Appendicitis

Question 1

What are some manifestations of appendicitis

Answer 1

First generalized lower quadrant pain, then the pain radiates to Right Lower Quadrant Pain. The pain is aggravated by moving. Low grade temp. Anorexia. n/v

Question 2

Why is prompt assessment vital with appendicitis

Answer 2

To determine if there has been a perforation

Question 3

When performing the assessment, what questions do you want to ask?

Answer 3

Are you having any pain. What is the onset, duration and progression of your pain? Any alleviating factors? Any n/v? Recent foods/fluids? Any medications taken? Any allergies?

Question 4

What tasks will you perform during an abdominal assessment

Answer 4

VS, assess abdomen, palpate abdomen, auscultate abdomen,

Question 5

What are some peritoneal signs of appendicitis

Answer 5

McBurney’s Point ( Blumberg’s)
Rovsing’s Sign
Psoas Signs

Question 6

What is McBurneys Point

Answer 6

Halfway between iliac crest and umbilicus

rebound tenderness- relief of pain during palpation, pain intensifies when release of pressure

Question 7

What is Rovsing’s sign

Answer 7

Apply pressure to LLQ and quick release results in pain in RLQ

Question 8

What is Psoas Signs

Answer 8

Roll patient on the left side extend right against resistance, pt feels pain in RLQ

Question 9

What is Obturator sign

Answer 9

Flex pt knee to chest and internally rotate, patient feels pain in RLQ

Question 10

What are some signs of appendix perforation

Answer 10

Pain is suddenly gone, elevated T, increased WBC (+20K)

Question 11

What is it called when GI contents are emptied into the abdominal cavitty

Answer 11

peritonitis

Question 12

What are some diagnostic findings of appendicitis

Answer 12

ABD CT, US, X-Ray, UA, Pelvic Exam, CBC with WBC (elevated WBC and bands), hyperactive BS

Question 13

Nursing Care for Appendicitis

Answer 13

Administer IV fluids
Administer ABX (pre-op, peri-op, post-op)
Administer analgesics

Question 14

Why do you stop analgesics before surgery?

Answer 14

To monitor for ruptured appendix

Question 15

What are two kinds of appendix surgery

Answer 15

Laproscopic Appendectomy

Laprotomy

Question 16

Benefits of Lapropscopic Appendectomy

Answer 16

Small incision
Rapid Recovery
Short Stay
Infrequent complications
Direct visualization of appendix

Question 17

What occurs during Laprotomy?

Answer 17

Transverse incision at McBurney’s Point
Appendix is ligated
Removal of stomach contents
Wound Remains open

Question 18

Pre op Care

Answer 18

Insert all tubes
Establish baselines
Establish teaching needs and educate
Develop trusting relationship with TC
NPO status
Remove all jewelry, makeup and prosthetics
Obtain informed consent
Identify and secure all bands
Pt voids before admin pre op med

Question 19

Post Op Care

Answer 19

Monitor VS, LOC, site, pain, I and O, Lab values
Maintain Safety
Report all changes
Perform full assessment and VS q15 mins for first hour, q30 mins for next two hours, q hour for next four hours

Question 20

Post Op wound complications

Answer 20

Hemorrhage, Shock, DVT, PE, pneumonia, asctelacesis

, urinary retention, absence of peristalsis, dehesience, evisceration

Question 21

Nursing Care for dehisence or evisceration

Answer 21

Emergency Surgery, cover with moistened gauze and NS

Question 22

Discharge teaching for ruptured appendix

Answer 22

Longer hospital stay- IV ABX
admin anti-anxiety meds
teach wound care, s/s of infection
activity limitations
pain management

Question 23

Discharge for unruptured appendix

Answer 23

Discharged after BM
Establish nutritious diet plan
Teach s/s of infection