Inflammation Disorders

Question 1

Inflammation of the appendix

Answer 1

Appendicitis

Question 2

What age does the appendicitis often occur?

Answer 2

10 and 20 years of age

Question 3

What is the etiology of appendicitis?

Answer 3

Occlusion of the appendiceal lumen by the fecalith and intramural thickening caused by hypergrowth of the lymphoid tissue

Question 4

Clinical Manifestation of Appendicitis

Answer 4

-periumbilical pain (initial sign)
-anorexia, nausea and vomiting
-persistent and continuous pain

Question 5

Characteristics of persistent and continuous pain in appendicitis

Answer 5

-right lower quadrant
- McBurney Point (halfway between the umbilicus and right iliac rest)

Question 6

Assessment of appendicitis

Answer 6

-Psoas sign
-Obturator sign
- Blumberg sign
- Defense musculaire
- Rovsing sign
- prefer to lie still, occurs with right leg flexed
- low grade fever

Question 7

Complications in appendicitis include:

Answer 7

-peritonitis
-perforation
- abscess

Question 8

A major complication of appendix

Answer 8

Perforation

Question 9

Perforation leads to?

Answer 9

Leads to peritonitis, abscess formation and portal pylephlebitis

Question 10

When does perforation generally occurs?

Answer 10

Generally occurs 24 hours after the onset of pain

Question 11

Diagnosis of Perforation

Answer 11

-complete history & examination
- ct scan and UTZ
- WBC count

Question 12

Pain on passive extension of the right thigh

Answer 12

Psoas Sign

Question 13

Patient lies on the left side

Answer 13

Psoas Sign

Question 14

Examiner extend the right thigh of patient while applying counter resistance to the right hip

Answer 14

Psoas Sign

Question 15

Pain on passive internal rotation of the flexed thigh

Answer 15

Obturator Sign

Question 16

Examiner move the left leg laterally while applying resistance to the lateral side of the knees resulting in internal rotation of the femur

Answer 16

Obturator Sign

Question 17

-Rebound tenderness
-Pain upon removal of pressure rather than application of pressure to the abdomen

Answer 17

Blumberg Sign

Question 18

What happens to the abdominal wall when blumberg sign occur?

Answer 18

Abdominal wall compress slowly and then rapidly increased

Question 19

also known as muscle guarding

Answer 19

Defense Musculaire

Question 20

Denote on the acute abdomen (Painful abdomen)

Answer 20

Defense Musculaire

Question 21

What is defense musculaire?

Answer 21

Spasm of the lensed abdominal muscle to keep underlying tissues from being disturbed

Question 22

What is rovsing sign?

Answer 22

May elicit pain through palpating to the left lower quadrant; this paradoxically can be felt to the right lower quadrant

Question 23

Surgical Management of appendicitis

Answer 23

-Appendectomy
-Ruptured Appendix

Question 24

Surgical removal of the appendix

Answer 24

Appendectomy

Question 25

Performed immediately to decrease risk of perforation

Answer 25

Appendectomy

Question 26

Done if inflammation is localized

Answer 26

Appendectomy

Question 27

Ruptured appendix includes

Answer 27

-Antibiotic Therapy
- Parenteral Nutrition

Question 28

What antibiotic should be given in patients with appendectomy

Answer 28

Metronidazole

Question 29

Metronidazole is given in what?

Answer 29

Parenteral via iv drip

Question 30

What’s the rationale in giving the patient antibiotic therapy?

Answer 30

Prevent sepsis for 6 to 8 hours before appendectomy

Question 31

Nursing Management of Appendicitis or Perforation

Answer 31

-Avoid laxatives and enema (increase peristalsis that may perforate the appendix)
- NPO ( to ensure the stomach is empty if surgery is needed)
- Local application of heat is discouraged

Question 32

Pre-operative nursing care in appendectomy

Answer 32

-high fowler’s position (to reduce tension on the incision and abdominal organs)
- early ambulation is encouraged
- Diet is advance as tolerated
- Resume activities 2 to 3 weeks

Question 33

Results from a localized or generalized inflammation of the peritoneum

Answer 33

Peritonitis

Question 34

This may be acute or chronic

Answer 34

Peritonitis

Question 35

Chemical peritonitis

Answer 35

Ectopic Pregnancy

Question 36

Bacterial Peritonitis

Answer 36

• Ruptured appendix
• Gun shot wounds

Question 37

Primary causes of Peritonitis

Answer 37

-Blood borne organisms
- Genital tract of organisms
- Cirrhosis with ascites
- Gi tract of organisms

Question 38

Secondary causes of peritonitis

Answer 38

-Appendicitis with rupture
-Blunt or penetrating trauma to abdominal organs
- Diverticulitis with rupture
- Pancreatitis
- Ischemic Bowel Disease

Question 39

Clinical Manifestations of Peritonitis

Answer 39

-Tenderness over the involved area (initial sign)
- abdominal pain
- rebound tenderness, muscle rigidity and spasm
- Ascites, fever and abdominal distention

Question 40

Major Signs of irritation in peritonitis

Answer 40

-rebound tenderness
- muscle rigidity
- spasm

Question 41

Diagnostics of Peritonitis

Answer 41

-CBC
- Peritoneal aspiration with fluid analysis
- Ct scan and ultrasound

Question 42

An endoscope is placed through a stab wound in the abdomen to inspect peritoneum

Answer 42

Peritoneoscopy

Question 43

Direct examination of the peritoneum

Answer 43

Peritoneoscopy

Question 44

What is obtained in the peritoneoscopy?

Answer 44

Biopsy specimen

Question 45

Medical Management of Peritonitis

Answer 45

-Antibiotic
- NG suctioning
- Analgesic
- IV fluid administration
- Parenteral nutrition

Question 46

Nursing Management of Peritonitis

Answer 46

-Monitor signs for sepsis, pain and response to analgesics therapy
- Position in knees flexed (to increase comfort)
-Provide rest and quite environment
- NPO and NG Tube is in place (to decrease gastric distention)