to the cecum just below the ileocecal valve It empties into the colon inefficiently and its lumen is small it is prone to becoming obstructed and is vulnerable to infection appendicitis ID: 715211
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Slide1
AppendicitisSlide2
Definition
The appendix is a small, finger-like appendage attached
to the
cecum just below the
ileo-cecal
valve
.
It empties into
the colon inefficiently and its lumen is
small;
it is
prone to
becoming obstructed and is vulnerable to
infection (appendicitis).
It is the
most common
cause of acute
inflammation in RLQ of the abdominal cavity and the most common cause
of emergency abdominal surgery
.Slide3
definition
Appendicitis results from obstruction, inflammation, and infection of
the appendix.
Obstruction
leads to
hypoxia, leading to gangrene and/or perforation
of the appendix.
Perforation
can result in the formation of an
abscess and/or
peritonitis.
Appendicitis
is not preventable, therefore early detection is important.Slide4Slide5Slide6
Diagnostic Procedures and Nursing Interventions
Diagnosis is based on a complete physical examination
and laboratory
and imaging tests.
WBCs
count and differential:
(10,000
to
18,000/mm3) ,
20,000/mm3
may indicate peritonitis.
Abdominal US may
show an enlarged appendix.
Abdominal
CT may
be diagnostic if symptoms
are recurrent
or prolonged.
(Check
allergies and renal function
???)
Urinalysis
Pregnancy test, PID??Slide7
Therapeutic Procedures and Nursing Interventions
Surgical
management includes an
appendectomy :
With laparoscope
or
an
open
approachSlide8
Assessments
Monitor
for signs and
symptoms:
Mild or cramping,
epigastric
or
periumbilical
pain (initial)
Constant, intense
RLQ
pain (later
)
Rebound tenderness (pain after deep pressure is applied and released)
over
McBurney’s
point (located halfway between the umbilicus and anterior
iliac spine
)
Pain that decreases with a decrease in right hip flexion or increases
with coughing
and movement may indicate perforation with peritonitis.Slide9
Clinical Manifestations
Low grade fever
, nausea, and sometimes vomiting;
loss
of
appetite is
common; constipation can occur.
At
McBurney’s
point
,
local
tenderness with
pressure and some rigidity of the lower
portion
of
the right
rectus muscle.
Rovsing’s
sign
(
palpating left lower
quadrant, causes
pain in right lower quadrant
)
Muscle rigidity, tense positioning, guarding may indicate perforation
with peritonitis
.
If appendix ruptures, pain becomes more diffuse;
abdominal distention
develops from paralytic ileus, and
condition worsens
.Slide10
NANDA Nursing Diagnoses
Acute
pain
Risk for infection
Risk for deficient fluid volume
Deficient knowledge
AnxietySlide11
Nursing Interventions
Preoperative
Upon admission, maintain NPO status due to the possibility of
emergency surgery
.
Administer IV fluids as prescribed.
Encourage semi-Fowler’s position to contain abdominal drainage in the
lower abdomen
.
Avoid laxatives/enemas or application of heat to the abdomen, which
could cause
perforation.Slide12
Postoperative
Administer
opioid analgesia (usually morphine sulfate) as ordered.
Administer IV antibiotics as ordered (surgical prophylaxis, perforation).
For peritonitis, monitor nasogastric (NG) tube drainage.
For perforation or abscess, monitor surgical drains.Slide13
Complications and Nursing Implications
Peritonitis
due to perforation – Perforation is a life-threatening emergency.
The risk of perforation is greatest 48
hr
following the onset of
appendicitis pain
.
Carefully assess the client for:
Fever of 38.2° C
or
higher.
Acutely ill appearance.
Board-like
abdomen
Decreased urinary output.
Septicemia.
Treatment includes administration of broad spectrum IV antibiotics.
.