Pre-op diagnoses: Risk Factors:

- Altered Comfort: Acute Pain r/t - Fecalith formation

obstruction on the lumen of the -kinking of the appendix
inflammed appendix secondary to -swelling of the bowel wall
-RLQ abdominal pain
appendicitis -external occlusion of bowel by
-rebound tenderness
- Anxiety r/t impending surgery adhesion
- Risk for fluid volume deficit r/t oral - rise in Temp= >37.5 0C
restriction and vomiting - nausea and vomiting
- rigidity of the lower portion of t
Obstruction on the lumen of the right rectus muscle
Pre-op Nursing Interventions appendix
-relieve anxiety and offer emotional support
Diagnostic Period Nursing Interventio
- provide knowledge and clarify patient's doubts about
- make patient comfortable and relieve an
the procedure and condition
- relieve pain through relaxation techniques and othe increase accumulation of mucus - relieve pain through relaxation technique
non-pharmacologic techniques non-pharmacologic techniques
- address body image issues before surgery - address body image issues before surger
- offer spiritual support - offer spiritual support
- start IVF as ordered increase intraluminal pressure - start IVF as ordered
-insert FBC and monitor urine output - NPO
- give anitbiotic therapies as ordered ! do not give laxatives
- put on CBR status ! withhold Analgesics
decrease blood flow / supply ! Do not apply hot compress on abdom
- NPO
- do skin preparation of the abdomen
- make sure informed consent is obtained
- transport patient to the Operating Room venous congestion

Thrombosis of the luminal blood ulceration of lume

shifting of fluids vessels

edema

ischemia

Diagnostic Exams: purulent exudates

1. CBC= increase in WBC and Neutrophils ---infection form
2. Urinalysis tissue necrosis
3. X-ray/ CT scan of abdomen : imflammed appendix
4. Peritoneal Lavage:
* increase in amylase level
* presence of bacteria further distention of the
* presence of bile and fecal material appendix
* RBC= > 100, 000

perforation/ rupture of the

appendix gangrene

POST-OP Nursing Interventions
release of exudates with E.coli, Klebsiella,
For unruptured Appendicitis For ruptured Appendicitis
1. Assess for: 1. Assess for:
- Bowel sounds - Bowel sounds
- bowel movement - bowel movement
- passing of flatus - passing of flatus
- nausea - nausea
- boardlike abdominal rigidity - boardlike abdominal rigidity
- vital signs (Temperature) - vital signs (Temperature)
- incision site - incision site
2. Give pain medications as ordered 2. Place in high- fowler's position
3. Offer clear fluids in the morning 3. give morphine sulfate for pain
after surgery 4. if bowel sounds is ok, provide food,
4. remove IVF if patient is able to eat as ordered
and drink 5. for NPO status patients, pat OS or
5. monitor s/s of infection tissue on lips to prevent crackings
6. do wound care and dryness
7. encourage mobility 1-2 days post- 6. Assess for infection and do wound
op; care
8. expect ambulation 4-5 days post- 7. for patients using diapers,
op encourage changing as often
9. monitor urine output 8. watch out for complications
9. turn and position patient every 2
hours
10. teach patient how to support and
splint site upon movement
11. teach deep breathing
12. encourage early mobility and
ambulation
13. give ordered supplements
Legend:
Pathology Nursing Interventions
laboratory exams Clinical manifestations
Medical interventions Possible Post-op complications
Nursing Diagnoses
appendix gangrene
Proteus, Pseudomonas bacteria to Post-op diagnoses:
peritoneal cavity - Altered Comfort: Pain
of incision site on abdo
- Altered Nutrition: Les
localized inflammation of the requirement r/t NPO st
peritoneum - Risk for infection r/t b
skin secondary to App
Appendectomy and
Peritoneal Lavage
Complications Nursing Intervention
1. Peritonitis - Observe for abdominal tenderness,
  vomiting, abdominal rigidity and tac
  - Employ constant nasogastric suctio
  - Correct dehydration as prescribed
  - Administer antibiotic agent as pres
   
2 Wound infection - Assess incision site for undesirable
  pus formation
  - Assess for pain
  - Change dressing as frequently as n
  - Observe for fever and tachycardia
  - Administer antibiotic agent as pres
3. Ileus (Paralytic and - Assess for bowel sounds
Mechanical) - Employ nasogastric intubation and
  - Replace fluids and electrolytes by I
prescribed
- Prepare for surgery, if diagnosis of
ileus is established
Medical interventions Possible Post-op complications

Nursing Diagnoses
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emia

necrosis

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gnoses:
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ition: Less than body
r/t NPO status
ction r/t break in the
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rventions

nderness, fever,
y and tachycardia
ric suction
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t as prescribed

desirable redness, and

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hycardia
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