This document provides information about appendicitis including: 1) The appendix is a small finger-shaped pouch located where the small and large intestines meet that is prone to obstruction and infection. 2) Appendicitis is an inflammation of the appendix that most commonly affects adolescents and young adults. It can be acute, chronic, simple, or complex depending on symptoms and complications. 3) Risk factors include age, sex, family history, infection, and obstruction. Symptoms are evaluated and diagnostic tests like blood tests, imaging, and urine tests are used to confirm appendicitis.

1. APPENDICITIS
Mrs. D. Melba Sahaya Sweety RN,RM
PhD Nursing , MSc (Pediatric Nursing), B.Sc Nursing
Associate Professor
Enam Nursing College,
Savar, Bangladesh.

2. ● The appendix is a 4 inches (8 – 10cm)long finger-shaped pouch
present at the junction of the small and large intestine. It is
normally present in the lower right abdomen.
INTRODUCTION
The appendix fills with by product of
digestion and empties regularly in to
the cecum. Because of its empties
inefficiently and its lumen is small,
the appendix is prone to obstruction
and is particularly vulnerable to
infection.

3. DFINITION
Appendicitis is an inflammation of
the appendix that develops most common in
adolescents and young adults.
( Joyce M Black)

4. TYPES OF APPENDICITIS
Types of
Appendicitis
Based on the
Onset
Acute
Appendicitis
Chronic
Appendicitis
Based on
the
Difficulties
Simple
Appendicitis
Complex
Appendicitis

5. Acute appendicitis: This condition manifests itself within a few
days to hours and necessitates immediate medical attention or
surgery.
Chronic appendicitis: Chronic appendicitis is an inflammation
that can last for a long time. . It is a rare illness.
 Simple appendicitis : Complication-free cases are
called simple appendicitis.
 Complex appendicitis : Appendix rupture or
abscess are common consequences in cases of
complex appendicitis.
TYPES OF APPENDICITIS

6. 01 02
04
03
ETIOLOGY
Faecal impaction and/or
a feacality : A layered
build up of calcium salts and
faecal debris around a piece
of faecal material within the
appendix
Lymphoid Hyperplasia:
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,
Strongyloides,
stercoralis
Uncommon Causes: 1. Tumors
2. Foreign Material : A wide variety of
foreign objects can become lodged in the
appendix. Some of these include: shotgun
pellets, tongue studs, and activated
charcoal , intestinal worms, lymphadenitis

7. 1, Infection,
possibly stomach
infection that has
travelled to the
site of appendix.
2,Obstruction such
as a hard piece of
stool getting
trapped in the
appendix leading to
infection of the
appendix.
RISK FACTORS
3,Age. Appendicitis most
often affects teens and
people in their
20sTrusted Source, but it
can occur at any age.
4,Sex. Appendicitis is
more common in males
than females.
5, Family
history. People
who have a family
history of
appendicitis are at
heightened risk of
developing it.

8. Due to etiological and Risk factors
PATHOPHYSIOLOGY
Obstruction of the Appendiceal lumen
Build up of Mucous in the appendix
Increased Lumen pressure
Ulceration of the appendix mucosal lining
Decreased oxygen supply and Blood flow to the appendix
Bacterial Invasion and Proliferation Inflammation, swelling and
Appendicitis

9. CLINICAL MANIFESTATION

10. CLINICAL MANIFESTATION
REBOUND TENDERNESS
(ie, production or intensification
of pain when pressure is
released) may be present.
Symptoms
ROVSING’S SIGN: The
Rovsing’s sign is positive
when pressure over the
patient’s left lower quadrant
causes pain in the right lower
quadrant.

11. CLINICAL MANIFESTATION
OBTURATOR’S SIGN : Pain on
passive internal rotation of the flexed
thigh. Examiner moves lower leg
laterally while applying resistance to
the lateral side of the knee resulting in
internal rotation of the femur.
PSOA’S SIGN: Psoas sign is right
lower-quadrant pain that is produced with
the patient extending the hip due to
inflammation of the peritoneum.
Straightening out the leg causes the pain
because it stretches the muscles.

