APPENDICITIS

APPENDIX – a small finger like appendages about 10cm long that is attached to the cecum just below the ileocecal valve.

APPENDICITIS – is the inflammation of the vermiform appendix caused by an obstruction of the intestinal lumen from infection, stricture, fecal mass, foreign body, or tumor.

DEFINITION OF TERMS

ROVSING’S SIGN – an indication of acute appendicitis in which pressure on the left lower quadrant of the abdomen causes pain in the right lower quadrant.

LAPAROSCOPY – technique to examine the abdominal cavity with a laparoscope through one or more small incision in the abdominal wall, usually at the umbilicus.

PERITONITIS –inflammation of the peritoneum.

ABSCESS - collection of purulent

ANATOMY

The appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith, tumor, or foreign body.

The inflammatory process increases intraluminal pressure, initiating a progressively severe, generalized or periumbilical pain that become localized to the right lower quadrant of the abdomen within few hour.

The inflamed appendix fills with pus.

PATHOPHYSIOLOGY

Age

Gender

RISK FACTORS:

Periumbilical pain progresses to right lower quadrant pain and is usually accompanied by a low grade fever and nausea.

Loss of appetite

Rebound tenderness

Rovsing’s sign

Constipation

CLINICAL MANIFESTATIONS

COMPLETE BLOOD COUNT - it demonstrate an elevated WBC count

with an elevation of the neutrophils.

Abdominal x-ray films

Ultrasound

CT scan 

ASSESSMENT AND DIAGNOSTIC FINDINGS

Perforation

Abscess

Peritonitis

COMPLICATIONS

Immediate surgery Administration of IV fluids and antibiotic - To correct or prevent fluid and electrolyte

imbalance, dehydration and sepsis until surgery is performed.

MEDICAL MANAGEMENT 

Relieving Pain

Preventing Fluid Volume Deficit

Reducing Anxiety

Eliminating Infection

Maintaining Skin Integrity

Attaining Optimal Nutrition

NURSING RESPONSIBILITIES

APPENDECTOMY

Removal of the appendix

Performed as soon as possible to decrease the risk of perforation

Definition

Laparotomy

Laparoscopy

2 Ways To Perfomed:

Basic Set

Basic Sharps

AP

OS

Babcock

Silk

INSTRUMENTS USED

During an appendectomy, an incision two to three inches in length is made through the skin and the layers of the abdominal wall in the area of the appendix. The surgeon enters the abdomen and looks for the appendix, usually located in the right lower abdomen. After examining the area around the appendix to be certain that no additional problem is present, the appendix is removed.

HOW IT IS DONE?

This is done by freeing the appendix from its attachment to the abdomen and to the colon, cutting the appendix from the colon, and sewing the over the hole in the colon. If an abscess is present, the pus can be drained with drains (rubber tubes) that go from the abscess and out through the skin. The abdominal incision then is closed.

Newer techniques for removing the appendix involve the use of the laparoscope. The laparoscope is a thin telescope attached to a video camera that allows the surgeon to inspect the inside of the abdomen through a small puncture wound (instead of a larger incision). If appendicitis is found, the appendix can be removed with special instruments that can be passed into the abdomen, just like the laparoscope, through small puncture wounds.

The benefits of the laparoscopic technique include less post-operative pain (since much of the post-surgery pain comes from incisions) and a speedier recovery. An additional advantage of laparoscopy is that it allows the surgeon to look inside the abdomen to make a clear diagnosis in cases in which the diagnosis of appendicitis is in doubt. For example, laparoscopy is especially helpful in menstruating women in whom a rupture of an ovarian cysts may mimic appendicitis.

If the appendix is not ruptured (perforated) at the time of surgery, the patient generally is sent home from the hospital in one or two days. Patients whose appendix has perforated generally are sicker than patients without perforation. After surgery, their hospital stay often is prolonged (four to seven days), particularly if peritonitis has occurred. Intravenous antibiotics are given in the hospital to fight infection and assist in resolving any abscess

Occasionally, the surgeon may find a normal-appearing appendix and no other cause for the patient's problem. In this situation, the surgeon may remove the appendix. The reasoning in these cases is that it is better to remove a normal-appearing appendix than to miss and not treat appropriately an early or mild case of appendicitis.

All diagnostic tests and procedures are explained to promote cooperation and relaxation.

The patient is prepared for the type of surgical procedures as well as the post operative care.

Measures to prevent postoperative complication are taught, including coughing, turning, and deep breathing using splint at the incision site.

I.V fluids or total parenteral nutrition before surgery maybe ordered to improved fluid and electrolyte balance and nutritional status.

Intake and output is monitored.

PREOPERATIVE MANAGEMENT

Preoperative laboratory are obtained. Bowel cleansing will be initiated 1 to 2 days

before surgery for better visualization. Antibiotics are ordered to decrease the

bacterial growth in the colon. Patient may not have anything by mouth after

midnight the night before surgery. Medication may be withheld, if ordered. This will keep the GI tract clear.

Position the patient on the OR table Skin preparation Induction of anesthesia Procedures done aseptically Closing of the incision Dressing of the site

INTRAOPERATIVE NURSING CARE

Monitor vital signs for sign of infection and shock such as fever, hypotension and tachycardia.

Monitor I and O for sign of imbalance, dehydration, and shock.

Assess abdomen for increased pain, distention, rigidity, and rebound tenderness because these may indicate postoperative complications.

Evaluate dressing and incision. Evaluate the passing of flatus or feces.

POST OPERATIVE MANAGEMENT AND NURSING CARE

Monitor for nausea and vomiting. Laboratory values are monitored and patient

is evaluated for sign and symptoms of electrolyte imbalances.

Wound drains, I.V, and all other catheter are monitored and evaluated for signs of infections.

Turning , coughing, deep breathing, and incentive spirometry are performed every 2 hours.

Diet is advanced as ordered. Administration of medications as ordered

Patient Education and Health Maintenance

o Instruct patient to avoid heavy lifting for 4 to 6 weeks after surgery.

o Instruct patient to report symptoms of anorexia, nausea, vomiting, fever, abdominal pain, incisional redness and drainage postoperatively.

Reported by:Mhay Del Poso

andVanessa Duncil