Watch More! Unlock the full videos with a FREE trial
Add to Study plan
Master
Included In This Lesson
Study Tools
Appendicitis Interventions (Picmonic)
Appendicitis Assessment (Picmonic)
Appendicitis Pathochart (Cheat Sheet)
Access More! View the full outline and transcript with a FREE trial
Transcript
In this care plan, we will explore appendicitis.
So, in this appendicitis care plan, we're going to talk about the desired outcome, the subjective and objective data in the nursing interventions, along with the rationales.
So, our medical diagnosis is appendicitis. Appendicitis is the obstruction and inflammation of the inner lining of the appendix. Infection will eventually occur leading to necrosis, gangrene, perforation of the appendix, which can cause peritonitis out in the abdominal cavity. So, obstruction of the appendix results from fecal matter that might get stuck in there, um, cancer infection or foreign body, anything that could block that opening of the appendix. Bacteria multiplies causing inflammation and infection in the appendix. So, our desired outcome is optimal pain relief and the patient will be free from infection.
Now, let's look at the care plan. We'll start with the subjective data. So, your patient might be experiencing abdominal pain, especially in that right lower quadrant where the appendix is located due to the inflammation and possible rupture of the appendix. Your patient might be experiencing nausea and chills. If it's ruptured, your patient might be also experiencing diarrhea or constipation because of that inflammation and possibly infectious appendix, which is located in the intestines causing irritation. So, this irritation might also cause your patient to experience some anorexia where they just aren't eating like they should be.
Now, let's look at the objective data. So, the patient might experience a fever or elevated white blood cells in CRP due to inflammation and infection. This will worsen when it ruptures, a patient may experience vomiting due to that GI irritation and infection. While assessing the patient, you might notice rebound tenderness at McBurney's point, which is the location of the inflamed Appendix. The patient might curl up into a fetal position to try to help reduce that pain.
Now, let's look at our nursing interventions for appendicitis. You will assess and manage your patient's pain levels. It's important to look at the level of severity, quality and timing of the pain, because these can all indicate different things on what's going on. So, severe pain from the inflammation that suddenly goes away can indicate that the appendix has ruptured after time. When the infection spreads into the peritoneum, the patient will start to have more pain, which may indicate peritonitis. Treat accordingly with pain medications ordered by the doctor. So, you may want to place the patient in a semi Fowler's position because gravity helps to reduce abdominal stress and relieves pain.
Monitor the patient's lab values, especially the white blood cells, which will determine infection and CRP because elevated CRP will show you that there's some inflammation going on. Monitor your patient's vital signs. Fever is a sign of infection, peritonitis, and even sepsis. Hypotension and tachycardia indicate dehydration. You will prep the patient for an appendectomy because surgery to remove the appendix is the only treatment for appendicitis. You have to get it out. So, initiate IV access and get informed consent from your patient. After surgery, provide post-op care. Your patient is going to need to maintain the NPO status until their gag reflex returns to avoid aspiration. You'll advance their diet as tolerated per doctor order. Our last nursing intervention is to encourage abdominal splinting. This is before and after surgery. This is going to help aid in pain management and prevent a dehiscence of that incision.
We love you guys. Now go out and be your best self today and as always, happy nursing!
So, in this appendicitis care plan, we're going to talk about the desired outcome, the subjective and objective data in the nursing interventions, along with the rationales.
So, our medical diagnosis is appendicitis. Appendicitis is the obstruction and inflammation of the inner lining of the appendix. Infection will eventually occur leading to necrosis, gangrene, perforation of the appendix, which can cause peritonitis out in the abdominal cavity. So, obstruction of the appendix results from fecal matter that might get stuck in there, um, cancer infection or foreign body, anything that could block that opening of the appendix. Bacteria multiplies causing inflammation and infection in the appendix. So, our desired outcome is optimal pain relief and the patient will be free from infection.
Now, let's look at the care plan. We'll start with the subjective data. So, your patient might be experiencing abdominal pain, especially in that right lower quadrant where the appendix is located due to the inflammation and possible rupture of the appendix. Your patient might be experiencing nausea and chills. If it's ruptured, your patient might be also experiencing diarrhea or constipation because of that inflammation and possibly infectious appendix, which is located in the intestines causing irritation. So, this irritation might also cause your patient to experience some anorexia where they just aren't eating like they should be.
Now, let's look at the objective data. So, the patient might experience a fever or elevated white blood cells in CRP due to inflammation and infection. This will worsen when it ruptures, a patient may experience vomiting due to that GI irritation and infection. While assessing the patient, you might notice rebound tenderness at McBurney's point, which is the location of the inflamed Appendix. The patient might curl up into a fetal position to try to help reduce that pain.
Now, let's look at our nursing interventions for appendicitis. You will assess and manage your patient's pain levels. It's important to look at the level of severity, quality and timing of the pain, because these can all indicate different things on what's going on. So, severe pain from the inflammation that suddenly goes away can indicate that the appendix has ruptured after time. When the infection spreads into the peritoneum, the patient will start to have more pain, which may indicate peritonitis. Treat accordingly with pain medications ordered by the doctor. So, you may want to place the patient in a semi Fowler's position because gravity helps to reduce abdominal stress and relieves pain.
Monitor the patient's lab values, especially the white blood cells, which will determine infection and CRP because elevated CRP will show you that there's some inflammation going on. Monitor your patient's vital signs. Fever is a sign of infection, peritonitis, and even sepsis. Hypotension and tachycardia indicate dehydration. You will prep the patient for an appendectomy because surgery to remove the appendix is the only treatment for appendicitis. You have to get it out. So, initiate IV access and get informed consent from your patient. After surgery, provide post-op care. Your patient is going to need to maintain the NPO status until their gag reflex returns to avoid aspiration. You'll advance their diet as tolerated per doctor order. Our last nursing intervention is to encourage abdominal splinting. This is before and after surgery. This is going to help aid in pain management and prevent a dehiscence of that incision.
We love you guys. Now go out and be your best self today and as always, happy nursing!
View the FULL Transcript
When you start a FREE trial you gain access to the full outline as well as:
- SIMCLEX (NCLEX Simulator)
- 6,500+ Practice NCLEX Questions
- 2,000+ HD Videos
- 300+ Nursing Cheatsheets
“Would suggest to all nursing students . . . Guaranteed to ease the stress!”
