Chapter 24: Appendicitis (Children)

Question 1

Appendicitis

Answer 1

inflammation of the appendix (small sac-like structure at the end of the cecum
-requires abdominal surgery

Question 2

What happens in appendicitis

Answer 2

the lumen of the appendix becomes obstructed with fecal matter, lymphoid tissue, tumor, parasite, foreign body, or inspissated (thickened) cystic fibrosis secretions, which cause the appendix to become distended and subject to ischemia and necrosis

Question 3

What are the characteristic symptoms caused by?

Answer 3

the inflammation around the infected appendix with approximately a “36 to 72 hour window from the onset of pain to the rupture of the gangrenous appendix”
-rupture usually occurs within 48 hours of the onset of symptoms

Question 4

When is this likely to occur?

Answer 4

increases with age

• average occurrence between 6 and 10 years of age
• slightly higher in boys
• perforation twice as likely for children younger than 5

Question 5

Signs and Symptoms

Answer 5

> earliest symptoms: periumbilical pain (pain around umbilicus); often wakens child peaking at 4-hour intervals; periumbilical pain subsides and then is followed by the classic sign of right lower quadrant pain
additional symptoms:
-vomiting generally follows periumbilical pain
-anorexia
-stools described as low in volume and mucus-like, diarrhea is atypical (uncommon)
-constipation
-high fever may be associated with perforation; otherwise afebrile or have a low fever

Question 6

When is perforation suspected?

Answer 6

when abdominal pain is suddenly relieved without intervention
-physician is notified immediately; child needs immediate attention

Question 7

Diagnosis

Answer 7

experiences a progression of symptoms with no single test providing overall confirmation of diagnosis

• laboratory findings: elevated WBC count; does not distinguish simple appendicitis from perforated appendicitis; some may have a normal WBC with appendicitis
• abdominal radiograph: may reveal fecal matter or some other obstruction
• ultrasound and CT may help differentiate abdominal pain from other causes

Question 8

Appendicitis Physical Examination: Rebound Tenderness

Answer 8

• presence of involuntary guarding
• rebound tenderness with pain over McBurney’s point which is located 1.5-2 inches from the right anterior superior iliac crest on a line toward the umbilicus

Question 9

Appendicitis Physical Examination: Heel-drop jarring test

Answer 9

• stands on toes for 15 seconds, then drops on heels
• inability to stand straight or climb stairs
• winces when getting off examination table

Question 10

Appendicitis Physical Examination: Psoas sign

Answer 10

abdominal pain with right hip flexion against resistance

Question 11

Appendicitis Physical Examination: Obturator sign

Answer 11

pain on passive internal rotation of the flexed right thigh

Question 12

Appendicitis Physical Examination: Rovsing’s sign

Answer 12

deep pressure in lower left abdominal quadrant elicits pain with a sudden release

Question 13

Prevention

Answer 13

surgical condition that cannot be prevented

Question 14

Nursing Care after Appendectomy

Answer 14

• monitoring intake and output
• wound care
• pain control
• NPO for 24 hours or until peristalsis returns
• most discharged home in 2 to 3 days
• if procedure performed by laparoscopic (abdominal exploration) with an endoscope, child may remain in hospital overnight or be discharged same day of surgery
• if perforation occurred, drains may protrude from the incision or the wound and remain open to prevent infection and allow healing
• in the case of a perforated appendix, IV antibiotics given for 7 to 14 days
• child remains NPO with a NG tube in place until bowel function returns

Question 15

Surgical Care

Answer 15

treatment is surgical; appendectomy is curative if performed before perforation
-if perforation occurs, a course of postoperative antibiotics is needed

Question 16

Education/ Discharge

Answer 16

• wound care; surgical site clean and dry and monitoring for signs of infection
• instructed on pain management and progression of activity over a 2-week period and the resumption of normal nutritional intake as directed by health-care provider and as tolerated