Appendicitis Symptoms, Examination, Nursing Assessment | NCLEX Review Appendectomy and Peritonitis Flashcards
Inflammation of the appendix
Appendicitis
Connected to the ascending colon
finger-like/worm-like area that comes/protrudes off cecum of ascending colon
Where is the appendix
Plays role in storing good bacteria in GI tract after diarrhea illness - helps maintain healthy gut flora; good bacteria congregate in appendix until after diarrhea clears and once illness gone migrate out repopulate LI so have healthy gut bacteria
Appendix func
Obstruction - big cause; something gets in lumen of appendix
trauma/injury
Causes appendicitis
Most common cause: fecalith: hardened stool - calcified and blocked lumen appendix - nothing out appendix - increased pressure and issues and eventually can rupture - when ruptures can lead to comps
Parasites (worms), foreign body ingested, swollen lymph node in lining of appendix (too enlarged over long-period time - constant battles with infections or Chrons, mononucleosis, gastroenteritis)
Obstruction - big cause; something gets in lumen of appendix
Perforation
Abscess
Peritonitis - not treated can lead to shock/death
Comps of appendicitis
Caused by obstruction by fecalith - blockage in the lumen of appendix leading to increased pressure inside the appendix because inside appendix is mucosal lining and mucosal lining secretes mucos and fluids and that is secreted but have blockage so not going anywhere and stays there; bacteria in appendix multiply; cannot go anywhere - pressure builds - within 48-72hr of appendicitis setting in pt at major risk for perforation - physician needs get in there and treat it - remove it
Results from increased pressure: start get major venous obstruction: causes occlusion blood flow and current blood already there stays stagnant and starts coagulate - when that happens get ischemia to appendix - slowly start dying - walls start getting weak and breaking down; when walls break down from ischemia - spill contents into abdominal cavity: leading to peritonitis - site where ruptured: get abscess: collection pus: WBCs at site - not want to happen
When peritonitis sets in after appendix rupture - can lead to septic, shock, death
Patho of appendicitis
Abdominal pain (start as dull around belly button then radiate down to RLQ where localize)
Point of McBurney’s - where pain most intense on pt; find belly button find where ant superior iliac spine - ⅓ distance between those - most intense pain - abt where appendix is
Poor appetite
Elevated temp
Nausea/vomiting
Desire to be in fetal position (relieve pain over on side laying with knees bent - pain less intense)
Increased WBC (inflammation), inability pass gas/stool - constipated - some have diarrea
eXperience rebound tenderness or abdominal rigidity; pain more intense when let go; abdominal rigidity - involuntary flexion of abdominal muscles
Appendicitis s&s
appendectomy - open surgery or laparoscopic
Most common treatments appendicitis:
Monitor VS: looking for s&s of perforation and peritonits
Monitor pain level
Signs of perforation: relief of pain followed by increased pain; not good thing even if pt thinks so; spilled everything into abdominal cavity
Signs of peritonitis - increased HR, RR, temp; abd distention/bloating (contents spilled into cavity) - not told you about perforation; notify physician immediately
Keep pt NPO
Pain relief (non-pharm - positioning (fetal position helps), ice); monitor pain so no pain meds
No heat, enemas, laxatives - increase chance perforation; can do ice
Preop Nsg care
Monitor VS (esp temp - spiking - risk of infection) and surgical site for infection
Maintain drain per MD order (often present if ruptured appendix) - drain excessive drainage from irrigation used to wash abd cavity (peritonitis) and to remove infection; removed when stops draining; position on R side to help with drainage
Ambulating, using IS, cough/deep breathing, splinting surgical site (prevent blood clots and pneumonia)
Administer IV antibiotics and pain meds per MD order
Maintain NG tube if present to remove stomach fluids and swallowed air…keep NPO until removed
BIG - Monitor BS, want hear sounds, ask if passing gas - GI sys working, need have BM within 2-3 days after surgery
Diet start slow - reintroducing foods with clear (no n&v), then full then to solid food - follow high fiber diet - stool soft so not strain when using bathroom
Laparoscopic surgery - may have shoulder pain for few days - inflated abd with CO2 to push abd wall from internal organs so can see appendix operate; gas leaving can cause shoulder pain
Postop Nsg care
