SURGERY & SURGICAL NURSING I
TOPIC: APPENDICITIS
PRESENTED
BY:
TIZIBENJI SITALI
3/21/2023
TIZIBENJI
SITALI
BSc.
NURSING
STUDENT
1

GENERAL OBJECTIVE
At the end of the lecture/ discussion the
first year registered nursing students
should demonstrate an understanding of
appendicitis and management of a
patient with appendicitis.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

SPECIFIC OBJECTIVE
Define appendicitis.
Types of appendicitis
State the causes of appendicitis.
Explain the pathophysiology of
appendicitis.
State the signs and symptoms of
appendicitis.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

SPECIFIC OBJECTIVE
CONT…
Explain the management of patient with
appendicitis.
State the complications of appendicitis.
Explain the IEC given post
appendicectomy.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

INTRODUCTION
The appendix is a tube about three to four
inches extending from the large intestines at
the apex of the ceacum.
The functions of the appendix are not clearly
understood but its walls contain lymphoid
cells which contribute in infection prevention
and one can live without it, without apparent
consequences.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

Appendicitis is a surgical emergency that
requires prompt surgery to remove the
appendix so that it does not perforate
and lead to peritonitis.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

DIAGRAM SHOWING THE APPENDIX
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

OPENING OF VERMIFORM APPENDIX
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SITALI
BSc.NURSING
STUDENT

DEFINATION
Appendicitis is the inflammation of the
vermiform appendix which can be acute
or chronic. ( Harkness Dinkher. 10th
Edition 1996).
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

TYPES OF APPENDICITIS
a)Non Obstructive Acute Appendicitis
• In this type of appendicitis the inflammation usually
commences in the mucous membranes less often in the
lymph follicles like any inflammatory process. It terminates
in one of the following;
• Resolution
• Suppuration
• Ulceration
• Gangrene
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

TYPES OF APPENDICITIS
b)Obstructive Acute Appendicitis
• In this type of appendicitis obstruction can be
in the lumen (due to faecal matter, foreign
body or parasites etc) or in the wall. About
one third of cases of acute appendicitis
belong to this type.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

CAUSES
It occurs secondary to obstruction of
appendiceal lumen which could be due to
infection, foreign body, tumour or stricture.
Kinking of the appendix which leads to
blockage.
Infection from adjacent organs or blood.
Manipulation during surgery.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

PATHOPHYSIOLOGY
The lumen of the proximal end of the
appendix is shared with the ceacum,
whereas the distal end is closed.
The appendix fills and empties regularly
in the same way as the ceacum.
However, the lumen for the appendix is
narrow and is easily obstructed.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

PATHOPHYSIOLOGY
CONT…
The obstruction of the lumen and the
subsequent bacterial over growth is the
usual cause of appendicitis.
When the lumen becomes obstructed,
the blood supply is disrupted, the
appendix becomes distended and hypoxic
leading to inflammation.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

PATHOPHYSIOLOGY
CONT…
Any bacteria present (especially
Escherichia coli), start to multiply in the
appendix and infection develops with pus
formation.
Severe infection and distension leads to
perforation of the appendix and this
leads to peritonitis.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

SIGNS AND SYMPTOMS
Low grade fever due to infection
Abdominal pain which is more in the
right lower quadrant at Mc Burney’s
point.
Abdominal tenderness due to
inflammation of the appendix.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

SIGNS AND SYMPTOMS
CONT…
Nausea and vomiting due to
gastrointestinal irritation due to presence
of inflammation.
Loss of appetite due to pain.
Constipation due to pain.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

SIGNS AND SYMPTOMS
CONT…
Pain on defeacation if the tip of appendix
rests against the rectum and pain on
urination if it impinges the ureter or it is near
the bladder.
Patient walks bending or lies down with
knees bent up to reduce pain.
Abdominal distension if appendix has
raptured.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

MANAGEMENT
AIMS
To promote comfort
To prevent complications
To promote quick recovery
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

INVESTIGATIONS
History- patient will complain of pain in the right
hypochondriac region.
Physical examinations will review a positive
Rovsing’s sign -which is when pressure is applied
on the left lower quadrant pain is felt on the right
lower quadrant.
Abdominal x-ray: Reveals a right lower quadrant
density or localized distension of the bowel.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

INVESTIGATIONS
CONT…
Ultra sound studies: Reveals a right
lower quadrant density or localized
distension of the bowel.
Full blood count: demonstrates an
elevated white blood cell count.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

TREATMENT
Appendicectomy is the surgical removal of
the appendix and is the treatment of choice
for appendicitis.
 When appendicitis is diagnosed, it is treated
as a surgical emergency and quick
appendicectomy is done to prevent
rapture/perforation which leads to
peritonitis.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

TREATMENT CONT.
 The operation is done through an abdominal incision or laparoscopy.
 If rapture or abscess had occurred, laparatomy is performed,
abdominal cavity washed and drainage tube left in situ for drainage.
 Antibiotics are commenced before operation to combat infection.
 Analgesics are given cautiously in order not to mask the diagnosis.
 Intravenous fluids e.g ringers lactate and normal saline are given to
maintain fluid and electrolyte balance.
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SITALI
BSc.NURSING
STUDENT

INFORMATION, EDUCATION AND COMMUNICATION
Patient is told to come back for removal
of sutures on the 5th-7th day post
operatively if non absorbable suture
material was used.
Patient is advised on the importance of
hygiene to prevent infections.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

IEC CONT…
Patient is encouraged to ambulate/ exercise
to promote healing.
Patient is advised on how to take the
prescribed drugs.
Patient is advised on the importance of a
mixed balanced diet to promote quick
healing.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

SUMMARY
We have discussed appendicitis, which is a surgical
emergency and one of the common causes of
acute abdomen.
We have looked at the causes, pathophysiology,
signs and symptoms and the management.
We have also discussed the IEC given to the
patient.
Thank you very much for your participation and
cooperation.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

ASSIGNMENT
Read and write notes on the
complications of appendicitis.
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT

THE END
THANK YOU FOR YOUR ATTENTION
3/21/2023
TIZIBENJI
SITALI
BSc.NURSING
STUDENT
28

REFERRENCE
 MEDICAL TEXT BOOKS/Brunner and Suddarth's Textbook of Med.-
Surg. Nursing 12th ed. (2 vols) - S. Smeltzer, et al., (Lippincott, 2010)
BBS.pdf
 Suzanne C. Smeltzer, Brenda G. Bare, Jannice L. Hinkle. Medical-
Surgical nursing, 11th edition, 2008.
 Kumar P. and Clark M. (2005), Clinical Medicine, 6th edition, Elsevier
Saunders, London, UK
 Joe J. T. Andra, Gordon J. A. Clunie, Andrew H. Kaye &Julian A.
Smith. (2006) Text book of Surgery, 3rd Edition, Blackwell
Publishing, Victoria, Australia
 www.m.webmd.com/a-z-guides/digestive-disease-appendicitis
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TIZIBENJI
SITALI
BSc.NURSING
STUDENT