Appendicitis can be managed and can prevent complications if cared comprehensively.

1. Appendicitis
DR.ESWARAPPA S
PROFESSOR
SHRIDEVI COLLEGE OF NURSING
TUMKUR

3. Indroduction:
• The appendix is a small fingerlike appendage
about 10 cm (4 in) long, attached to the
cecum just below the ileocecal valve.
• No definite functions can be assigned to it in
humans.
• The appendix fills with food and empties as
regularly as does the cecum.
• It is prone to become obstructed and is
particularly vulnerable to infection
(appendicitis) because it is small.

4. Facts about Appendicitis:
• Appendicitis is the most common cause of acute
inflammation in the right lower quadrant of the
abdominal cavity.
• About 7% of the population will have appendicitis
at some time in their lives.
• Males are affected more than females and
teenagers more than adults.
• It occurs most frequently between the age of 10
and 30.
• It is more prevalent in countries in which people
consume a diet low in fiber and high in refined
carbohydrates.

5. Definition:
Appendicitis is inflammation of the vermiform
appendix caused by an obstruction attributable
to infection, structure, fecal mass, foreign
body, or tumor.

7. Pathophysiology of Appendicitis:
• The appendix becomes inflamed and
edematous as a result of becoming kinked or
occluded by a fecalith, (a hard stony mass of
feceas in the intestinal tract) /tumor, or
foreign body.
• The inflammatory process increases intra
• luminal pressure, initiating a progressively
severe, generalized or peri umbilical pain that
become localized to the right lower quadrant
of the abdomen within few hour.
• The inflamed appendix fills with pus.

8. Pathophysiology of Appendicitis:

9. Risk Factors:
• Caused by various infections such as
• virus, Coxsackievirus has been associated with
cecal inflammation and periappendiceal
lymphoid hyperplasia.
• Bacteria and (Klebsiella, Enterobacte)
• Parasites(Entamoeba,histolytica) Schistosoma in your
digestive tract. Or
• it may happen when the tube that joins your large
intestine and appendix is blocked or trapped by stool.
Sometimes tumors can cause appendicitis. The
appendix then becomes sore and swollen.

10. Risk Factors
Abdominal injury or trauma.
Blockage at the opening where the appendix
connects to the intestines.
Digestive tract infection.
Inflammatory bowel disease.
Growths inside the appendix.

11. Clinical Manifestations:
1. Generalized or localized abdominal pain in the
epigastric or periumbilical areas and upper right
abdomen.
2. The pain localizes in the right lower quadrant and
intensity increases with 2 to 12 hours.
3. Anorexia, moderate malaise, mild fever, nausea and
vomiting.
4. Usually constipation occurs ; occasionally diarrhea.
5. Rovsing’s Sign: which pressure on the left lower
quadrant of the abdomen causes pain in the right
lower quadrant.
6. Rebound tenderness, involuntary guarding, generalized
abdominal rigidity.

12. Diagnostic Evaluation:
Physical examination consistent with clinical
manifestations.
WBC count reveal moderate leukocytosis (10,000
to 16,000/mm3).
Urinalysis rule out urinary disorders.
Abdominal x-ray may visualize shadow consistent
with fecal in appendix; perforation will reveal free
air.
Abdominal ultrasound or CT scan can visualize
appendix and rule out other conditions, such as
diverticulitis and crohn’s disease.
Focused appendiceal CT can quickly evaluate for
appendicitis.

13. Complications of Appendicitis
•
If it isn’t treated, a diseased appendix can rupture. A
burst appendix can cause an infection that can lead to
serious illness and even death. Complications include:
•
Abscess: You may develop an appendicular abscess, or a
pocket of infectious pus. Your healthcare provider will
place drainage tubes in your abdomen. These tubes
remove fluid from the abscess before surgery. The
drainage process may take a week or longer. During this
time, you take antibiotics to fight infection. After the
abscess is gone, you’ll have surgery to remove the
appendix.

