APPENDICITIS

Is the inflammation of the vermiform appendix caused by an obstruction of the intestinal lumen from infection, stricture, fecal mass, foreign body or tumor.

Pathophysiology and Etiology

 Obstruction is followed by edema, infection and ischemia As intraluminal tension develops, necrosis and perforation usually occur Appendicitis can affect any age-group; most common in adolescence/young adults, especially males Clinical Manisfestation enerali!ed or locali!ed abdominal pain in the epigastric or periumbilical areas and upper right abdomen. "ithin # to $# hours, the pain locali!es in the right lower %uadrant and intensity increases Anorexia, moderate malaise, mild fever, nausea and vomiting &sually constipation occurs, occasionally diarrhea 'ebound tenderness, involuntary guarding, generali!ed abdominal rigidity Diagnostic Evaluation (hysical examination consistent with clinical manifestations ")* counts reveals moderate leu+ocytosis ,$-,--- to $.,---/mm /0 with shift to the left ,increased immature neutrophils0 &rinalysis to rule out urinary disorders Abdominal 1-rays may visuali!e shadow consistent with fecalith in appendix; perforation will reveal free air Abdominal ultrasound or *2 scan can visuali!e appendix and rule out other conditions, such as diverticulitis and *rohn3s disease. 4ocused appendiceal *2 can %uic+ly evaluate for appendicitis Management 5urgery ,appendectomy0 is indicated

5imple appendectomy or laparoscopic appendectomy in absence of rupture or peritonitis

An incisional drain may be placed if an abscess or rupture occurs (reoperatively maintain bed rest, 6(O status, I.7. hydration, possible antibiotic prophylaxis, and analgesia

Complications (erforation ,in 89: of cases0 Abscess (eritonitis Nursing Assessment Obtain history for location and extent of pain Auscultate for presence of bowel sounds, peristalsis may be absent or diminished On palpation of the abdomen, assess for tenderness anywhere in the right lower %uadrant, but usually locali!ed over ;c)urney3s point ,point <ust below midpoint of line between umbilicus and iliac crest on the right side0. Assess for rebound tenderness in the right lower %uadrant as well as referred rebound when palpating the left lower %uadrant Asses for positive psoas sign by having the patient attempt to raise the right thigh against the pressure of your hand placed over the right +nee. Inflammation of the psoas muscle in acute appendicitis will increase abdominal pain with this maneuver

 Assess for positive obturator sign by flexing the patient3s right hip and +nee and rotating the leg internally. =ypogastric pain with this maneuver indicates inflammation of the obturator muscle Nursing Diagnosis Acute pain related to inflamed appendix 'is+ of infection related to perforation Nursing Interventions 'elieving (ain ;onitor pain level, including location, intensity, and pattern Assist patient to comfortable positions, such as semi-4owler3s and +nees up 'estrict activity that may aggravate pain, such as coughing and ambulation Apply ice bag to abdomen for comfort ive antiemetics and analgesics as ordered and evaluate response

Avoid indiscriminate palpation of the abdomen to avoid increasing the patients discomfort Drug Alert: Do not give analgesics/antipyretics to mask fever, and do not administer cathartics because they may cause rupture.

(reventing Infection ;onitor fre%uently for signs and symptoms of worsening conditions indicating perforation, abscess and peritonitis> increasing severity of pain, tenderness, rigidity, distention, ileus, fever, malaise, tachycardia Administer antibiotics as ordered

 (romptly prepare patient for surgery

?valuation> ?xpected Outcome 7erbali!es decreases pain to # or / level on --$- scale with positioning and analgesics Afebrile; no rigidity or distention

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5ubmitted by> Group Irr !"E 5an @iego, 'omaida '. 5antos, (rincess ;ary 5ison, Aaymalyn 2ome, 'owel 2orio, Aohnson &rtola, =annah *amille 7alles, 'ose Anne 7aloria, Bristal ;ay 7illacorta, Aida