Appendicitis

Appendicitis

• s inflammation of the appendix.

• When the appendix becomes inflamed or infected, rupture may occur within a matter of hours, leading to peritonitis and sepsis

• It sits right below the colon, 24-48 hrs till the appendix burst causing waste product to enter peritoneal cavity and causing peritonitis

appendicitis risk factors

• Obstruction by fecalith–the waste product. Are binding together clogging appendix, appendicolith–calcium is sticking and causing the obstruction (calcified deposit), or foreign bodies, bacteria or toxins

• Low-fiber diet

• High intake of refined carbohydrates

appendicitis clinical manifestations

• Constant dull pain in the periumbilical area that descends to the right lower quadrant.

• Anorexia, nausea, and vomiting- won’t feel hunger 

• Abdominal pain that is most intense at McBurney’s point

• Rebound tenderness and abdominal rigidity

• Psoas sign- right leg pulled back→ shooting pain across abdomen 

• Rovsing signs- palpating in LLQ will cause shooting pain in RLQ after pressure is released 

• Low-grade fever

• Elevated white blood cell count

• Client in side-lying position, with abdominal guarding and legs flexed

• Constipation or diarrhea

Diagnostic Evaluation

• Leukocyte count greater than 10,000/mm 3, neutrophil count greater than 75%

• Abdominal radiographs

• Ultrasound studies- appendix can only enlarge so much until it burst 

• CT scans may reveal right lower quadrant density or localized distention of the bowel.

Complications of Appendicitis

• Perforation of the appendix→ lead to peritonitis or an abscess. 

• occurs 24 hours after onset of pain,

• symptoms include

  • fever (37.7°C [100° F] or greater)

  • abdominal distension and rigidity

  • continued pain, tenderness, guarding.

Complications of Appendicitis

Peritonitis

Peritonitis

• Inflammation of the peritoneum with bacteria, bile, and/or enzymes

• Sharp abdominal pain, rebound tenderness, guarding

• Fever

• Nausea and vomiting

• Tachycardia, Tachypnea

• Abdominal distension and rigidity and decreased bowel sounds

• Pt may lie still and take only shallow respirations because movement worsens pain

• Tx: ATBs

Medical Management…Appendectomy

• An open appendectomy is completed with a transverse right lower quadrant incision, usually at the McBurney point.

  • Long time to recover especially with peritonitis 

• A laparoscopic appendectomy

  • Go home next day, pain is from gas inside the body from the procedure that needs to be released 

If the appendix has ruptured and there is evidence of peritonitis or an abscess,

conservative treatment including

• 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 analgesics.

Drug Therapy

• Crystalloid (salt water) intravenous fluids and isotonic solutions

• Antibiotics (broad-spectrum antibiotic coverage) to control local and systemic infection and reduces the incidence of postoperative wound infection

• Analgesics

Crystalloid (salt water) intravenous fluids and isotonic solutions,

• such as Normal Saline solution or Lactated Ringers 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 ml/kg of body weight and electrolytes are replaced

Preoperative interventions

• NPO and IV to prevent dehydration

• Monitor pain and signs of ruptured appendix and peritonitis and BOWEL SOUNDS

  • Position right-side lying or low to semi fowler position to promote comfort.

• Apply ice packs to abdomen every hour as prescribed AVOID HEAT

• Administer antibiotics

• Avoid laxatives or enema.

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 returns

• Explain that the patient should avoid heavy lifting

If rupture of appendix occurred, expect a

Penrose drain to be inserted, or the incision may be left to heal inside out.

• Expect that drainage from the Penrose drain may be profuse for the first 2 hours.

post op care Teach the patient to

observe the wound and report to the physician any increased swelling, redness, drainage, odor, or separation of the wound edges.

post op care Notify the HCP if a

fever develops. The patient needs to know these may be symptoms of wound infection.

Assessment findings suggestive of peritonitis include which of the following? Select all that Apply.

Rebound tenderness

A soft, distended abdomen

Dull, intermittent abdominal pain

Shallow respirations with bradypnea

Observing that the patient is lying in a guarded position