Appendicitis

The appendix becomes inflamed & edematous as a result of becoming *kinked/ occluded by..*

*1) Fecalith:* • Hardened mass of stool. *2) Lymphoid hyperplasia:* • secondary to inflammation / infection *3) Foreign bodies or tumors:* • ex: fruit seeds

Perforation occurs within...

*6-24 hours after onset of pain:* • Leads to peritonitis

Medical management:

*Antibiotics & IV fluids are given until surgery is preformed:* • Prevents sepsis, fluid & electrolyte imbalance, dehydration.

Appendicitis in older adults:

*DIAGNOSIS & TREATMENT CAN BE DELAYED:* • Uncommon • *Pain may be absent* or minimal. • *Fever & leukocytosis* may be absent.

After surgery, what position is the pt put in?

*HIGH-FOWLER'S:* • ↓ pain • ↓ tension on incision. • Promotes thoracic expansion (↓ atelectasis).

Lab assessments of appendicitis:

*Leukocytosis* • 10-18 with a shift to the left (immature WBC). • X-ray • Ultrasound • CT scan

Rovsing sign:

*pain in the RLQ* when the LLQ is palpated (indicative of appendicitis)

Appendectomy is...

...the *most common cause* of emergency abdominal surgery.

Once obstructed, the appendix becomes...

Ischemic → bacterial overgrowth occurs → gangrene *or* perforation

Food is tolerated on the day of surgery if...

bowel sounds are present.

Leukocytosis does not...

establish diagnosis.

The older pt may have no symptoms until....

the appendix becomes *gangrenous or perforated.* • ↑ complications • ↑ mortality

When should sutures be removed?

within *1-2 weeks* after surgery.

Appendicitis typically occurs when?

• *10-30 years.* • More common in *males.* • Familial predisposition.

Why is the appendix so prone to *obstruction & infection?*

• *Empties inefficiently* into cecum. • Has a *small lumen.*

In a woman, what may be preformed?

• *Pregnancy test * to rule out an ectopic pregnancy.

What provides the most important assessment?

• History

The pt with suspected appendicitis should NEVER receive...

• Laxatives • Enemas • Heat

Local tenderness may be elicited at _____ ______ when pressure is applied.

• McBurney point

Nursing interventions:

• NPO • IV fluids, antibiotics • Opioid analgesics • Semi-fowler's position • *NGT* if evidence of paralytic ileus.

In general, a *laxative should not be given* when the person has...

• Nausea • Fever • Abdominal pain

Pt may be discharged the day of the surgery if...

• Surgery was *laparoscopic.* • Temp. is normal • No undue discomfort.

Clinical manifestations in 50% of ppl with appendicitis:

• Vague *periumbilical* pain. • Pain progresses to *RLQ.* • N, V • Constipation • Anorexia • Low-grade fever (99 - 100.5°F)

When can normal activity / heavy lifting be resumed?

• Within 2-4 weeks.

No improvement in outcomes, but longer hospital stays when what are used?

• drains

Semi-fowlers position helps to...

• localize drainage in lower abdomen.

Rebound tenderness:

• pain increases when *pressure is removed.*

Sudden pain relief / diffuse pain may indicate...

• rupture of appendix → peritonitis

A urinalysis is usually obtained to rule out...

a UTI

Incentive spirometers should be used...

5-10x per hour.

Appendectomy is preformed...

as soon as possible to avoid perforation.