2. INTRODUCTION
Appendix is a finger like blind ended tube connected to the cecum (usually located
in the Right Lower Quadrant (RLQ) of the abdomen).
Inflammation of the appendix is known as appendicitis.
It can be of two types:
1. Acute appendicitis
2. Chronic appendicitis
3. ETIOLOGY
Decreased dietary fibers
Blockage of opening from the appendix into the cecum (may be due to thick
mucous, stool, fecolith that enters the appendix from caecum)
Swelling of the lymphatic tissue in the appendix which may block the appendix.
Obstruction of the appendiceal orifice by tumor.
Intestinal parasite can proliferate in the appendix and occlude the lumen.
4.
5. CLINICAL FEATURES
Symptoms
1. Pain in right lower quadrant.
2. Low grade fever.
3. Nausea, vomiting (especially incase of intestinal obstruction)
4. Anorexia
5. Occasionally it can be accompanied with diarrhea or constipation.
6. CONT..
SIGN
Deep tenderness at Mc Burney's point, known as Mc Burneys sign.
Rebound tenderness in Right Iliac Fossa.
Deep palpation of the left iliac fossa may cause pain in the right iliac fossa i.e.
Rovsing’s sign.
Positive Psoas Sign: Extension of right leg of patient lying in left lateral position
results in abdominal pain.
7. DIAGNOSTIC EVALUATION
1. History Taking
2. Physical Examination
3. Investigations
White Blood Cell Count: usually elevated with infection.
C reactive protein (CRP) : elevated
Abdominal X- Ray : it may detect the fecolith.
Ultrasound : It can identify an enlarged appendix or an abscess.
8. CONT…
Computerized tomography (CT) Scan : Useful in diagnosing appendicitis and peri-
appendiceal abscesses as well as in excluding other diseases inside the abdomen
and pelvis that can mimic appendicitis.
9. MEDICAL MANAGEMENT
Antibiotics for infection
Antipyretic for fever.
Analgesic for pain.
IV fluid to correct fluid and electrolyte imbalance and dehydration.
10. SURGICAL
Open appendectomy : Open surgical removal of the appendix.
Laparoscopic appendectomy : Laparoscopic surgical removal of appendix.
Laparotomy : Incase of perforated or ruptured appendix open laparotomy is done.
11. NURSING MANAGEMENT
Nursing Assessment
History taking
Medical history
Complaints of pain
Nausea, vomiting, increased body temperature
Past medical history
Physical examination
12. Nursing Intervention
Preoperative interventions
Maintain NPO status.
Administer fluids intravenously to prevent dehydration.
Monitor for changes in level of pain.
Monitor for signs of ruptured appendix and peritonitis.
13. CONT…
Position right-side lying or low to semi fowler position to promote comfort.
Monitor bowel sounds.
Apply ice packs to abdomen every hour for 20-30 minutes as prescribed.
Administer antibiotics as prescribed.
Avoid the application of heat in the abdomen.
Avoid laxatives or enema.
14. Postoperative interventions
Monitor temperature for signs of infection.
Assess incision for signs of infection such as redness, swelling and pain.
Maintain NPO status until bowel function has returned.
Advance diet gradually or as tolerated or as prescribed when bowel sound return.
If rupture of appendix occurred, expect a drain to be inserted, or the incision maybe left to heal
inside out.
Expect that drainage from the drain maybe profuse for the first 2 hours.
15. Discharge and Home Healthcare Guidelines
MEDICATIONS: Be sure the patient understands any pain medication prescribed, including doses,
route, action, and side effects. Make certain the patient understands that he or she should avoid
operating a motor vehicle or heavy machinery while taking such medication.
INCISION: Sutures are generally removed in the physician’s office in 5 to 7 days. Explain the need
keep the surgical wound clean and dry. Teach the patient to observe the wound and report to the
physician any increased swelling, redness, drainage, odor, or separation of the wound edges. Also
instruct the patient to notify the doctor if a fever develops. The patient needs to know these may
be symptoms of wound infection. Explain that the patient should avoid heavy lifting and should
question the physician about when lifting can be resumed.
16. CONT…
COMPLICATIONS: Instruct the patient that a possible complication of appendicitis is peritonitis.
Discuss with the patient symptoms that indicate peritonitis, including sharp abdominal pains, fever,
nausea and vomiting, and increased pulse and respiration. The patient must know to seek medical
attention immediately should these symptoms occur.
NUTRITION: Instruct the patient that diet can be advanced to her or his normal food pattern as
long as no gastrointestinal distress is experienced.
17. NURSING CARE PLANS
Acute Pain related to presence of a surgical incision as evidenced by reports of pain, facial
grimacing, muscle guarding, distraction behaviors and expressive behavior (restlessness, moaning,
crying, irritability).
