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APPENDICITIS

By the end of this session, students will be


able to
Define Appendicitis

Identify predisposing factors Appendicitis

Identify symptoms patient with Appendicitis

Identify Etiology and Risk Factor Appendicitis

Define to diagnosed Appendicitis

Identify physical examination to rule out


Appendicitis
Learning Objective

Explain management of Acute Appendicitis


Identify complications of Acute Appendicitis
Discuss nursing diagnosis for patient with
Acute Appendicitis
PATHOPHYSIOLOGY
Obstruction of the appendiceal lumen is the
primary appendiceal lumen leads to distension of
the appendix due to accumulated intraluminal
fluid.
Ineffective lymphatic and venous drainage allows
bacerial invasion of the appendiceal wall and in
advanced cases, perforation and spillage of pus
into the peritoneal cavity.
WHAT IS APPENDICITIS?

APPENDICITIS IS A
PAINFUL SWELLING
AND INFECTION OF
THE APPENDIX.
WHAT IS THE APPENDIX?
The appendix is a fingerlike pouch
attached to the large intestine and located
in the lower right area of the abdomen.
The inside of the appendix is called the
appendiceal lumen.
WHAT CAUSES APPENDICITIS?
Obstruction of the appendiceal lumen causes
appendicitis. Mucus backs up in the appendiceal
lumen, causing bacteria that normally live inside
the appendix to multiply. The appendix swells
and becomes infected. Sources of obstruction
include.
Feces, parasites, or growth that clog the
appendiceal lumen
WHAT CAUSES APPENDICITIS?

Enlarged lymph tissue in the wall of the


appendix, caused by infection in the
gastrointestinal tract or elsewhere in the body.
Inflammatory bowel disease, including Crohns
disease and ulcerative colitis.
Trauma to the abdomen.
An inflamed appendix will likely burst if not
removed. Bursting spreads infection throughout
the abdomen-a potentially dangerous condition
called peritonitis.
Symptoms
The main symptom of appendicitis is
abdominal pain. The abdominal pain
usually:
a) Occurs suddenly, often causing a person to
wake up at night.
b) Occurs before other symptoms
c) Begins near the belly button and then moves
lower an to the right.
Symptoms
d) Is new and unlike any pain felt before
e) Gets worse in a matter of hours
f) Gets worse when moving around,
taking deep breaths, coughing or
sneezing.
Other symptoms of
Appendicitis
Loss of appetite
Nausea
Vomiting
Constipation or diarrhea
Inability to pass gas
Other symptoms of Appendicitis

A low-grade fever that follows other


symptoms
Abdominal swelling
The feeling that passing stool will relieve
discomfort.
Etiology and Risk Factors
A fecalith ( a fecal calculus, or stone) that occludes the
lumen of the appendix
Kinking of the appendix
Swelling of the bowel wall
Fibrous conditions in the bowel wall
External occlusion of the bowel by adhesion
Infection with Yersinia organisms has been found in up
to 30% of cases
How is Appendicitis diagnosed?

Rectal examination

Blood tests to check for signs of infection

(high white blood cell count)


Urine test to rule out a urinary tract infection.
How is Appendicitis diagnosed?

Chest X-ray because of pneumonia in the lower


right lung can cause pain similar to appendicitis
Ultrasound may be performed to determine if the
appendix appears to be inflamed
Physical Examination
a) Guarding : Occurs when a person
subconsciously tenses the abdominal muscles
during an examination. Voluntary guarding
occurs the moment the doctors hand touches
the abdomen. Involuntary guarding occurs
before the doctor actually makes contact.
Physical Examination
b) Rebound tenderness : A doctor tests for
rebound tenderness by applying hand
pressure to a patients abdomen and then
letting go. Pain felt upon the release of the
pressure indicates rebound tenderness.
Physical Examination
c) Rovsings sign : By applying hand pressure to
the lower left side of the abdomen. Pain on the
lower right side of the abdomen upon the
release of pressure on the left side indicates
the presence of Rovsings sign.
Physical Examination
d) Psoas sign : The right psoas muscle runs over
the pelvis near the appendix. Flexing this muscle
will cause abdominal pain if the appendix is
inflamed. A doctor can check for the psoas sign
by applying resistance to the right knee as the
patient tries to lift the right thigh while lying
down.
Physical Examination
e) Obturator sign : The right obturator muscle alo
runs near the appendix. A doctor tests for the
obturator sign by asking the patient to lie down
with the right leg bent at the knee. Moving the
bent knee left and right requires flexing the
obturator muscle and will cause abdominal pain
if the appendix is inflamed.
McBurneys point
.McBurneys point

Deep tenderness at McBurney's point, known as


McBurney's sign, is a sign of Acute
Appendicitis. The clinical sign of rebound pain
when pressure is applied is also known as
Aaron's sign.
Management of Acute Appendicitis
Pre-operative care

NPO, IV therapy, close monitoring

Specific pre-operative preparation

Emergency operation

Acute appendicitis appendicectomy

Perforation with peritonitis laparotomy


Post operative care
Day 1 : Close monitoring vital sign ,oral

by mouth, measuring abdominal

girth and medication


Day 2 : Wound inspection, support patient

to do ADL.
Day 3 : Patient discharged as Doctor

order.
Complications of Acute Appendicitis

Perforation
Appendicular mass
Abscess
Peritonitis

Infection of surgical wound.


Nursing diagnosis for clients with
Acute Appendicitis
Pre-operative:
- Potential complication : perforation related to
inflammatory process
- Anxiety related to disease process and treatment.
Post operatives:
- Altered comfort related to surgery
- High risk for infection of surgical incision.
Diagnosis, Outcomes, Interventions
Nursing diagnosis

Acute Pain related to inflammation

Outcomes

Decreased postoperative pain

Interventions

Medicate as indicated

Assess for abrupt pain changes, which indicate


perforation
Diagnosis, Outcomes, Interventions,
contd

Nursing diagnosis
Risk for Infection related to rupture of
appendix
Outcomes
Infection will not develop
Interventions
Assess vital signs
Administer antibiotic therapy
Assess and maintain drains and dressing
Diagnosis, Outcomes, Interventions,
contd
Nursing diagnosis

Risk for Deficient Fluid Volume related to


vomiting
Outcomes

Fluid and electrolyte balance

Interventions

Administer IV fluids

Careful assessment of intake and output


Define Appendicitis
Identify causes Appendicitis
Identify physical examination patient with
Appendicitis
Discuss nursing diagnosis for patient with
Appendicitis
Acute inflammation of the appendix, usually
resulting from bacterial infection, which may be
precipitated by obstruction of the lumen by a
fecalith; variable symptoms often consisting of
periumbilical, colicky pain and vomiting may be
followed by fever, leukocytosis, persistent pain,
and signs of peritoneal inflammation in the right
lower quadrant of the abdomen; perforation or
abscess formation is a frequent complication of
delayed surgical intervention.
http://www.healthcommunities.com/appendicitis/
what-is-acute-appendicitis.shtml
https://www.drugs.com/dict/acute-
appendicitis.html
http://www.webmd.com/digestive-
disorders/picture-of-the-appendix
Smelter,S.C.O.,Bare B.G. (2009). Brunner &
Suddarth: A Textbook of Medical-Surgical
Nursing, 11th Edition. Lippincott Williams &
Wilkins, New Dehli