Catanduanes State University
COLLEGE OF HEALTH SCIENCES
Nursing Department
APPENDICITIS
PRESENTED BY:
ALYANNA LYZANDRA BAS
BSN 3D
APPENDICITIS
It is the inflammation of appendix
often caused by a blockage that
triggers infection, swelling, and severe
pain
It is the most frequent cause of acute
abdominal pain and most common
reason for emergency abdominal
surgery.
Appendicitis | Definition
TYPES
ACUTE APPENDICITIS
most common form and occurs suddenly
CHRONIC APPENDICITIS
rare form where inflammation continues over
a long period
RECURRENT APPENDICITIS
appendix gets inflamed repeatedly
Appendicitis | Types
STAGES
Early Stage
the appendix becomes mildly inflamed
pain is manageable, but if left untreated,
inflammation can worsen
diagnosing at this stage allows for effective
treatment with minimal complications
Appendicitis | Stages
STAGES
Suppurative Stage
the appendix swells and fills with pus.
the pain becomes more intense.
surgical removal of the appendix is usually
required at this stage to prevent further
complications.
Appendicitis | Stages
STAGES
Gangrenous Stage
this occurs when the blood supply to the
appendix is cut off, causing tissue death
the risk of rupture significantly increases
patients may experience severe pain and a
rapid decline in health.
Appendicitis | Stages
STAGES
Perforated Stage
the appendix bursts, releasing infectious
material into the abdominal cavity
this can lead to peritonitis (severe abdominal
infection)
emergency surgery is required to clean the
abdominal cavity and remove the appendix
Appendicitis | Stages
EPIDEMIOLOGY
typically occurs between the
ages of 10 and 30
falls out about 7% to 12% of the
world’s population
more common among males
than females
Appendicitis | Epidemiology
ETIOLOGY
It is primarily caused by an obstruction of the
appendiceal lumen by a:
fecalith (accumulated feces)
foreign bodies
tumor of the cecum or appendix or
intramural thickening caused by hypergrowth of
lymphoid tissue
Appendicitis | Etiology
ETIOLOGY
Nonobstructive Causes:
hematogenous spread of infection
vascular occlusion
trauma
diet lacking fibers
Appendicitis | Etiology
ANATOMY & PHYSIOLOGY
APPENDIX
a small, vermiform (wormlike)
appendage about 8-10 cm
(3-4 in) long that is attached
to the cecum just below the
ileocecal valve
Appendicitis | Anatomy & Physiology
ANATOMY & PHYSIOLOGY
Physiology of the Appendix:
acts as a "safe house" for beneficial gut
bacteria, aiding in immune system
maturation & producing IgA antibodies
Appendicitis is caused by blockage,
leading to bacterial infection, swelling,
decreased blood flow, pain, and possible Inflammed Appendix
rupture if untreated
Appendicitis | Etiology
PATHOPHYSIOLOGY
Obstruction of the appendiceal lumen Accumulation of Mucus and Secretions
Impaired Blood Supply (Ischemia) Increased Intraluminal Pressure
Bacterial Overgrowth and Infection Inflammation (Appendicitis)
Rupture (if untreated)
Appendicitis | Pathophysiology
CLINICAL MANIFESTATIONS
periumbilical pain
anorexia
nausea
vomiting
low-grade fever
local tenderness at McBurney’s point
Rovsing’s sign
constipation
diarrhea
Appendicitis | Clinical Manifestations
CARDINAL SIGNS
ROVSING’S SIGN MCBURNEY'S POINT
Clinical indicator for acute appendicitis A positive test (McBurney's sign)
where deep palpation of the left lower occurs if there is intense pain, often
quadrant (LLQ) of the abdomen causes accompanied by pain upon releasing
pain in the right lower quadrant (RLQ) pressure (rebound tenderness).
Appendicitis | Clinical Manifestations | Cardinal Signs
ASSESSMENT
History taking (especially tracking the sequence of
symptoms)
Risk Factors
Physical Examination/Pain Assessment
- Rebound tenderness, Rovsing’s sign, PSOAS sign,
Obturator sign
Laboratory Findings (WBC count, PT, Urinalysis)
Imaging Studies (UTZ, CT Scan)
Appendicitis | Assessment
MANAGEMENT
MEDICAL:
IV Fluids - to correct fluid & electrolyte imbalance &
dehydration and it is administered prior to surgery.
Antibiotic Prophylaxis - to prevent sepsis, antibiotics
are administered until the surgery is performed.
Drainage - an abscess may form and surgeon may
place a drain in the abscess
NPO - for the possibility of surgery and to avoid
making the inflammation worse
Appendicitis | Management | Medical
MANAGEMENT
SURGICAL:
Appendectomy - the surgical removal of the
appendix which performed as soon as it is possible to
decrease the risk of perforation
Laparoscopy - minimally invasive surgical (MIS)
procedure with one or more small incisions near the
umbilicus through which a small endoscope is
placed
Appendicitis | Management | Surgical
MANAGEMENT
SURGICAL:
Laparatomy - an open surgical approach with a
large abdominal incision for complicated or atypical
appendicitis or peritonitis.
Natural Orifice Transluminal Endoscopic Surgery
(NOTES) - advanced, less common, and minimally
invasive technique that attempts to remove the
appendix through natural body orifices (such as the
mouth, vagina, or rectum) to avoid external scarring.
