APPENDICITIS

DEFINITION OF TERMS

APPENDIX a small finger like appendages

about 10cm long that is attached to the
cecum just below the ileocecal valve.

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.

ROVSINGS SIGN an indication of acute

appendicitis in which pressure on the left
lower quadrant of the abdomen causes
pain in the right lower quadrant.
LAPAROSCOPY technique to examine the
abdominal cavity with a laparoscope
through one or more small incision in the
abdominal wall, usually at the umbilicus.
PERITONITIS inflammation of the
peritoneum.
ABSCESS - collection of purulent

ANATOMY

PATHOPHYSIOLOGY
The appendix becomes inflamed and
edematous as a result of becoming kinked
or occluded by a fecalith, tumor, or foreign
body.
The inflammatory process increases
intraluminal pressure, initiating a
progressively severe, generalized or
periumbilical pain that become localized to
the right lower quadrant of the abdomen
within few hour.
The inflamed appendix fills with pus.

RISK FACTORS:

Age

Gender

CLINICAL MANIFESTATIONS

Periumbilical pain progresses to right lower

quadrant pain and is usually accompanied
by a low grade fever and nausea.

Loss of appetite

Rebound tenderness

Rovsings sign

Constipation

ASSESSMENT AND DIAGNOSTIC FINDINGS

COMPLETE BLOOD COUNT

- it demonstrate an elevated WBC count
with an elevation of the neutrophils.

Abdominal x-ray films

Ultrasound

CT scan

COMPLICATIONS

Perforation

Abscess

Peritonitis

MEDICAL MANAGEMENT

Immediate surgery
Administration of IV fluids and antibiotic
- To correct or prevent fluid and electrolyte
imbalance, dehydration and sepsis until
surgery is performed.

NURSING
RESPONSIBILITIES

Relieving Pain

Preventing Fluid Volume Deficit

Reducing Anxiety

Eliminating Infection

Maintaining Skin Integrity

Attaining Optimal Nutrition

APPENDECTOM
Y

Definition

Removal

of the appendix

Performed

as soon as possible to decrease

the risk of perforation

2 Ways To Perfomed:

Laparotomy

Laparoscopy

INSTRUMENTS USED

Basic Set

Basic Sharps

AP

OS

Babcock

Silk

HOW IT IS DONE?

During an appendectomy, an incision two to

three inches in length is made through the
skin and the layers of the abdominal wall in
the area of the appendix. The surgeon enters
the abdomen and looks for the appendix,
usually located in the right lower abdomen.
After examining the area around the appendix
to be certain that no additional problem is
present, the appendix is removed.

This is done by freeing the appendix from

its attachment to the abdomen and to the
colon, cutting the appendix from the colon,
and sewing the over the hole in the colon. If
an abscess is present, the pus can be
drained with drains (rubber tubes) that go
from the abscess and out through the skin.
The abdominal incision then is closed.

Newer techniques for removing the appendix

involve the use of the laparoscope. The
laparoscope is a thin telescope attached to a
video camera that allows the surgeon to inspect
the inside of the abdomen through a small
puncture wound (instead of a larger incision). If
appendicitis is found, the appendix can be
removed with special instruments that can be
passed into the abdomen, just like the
laparoscope, through small puncture wounds.

The benefits of the laparoscopic technique

include less post-operative pain (since
much of the post-surgery pain comes from
incisions) and a speedier recovery. An
additional advantage of laparoscopy is that
it allows the surgeon to look inside the
abdomen to make a clear diagnosis in cases
in which the diagnosis of appendicitis is in
doubt. For example, laparoscopy is
especially helpful in menstruating women in
whom a rupture of an ovarian cysts may
mimic appendicitis.

If the appendix is not ruptured (perforated)

at the time of surgery, the patient generally
is sent home from the hospital in one or two
days. Patients whose appendix has
perforated generally are sicker than
patients without perforation. After surgery,
their hospital stay often is prolonged (four
to seven days), particularly if peritonitis has
occurred.
Intravenous antibiotics are given in the
hospital to fight infection and assist in
resolving any abscess

Occasionally, the surgeon may find a

normal-appearing appendix and no other
cause for the patient's problem. In this
situation, the surgeon may remove the
appendix. The reasoning in these cases is
that it is better to remove a normalappearing appendix than to miss and not
treat appropriately an early or mild case of
appendicitis.

PREOPERATIVE MANAGEMENT
All diagnostic tests and procedures are
explained to promote cooperation and
relaxation.
The patient is prepared for the type of surgical
procedures as well as the post operative care.
Measures to prevent postoperative complication
are taught, including coughing, turning, and
deep breathing using splint at the incision site.
I.V fluids or total parenteral nutrition before
surgery maybe ordered to improved fluid and
electrolyte balance and nutritional status.
Intake and output is monitored.

Preoperative laboratory are obtained.

Bowel cleansing will be initiated 1 to 2 days
before surgery for better visualization.
Antibiotics are ordered to decrease the
bacterial growth in the colon.
Patient may not have anything by mouth after
midnight the night before surgery. Medication
may be withheld, if ordered. This will keep the
GI tract clear.

INTRAOPERATIVE NURSING CARE

Position the patient on the OR table
Skin preparation
Induction of anesthesia
Procedures done aseptically
Closing of the incision
Dressing of the site

POST OPERATIVE MANAGEMENT AND NURSING CARE

Monitor vital signs for sign of infection and

shock such as fever, hypotension and
tachycardia.
Monitor I and O for sign of imbalance,
dehydration, and shock.
Assess abdomen for increased pain,
distention, rigidity, and rebound tenderness
because these may indicate postoperative
complications.
Evaluate dressing and incision.
Evaluate the passing of flatus or feces.

Monitor for nausea and vomiting.

Laboratory values are monitored and patient
is evaluated for sign and symptoms of
electrolyte imbalances.
Wound drains, I.V, and all other catheter are
monitored and evaluated for signs of
infections.
Turning , coughing, deep breathing, and
incentive spirometry are performed every 2
hours.
Diet is advanced as ordered.
Administration of medications as ordered

Patient Education and Health Maintenance

Instruct patient to avoid heavy lifting for 4

to 6 weeks after surgery.

Instruct patient to report symptoms of

anorexia, nausea, vomiting, fever,
abdominal pain, incisional redness and
drainage postoperatively.

Reported by:
Mhay Del
Poso
and
Vanessa
Duncil