Chapter 24: Appendicitis (Children) Flashcards
Appendicitis
inflammation of the appendix (small sac-like structure at the end of the cecum
-requires abdominal surgery
What happens in appendicitis
the lumen of the appendix becomes obstructed with fecal matter, lymphoid tissue, tumor, parasite, foreign body, or inspissated (thickened) cystic fibrosis secretions, which cause the appendix to become distended and subject to ischemia and necrosis
What are the characteristic symptoms caused by?
the inflammation around the infected appendix with approximately a “36 to 72 hour window from the onset of pain to the rupture of the gangrenous appendix”
-rupture usually occurs within 48 hours of the onset of symptoms
When is this likely to occur?
increases with age
- average occurrence between 6 and 10 years of age
- slightly higher in boys
- perforation twice as likely for children younger than 5
Signs and Symptoms
> earliest symptoms: periumbilical pain (pain around umbilicus); often wakens child peaking at 4-hour intervals; periumbilical pain subsides and then is followed by the classic sign of right lower quadrant pain
additional symptoms:
-vomiting generally follows periumbilical pain
-anorexia
-stools described as low in volume and mucus-like, diarrhea is atypical (uncommon)
-constipation
-high fever may be associated with perforation; otherwise afebrile or have a low fever
When is perforation suspected?
when abdominal pain is suddenly relieved without intervention
-physician is notified immediately; child needs immediate attention
Diagnosis
experiences a progression of symptoms with no single test providing overall confirmation of diagnosis
- laboratory findings: elevated WBC count; does not distinguish simple appendicitis from perforated appendicitis; some may have a normal WBC with appendicitis
- abdominal radiograph: may reveal fecal matter or some other obstruction
- ultrasound and CT may help differentiate abdominal pain from other causes
Appendicitis Physical Examination: Rebound Tenderness
- presence of involuntary guarding
- rebound tenderness with pain over McBurney’s point which is located 1.5-2 inches from the right anterior superior iliac crest on a line toward the umbilicus
Appendicitis Physical Examination: Heel-drop jarring test
- stands on toes for 15 seconds, then drops on heels
- inability to stand straight or climb stairs
- winces when getting off examination table
Appendicitis Physical Examination: Psoas sign
abdominal pain with right hip flexion against resistance
Appendicitis Physical Examination: Obturator sign
pain on passive internal rotation of the flexed right thigh
Appendicitis Physical Examination: Rovsing’s sign
deep pressure in lower left abdominal quadrant elicits pain with a sudden release
Prevention
surgical condition that cannot be prevented
Nursing Care after Appendectomy
- monitoring intake and output
- wound care
- pain control
- NPO for 24 hours or until peristalsis returns
- most discharged home in 2 to 3 days
- if procedure performed by laparoscopic (abdominal exploration) with an endoscope, child may remain in hospital overnight or be discharged same day of surgery
- if perforation occurred, drains may protrude from the incision or the wound and remain open to prevent infection and allow healing
- in the case of a perforated appendix, IV antibiotics given for 7 to 14 days
- child remains NPO with a NG tube in place until bowel function returns
Surgical Care
treatment is surgical; appendectomy is curative if performed before perforation
-if perforation occurs, a course of postoperative antibiotics is needed