14. Complications of appendicitis
•
Abdominal infection: Peritonitis can be life-
threatening if infection spreads throughout
the abdomen. Abdominal surgery
(laparotomy) removes the ruptured appendix
and treats the infection.
•
Sepsis: Bacteria from a ruptured appendix can
get into your bloodstream. If it does, it can
cause a serious condition called sepsis. Sepsis
causes widespread inflammation in many of
your organs. It can be fatal. It requires hospital
treatment with strong antibiotics

15. Treatment and Management:
1. Surgery.
2. Parenteral replacement.
3. Medication.

16. Continue……… Surgery:
Appendectomy:
It is a surgery to remove of the appendix.
It is the effective treatment.
It is performed if appendicitis is diagnosed as
soon as possible to decrease the risk of
perforation.
Appendectomy may be performed under a
general or spinal anesthetics with a low
abdominal incisions or by laparoscopy which
is recently highly effective method.

17. Continue…….. Treatment
Administration of IV fluids and antibiotic to
correct or prevent fluid and electrolyte
imbalance, dehydration and sepsis until
surgery is performed.
Administration of Antibiotics.
Analgesics can be administered after the
diagnosed is made.

18. Complications:
Perforation of the appendix:
Peritonitis.
Abscess formation.
Portal pylephlebitis.
If left untreated, appendicitis may progress to abscess,
perforation, subsequent peritonitis, and death

20. Nursing Diagnosis:
•
1. Acute Pain related to Distension of
intestinal Possibly evidenced by Reports of
pain Facial grimacing, muscle guarding;
distraction behaviors Expressive behavior
(restlessness, moaning, crying, vigilance,
irritability, sighing) tissues by inflammation

21. Nursing Interventions:
Monitor frequently for signs and symptoms of
worsening condition, indicating perforation, abscess,
or peritonitis (increasing severity of pain, tenderness,
rigidity, distention, absent bowel sounds, fever,
malaise, and tachycardia).
Notify health care provider immediately if pain
suddenly ceases, this indicates perforation, which is a
medical emergency.
Assist patient to position of comfort such as semi-
fowlers with knees are flexed.

22. Continue………..Nursing Interventions
Apply ice bag to abdomen for comfort.
Avoid indiscriminate palpation of the abdomen to avoid
increasing the patients discomfort.
Promptly prepare patient for surgery once diagnosis is
established.
Explain signs and symptoms of postoperative
complications to report-elevated temperature, nausea
and vomiting, or abdominal distention; these may
indicate infection.
Do not give analgesics/antipyretics to mask fever, and
do not administer cathartics because they may cause
rupture.

23. Restrict activity that may aggravate pain, such as
coughing and ambulation.
Instruct patient on turning, coughing, or deep
breathing, use of incentive spirometer, and
ambulation. Discuss purpose and continued
importance of these maneuvers during recovery
period.
Teach incisional care and avoidance of heavy
lifting or driving until advised by the surgeon.
Advise avoidance of enemas or harsh laxatives;
increased fluids and stool softeners may be used
for postoperative constipation.
Continue………..Nursing Interventions

24. Discharge Planning:
Antibiotics for infection and analgesic agent can
be given for pain after the surgery.
Within 12 hrs of surgery you may get up and
move around.
Within 2-3 week usually can return to normal
activities s after laparoscopic surgery.
To care wound perform dressing changes and
irrigations as prescribe avoid taking laxative or
applying heat to abdomen when abdominal pain
of unknown cause is experienced.
Reinforce need for follow-up appointment with
the surgeon and to call the physician if the pain
increase at the incision site .

25. Continue……………Discharge Planning
Document bowel sounds and the passing of
flatus or bowel movements (these are signs of
the return of peristalsis.
Watch for surgical complications such as
continuing pain or fever, which indicate an
abscess .
Stitches removed between fifth and seventh
day.
Liquid or soft diet until the infection subsides
Soft diet is low in fiber and easily breaks down
in the gastrointestinal tract.

26. Nursing Responsibilities:
Relieving Pain.
Preventing Fluid Volume Deficit.
Reducing Anxiety.
Eliminating Infection.
Maintaining Skin Integrity.
Attaining Optimal Nutrition

27. Thanks