APPE N D IC I T I S

N A C . L A T O WE D ,RN,M A N
PREPARED BY: ROMA
 •the role of the appendix:

❖store the “good” bacteria in our gi tract while the tract

is recovering from a diarrhea illness (so it helps

maintain healthy gi flora).

DEFINITION
Appendicitis (also known as epityphlitis) is the inflammation of

the appendix which is a small finger-like appendage attached to

the cecum.
•CAUSE
ObstructionOF APPENDICITIS
of some form:

✔Most common fecalith (hard stool that blocks the appendix)

✔Parasites (worms)
✔Foreign body that may have been ingested
✔Swollen lymph nodal tissue in the mucosal lining of the appendix can
swell.

•Trauma/injury
 Mucous, fluid and
bacteria continue to
PATHOPHYSIOLOGY grow

ETIOLOGY: Obstruction on Increase pressure Inflammation

the appendiceal inside the and swelling of
CAUSE lumen appendix the appendix

Contents e.g.
bacteria leaks
Venous
PERITONITIS into the Ischemia onstruction
abdominal
cavity
 S T A G E S O F
APPE N D IC I T I S
EARLY/ACUTE STAGE (CATARRHAL
APPENDICITIS)

•The initial inflammation of the appendix due to blockage and

infection.

•Symptoms – mild abdominal pain usually around the navel, nausea

and low grade fever
SUPPURATIVE STAGE
(PHLEGMONOUS APPENDICITIS

•The inflammation increases and pus starts to accumulate

•Symptoms: pain becomes sharper and shifts to the lower right side of
the abdomen, nausea and vomiting and tenderness intensifies
GANGRENOUS APPENDICITIS
•The appendix starts to die due to lack of blood flow leading to
gangrene

•Symptoms: pain temporarily lessen as the nerve cells die, fever, chills
worsen

•Risk of rupture
PERFORATED STAGE
(RUPTURED)APPENDICITIS

•The appendix starts to burst, releasing bacteria and pus into the
abdominal cavity leading to peritonitis.

•Symptoms include a painful, swollen area in the abdomen and

persistent fever
SIGNS AND SYMPTOMS OF APPENDICITIS
•Nausea/vomiting
•Desire to be in the fetal position to relieve pain (side lying with knees bent)
•Increased WBC, inability to pass gas or have a bowel movement
(constipation..Can have diarrhea too)

•Experiences rebound tenderness and abdominal rigidity on palpation (involuntary

stiffening of the abdominal muscle when abdomen palpated).
SIGNS AND SYMPTOMS OF APPENDICITIS
•Abdominal pain (will be dull at first with pain at or around the belly button that
radiates to the right lower quadrant and it will localize at this spot)

•Point of mcburney’s will have the most pain (found one-third distance between
the belly button and anterior superior iliac spine)

•Poor appetite
•Elevated temperature
 ASSESSMENT AND DIAGNOSTIC
FINDINGS
Diagnosis is based on the results of a complete physical examination and on laboratory findings
and imaging studies.

•Cbc count. A complete blood cell count shows an elevated WBC count, with an elevation of
the neutrophils.

•Imaging studies. Abdominal x-ray films, ultrasound studies, and CT scans may reveal a right
lower quadrant density or localized distention of the bowel.

•Laparoscopy. A diagnostic laparoscopy may be used to rule out acute appendicitis in

equivocal cases.

•C-reactive protein. Protein produced by the liver when bacterial infections occur and rapidly
increases within the first 12 hours.
MEDICAL MANAGEMENT
Medical management should be performed carefully to avoid altering the presenting symptoms.

• 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 occurs, an abscess may form and the patient is
initially treated with antibiotics and the surgeon may place a drain in the abscess.
 SURGICAL MANAGEMENT
Immediate surgery is typically indicated if appendicitis is diagnosed.

•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.
NURSING 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.

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.
NURSING INTERVENTIONS
The nurse prepares the patient for surgery.

•Iv infusion. An IV infusion is made to replace fluid loss and promote adequate
renal functioning.

•Antibiotic therapy. Antibiotic therapy is given to prevent infection.

•Positioning. After the surgery, the nurse places the patient on
a high-fowler’s position to reduce the tension on the incision and abdominal
organs, thereby reducing pain.

•Oral fluids. When tolerated, oral fluids could be administered.

PRE-OPERATIVE NURSING CARE
Monitoring:
•Vital signs
•Signs the appendix may have rupture (perforated) : patient’s pain is suddenly
relieved which will be followed by intense abdominal pain

•Signs of peritonitis
•Increased HR, increase respiration, increased temperature, and status of
abdominal pain (very intense) and abdominal distention/bloating
PRE-OPERATIVE NURSING CARE
•Maintain nothing by mouth
•Pain relief (especially non-pharmacology with positioning)…watch pain
medications because they can mask pain and it is important the patient notifies
you if the pain is suddenly gone

•NO HEAT (can use ice application to abdomen if needed) increases risk of
rupture

•NO ENEMAS (may have constipation or inability to expel gas)

or laxatives…increases risk of rupturing appendix
POST-OPERATIVE NURSING CARE
Monitor:

•Vital signs (especially temperature which can indicate infection)

•Surgical incision site for infection (extreme redness or purulent drainage)
•Maintain drain after surgery, if present. Keep the patient on the right side which
will allow gravity to help with drainage
POST-OPERATIVE NURSING CARE
•Ambulating (getting out of bed), incentive spirometer usage, coughing and deep
breathing (splinting wound)…prevent blood clots and developing pneumonia

•Administering IV antibiotics per MD order (usually ordered if the appendix

ruptured)

•Maintain NG tube if present (remove stomach fluids and swallowed air). It will be
removed when bowels start to work…keep NPO until tube is removed.
POST-OPERATIVE NURSING CARE
•Diet: clears, then full, and solids as tolerated. Encourage patient to eat a high
fiber diet (decreases straining during bowel movements).

•Monitor bowel sounds (are they present?), Patient passing gas?, And when last
bowel movement was (should have a BM within 2-3 days after surgery…if not
notify doctor

•If done laparoscopic: patient may experience shoulder pain for a couple of days
after surgery.

•Administering pain relief as ordered by md.

DISCHARGE AND HOME CARE GUIDELINES
Discharge teaching for patient and family is imperative.

•Removal of sutures. The nurse instructs the patient to make an appointment with
the surgeon to remove the sutures between the 5th and 7th days after surgery.

•Activities. Heavy lifting is to be avoided postoperatively; however, normal

activity can be resumed within 2 to 4 weeks.

•Home care. A home care nurse may be needed to assist with incision care and to
monitor the patient for complications and wound healing.