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    Appendicitis Manuscript

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    kint manlangit
    1. Appendicitis is an inflammation of the appendix that commonly requires surgical removal (appendectomy) to prevent complications. It occurs when the appendix becomes blocked, allowing bacteria to multiply and cause infection. 2. Symptoms include initially vague pain that progresses to sharp pain localized to the lower right abdomen. Diagnosis is based on symptoms, lab tests showing elevated white blood cells, and imaging showing an enlarged appendix. 3. Treatment involves antibiotics, IV fluids, and prompt appendectomy, which is usually performed laparoscopically. Nursing care focuses on pain management, monitoring for dehydration and infection, and providing wound care post-surgery.

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    Appendicitis Manuscript

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    kint manlangit
    28 views4 pages
    1. Appendicitis is an inflammation of the appendix that commonly requires surgical removal (appendectomy) to prevent complications. It occurs when the appendix becomes blocked, allowing bacteria to multiply and cause infection. 2. Symptoms include initially vague pain that progresses to sharp pain localized to the lower right abdomen. Diagnosis is based on symptoms, lab tests showing elevated white blood cells, and imaging showing an enlarged appendix. 3. Treatment involves antibiotics, IV fluids, and prompt appendectomy, which is usually performed laparoscopically. Nursing care focuses on pain management, monitoring for dehydration and infection, and providing wound care post-surgery.

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    1. Appendicitis is an inflammation of the appendix that commonly requires surgical removal (appendectomy) to prevent complications. It occurs when the appendix becomes blocked, allowing bacteria to multiply and cause infection. 2. Symptoms include initially vague pain that progresses to sharp pain localized to the lower right abdomen. Diagnosis is based on symptoms, lab tests showing elevated white blood cells, and imaging showing an enlarged appendix. 3. Treatment involves antibiotics, IV fluids, and prompt appendectomy, which is usually performed laparoscopically. Nursing care focuses on pain management, monitoring for dehydration and infection, and providing wound care post-surgery.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    28 views4 pages

    Appendicitis Manuscript

    Uploaded by

    kint manlangit
    1. Appendicitis is an inflammation of the appendix that commonly requires surgical removal (appendectomy) to prevent complications. It occurs when the appendix becomes blocked, allowing bacteria to multiply and cause infection. 2. Symptoms include initially vague pain that progresses to sharp pain localized to the lower right abdomen. Diagnosis is based on symptoms, lab tests showing elevated white blood cells, and imaging showing an enlarged appendix. 3. Treatment involves antibiotics, IV fluids, and prompt appendectomy, which is usually performed laparoscopically. Nursing care focuses on pain management, monitoring for dehydration and infection, and providing wound care post-surgery.

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    of 4

    Republic of the Philippines

    CENTRAL MINDANAO UNIVERSITY


    COLLEGE OF NURSING
    University Town, Musuan, Maramag, Bukidnon
    E-mail: nursing@cmu.edu.ph

    NCM 74
    Care of Clients with Problems in Nutrition, and Gastrointestinal, Metabolism and Endocrine,
    Perception and Coordination (Acute and Chronic)

    APPENDICITIS
    Midterm Concept Map Presentation

    Submitted by:
    Hazel Jane N. Gimena
    BSN 3B

    Submitted to:
    Ms. Neda Joy Espina, RN
    Clinical Instructor

    February 24, 2022


    APPENDICITIS

    According to Hinkle & Cheever (2018), appendix is a small, vermiform (i.e., wormlike)
    appendage about 8 to 10 cm (3 to 4 inches) long that is attached to the cecum just below the
    ileocecal valve. The appendix fills with by-products of digestion and empties regularly into the
    cecum. Because it empties inefficiently and its lumen is small, the appendix is prone to
    obstruction and is particularly vulnerable to infection (i.e., appendicitis).

    Appendicitis refers to the inflammation of the appendix. Acute appendicitis, the most common
    abdominal emergency that requires surgical treatment, shows a lifetime risk of 7%. Its overall
    incidence is approximately 11 cases per 10,000 individuals per year, and may occur at any age,
    although it is relatively rare at the extremes of age (Petroianu et al., 2016). It typically presents
    acutely, within 24 hours of onset, but can also present as a more chronic condition.