Appendicitis | Management | Surgical
MANAGEMENT
Appendicitis | Management | Surgical
NURSING CARE PLAN
ASSESSMENT DIAGNOSIS
Subjective: Acute Pain r/t inflammation of
“Masakit ang tiyan ko lalo the appendix as evidenced by
na sa kanan” verbal report of abdominal pain,
Nausea, loss of appetite guarding, and pain scale of 7/10
Objective:
Pain scale: 7/10 PLANNING
Guarding of right lower Report decreased pain (≤3/10)
quadrant Appear relaxed and
Fever (38°C) comfortable
Elevated WBC count Show stable vital signs
Appendicitis | Management | Nursing Care Plan
NURSING CARE PLAN
INTERVENTION
Assess pain location, intensity, and characteristics regularly
Place patient in semi-Fowler’s position for comfort
Instruct patient to avoid applying heat to the abdomen
Administer prescribed analgesics as ordered
Monitor vital signs and signs of perforation (increasing pain, rigidity,
fever)
EVALUATION
Patient verbalized pain decreased to Vital signs within normal
3/10 limits
Patient appears more comfortable Goal met
Appendicitis | Management | Nursing Care Plan
MANAGEMENT
NURSING
Keep the patient NPO until the HCP evaluates the
patient
Monitor vital signs and perform ongoing assessment
to detect any deterioration in condition
Give IV fluids, analgesics, and antiemetics as ordered
Provide comfort measures
Auscultate for the return of bowel sounds and queries
for passing of flatus.
Appendicitis | Management | Nursing
MANAGEMENT
NURSING
Monitor urine output
Encourage early ambulation before the surgery
Discharge instruction for the patient and the family
Provide Incision care and activity guidelines
Teach proper dressing changes and irrigations as
prescribed
Appendicitis | Management | Nursing
MANAGEMENT
LABS AND DIAGNOSTICS
Moderate elevation of the WBC count (leukocytosis) to
10,000 to 18, 000/mm³
WBC of 20,000 mm³ may indicate a perforated
appendix
C-reactive protein levels are typically elevated
UTZ may show the presence of an enlarged appendix
Appendicitis | Management | Labs & Diagnostics
MANAGEMENT
LABS AND DIAGNOSTICS
CT Scan is used to diagnose and may reveal the
presence of fecaloma (small stone of feces)
PT may be ordered for women of childbearing age to
rule out ectopic pregnancy and before radiologic
studies are done
Transvaginal UTZ may be used to confirm diagnosis
Urinalysis is obtained to rule out UTI or Renal Calculi
Appendicitis | Management | Labs & Diagnostics
PHARMACOLOGY
Penicillins + Beta-lactamase Inhibitors:
Piperacillin/tazobactam (Zosyn)
Ampicillin/sulbactam (Unasyn)
Ticarcillin/clavulanate (Timentin)
Cephalosporins
Cefotetan
Cefoxitin
Cefepime
Appendicitis | Management | Pharmacology
PHARMACOLOGY
Carbapenems: Fluoroquinolones:
Meropenem Ciprofloxacin
Ertapenem Levofloxacin
Moxifloxacin
Aminoglycosides:
Gentamicin Anti-infective Agents
Metronidazole
Analgesics:
Tigecycline
Morphine
sulfate
Appendicitis | Management | Pharmacology
DIET & ACTIVITY
Pre-op
NPO (Nothing by mouth)
- to prevent aspiration during anesthesia
- to prepare for possible emergency appendectomy
IV fluids are given to maintain hydration
Post Surgery Diet
Initial Phase (Soft/Bland): Focus on easy-to-digest, low-fiber
foods such as white rice, white bread, noodles, boiled potatoes,
soft pasta, and broth.
Appendicitis | Management | Diet & Activity
DIET & ACTIVITY
Post Surgery Diet
Protein Intake: Include lean proteins like steamed fish, chicken,
and tofu to assist with healing.
Hydration: Drink plenty of water and clear fluids to prevent
constipation and support recovery.
Foods to Avoid: Avoid fatty, fried, or spicy foods, alcohol, sugary
sweets, and raw vegetables, which are difficult to digest and
can cause discomfort.
Meal Structure: Eat small, frequent meals to aid digestion.
Appendicitis | Management | Diet & Activity
DIET & ACTIVITY
Activity and Recovery
Immediate Post-Op: Light walking is encouraged to
promote blood circulation and bowel function.
Restrictions: Avoid heavy lifting, intense exercise, and
abdominal strain
Recovery Time: Laparoscopic surgery generally allows
for a return to normal activities within 1–2 weeks, while
open surgery may take longer.
Wound Care: Keep the incision site clean and dry.
Appendicitis | Management | Diet & Activity
PROGNOSIS
With an early operation, the chance of death from
appendicitis is very low. The person can usually leave
the hospital in 1 to 3 days, and recovery is normally
quick and complete. However, older people often take
longer to recover.
Without surgery or antibiotics (as might occur in a
person in a remote location without access to modern
medical care), appendicitis is fatal in many people.
Appendicitis | Prognosis
PROGNOSIS
The prognosis is worse for older adults and for people
who have a ruptured appendix, an abscess, or
peritonitis.
Appendicitis | Prognosis
REFERENCES
Hinkle, J. L., & Cheever, K. H. (2022). Brunner & Suddarth's textbook of medical-surgical nursing
(15th ed.). Wolters Kluwer.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2021).
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Appendicitis | References
"Like the appendix, some things hide quietly
until they hurt you unexpectedly… and when
it finally bursts, it rips through you, a
reminder that ignoring feelings never works."
THANK YOU !