12. CLINICAL MANIFESTATION
DUNPHY'S SIGN:
Increased pain in the right
lower quadrant with
coughing.
.
MCBURNEY’S SIGN : Mc Burney’s Point is two third
away from umbilicus to Anterior superior iliac spine
To elicit Mcburney’s sign patient should be in supine position
with his knees slightly flexed and his abdominal muscles
relaxed. Palpate deeply and slowly in the right lower quadrant
over McBurney’s point ,located about 2” from the Right
Anterior Superior Iliac Spine, On a line between the spine and
umbilicus. Pain and tenderness is a positive sign and indicates
appendicitis.

13. History Collection and Physical Examination :
Collect history regarding the signs and symptoms and
conduct physical examination to rule out the signs of
Appendicitis
DIAGNOSTIC EVALUATION
Blood test: to check for a high white blood cell count,
which may indicate an infection.
Imaging tests: 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 pain.
Urine test: to make sure that a urinary tract infection or
a kidney stone isn't causing your pain.

14. COMPLICATION
Gangrene or perforation of the
appendix
Peritonitis ( reptured appendix
cause Peritonitis
Abscess formation or portal
pylephebitis ( which is septic thrombosis
of the portal vein caused by vegetative
emboli that arises from septic intestine.
Sepsis (Bacteria from a ruptured
appendix can get into your bloodstream)

15. MANAGEMENT
MEDICAL MANAGEMENT
To correct or prevent fluid and electrolyte imbalance, dehydration, and
sepsis,
Antibiotics and IV fluids are given until surgery is performed.
Antibiotics (Cefotaxime 250mg, 500mg • Levofloxacin 500 mg •
Metronidazole 500mg/100ml, 400 mg tablet) Analgesics can be
administered after the diagnosis is made. (Morphine sulphate 10 mg/ml)
SURGICAL MANAGEMENT
Appendectomy : most appendectomies are done
laparoscopically. Laparoscopic procedures take place with a
scope through small incisions. This minimally invasive approach
helps you heal faster, with less pain. Major abdominal surgery
(laparotomy) is done if the appendix ruptures.

16. MANAGEMENT
NURSING MANAGEMENT
Nursing management include:
 Relieving pain.
 Preventing fluid volume deficit.
 Reducing anxiety.
 Eliminating infection due to the
potential or actual disruption of the
GI tract.
 Maintaining skin integrity.
 Attaining optimal nutrition.

17. 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
 Administer antibiotics as prescribed
 Preparation for surgery i.e. physically & psychologically
 Alley anxiety & fears
 Obtain 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
NURSING MANAGEMENT

18. 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 and 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, and Maintaine Intake and output chart
 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
 Medication as per prescription (Drugs – Antibiotics, analgesic & Anticholenergies 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.
NURSING MANAGEMENT

19. NURSING DIAGNOSIS
 Acute Pain May be related to, Distension of intestinal tissues by
inflammation or Presence of surgical incision as evidenced by report of
pain
 Risk for Fluid Volume Deficit, may related to, Preoperative vomiting,
postoperative restrictions (e.g., NPO)/, Hypermetabolic state (e.g., fever,
healing process)/ Inflammation of peritoneum with sequestration of
fluid /as evidenced by dry lips, skin and sunken eyes.
 Risk for Infection, may related to, Inadequate primary defenses;
perforation/rupture of the appendix; peritonitis; abscess formation,
Invasive procedures, surgical incision as evidenced by fever, tenderness,
Redness and pus formation on surgical incision.
 Deficient Knowledge May be related to Lack of exposure/recall;
information misinterpretation, Unfamiliarity with information resources
as evidenced by asking questions
 Anxiety related to impending surgery as manifested by facial expression.