Appendicitis Paint Map

What is the pathophysiology of appendicitis?

Pathophysiology: Appendicitis occurs when bacteria invade the lumen and wall of the appendix, leading to infection and inflammation. The lumen may become obstructed by fecal matter, tumors, or foreign bodies, which increases pressure, reduces blood flow, and can cause tissue necrosis.
Rationale: This inflammation can progress to perforation, peritonitis, or sepsis if not treated promptly.

What are risk factors for appendicitis?

A:

• Young age (10–30 years)

• Family history of appendicitis

• Diet low in fiber and high in refined carbohydrates

• History of GI infections
  Rationale: These factors can contribute to obstruction or infection of the appendix, triggering inflammation.

What assessment cues indicate possible appendicitis?

A:
History:

• Age, onset, and progression of pain (usually begins near the umbilicus, then shifts to RLQ)

• Nausea and vomiting following abdominal pain

Physical Exam:

• RLQ pain (McBurney’s point tenderness)

• Abdominal guarding

• Low-grade fever
  Rationale: Classic presentation is RLQ pain with rebound tenderness and symptoms of localized peritoneal irritation.

Which assessment cues suggest complications of appendicitis?

A:

• Signs of sepsis: fever, tachycardia, hypotension

• Signs of perforation/peritonitis: board-like abdomen, rebound tenderness, sudden cessation of pain, fever >101°F

• Pain worse with coughing or movement, relieved by bending right hip or knees
  Rationale: These findings require immediate intervention to prevent shock or death.

What lab and diagnostic findings support appendicitis or its complications?

• CBC: WBC ≥ 10,000/mm³ with left shift; WBC ≥ 20,000/mm³ suggests perforation

• CT scan: Presence of fecaloma (hardened stool mass blocking appendix)

• Ultrasound: Enlarged appendix

Rationale:

• A left shift means there’s an increase in the number of immature neutrophils (bands) in the blood. This happens when the body is fighting an acute bacterial infection, like appendicitis, and the bone marrow releases immature white cells to meet the demand.

• Imaging (CT or ultrasound) confirms the diagnosis by visualizing obstruction, swelling, or inflammation.

• Markedly elevated WBC (>20,000) suggests perforation with possible peritonitis, which is a surgical emergency.

What nonsurgical interventions are used for appendicitis?

• NPO

• IV fluids (Normal saline, Lactated Ringers, D5W)

• Ice to affected area (avoid heat)
  Rationale: Prevent worsening inflammation and prepare patient for possible surgery.

What are key preoperative nursing actions for an appendectomy?

• Verify informed consent (surgeon explains procedure; nurse clarifies and witnesses signature)

• Obtain baseline assessment and vitals

• Review labs and report abnormalities

• Maintain NPO

• Establish IV access (18–20 gauge)

• Administer prophylactic antibiotics
  Rationale: Ensures patient safety and readiness for anesthesia and surgery.

What are key postoperative nursing actions after an appendectomy?

• Monitor airway and breathing

• Assess bowel sounds/flatus

• Clear liquids for first 24 hrs, then soft diet

• Avoid NSAIDs/aspirin for 10 days

• Teach splinting, coughing, deep breathing, and early ambulation

• Report: abdominal pain, bleeding, chest pain, dysphagia, N/V, or shortness of breath
  Rationale: Prevents complications, supports healing, and educates patient for safe recovery.

What important nursing considerations apply to appendicitis?

HELL No!

• H → No Heat

• E → No Enemas

• L → No Laxatives

• L → Do not Lay the client flat

These actions increase the risk of perforation and pain.

Also:

• Monitor older adults closely for perforation — they may present with fewer classic symptoms but are at higher risk for complications.

Rationale: Avoiding heat, enemas, and laxatives prevents increased blood flow, motility, or pressure in the appendix that could cause rupture. Lying flat may worsen abdominal drainage and pain.

A nurse is assessing a client suspected of having appendicitis. Which finding requires immediate provider notification?
A. RLQ pain with rebound tenderness
B. Sudden cessation of abdominal pain
C. Low-grade fever
D. Nausea and vomiting after onset of pain

Correct answer: B
Rationale: Sudden cessation of pain in appendicitis can indicate rupture of the appendix, which may lead to peritonitis. This is a medical emergency requiring immediate intervention. RLQ pain, low-grade fever, and nausea/vomiting are expected early signs of appendicitis.

Which preoperative order for a client with suspected appendicitis should the nurse question?
A. Maintain NPO status
B. Apply a heating pad to the abdomen
C. Start an IV line with 0.9% sodium chloride
D. Administer prescribed prophylactic antibiotics

Correct answer: B
Rationale: Heat should be avoided in appendicitis because it increases blood flow and risk of perforation (HELL No! mnemonic: Heat, Enemas, Laxatives, Lay flat). NPO, IV fluids, and prophylactic antibiotics are appropriate preoperative orders.

The nurse is caring for an older adult postoperative day 1 after an appendectomy. Which assessment finding is most concerning?
A. Pain at the incision site
B. Abdominal distention and absence of bowel sounds
C. Clear liquid intake without nausea
D. Using splinting when coughing

Correct answer: B
Rationale: Abdominal distention and absent bowel sounds may indicate ileus or developing peritonitis and require immediate follow-up. Pain and splinting are expected; tolerating clear liquids is a positive sign of recovery.

Which statement by a client recovering from an appendectomy indicates the need for further teaching?
A. “I will return to my usual activities in 1–2 weeks.”
B. “I will call my provider if I have fever or worsening abdominal pain.”
C. “I will avoid NSAIDs and aspirin for 10 days.”
D. “I will use a heating pad on my abdomen for pain relief.”

Correct answer: D
Rationale: Heat should be avoided post-appendectomy due to increased blood flow and potential risk of infection spread. All other statements indicate correct understanding of discharge instructions.

A client with suspected appendicitis has a WBC count of 21,000/mm³. What is the nurse’s priority action?
A. Document the finding and recheck in 4 hours
B. Notify the provider immediately
C. Administer antipyretics as prescribed
D. Encourage oral fluids

Correct answer: B
Rationale: WBC ≥ 20,000/mm³ suggests possible perforated appendix. This is an urgent finding requiring immediate provider notification to prevent sepsis.