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Pedi appendicitis
- 1. Presentation by- Miss Sneha Karforma
- 3. A condition in which the appendix becomes inflamed and filled with pus, causing pain. The appendix is a pouch-like structure attached at the start of the large intestine that has no known purpose. Appendicitis begins with fever and pain near the belly button and then moves toward the lower-right side of the abdomen. This is often accompanied by nausea, vomiting, loss of appetite, fever and chills. Appendicitis is usually treated with antibiotics and surgery is required within 24 hours of its diagnosis. If untreated, the appendix can rupture and cause an abscess or systemic infection (sepsis).
- 5. In India more than one million cases per year. Although it can strike at any age, appendicitis is rare in children younger than 2. It’s most likely to affect people between the ages of 10 and 30. Appendicitis happens when the appendix gets blocked, often by poop, a foreign body (something inside you that isn’t supposed to be there), or cancer. Blockage may also result from infection, since the appendix can swell in response to any infection in the body.
- 6. MOST COMMON SYMPTOMS Pain in the periumbilical area that descends to the right lower quadrant. Abdominal pain that is most intense at McBurney’s point Rebound tenderness and abdominal rigidity Low-grade fever Elevated white blood cell count Anorexia, nausea, and vomiting Client in side-lying position, with abdominal guarding and legs flexed Constipation or diarrhea
- 8. OTHER LESS COMMON SYMPTOMS Dull or sharp pain anywhere in your upper or lower belly, back, or rear end Painful or difficult peeing Vomiting before your belly pain starts Severe cramps Constipation or diarrhea with gas
- 10. Examination of your abdomen to look for inflammation Urine test to rule out a urinary tract infection Rectal exam Blood test to see whether your body is fighting an infection CT scans Ultrasound
- 11. Appendicitis is almost always treated as an emergency. Surgery to remove the appendix, which is called an appendectomy, is the standard treatment for almost all cases of appendicitis. Generally, if your doctor suspects that you have appendicitis, they will quickly remove it to avoid a rupture. If you have an abscess, you may get two procedures: one to drain the abscess of pus and fluid, and a later one to take out the appendix. But some research shows that treating acute appendicitis with antibiotics may help you avoid surgery.
- 12. Primary Preoperative Nursing Diagnosis Pain (acute) related to inflammation Primary Postoperative Nursing Diagnosis Risk for infection related to the surgical incision
- 13. Imbalanced nutrition: Less than body requirements Impaired skin integrity Ineffective tissue perfusion: GI Risk for deficient fluid volume Risk for injury
- 14. An appendectomy (surgical removal of the appendix) is the preferred method of management for acute appendicitis if the inflammation is localized. An open appendectomy is completed with a transverse right lower quadrant incision, usually at the McBurney point. A laparoscopic appendectomy may be used in females of childbearing age, those in whom the diagnosis is in question, and for obese patients. If the appendix has ruptured and there is evidence of peritonitis or an abscess, conservative treatment consisting of antibiotics and intravenous (IV) fluids is given 6 to 8 hours prior to an appendectomy. Generally, an appendectomy is performed within 24 to 48 hours after the onset of symptoms under either general or spinal anesthesia. Preoperative management includes IV hydration, antipyretics, antibiotics, and, after definitive diagnosis, analgesics.
- 15. The major complication is perforation of the appendix, which can lead to peritonitis or an abscess. Perforation generally occurs 24 hours after onset of pain, symptoms include fever (37.7°C [100° F] or greater), toxic appearance, and continued pain and tenderness.
- 16. Crystalloid intravenous fluids an isotonic solutions such as normal saline solution or lactated Ringer’s solution 100–500 mL/hr of IV, depending on volume state of the patient, is used to replaces fluids and electrolytes lost through fever and vomiting; replacement continues until urine output is 1 cc/kg of body weight and electrolytes are replaced Antibiotics (broad-spectrum antibiotic coverage) to control local and systemic infection and reduces the incidence of postoperative wound infection Other Drugs: Analgesics.
- 17. Maintain NPO status. Administer fluids intravenously to prevent dehydration. Monitor for changes in level of pain. Monitor for signs of ruptured appendix and peritonitis 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.
- 18. 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 ruptured of appendix occurred, expect a Penros drain to be inserted, or the incision maybe left to heal inside out. Expect that drainage from the Penros drain maybe profuse for the first 2 hours.