Nursing Care Plan for Appendicitis

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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

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!