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Outline
Pathophysiology
Appendicitis is the obstruction and inflammation of the inner lining of the appendix. If left untreated, increasing inflammation and infection can lead to necrosis, gangrene or perforation of the appendix in which the infectious materials spill out into the abdominal cavity causing peritonitis. Appendicitis is considered a medical emergency and requires surgery to remove the appendix (appendectomy).
Etiology
Obstruction of the appendix may result from fecal material, infection, a foreign body or cancer blocking the opening of the appendix. The bacteria from the collection of fecal matter or infection multiply rapidly which causes the appendix to become inflamed, distended and filled with pus, creating an obstruction.
Desired Outcome
Optimal pain relief and patient will be free from infection.
Appendicitis Nursing Care Plan
Subjective Data:
- Abdominal pain – periumbilical that migrates to RLQ
- Nausea
- Chills
- Anorexia
- Diarrhea or constipation reported
Objective Data:
- Fever, diaphoresis
- Vomiting
- Fetal position to reduce pain
- Rebound tenderness at McBurney’s Point
- Inflamed hemiscrotum (male infants and children)
- Abnormal labs
- ↑ WBC
- ↑ CRP
Nursing Interventions and Rationales
- Place in semi-Fowler’s position
This position allows gravity to assist by reducing abdominal stress and relieves discomfort
- Monitor Labs
Abnormal labs are indications of illness progression. Monitor for:
- CRP >1 mg/dL – indicates inflammation. Very high levels may indicate gangrene
- WBC >10,500 – indicates infection
- Neutrophils >75%
- Monitor vital signs
- Fever, chills and diaphoresis are signs of infection, developing sepsis, abscess or peritonitis
- Hypotension with tachycardia may indicate dehydration if vomiting or diarrhea is severe
- Prep for surgery to remove appendix (appendectomy)
- Initiate IV access
- Informed Consent obtained
- Provide Post-Op care after appendectomy
- Maintain NPO status to empty gastric contents and remain NPO post surgery until gag reflex has returned to reduce the risk of aspiration
- Clear liquids, advance diet as tolerated
- Assess and manage pain
- Note location, severity and quality of pain and any changes in characteristics which may signify abscess or peritonitis
- Administer analgesics as ordered for pain management
- Place ice pack on RLQ to aid in pain relief – avoid using heat as it may cause the appendix to rupture
- Encourage abdominal splinting
Education the patient on ways to protect abdomen before and after surgery by splinting with a pillow- this will aid in pain management and prevent dehiscence of incision.
References
- https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis/diagnosis
- https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543
- https://www.nursingtimes.net/clinical-archive/infection-control/treatment-and-management-of-acute-appendicitis/201482.article
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