Appendicits Flashcards
Appendix
Finger-like appendage
10 cm ( 4 inches) long,
just below ileocecal
valve
Fills with food and
empties into cecum but
prone to obstructionvulnerable to infections
What population is at risk
In Canada, appendicitis has
been the leading digestive
disease resulting in
hospitalization; surgery is
necessary
More common between ages
10- 30 but can occur in any
age
Causes of appendix infection
kinking or occlusion by hard mass of stool
(fecalith), tumor or foreign body
major complication of appendicitis
perforation of the appendix, which can
lead to peritonitis, abscess formation, or
portal pylephlebitis (inflamed thrombus
in portal vein)
Clinical Manifestations
Vague epigastric or periumbilical
pain progressing to right lower
quadrant; dull, poorly localized to
sharp, discrete & well localized
Local tenderness at Mc Burney’s
Point in up to 50% of cases when
pressure applied
Is usually accompanied by a low grade fever and nausea and
sometimes by vomiting and/or
constipation
Rebound tenderness – worsening of
pain when pressure released may
be present
Psoas sign
pain is
elicited in the RLQ when
the patient raises their
leg against resistance
Obturator sign
pain
elicited in RLQ when
patient lies supine and
right leg is lifted and
rotated internally
Rosving sign
is felt in
the RLQ when deep
palpation is applied to
the LLQ – pain worsens
when pressure is
removed
Mc Burney’s Point
Classic sign of appendicitis in which pain is halfway between umbilicus and right iliac crest
Clinical Manifestations of Ruptured Appendix
pain more diffuse
Abdominal distention
Constipation may occur with appendicitis,
Diagnostic tests to do
CBC- Elevated WBC’s neutrophils elevated
Abdominal X-ray, ultrasound and CT may reveal right
lower quadrant density or localized distention of bowel
Diagnostic laparoscopy may also be done
Emergency Management of
Appendicitis (pre to post op)
Make patient NPO
IV hydration with an isotonic solution
Pain management – (i.e. IV morphine)
Prepare for surgery – consent, peri-operative teaching
Post-op complications, activity restrictions
Early ambulation
Bowel management – stool softeners
Incision care – signs of infection
Deep breathing and coughing, frequent turning to prevent
pulmonary complications
Prophylactic antibiotics
signs of Perforation, post-op (when is perforation most likely to occur?)
Perforation generally occurs 24 hours
after onset of pain; symptoms- fever of
37.7 C or greater, toxic appearance,
continued abdominal pain or tenderness increased HR and RR can be sign its progressing to peritonitis
Perforation can lead to peritonitis,
abscess or portal pylephlebitis (septic
thrombosis)
Gerontological considerations
Uncommon
in older populations but if occurs
symptoms may vary greatly; pain may be
absent or minimal; fever and leukocytosis
may be absent; symptoms may be vague
suggesting bowel obstruction;
Abscesses Nursing interventions
- Administer and monitor antibiotics as prescribed
- Evaluate for anorexia, chills, fever, diaphoresis (vital signs)
- Pelvic abscess: Observe for diarrhea- may indicate pelvic abscess
and prepare patient for rectal exam and surgical procedure - Subprhenic (under diaphragm): prepare patient x-ray, surgery
Peritonitis Nursing interventions
- Monitor for: abdominal tenderness, rigidity; fever, vomiting &
tachycardia - Manage constant nasogastric suction as prescribed
- Manage dehydration as prescribed
Ileus (paralytic & mechanical) Nursing interventions
- Assess for bowel sounds
- Manage nasogastric suction
- Replace fluids and electrolytes with IV fluids as prescribed
- Prepare for possible surgery if mechanical ileus is established
Post Operative interventions
Position in high Fowler’s to reduce tension on incision
Manage pain- opiates
Fluids, food as tolerated when bowel sounds return on
day of surgery
If peritonitis possible:
Drain left in place
May be hospitalized for several days- monitor for intestinal
obstruction or secondary hemorrhage; monitor wbc, vital
signs
Discharge: Home care- patient or family taught incisional
care, dressing changes, irrigations as prescribed and/or
home care nurse
discharge
same day if T ok, no undue surgical discomfort and
appendectomy was uncomplicated
Follow-up appointment 5- 7 days for suture removal
Incision care guidelines reviewed
No heavy lifting but can resume usually activities within 2-
4 weeks
Should you give laxatives to someone with a suspected ruptured appendix?
Laxative may result in perforation of inflamed appendix;
generally, laxatives, or cathartics should not be given to
person with fever, nausea and abdominal pain
Considerations for females with suspected appendicitis
Pregnancy test for women of childbearing age to rule
out ectopic pregnancy before doing x-ray
Should you apply heat to help with pain?
Local application of heat should never be used because it may cause the
appendix to rupture.