    Etiology. Appendicitis occur due to luminal obstruction from a variety of causes, which include
    fecaliths (hardened stool), lymphoid hyperplasia, foreign bodies, parasites, and by both primary
    (carcinoid, adenocarcinoma, Kaposi sarcoma, and lymphoma) and metastatic (colon and
    breast) tumors (Petroianu et al., 2016).

    Precipitating Factors. One of it is Diet, children who eat a low-fiber diet high in refined
    carbohydrates are at greater risk for appendicitis, possibly because of the increased risk of
    obstruction at the appendix, according to the Annals of Emergency Medicine.

    Predisposing Factors. Although appendicitis can occur at any age, it typically occurs between
    the ages of 10 and 30 years. Males have a slightly higher predisposition of developing acute
    appendicitis compared to females.

    Pathophysiology
    The appendix becomes inflamed and edematous as a result of becoming kinked or
    occluded by a fecalith (i.e., hardened mass of stool), lymphoid hyperplasia (secondary to
    inflammation or infection), or rarely, foreign bodies (e.g., fruit seeds) or tumors.
    When obstructed, commensal bacteria in the appendix can multiply, resulting in acute
    inflammation. Resulting to the Rapid distension of the appendix ensues because of its small
    luminal capacity, and intraluminal pressures can reach 50 to 65 mm Hg. This appendiceal
    condition lead to enlargement of the cecum due to the cecal localized ileum, caused by the
    inflammatory process. The cecal content is stored and is not conducted to the right colon. The
    presence of fecal loading inside a large cecum is identified in the plain abdominal radiography
    as a specific sign of acute appendicitis.
    As luminal pressure increases, venous pressure is exceeded and mucosal ischemia
    develops. Once luminal pressure exceeds 85 mm Hg, thrombosis of the venules that drain the
    appendix occurs, and in the setting of continued arteriolar inflow, vascular congestion and
    engorgement of the appendix become manifest.
    Lymphatic and venous drainages are impaired and ischemia develops. Mucosa becomes
    hypoxic and begins to ulcerate, resulting in compromise of the mucosal barrier, and leading to
    invasion of the appendiceal wall by intraluminal bacteria. Most of the bacteria are gram-
    negative, mainly Escherichia coli (present in 76 % of cases), followed by Enteroccocus (30 %),
    Bacteroides (24%) and Pseudomonas (20%). Once significant inflammation and necrosis
    occur, the appendix is at risk of perforation, leading to a localized abscess and sometimes frank
    peritonitis.
    Clinical Manifestation. Vague periumbilical pain (i.e., visceral pain that is dull and poorly
    localized) with anorexia progresses to right lower quadrant pain (i.e., parietal pain that is sharp,
    discrete, and well localized) and nausea in approximately 50% of patients with appendicitis
    (Craig, 2015). A low-grade fever may be present. Local tenderness may be elicited at
    McBurney point when pressure is applied. Rebound tenderness (i.e., production or
    intensification of pain when pressure is released) may be present. Rovsing sign may be elicited
    by palpating the left lower quadrant; this paradoxically causes pain to be felt in the right lower
    quadrant. Constipation can also occur with appendicitis.

    Diagnostic Tests. Diagnosis is based on the results of a complete history and physical
    examination and on laboratory findings and imaging studies. The CBC demonstrates an
    elevated white blood cell count with an elevation of the neutrophils. C-reactive protein levels
    are typically elevated. A CT scan may reveal a right lower quadrant density or localized
    distention of the bowel; enlargement of the appendix by at least 6 mm is suggestive of
    appendicitis (Saccomano & Ferrara, 2013).

    Medical and Surgical Management.


