MINISTRY OF HEALTH

Directorate General of Khoula Hospital Directorate of Nursing and Midwifery Affairs

Nursing Care of the patient with Appendectomy

Ward CNE Present by Lovely K Thomas Private Ward (May 2013)

Learning Objectives
At the end of this lecture the staff will able to (a) Define appendectomy (b) State pathology (c) Explain management of appendectomy (d) State pre & post operative care of appendectomy

Outline
Introduction Definition Pathology Clinical Manifestation Diagnostic Evaluation Management Complications Pre operative care

 Post operative care Health Education Conclusion Reference

Introduction
Appendicitis the most common cause of acute abdomen in the United State, is the most common reason for emergency abdominal surgery. Although it can occur at any age. It more commonly occurs between the ages of 10 and 30 years. (Ref:Brunner Suddarths text book of Medical&Surgical Nursing 11th edition)

Definition
Appendicitis: An inflammation of the appendix. Appendectomy: the surgical procedure of removal of the appendix.

Pathology
The appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fealith (ie hardened mass of stool), tumor, or foreign body. The inflammatory process increase intraluminal pressure, initiating a progressively sever, generalized or periumbilical pain that becomes localized to the right lower quadrant of the abdomen within a few hours. Eventually, the inflamed appendix fill with pus. (Ref: Brunner Suddarths text book of Medical&Surgical Nursing 11th edition)

Clinical Manifestation
Periumbilical abdominal pain, nausea, vomiting, localization of pain to right iliac fossa Mild pyrexia Patient is flushed, tachy cardia, furred tongue Right sicled pelvic tenderness Loss of appetite is common Usually constipation occurs, occasionally diarrhea

(Ref: Clinical Surgery Page 163-165)

Diagnostic Evaluation
Physical examination consistent with clinical manifestations. WBC count reveals moderate leukocytosis(10,000 to 16,000/mm3) with shift to the left( increased immature neutrophils). Urinalysis to rule out urinary disorders.

Abdominal X-ray may visualize shadows consistent with fecalith in appendix perforation will reveal free air.

Abdominal ultrasound or CTscan can visualize appendix and rule out other conditions , such as diverticulitis. Focused appendiceal CT can quickly evaluate for appendicitid. (Ref: Lippincott Manual of Nursing practice 9th edition

Management
Surgery (appendectomy) is indicated. Simple appendectomy or laparoscopic appendectomy in absence of rupture or peritonitis An incisional drain may be placed if an abscess or rupture occurs. Preoperatively maintain bed rest, NPO status, I.V. hydration, possible antibiotic prophylaxis, and analgesia. (Ref:Lippincott Manual of Nursing Practice 9th edition Chapter-18 page- 690 )

Complications
The major complication of appendicitis is perforation of the appendix which can lead to peritonitis perforation generally occurs 24 hours after the on set of pain symptoms included a fever of 37.7*c or greater a toxic appearance and continued abdominal pain or tenderness

(Ref:Brunner Suddarths text book of Medical&Surgical Nursing 11th edition)

Pre operative care Assess patient database

Activity/rest Circulation Food/fluids Pain/discomfort Respiration Allergic Obtain informed consent from the patient Carry out the doctors pre-operative orders (blood investigations,NPO, administration of drugs such as insulin, hormones, hypertensive drugs, antibiotics etc.) Skin preparation shaving (nipple line to midthigh)

Psychological support encourage to ventilate feelings, allow the patient to clear his doubts. Before sending the patient to O.T, empty the bladder, change to hospital gown, remove all ornament, false teeth, nail polish, hair pins etc. Handed over the patient to O.T staff with all documents.

Post operative care

Check vital signs, color of the skin, nails, skin temperature. Check operation site for bleeding , discharge and functioning of the devices like drainage tubes, I.V set etc. If drainage tube present, it should keep below the level of operation site. Keep the patient well covered and side rails up. Never leave the patient alone. Asses the pain of the patient and carry out the doctors order Assess level of consciousness Give clear fluid for first POD Administer I.V prophylaxis ,antibiotics as ordered. Maintaing aseptic technique during dressing

Encourage patient to do room exercises

(Ref: www.surgery channel.com/appendectomy

Health Education
Instruct the patient to avoid heavy lifting for 4 to 6 weeks after surgery. Keep the operation area clean. Continue following treatment, if needed . All patient are instructed to maintain personal hygiene. Instruct the patient to continue treatment as per doctors order. Instruct the patient to report symptoms of anorexia, nausea, vomiting, fever, abdominal pain, incisional redness or oozing from operated site etc.

Conclusion
Appendicitis is the commonest surgical emergency in Western countries. Open appendectomy or laparoscopic appendectomy is recommended for the treatment of appendicitis. Laparoscopic appendectomy is as safe and efficient as open appendectomy. Always remember than appendicitis is different for every ones some people may have all the symptoms some people may have just one. If you think you have a medical emergency or are just worried always see a doctor to be safe.

Reference

Brunner&Suddarths Text book of Medical&Surgical Nursing 11th edition

Lippincott Manual of Nursing Practice 2010 Clinical Surgery 1998

www.surgery channel.com/appendectomy