electrolyte imbalance
and dehydration, IV fluids are administered prior to
surgery.
● Antibiotic therapy. To prevent sepsis, antibiotics
are administered until the surgery is performed.
● Drainage. When perforation of the appendix SURGICAL MANAGEMENT
occurs, an abscess may form and the patient is Immediate surgery is typically indicated if
initially treated with antibiotics and the surgeon may appendicitis is diagnosed.
place a drain in the abscess
● Appendectomy. Appendectomy or the
surgical removal of the appendix is
performed as soon as it is possible to
decrease the risk of perforation.
● Laparotomy and laparoscopy. Both of
these procedures are safe and effective in
the treatment of appendicitis with
perforation.
 Appendicitis

NURSING MANAGEMENT

Nursing Assessment
Assessment of a patient with appendicitis may be both objective and subjective.

● Assess the level of pain.

● Assess relevant laboratory findings.
● Assess patient’s vital signs in preparation for surgery.

Diagnosis
Based on the assessment data, the most appropriate diagnoses for a patient with appendicitis are:

● Acute pain related to obstructed appendix.

● Risk for deficient fluid volume related to preoperative vomiting, postoperative restrictions.
● Risk for infection related to ruptured appendix.
 Appendicitis

NURSING MANAGEMENT

Nursing Interventions
Planning & Goals
The nurse prepares the patient for surgery.
Goals for a patient with appendicitis include:
● IV infusion. An IV infusion is made to replace fluid loss and
● Relieving pain. promote adequate renal functioning.
● Preventing fluid volume deficit. ● Antibiotic therapy. Antibiotic therapy is given to prevent
● Reducing anxiety. infection.
● Eliminating infection due to the potential or ● Positioning. After the surgery, the nurse places the patient
actual disruption of the GI tract. on a High-fowler’s position to reduce the tension on the
● incision and abdominal organs, thereby reducing pain.
Maintaining skin integrity.
● Oral fluids. When tolerated, oral fluids could be
● Attaining optimal nutrition.
administered.
 Appendicitis

NURSING MANAGEMENT

Nursing Interventions

The nurse prepares the patient for surgery.

● The nurse auscultates for the return of bowel sounds and queries the patient for passing of flatus.
● Urine output is monitored
● For discharge, the nurse instructs the patient to make an appointment to have the surgeon remove any
sutures and inspect the wound between 1 and 2 weeks after surgery. Incision care and activity guidelines
are discussed,
● Heavy lifting is to be avoided postoperatively, although normal activity can usually be resumed within 2 to
4 weeks.
 Appendicitis

NURSING MANAGEMENT
Evaluate then do Documentation Guidelines
The focus of documentation in patients with
appendicitis should include:
Discharge and Home Care Guidelines ● Client’s description of response to pain.
Discharge teaching for patient and family is imperative. ● Acceptable level of pain.
● Prior medication use.
● Removal of sutures. The nurse instructs the patient to make an ● Results of laboratory tests.
appointment with the surgeon to remove the sutures between the
● Surgical site.
5th and 7th days after surgery.
● Signs and symptoms of infectious process.
● Activities. Heavy lifting is to be avoided postoperatively; however, ● Recent or current antibiotic therapy.
normal activity can be resumed within 2 to 4 weeks.
● Plan of care.
● Home care. A home care nurse may be needed to assist with
● Teaching plan.
incision care and to monitor the patient for complications and ● Response to interventions, teaching, and
wound healing.
actions performed.
● Attainment or progress toward desired
outcomes.
● Modifications to plan of care.
● Long term needs.
 SOAPIE
SUBJECTIVE & ASSESSMENT PLANNING INTERVENTION RATIONALAE EVALUATION
OBJECTIVE
Subjective: Acute pain related After 4 hours of Independent:
to inflammation of nursing interventiona, After 4hours of
“Masakit angtiyan tissue the patient will •Investigate pain reports, •Changes inlocation orintensity nursing interventions,
ko” as verbalized demonstrate use of noting location, duration, are not uncommon but may the patient was able
bypatient. relaxation skills,other intensity (0-10scale) and reflect developing complications. todemonstrateuse
methods to promote characteristics (dull, ofrelaxationskills,
Objective: comfort. sharp,constant). •Reduces abdominal othermethods
distention,thereby reduces topromotecomfort.
• Facial maskof • Maintain semi-fowler’s tension.
pain. position.
• • Reduces muscle tension or
Guardingbehavior. •Move patientslowly guarding, which may help
•Reboundtenderne anddeliberately. minimize pain of movement.
ss.
•Provide comfortmeasure • Promotes relaxation and may
• V/S taken likeback rubs, deep breathing. enhance patient’s coping abilities
asfollows: Instruct in relaxation or by refocusing attention.
T: 37.3 visualization exercises. Provide
P: 80 diversional activities. •Reduces nausea and vomiting,
R: 18 which can increase intra-
Bp: 110/90 •Provide frequentoral care. abdominal pressure or
Remove noxious
environmental stimuli.

Collaborative
• Administer analgesics as • Reduce metabolic rate and
prescribed aids in pain relief and
promotes healing
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