Appendicitis, Peritonitis, Gastroenteritis

Acute Inflammatory Bowel Disease

Define Appendicitis (2)

• Inflammation of the appendix

• Caused by an obstruction of the lumen/opening of the appendix

Initial Cause of Appendicitis

Fecaliths or hard pieces of stool

Who’s at Increased Risk of Appendicitis

Adolescents & young adults

Clinical Manifestations - Appendicitis (6)

• RLQ pain - McBurney’s point

• Rebound tenderness

• Fever

• Perforation - Sudden pain relief

• Worsens Pain - Coughing, straining, movement, & deep breaths

• Position for Assessment - Lying with right knee flexed

Labs - Appendicitis (2)

• WBC elevated

• Check urine for genitourinary conditions that mimic appendicitis

Diagnostics - Appendicitis (3)

• CT Scan - Preferred

• Ultrasound

• MRI

Treatment - Appendicitis (3)

• Keep NPO

• Antibiotics & IV fluids

• Immediate appendectomy

Treatment - Appendicitis with Rupture (3)

• Keep NPO

• Antibiotics & IV fluids for 6-8 hours prior to appendectomy to prevent dehydration & sepsis

• Rupture may lead to peritonitis

Define Peritonitis (Hot Belly) (6)

• Inflammation of the peritoneum results from:

• Infection of the peritoneum due to puncture (surgery or trauma)

• Rupture of GI tract (diverticulitis, PUD, appendicitis, bowel obstruction)

• Infection from continuous ambulatory peritoneal dialysis.

• Septicemia

• Life threatening

Clinical Manifestations - Peritonitis (8) FAT RAT RN

• Fever

• Abdominal pain

• Tachycardia

• Rebound tenderness

• Abdominal distention

• Tachypnea & shallow breaths

• Rigid & board-like abdomen (hallmark)

• N&V

Labs - Peritonitis (2)

• CBC - Increased WBCs, increased ESR

• Serum electrolytes

Diagnostics - Peritonitis (3)

• Abdominal Xray

• Ultrasound

• CT scan

Nursing Interventions - Peritonitis (7)

• Watch for S/S of hypovolemic shock

• Monitor vitals

• Keep NPO

• IV fluid replacement, antiemetics, analgesics, antibiotics

• NGT to intermittent suction

• Position patient with knees flexed to increase comfort

• O2 as needed

Septic Nursing Interventions - Peritonitis

Monitor BUN/CR, I&O, ast/alt

Define Gastroenteritis (3)

• Inflammation of the mucosa of the stomach & small intestine

• Triggered by either bacterial or viral infection (Viruses most common)

• Vomiting & frequent watery stools place client at increased risk of fluid & electrolyte imbalance & impaired nutrition

Virus in Relation to Gastroenteritis (2)

• Norovirus

• Leading cause of foodborne outbreaks of acute gastroenteritis

Treatment - Gastroenteritis (6)

• Self-Limiting

• Wash Hands

• Encourage oral intake to prevent dehydration & fluid & electrolyte imbalance

• Antibiotics - If bacterial

• Elderly or Chronically Ill - May need IV fluids

• Do NOT give antidiarrheals

Gastroenteritis - Outbreaks (2)

• Close quarters

• Prisons, cruise ships, college dorms

Norovirus - Prevention (5)

• Wash hands often

• Cook shellfish 140 degrees or higher

• Don’t prepare food for others when sick

• Rinse fruits & vegetables

• After vomiting/diarrhea clean & disinfect surfaces & wash soiled laundry