This document provides an overview of appendicitis and hernia. It describes the anatomy of the appendix and causes of appendicitis. The clinical manifestations of appendicitis include abdominal pain and fever. Complications can include perforation. Treatment involves appendectomy. Nursing care focuses on pre-operative assessment and IV fluids/antibiotics, as well as post-operative monitoring for complications. Hernias are described as protrusions through weak areas of the abdominal wall. Common types and general causes are outlined. Clinical signs include bulging that reduces with lying down. Treatment options include surgery to repair or reinforce the abdominal wall.

1. Medical Surgical Nursing
Appendicitis and Hernia
‫الصحت‬ ‫معهد‬‫العالي‬
‫المادة‬ ‫مدرس‬
‫م‬.‫إختصاص‬ ‫جامعي‬
‫الوهاب‬ ‫عبد‬ ‫نزار‬ ‫صـالح‬
‫تمـريض‬ ‫علــوم‬ ‫ماجـستير‬
Salah Nazar Abdulwahhab M.Sc. Nursing
www.slideshare.net
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2. Anatomy of Digestive System
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3. Appendix
Appendix: is a small, fingerlike tubal sac, about 10 cm in long, attached
to the cecum just below the ileocecal junction
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4. Appendicitis
Appendicitis: inflammation of the appendix
most common reason for emergency abdominal surgery, can occur at any age
(more commonly between age10 - 30 years)
The obstructed appendix becomes inflamed, edematous and fill with pus
Types of Appendicitis
- Acute appendicitis: severe symptoms appear suddenly within 24 to 48 hours
- Chronic appendicitis: undiagnosed for several weeks, months, or years
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5. Clinical Manifestations of Appendicitis
- Acute pain: Right Lower quadrant.
- Low grade fever.
- Muscle spasm.
- Nausea and Vomiting.
- Loss of appetite.
- Constipation or diarrhea.
- At McBurney’s point positive: local tenderness with pressure and some rigidity of the
lower portion of the right rectus muscle.
- Rebound tenderness positive: location of appendix dictates amount of tenderness.
- Rovsing’s sign positive: palpating left lower quadrant ,causes pain in right lower
quadrant.
If appendix ruptures, pain becomes more diffuse; abdominal distention develops from
paralytic ileus, and condition worsens.
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6. Complications of Appendicitis
- perforation of the appendix, which can lead to
(peritonitis, abscess formation, septic thrombosis arise from septic
intestines)
- Perforation generally occurs 24 hours after the onset of pain.
Symptoms
- Fever (37.7C) or greater
- Toxic appearance
- Continued abdominal pain or tenderness
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7. Management
Medical Management
- Appendectomy: is the surgical removal of the appendix
(conventional or laparoscopic).
- Administer antibiotics and IV fluids until surgery is performed.
- Analgesic can be given after diagnosis is made (not given before a
suspected case of appendicitis to determine whether the patient has a
ruptured appendix or not).
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8. Management
Nursing Management
Preoperative Nursing Care
- IV infusion, to replace fluid loss and promote renal function
- antibiotic therapy (as described), to prevent infection.
- nasogastric tube is inserted, if there is evidence of paralytic ileus.
(An enema is not administered because it can lead to perforation)
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9. Management
Postoperative Nursing Care
- Places the patient in a high-Fowler’s position.
(to reduces the tension on the incision and abdominal organs)
- Analgesic to reduce pain (as prescribed)
- IV fluids if patient dehydrated before surgery
- Oral fluids are administered, when patient tolerated
- Food is provided as desired and tolerated on the day of surgery when normal bowel
sounds are present
- The patient may be discharged on the day of surgery if there is no complication
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10. Management
Discharge Nursing Plan
- Make an appointment with the surgeon to remove the sutures between
the 5th and 7th days after surgery
- care for the incision and perform dressing changes as prescribed
- Avoided heavy lifting postoperatively
- Return to normal activity within 2 to 4 weeks
- If drain is place at the area of the incision patient may be kept in the
hospital for several days and monitored carefully for signs of intestinal
obstruction or secondary hemorrhage
- A home care nurse may be needed if necessary (assist and to monitor)
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11. HERNIA
Protrusion of an organ or part of an organ through the wall of the cavity that normally
contains it.
Common Types Of Hernia
esophagus: protrudes up through the diaphragm near theHiatal hernia
and navelbone: between breastHerniaEpigastric
incision in the abdominal wall: in previouslyHerniaIncisional
of umbilicusin the muscle: weaknessHerniaUmbilical
: abdominal viscera passes through femoral ringHerniaFemoral
spermatictheregion (where: occur at the inguinal canal in the groinInguinal Hernia
cord in males or the round ligament in females)
- direct Inguinal Hernia: usually occur only in male adults and are caused by a
weakness in the muscles of the abdominal wall that develops over time
- indirect Inguinal Hernia: caused by a defect in the abdominal wall that is congenital,
or present at birth11

12. Types of Hernias
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13. General Causes of hernia
Any increases at the pressure of the abdominal cavity may form hernia
like:
- Obesity
- Heavy lifting things
- Coughing or sneezing
- Straining during a bowel movement or urination
- Fluid in the abdominal cavity
- Hereditary
- Pregnancy
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14. Clinical Manifestation
- An abnormal bulging seen in the affected area especially when straining
or coughing
- discomfort due to tension on tissues around the hernia.
- The herniation may disappear when the patient lies down.
- If the intestinal mass easily returns to the abdominal cavity or can be
manually placed back ,it is called (reducible hernia).
When adhesions or edema occur between the sac and its contents, the
hernia becomes (irreducible hernia)14

15. Nursing Education to Prevent Hernia
- Not smoking
- Seeing doctor to avoid developing a persistent cough
- Maintaining normal weight
- Avoiding straining during bowel movements or urination
- lifting objects with knees not back
- Avoiding lifting heavy weights
- Wear a support binder when lifting weights
- Eating high-fiber foods to prevent constipation
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16. The Treatment
Treatment options include
- Observing the hernia
- Using short term support devices
- Surgery to cure the hernia
Emergency surgery for (strangulation or bowel obstruction)
sac, sewing thehernialcontents of the: replacing theHerniorrhaphy
weakened tissue, and closing the opening.
the abdomen and reinforcing thehernia intothe: replacingHernioplasty
weakened muscle wall with wire, fascia, or mesh.
Bowel resection or a temporary colostomy may be necessary if the hernia
is strangulated
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17. Preoperative Nursing Care
- Patients should be encouraged to drink plenty of fluids for two days
before operation.
- Patients should be encouraged to eat foods containing fibers to avoid
constipation and pain after the operation.
- Patients can take laxatives if needed.
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18. Postoperative Nursing Care
1. Give the patient medications and I.V. fluids as prescribed
2. Check Vital signs
3. Wound care
4. Ice packs and elevation of the scrotum to reduce the swelling
5. Perform deep breathing to keep lungs clear postoperatively, but should avoid coughing.
6. Report difficulty urinating, bleeding, and signs and symptoms of infection, such as
redness, incisional drainage, fever, or severe pain.
7. Avoid lifting, driving, or sexual activities for 2 to 6 weeks
8. Support the wound during sneezing or coughing with raise the head towards the ceiling
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19. Thank You
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