Desired Outcomes
The client will report pain is relieved/controlled.
The client will appear relaxed, and able to sleep/rest appropriately.
The client will demonstrate the use of relaxation skills and diversional activities, as indicated, for
individual situations.
18. Nursing Assessment and Rationales
1. Assess pain, noting location, characteristics, and severity (0–10 scale).
and report changes in pain as appropriate.
Useful in monitoring the effectiveness of the medication, and the progression of
healing. Changes in characteristics of pain may indicate developing abscess
or peritonitis, requiring prompt medical evaluation and intervention.
2. Watch closely for possible surgical complications.
Continuing pain and fever may signal an abscess.
19. Nursing Interventions and Rationales
1. Provide accurate, honest information to patients and SO.
Being informed about the progress of the situation provides emotional support,
helping to decrease anxiety.
2. Keep at rest in a semi-Fowler’s position.
To lessen the pain. Gravity localizes inflammatory exudate into the lower abdomen
or pelvis, relieving abdominal tension, which is accentuated by the supine position
3. Encourage early ambulation.
Promotes normalization of organ function (stimulates peristalsis and passing of
flatus, reducing abdominal discomfort).
20. 4. Provide diversional activities
Refocuses attention, promotes relaxation, and may enhance coping abilities.
5. Keep NPO and maintain NG suction initially.
Decreases discomfort of early intestinal peristalsis, gastric irritation, and vomiting.
6. Place an ice bag on the abdomen periodically during the initial 24–48 hr., as appropriate.
Soothes and relieves pain through desensitization of nerve endings. Note: Do not use heat,
because it may cause tissue congestion.
7. Never apply heat to the right lower abdomen.
This may cause the appendix to rupture.
8. Administer analgesics as indicated.
Relief of pain facilitates cooperation with other therapeutic interventions (ambulation,
pulmonary toilet).
21. CONT…
Risk for Deficient Fluid Volume related to Inflammation of the peritoneum with
sequestration of fluid and postoperative restrictions (e.g., NPO)
Desired Outcomes
The client will maintain adequate fluid balance as evidenced by moist mucous
membranes, good skin turgor, stable vital signs, and individually adequate urinary
output.
22. Nursing Assessment and Rationales
1. Monitor BP and pulse.
Variations help identify fluctuating intravascular volumes.
2. Inspect mucous membranes; assess skin turgor and capillary refill.
Indicators of the adequacy of peripheral circulation and cellular hydration.
3. Monitor Intake and Output; note urine color and concentration, specific gravity.
The decreasing output of concentrated urine with increasing specific gravity suggests dehydration and
the need for increased fluids.
4. Auscultate and document bowel sounds. Note passing of flatus, and bowel movement.
Indicators of return of peristalsis, readiness to begin oral intake. Note: This may not occur in the
hospital if the patient has had a laparoscopic procedure and has been discharged in less than 24 hr.
23. CONT…
Nursing Interventions and Rationales
1. Provide clear liquids in small amounts when oral intake is resumed, and progress
diet as tolerated.
Reduces the risk of gastric irritation and vomiting to minimize fluid loss.
2. Give frequent mouth care with special attention to the protection of the lips.
Dehydration results in drying and painful cracking of the lips and mouth.
3. Maintain gastric and intestinal suction, as indicated.
An NG tube may be inserted preoperatively and maintained in the immediate postoperative
phase to decompress the bowel, promote intestinal rest, and prevent vomiting.
4. Administer IV fluids and electrolytes.
The peritoneum reacts to irritation and infection by producing large amounts of intestinal
fluid, possibly reducing the circulating blood volume, and resulting in dehydration and
relative electrolyte imbalances.
25. SUMMARY
Appendicitis is an inflammation of the appendix. It Can be Acute or chronic. It is
usually caused by the blockage of opening from the appendix to the caecum due to
fecolith, parasites or tumors. Clinical features include abdominal pain, fever, nausea,
vomiting, local tenderness and rebound tenderness.
Diagnosis can be made through history taking, physical examination, Complete blood
count, abdominal X-ray, Abdominal CT scan and Abdominal ultrasound.
The management of appendicitis includes medical, surgical and nursing management.
26. Reference
Brunner and Suddarth’s, textbook of medical surgical nursing, Published by
lippincot Williams and Wilkins, Edition 11th , Volume 1, page no 854
Black M. Joyce, Medical surgical nursing, published by Elsevier, Edition 8th, Volume
2, page no 1406
Smeltzer C. Suzane, Textbook of medical surgical nursing, published by Lippincott,
Edition 9th, page no. 789
Bailey and Loves Short Practice of Surgery, Published CRC press Taylor & Francis
Group LLC, Edition 27th , Page no 1299
