06.05 Appendicitis

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Mcburneys Point, Appendicitis (Image)
Appendix, Appendicitis (Image)
Laparoscopic Appendectomy (Image)
Anatomy of the Digestive Tract (Image)
Appendectomy Appendicitis (Image)
Abdominal Pain – Assessment (Cheat Sheet)
Appendicitis – Assessment (Mnemonic)
Appendicitis Interventions (Picmonic)
Appendicitis Assessment (Picmonic)

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Hey everybody in this lesson we're going to be talking about appendicitis as it occurs in pediatric patients. I know you have already come across this topic in your adult courses so I really just want to focus on the things that can be just a little bit different when children have appendicitis.

Appendicitis is actually the most common cause of emergency abdominal surgery in childhood.

Just as quick refresher, the appendix is this little pouch that extends beyond the cecum that you see here and it's located in the right lower quadrant of the abdomen. And what happens in appendicitis is that the appendix becomes inflamed and infected. The appendix may eventually rupture or perforate, which allows stool to leak into the abdomen. This causes inflammation to spread to the entire abdomen and can lead to shock. Now this is a complication that can happen in adults as well as children, but there is an increased risk for perforation in kids. This is because diagnosis of appendicitis can be a little tricky in kids and is often delayed. Generally, appendicitis is diagnosed with a thorough physical exam, a CBC looking for signs of infection and a CT Scan of the abdomen, but kids have a difficult time explaining their pain to others so this makes it difficult to get an accurate clinical picture.

Let’s talk a little bit more about how the abdominal pain associated with appendicitis is a little bit different for children. The first thing to know is that the pain for kids is actually pretty non-specific and is described as being in the centre of the abdomen or around the belly button rather than the right lower quadrant (RLQ) pain we associate with appendicitis. Over time, the pain does usually move to RLQ, but initially it’s more central.

In adults it’s common to check for rebound tenderness to help diagnose appendicitis, but this is really difficult to test for in children who are extremely anxious and in a lot of pain. Paying attention to the child’s posture and movement is a one of the ways to get a sense of how bad their abdominal pain is. Most kids who have severe pain will lie motionless and rigid on their bed because they are afraid to move. You may also notice a decreased range of motion in the right hip.

One thing to note is that if the pain suddenly goes away this can be a sign that the appendix has burst, which is not good and makes treatment a lot more complicated.

Other symptoms that are associated with appendicitis in kids as well as adults are vomiting, decreased appetite, and potentially a fever.

So treatment for appendicitis is to remove that inflamed appendix. Prior to surgery our nursing care is going to be all about managing the child’s pain and prepping them for surgery. This means keeping them in a comfortable position, making them NPO and probably starting fluids. Make sure heat packs are not used for pain relief because this could cause the appendix to burst!

Your nursing priorities after surgery are to monitor for post op complications like an ileus, which is when the bowels stop moving and working, or post op infection. So your nursing interventions are focused on monitoring for the return of bowel sounds, getting the patient up and moving as quickly as possible and keeping them NPO until we know those bowels are moving again. They will also need IV Fluids and medications for pain management. For patients with a perforated appendix management is a little more complicated and recover takes a bit longer. Remember, when a perforation happens infection is spread all throughout the abdomen so, the bowels will be a slower to recover and IV antibiotics are a essential to help combat infection.
Your priority nursing Concepts for pediatric patient with appendicitis are gastrointestinal and liver metabolism, elimination, and comfort.
Ok so lets recap your major points for this lesson. Appendicitis is an inflamed appendix and this is the most common cause of abdominal surgery in children. Sometimes appendicitis can be a little bit more difficult to diagnose in our pediatric patients and this is because the pain can be more generalized and also kids just have a difficult time describing what they're feeling. This delay in diagnosis increases the risk of perforation which really complicates recover. Treatment for appendicitis is an appendectomy which is just removal that inflamed appendix.

Our nursing care for appendicitis is all about preventing complications and the most common issues are peritonitis (or infection and inflammation in the abdomen), and ileus (which is lack of movement in the intestines). So we have to be on the lookout for signs of infection and also monitoring their bowel function really closely.

That's it for a lesson on appendicitis in the pediatric patient. Make sure you check out all the resources attached to this lesson. Now go out and be your best self today and Happy Nursing!
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