Appendectomy & Pre- and Post-Op Care

Question 1

Risk factors

Answer 1

Appendicitis risk factors:
1. Inflammatory or infectious diseases – Crohn’s, gastroenteritis

2. FB – Trauma, swallowed item, tumor (obstruction)
3. Genetic factor – Cystic fibrosis

Question 2

Etiology

Answer 2

Blockage resulting in inflammation, increased pressure, restrictive blood flow, and RLQ abdominal pain/tenderness

If not removed = Bacteria and inflammation expands; abdominal wall stretched leading to perforation (bacteria and fluid released into abdominal cavity) and peritonitis

**Peritonitis can occur within 48-72 hrs. of first S/S

Question 3

Clinical manifestation

Answer 3

CM of appendicitis:
1. Periumbicular pain

2. Followed by: Anorexia, N/V/
3. Pain is persistent – shifts to right lower quad pain; coughing/sneezing/deep inhalation worsens pain, and pt prefers to lie still with right leg flexed
4. May have low grade fever

Question 4

Diagnostics

Answer 4

Tests:
1. Elevated WBC count

2. Urinalysis (to r/o GU conditions)
3. CT scan or sonogram to confirm diagnosis – look for obstructions and inflammation in RLQ

Question 5

Medical management

Answer 5

1. Surgical removal of appendix

2. If ruptured, antibiotics and IVF are given 6-8 hrs. PRIOR to appendectomy to prevent dehydration and sepsis

Question 6

Nursing management

Answer 6

PRE-OP:

1. I&Os
2. Keep pt NPO
3. Pain relief
4. Hydration – IVF
5. VS

POST-OP:

1. GI status – bowel sounds
2. Hydration – IVF and liquids once BS return
3. Pain relief
4. VS
5. Ambulation

**Prevent complications – infections