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02.02 Nursing Care and Pathophysiology for Appendicitis

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Overview

Pathophysiology: Obstruction and inflammation of the inner lining of the appendix. The infection leads to necrosis, gangrene, or perforation of the appendix, resulting in spilling into the abdominal cavity causing peritonitis.

I. Inflammation of the appendix

Nursing Points

General

 

  1. Unknown exact cause

  2. Major risk is rupture → pus and possibly fecal matter spill into the peritoneum

    1. Peritonitis 

    2. Sepsis

Assessment

  1. Abdominal pain at McBurney’s point

  2. Pain descends to RLQ

  3. rebound tenderness

  4. ↑ WBC, fever

  5. Fever

  6. Abdominal guarding

  7. Sudden relief of pain indicates rupture

    1. Medical emergency – requires surgical intervention immediately

Therapeutic Management

  1. Avoid heat application which can lead to rupture

  2. Avoid stimulation of peristalsis

    1. Keep NPO

  3. May require Appendectomy

    1. Keep NPO

    2. If rupture occurs, postoperative healing is prolonged

    3. Will have wound drains 

    4. NG tube for decompression

    5. Post-Op Care

      1. Monitor VS 

      2. Assess for abdominal distention

      3. Clear Liquids, Advance Diet as Tolerated

Nursing Concepts

  1. Infection Control

    1. Be alert for possible peritonitis or sepsis, especially if rupture

    2. Administer IV antibiotics

    3. Assess surgical site for s/s infection

  2. Comfort

    1. Assess pain with detailed assessment (OLDCARTS)

    2. Administer analgesics and corticosteroids as ordered

  3. Nutrition

    1. Patient may need to be NPO

    2. Will be on bowel rest for a day after surgery, then clear liquids and advance as tolerated.

Patient Education

  1. Should be on bedrest

  2. Report sudden relief of pain or worsening pain

Study Tools

Video Transcript

Okay, so let’s talk appendicitis. You’ve probably heard of this before and either have had your appendix out or know someone who has. So let’s look at it from the nursing perspective.

So just like the name sounds, appendicitis is inflammation of the appendix. The appendix is a tube-like structure that protrudes off the cecum of the large intestine. It’s believed to have been of use at some point, or possibly in utero, but it really has no apparent purpose in developed GI systems. One thing it CAN do, though, is get infected and inflamed.  When that happens, it is at risk for rupturing. This leads to pus and infectious material, and possibly even fecal matter leaking into the peritoneum. That can cause peritonitis and lead to sepsis, so we need to make sure this is being addressed quickly. It’s kind of like a bad hangnail – it hurts pretty bad, but if it gets infected it’s extremely painful and could even lead to the whole finger getting infected and having to lose the nail, or worse, your finger. Honestly, you could live without it, but it’s just really painful and needs to be addressed before it gets too severe.


The major assessment point for appendicitis is going to be abdominal pain in the Right Lower Quadrant, usually over what’s known as McBurney’s Point. If you draw a line from the navel, or belly button, down to the anterior superior iliac spine – that’s the bony part of your hip that you can feel in the front. About 2 inches away from the hip on that line is McBurney’s Point. So we’ll see most of the pain focused around that area. We’ll also see rebound tenderness. That means when you press deeply in that location and then lift your hand away, they have sharp, severe pain when you lift your hand. It might be tender when you press down, but it’s nothing compared to when you lift your hand away. They’ll also be guarding and tensing up their abdominal muscles. We’ll also likely see a fever and increased white blood cells because of the infection. A really important thing to note is that if they suddenly don’t have pain anymore, it might mean that the appendix has ruptured – the swelling isn’t putting pressure on anything anymore so their pain goes away – it’s actually not a good sign. If they do have a rupture, they’ll need to go to surgery right away to prevent peritonitis.  Key points for nursing care – don’t apply heat, that can actually make the swelling and inflammation worse. And, keep them NPO – both to rest the bowel and not irritate it more, but also because they might need an appendectomy to remove the infected appendix.


So they can do the appendectomy open or laparoscopic – this is an image of a laparoscopic removal of an inflamed appendix.  They’ll also washout any infectious material or fecal matter while they’re in there to make sure the area is super clean to prevent infection.  We’ll likely put them on IV antibiotics and we want to watch them closely after surgery. We’ll keep them NPO and even place an NG tube to decompress their stomach – the goal is to prevent any stimulation of the bowel for a little while. If they had a rupture, they’ll probably have wound drains for a few days to make sure any infectious fluid gets out. We’ll monitor their vital signs closely and assess their abdomen for distention or pain – these things can indicate possible peritonitis or sepsis, so we’ll watch them closely.


Priority nursing concepts include infection control, comfort, and nutrition. We want to treat and manage the infection and prevent peritonitis, assess and manage their pain, and consider nutritional needs since they’ll be NPO for a good bit. Be sure to check out the care plan attached to this lesson for more detailed nursing interventions and rationales.


So let’s recap – appendicitis is an inflamed and/or infected appendix that causes severe right lower quadrant pain, especially over McBurney’s point.  If it ruptures, it could cause peritonitis and possibly sepsis. It’s highly likely that patients with appendicitis will get an appendectomy, especially if it ruptures, to remove the appendix and any infectious material. We will focus on infection and pain control with IV antibiotics, analgesics, and assessing closely for the development of peritonitis.

That’s it for appendicitis. Make sure you check out all the resources attached to this lesson to learn more. Now, go out and be your best selves today. And, as always, Happy nursing!

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