    Immediate surgery is typically indicated if appendicitis is diagnosed (Craig, 2015;
    Saccomano & Ferrara, 2013). However, conservative nonsurgical medical management for
    uncomplicated appendicitis (i.e., absence of gangrene or perforation of the appendix, empyema
    or abscess formation, or peritonitis) has been instituted in some instances with a reduced risk
    of complications and similar hospital length of stay as appendectomy (Salminen, Paajanen,
    Rautio, et al., 2015). To correct or prevent fluid and electrolyte imbalance, dehydration, and
    sepsis, antibiotics and IV fluids are given until surgery is performed.
    Appendectomy (i.e., surgical removal of the appendix) is performed as soon as
    possible to decrease the risk of perforation. It is typically performed using general anesthesia
    with either a low abdominal incision (laparotomy) or by laparoscopy. Both laparotomy and
    laparoscopy are safe and effective in the treatment of appendicitis with or without perforation.
    However, recovery after laparoscopic surgery is generally quicker (Andersson, 2014; Bozkurt,
    Unsal, Kapan, 2015), and also remains as the gold standard for treating appendicitis, due to a
    low morbidity from the procedure. In females it also allows for better visualization of the uterus
    and ovaries, for assessment of any gynecological pathology. For complicated appendicitis (e.g.,
    with gangrene or perforation), the patient is typically treated with a 3- to 5-day course of
    antibiotics postoperatively (van Rossem, Schreinemacher, Treskes, et al., 2014).

    Nursing Diagnosis. Acute Pain


    Nursing Intervention.
    1. Note client’s age, developmental level, and current condition
    2. Assess pain reports, noting location, characteristics, and severity (0 to 10 [or similar]
    scale). Investigate and report changes in pain, as appropriate.
    3. Observe nonverbal cues and pain behaviors (e.g., how client holds body, facial
    expressions such as grimacing, withdrawal, narrowed focus, crying).
    4. Monitor skin color and temperature, as well as vital signs (e.g., heart rate, blood
    pressure, respirations).
    5. Keep at rest in semi-Fowler’s position.
    6. Provide comfort measures (e.g., touch, repositioning, quiet environment, focused
    breathing).
    7. Place ice bag on abdomen periodically during initial 24 to 48 hours, as appropriate.
    8. Administer analgesics, as indicated, to maximum dosage needed to maintain comfort.
    Nursing Diagnosis. Risk for Deficient Fluid Volume
    Nursing Intervention.
    1. Monitor vital signs.
    2. Inspect mucous membranes; assess skin turgor and capillary refill.
    3. Monitor intake and output (I&O); note urine color and concentration and specific
    gravity.
    4. Auscultate bowel sounds. Note passing of flatus and bowel movement.
    5. Provide clear liquids in small amounts when oral intake is resumed, and progress diet
    as tolerated.
    6. Give frequent mouth care with special attention to protection of the lips.
    7. Administer intravenous (IV) fluids and electrolytes.

    Nursing Diagnosis. Hyperthermia


    Nursing Intervention.
    1. Monitor client temperature—degree and pattern. Note shaking chills or profuse
    diaphoresis.
    2. Monitor environmental temperature. Limit or add bed linens, as indicated.
    3. Provide tepid sponge baths. Avoid use of alcohol.
    4. Administer antipyretics, such as acetylsalicylic acid (ASA) (aspirin) or acetaminophen
    (Tylenol).
    5. Provide cooling blanket, or hypothermia therapy, as indicated.

    Nursing Diagnosis. Risk for Infection


    Nursing Intervention.
    1. Practice and instruct in good hand-washing and aseptic wound care.
    2. Inspect incision and dressings. Note characteristics of drainage from wound or drains
    (if inserted) and presence of erythema.
    3. Monitor vital signs. Note onset of fever, chills, diaphoresis, changes in mentation, and
    reports of increasing abdominal pain.
    4. Obtain drainage specimens, if indicated.
    5. Administer Antibiotics.

    Prognosis.
    If left untreated, appendicitis can lead to abscess formation with the development of an
    enterocutaneous fistula. Diffuse peritonitis and sepsis can also develop, which may progress to
    significant morbidity and possible death.
    If diagnosed and treated early, as a relatively safe surgical procedure, the recovery
    within 24 to48 hours, is expected. Cases that present with advanced abscesses, sepsis,
    and peritonitis may have a more prolonged and complicated course, possibly requiring
    additional surgery or other interventions.

    References
    Doenges, M., Moorhouse, M.F., & Murr, A. (2014). Nursing Care Plans: Guidelines for
    Individualizing Client Care Across the Life Span. 9, 315 – 320.
    Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical- Surgical
    Nursing, 14th Edition. Philadelphia: Lippincott Williams & Wilkins.
    Petroianu A., & Villar – Barroso, T.V. (2016) Pathophysiology of Acute Appendicitis. JSM
    Gastroenterol Hepatol, 4(3), 1062.

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