Appendicitis and Peritonitis

Appendicitis

Inflammation or infection of the appendix.

Appendix

A small structure attached to the cecum of the large intestine.

True Function of the Appendix

Uncertain, but may have an immune role.

Lumen Obstruction

Occurs when the appendix is blocked by stool, foreign body, tumor, bacteria, or enlarged lymph tissue.

Engorgement

When the blocked appendix becomes filled with fluid, blood, mucus, and bacteria.

Symptoms of Appendicitis

Includes dull periumbilical pain, right lower quadrant pain, anorexia, nausea, vomiting, and rebound tenderness.

McBurney’s Point

Halfway between the umbilicus and the right iliac crest; where pain localizes in appendicitis.

Preferred Position for Client

Lying still with the right leg flexed.

Fever Significance

A fever over 101°F suggests possible perforation or peritonitis.

Warning Sign of Rupture

Sudden relief of pain may indicate rupture, not improvement.

Diagnosis of Appendicitis

Includes history, physical exam, CBC with differential, imaging (CT, ultrasound, MRI), and urinalysis.

White Blood Cell Count in Appendicitis

WBC and neutrophils are often elevated; normal WBC does not rule out appendicitis.

NPO

Clients are kept NPO in case surgery is needed.

Pain Control in Appendicitis

Includes cautiously using opioids to prevent masking symptoms.

Use of Ice

Applying ice may decrease blood flow and inflammation in the right lower quadrant.

Avoidance in Treatment

Heating pads, laxatives, and enemas are avoided as they can increase the risk of rupture.

Definitive Treatment for Appendicitis

Usually requires an emergent appendectomy.

Laparoscopic Surgery

Common if rupture has not occurred.

Open Surgery

May be needed if a rupture has occurred.

Post-Appendectomy Care

Includes monitoring ABCs, pain management, and incision care.

Signs of Peritonitis

Rigid, board-like abdomen, pain, tenderness, distention, and tachycardia.

Classic Hallmark of Peritonitis

A rigid, board-like abdomen.

Major Cause of Death from Surgical Infections

Peritonitis.

Nurse's Monitoring After Appendectomy

Includes bowel sounds, nausea, vomiting, fever, abdominal rigidity, tenderness, and tachycardia.

Early Ambulation Post-Surgery

Encouraged to promote peristalsis.

Diet Advancement Post-Surgery

Based on tolerance, bowel sounds, passage of flatus, and absence of nausea.

Signs of Abdominal Distention

Related to peritonitis; includes pain and tenderness.

Tachycardia in Peritonitis

Common symptom associated with infection or inflammation.

Purpose of Monitoring Bowel Sounds

To assess recovery after appendectomy.

Anorexia

Loss of appetite often seen in appendicitis.

Nausea and Vomiting in Appendicitis

Symptoms indicating irritation of the gastrointestinal tract.

Rebound Tenderness

Pain upon releasing pressure; a sign of peritonitis.

Treatment for Peritonitis

May require antibiotics and IV fluids.

Inflammation of the Peritoneum

Peritonitis, which is life-threatening.

Classic Symptoms of Peritonitis

Includes high fever and diminished to absent bowel sounds.

Contamination of Sterile Peritoneal Cavity

Results in peritonitis.

Postoperative Monitoring

Critical to detect early signs of complications like peritonitis.

Fluid and Blood Management for Ruptured Appendix

Potential need for IV fluids and antibiotics.

Ambulation Influence on Recovery

Promotes peristalsis and recovery after abdominal surgery.

Pressure Release in Appendix

Can lead to sudden relief of pain, indicating potential rupture.