Appendicitis

Question 1

Appendicitis

Answer 1

• acute inflammation of the appendix (a small projection of the cecum)
• inflammation occurs when the appendix becomes blocked with hard material (usually feces) that leads to a bacterial infection
• the lumen of the appendix becomes blocked and edematous, leading to the characteristic abdominal pain.

Question 2

Appendicitis: prevalence

Answer 2

• most often between ages 10-30 years
• peak incidence among adolescent males
• rare in older adult males

Question 3

Digestive system route

Answer 3

• mouth
• esophagus
• gastroesophageal junction
• stomach
• pylorus
• pyloric sphincter
• duodenum (12”)
• jejunum (8’)
• ileum (12’)
• cecum
• ascending colon
• transverse colon
• descending colon
• sigmoid colon
• rectum
• anus

Question 4

Appendicitis: manifestations

Answer 4

1) nausea and vomiting
2) classic abdominal pain
- cramping and pain around umbilicus and epigastric area
3) as condition progresses, pain moves to the RLQ (McBurney’s point) with rebound tenderness (pain after deep pressure is applied and released)
4) pain that is relieved by the right hip flexion and increases with coughing and movement may indicate perforation with peritonitis

Question 5

Laboratory and Diagnostic Tests

Answer 5

1) WBC count
- mild to moderate elevation
- greater than 20,000/mm3 may indicate peritonitis
2) ultrasound of the abdomen may show an enlarged appendix
3) abdominal computed tomography (CT) may be diagnostic if manifestations are recurrent or prolonged

Question 6

Treatment

Answer 6

1) IV fluids and antibiotics as prescribed
2) surgical management–appendectomy
- laparoscopic (using several small incisions and an endoscope)
- open approach (requires a larger abdominal incision)

Question 7

Preoperative

Answer 7

• maintain NPO status in anticipation of surgery and to prevent GI stimulation
• administer IV fluids and antibiotics as prescribed
• encourage semi-Fowler’s position to contain abdominal drainage in lower abdomen
• avoid laxatives/enemas or application of heat to the abdomen (can predispose client to perforation)

Question 8

Postoperative

Answer 8

• administer analgesia as prescribed
• administer IV antibiotics as prescribed (surgical prophylaxis, perforation)
• offer food as tolerated with return of bowel sounds
• if peritonitis occurred, monitor n NG tube drainage
• if perforation or abscess occur, monitor surgical drains

Question 9

Discharge Instructions

Answer 9

• if no complications, client discharge 12-24 hr after surgery
• discharge instructions similar to other types of abdominal surgery
• care of surgical incision
• recognition of indications of wound infection
• use postoperative medications (purpose, guidelines, adverse effects)
• activity restrictions (lifting, driving, returning to work)