Appendicitis - PowerPoint Presentation

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.Slide4
Slide5
Slide6

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 if contrast dye is

used)

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.

.