Appendicitis in children for nursing students

2. The appendix is a finger-shaped pouch attached to the large
intestine in the right-lower abdomen. The exact function of
the appendix is not known. The internal lumen, or tube-like
opening inside the appendix, can become blocked with feces,
parasites or enlarged lymph tissue.

3. It is the inflammation of the appendix

4.  Fecalith- A hard stony mass of feces
 Appendix is blocked by something, causing an infection. The
blockage may be caused by nose or mouth fluid, called
mucus.
 Blockage may be caused by a bend or twist in the appendix
itself.
 Infection
 Tumor
 stricture

5. Due to etiology
Appendix lumen obstruction leads to congestion within the appendix
Inflammatory exudate and mucous increases luminal pressure
Appendix may distend with mucus- mucocele
Appendicitis

6. Pain
◦ Initially periumbilical region
◦ Pain shift to right iliac fossa
◦ Parietal peritoneum irritated and inflamed
Anorexia
Nausea/ vomiting
 Pyrexia: Low grade
 Tenderness (localized) in the RIF
Rebound Tenderness/ BLUMBERG’S Sign

7.  History and physical examination- The doctor will ask for a
history of your child's symptoms and illness. They will
examine your child by checking the site of the pain and
pressing on the abdomen. The doctor may also ask your child
to walk to assess their pain.

8.  Blood examination-shows moderate leukocytosis
 Abdominal x-ray helps to identify the presence of
fecalith or perforation or intestinal obstruction

10. If appendicitis is suspected, the child should receive
nothing by mouth and be started on IV volume
replacement. Adequate hydration is important for
patients with suspected appendicitis, and in many cases
IV fluids may be required even after an appendectomy

11.  Broad-spectrum IV antibiotics effective
against enteric aerobes and anaerobes should
be administered immediately to all children
with obvious perforation
 Nonperforated appendicitis-cefoxitin or
cefotetan
 Perforated appendicitis- piperacillin-
tazobactam, ampicillin-sulbactam, ticarcillin-
clavulanate, or imipenem-cilastatin.

12. Appendectomy-An appendectomy is a definitive
treatment for appendicitis that can be performed
using either laparoscopy or open technique. It is
indicated in all patients that have early,
nonperforated appendicitis.

13.  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.

14.  Acute pain related to obstructed appendix.
 Risk for deficient fluid volume related to
preoperative vomiting, postoperative
restrictions.
 Risk for infection related to ruptured
appendix.

15.  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