1) Appendicitis is caused by obstruction of the appendix, usually by feces, leading to inflammation and swelling. Left untreated, it can rupture. 2) Symptoms include pain localized to the lower right abdomen, nausea, loss of appetite, and fever. Diagnosis is made through physical exam, blood tests, and imaging scans. 3) Treatment is surgical removal of the appendix (appendectomy). Without surgery, the appendix can continue to swell and rupture, causing infection and potentially life-threatening complications.

1. Appendicitis
Logman Mohammed

2. Introduction ..
Appendix:
A small out-pouching from the beginning
of the ascending colon(cecum of the large
intestine). Formally called the vermiform
appendix because it was thought to be
wormlike

5. Appendicitis
Is inflammation of the vermiform appendix
caused by an obstruction of the intestinal
lumen from infection, stricture, fecal mass,
foreign body, or tumor

6. 1. Events occur so rapidly that process takes about
1 to 3 days.
2. Appendix becomes blocked by feces, a foreign
object, or tumor.
3. Obstruction, along with continued secretion of
mucus, causes the wall of the appendix to
become distended.
4. The resulting inflammatory process causes an
increase in intraluminal pressure of the
appendix
Pathophysiology and Etiology

7. Pathophysiology and Etiology
5. Blood supply to the wall of the appendix is
reduced, causing ischemia and accumulation of
toxins.
6. Wall of the appendix starts to break down, and
normal bacteria found in the gut attacks the
decaying appendix.
7. Leads to necrosis and perforation of the appendix
8. Appendicitis can affect any age-group; most
common in adolescents/young adults, especially
males

8. Signs and Symptoms
 Fever, increased white blood cells,
 central abdominal Abdomen
 Within 2 to 12 hours of onset the pain usually
becomes localized to the right lower quadrant
at McBurney’s point midway between the
umbilicus and the right iliac crest

9. Abdominal regions

10. Signs and Symptoms

11.  Anorexia, moderate malaise, mild fever,
 nausea and vomiting.
 Usually constipation occurs; occasionally
diarrhea.
 Rebound tenderness, involuntary guarding,
generalized abdominal rigidity
Signs and Symptoms

12. Diagnostic Tests and Evaluation
• Physical examination consistent with clinical
manifestations.
• (CBC) reveals elevated leukocyte and
neutrophil counts.
• Urinalysis to rule out urinary disorders.
• Abdominal X-ray may visualize shadow
consistent with fecalith in appendix;
perforation will reveal free air.

13. • Ultrasound or computed tomographic
(CT) scan reveals an enlargement in the
area of the cecum
Diagnostic Tests and Evaluation

14. Therapeutic Interventions
1. Surgery (appendicectomy) is indicated.
 Simple appendicectomy or laparoscopic
appendicectomy in absence of rupture or
peritonitis.
 An incisional drain may be placed if an abscess or
rupture occurs.
2. Preoperatively maintain bed rest, NPO status,
I.V. hydration, possible antibiotic prophylaxis,
and analgesia

15. Complications
1. Perforation (in 95% of cases)
2. Abscess
3. Peritonitis
4. Appendix mass

16. Nursing Assessment
1. Obtain history for location and extent of pain.
2. Auscultate for presence of bowel sounds;
peristalsis may be absent or diminished.
3. On palpation of the abdomen, assess for
tenderness anywhere in the right lower
quadrant, but usually localized over McBurney's
point .
4. Assess for rebound tenderness in the right lower
quadrant as well as referred rebound when
palpating the left lower quadrant

17. 5. Assess for positive psoas sign by having the
patient attempt to raise the right thigh against
the pressure of your hand placed over the right
knee. Inflammation of the psoas muscle in acute
appendicitis will increase abdominal pain with
this maneuver.
6. Assess for positive obturator sign by flexing the
patient's right hip and knee and rotating the leg
internally. Hypogastric pain with this maneuver
indicates inflammation of the obturator muscle
Nursing Assessment

18. 1. Relieving pain, promote comfort
2. Preventing fluid volume deficit,
3. Reducing anxiety, eliminating infection due to the
potential or actual disruption of the GI tract,
4. Maintaining skin integrity, and attaining optimal
nutrition
5. Provide information about surgical procedure,
prognosis, treatment needs, and potential
complications
Nursing Priorities

19. Nursing Diagnoses
1. Acute Pain related to inflamed appendix
2. Risk for Infection related to perforation
3. Risk for deficient Fluid Volume related to
preoperative vomiting, postoperative
restrictions—(NPO),hypermetabolic
state—fever, healing process

20. Nursing Interventions
Relieving Pain:
 Monitor pain level, location, intensity, pattern.
 Assist patient to comfortable positions, such as semi-
Fowler's and knees up.
 Restrict activity that may aggravate pain, such as
coughing and ambulation.
 Apply ice bag to abdomen for comfort.
 Give antiemetics and analgesics as ordered and
evaluate response.
 Avoid indiscriminate palpation of the abdomen to
avoid increasing the patient's discomfort

21. Preventing Infection:
 Monitor frequently for signs and symptoms of
worsening condition indicating perforation,
abscess, or peritonitis:
increasing severity of pain, tenderness, rigidity,
distention, ileus, fever, malaise, tachycardia.
 Administer antibiotics as ordered.
 Promptly prepare patient for surgery
Nursing Interventions

22. Maintain fluid Volume:
 Monitor blood pressure (BP) and pulse
 Inspect mucous membranes; assess skin
turgor and capillary refill.
 Monitor intake and output (I&O); note urine
color and concentration and specific gravity.
 Auscultate bowel sounds. Note passing of
flatus and bowel movement
Nursing Interventions

23. Cont..
 Provide clear liquids in small amounts when
oral intake is resumed, and progress diet as
tolerated.
 Give frequent mouth care with special
attention to protection of the lips
 Maintain nasogastric (NG) and intestinal
suction, as indicated
 Administer intravenous (IV) fluids and
electrolytes

24. Patient Education and Health
Maintenance
1. Instructs the patient to make an appointment
to have the surgeon remove the sutures
between the 5th and 7th days after surgery
2. Instruct patient to avoid heavy lifting for 4 to 6
weeks after surgery.
3. Instruct patient to report symptoms of
anorexia, nausea, vomiting, fever, abdominal
pain, incisional redness or drainage
postoperatively.

25. Evaluation: Expected Outcomes
1. Verbalizes decreased pain to 2 or 3 level
on 0-to-10 scale with positioning and
analgesics
2. Afebrile; no rigidity or distention
3. Maintain adequate fluid balance as
evidenced by moist mucous membranes,
good skin turgor, stable vital signs, and
individually adequate urinary output

26. Thanks