Appendicitis Lecture on 1 nurses


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Appendicitis Lecture on 1 nurses

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  3. 3. <ul><li>Appendicitis </li></ul><ul><ul><li>Inflammation of the vermiform appendix that prevents mucus from passing into the cecum; if untreated, ischemia, gangrene, rupture and peritonitis occur. </li></ul></ul><ul><ul><li>It occurs in about 70% of the population and affects males more often than females. Most common in school-age children. </li></ul></ul><ul><li>Causes: </li></ul><ul><ul><li>May be caused by mechanical obstruction (fecaliths, intestinal parasites. Kinking of appendix, tumor or inflammation) or anatomic defect; may be related to decreased fiber in the diet and high intake of refined carbohydrates </li></ul></ul>
  4. 4. PATHOPHYSIOLOGY Obstruction of the appendix lumen Mucosal inflammation and bacterial proliferation Increased intra-luminal Pressure Lymphoid swelling Decreased venous drainage Thrombosis Bacterial invasion Abscess Gangrene Perforation (24 to 36 hours) Peritonitis
  5. 5. <ul><li>Assessment findings </li></ul><ul><ul><li>Acute abdominal pain that usually starts in the epigastric or umbilical region </li></ul></ul><ul><ul><ul><li>Pain gradually becomes localized in RLQ/ Mc Burney’s Point (halfway between the umbilicus and the anterior spine of the ileum) </li></ul></ul></ul><ul><ul><ul><li>Pain is initially intermittent then become steady and severe over a short period. </li></ul></ul></ul><ul><ul><li>Appendicitis “signs” </li></ul></ul><ul><ul><ul><li>Rebound tenderness (Blumberg sign) </li></ul></ul></ul><ul><ul><ul><li>Psoas sign (lateral position with right hip is palpated) </li></ul></ul></ul><ul><ul><ul><li>Rovsing’s sign (right quadrant pain when the left is palpated) </li></ul></ul></ul><ul><ul><ul><li>Obturator sign (pain on external rotation of the right thigh) </li></ul></ul></ul>
  6. 6. <ul><ul><li>Initially periumbilical pain then radiates to the RLQ </li></ul></ul><ul><ul><li>Nausea/ vomiting and ANOREXIA </li></ul></ul><ul><ul><li>Guarding of abdomen, rebound tenderness, walks stooped over </li></ul></ul><ul><ul><li>Decreased bowel sounds </li></ul></ul><ul><ul><li>Fever, low grade (temperature= 38-38.5 ºC). If high grade fever, suspect ruptured appendicitis. </li></ul></ul><ul><ul><li>Diagnostic tests </li></ul></ul><ul><ul><ul><li>WBC increased Elevated WBC (above 10,000/ </li></ul></ul></ul><ul><ul><ul><li>Ultrasound and abdominal x-ray to detect the fecalith </li></ul></ul></ul>
  7. 8. <ul><li>Nursing Interventions </li></ul><ul><ul><li>Administer antibiotics/ antipyretics as ordered </li></ul></ul><ul><ul><li>prevent perforation of the appendix; don’t give enemas or cathartics or use heating pad </li></ul></ul><ul><ul><li>In addition to routine pre-op care for appendectomy </li></ul></ul><ul><ul><ul><li>Give support to parents if seeking treatment was delayed </li></ul></ul></ul><ul><ul><ul><li>Explain necessity of obtaining lab work prior to surgery </li></ul></ul></ul><ul><li>COLLABORATIVE MANAGEMENT </li></ul><ul><ul><ul><ul><li>Bed rest </li></ul></ul></ul></ul><ul><ul><ul><ul><li>NPO </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Relieve pain (cold application over the abdomen, NEVER heat!) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Avoid factors that increase peristalsis, thereby rupture: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Heat application over the abdomen </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Laxative </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Enema </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>IVF therapy to maintain fluid-electrolyte balance </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Antibiotic therapy </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Surgery: Appendectomy </li></ul></ul></ul></ul>
  8. 9. <ul><li>Surgical procedure= APPENDECTOMY </li></ul><ul><ul><ul><ul><li>Spinal anesthesia is usually used </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Post-operatively, flat on bed for 6-8 hours </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Monitor for return of sensation in the lower extremities </li></ul></ul></ul></ul><ul><ul><ul><ul><li>NPO until peristalsis returns </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Ambulation after 24 hours </li></ul></ul></ul></ul><ul><ul><ul><ul><li>If appendicitis ruptured (peritonitis): with penrose drains; Position: semi-fowler’s position to localize inflammation within the pelvic area </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Resume all normal activities within 2 to 4 weeks </li></ul></ul></ul></ul><ul><ul><li>In addition to routine post-op care </li></ul></ul><ul><ul><ul><li>Monitor NG tube (usually with low suction) </li></ul></ul></ul><ul><ul><ul><li>Monitor penrose drains </li></ul></ul></ul><ul><ul><ul><li>Position in semi-fowler’s or lying on right side to facilitate drainage </li></ul></ul></ul><ul><ul><ul><li>Administer antibiotics as ordered </li></ul></ul></ul>
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