Appendicitis
S/S of Appendicitis
-classical abdomen pain starts first, them nausea and vomiting
Complications of Appendicitis (monitor for)
-fever -tachycardia -dehydration -nausea/vomiting -rebound tenderness -hiccups -distended/board-like abdomen
Postoperative action for Appendicitis
-give opioid analgesia (morphine) -monitor IV antibiotics -monitor NG tube drainage (peritoniti) -monitor surgical drain (perforation/abscess)
Appendicitis
-inflammation of appendix (small projection of the cecum)
Preoperative action for Appendicitis
-maintain NPO -monitor IV fluids -encourage semi-fowlers position -avoid laxatives/enemas -avoid application of heat
Risk factors of Appendicitis
-most common seem in people btw age 10-30 -rare in older adults
Complications of Appendicitis
-peritonitis
Sudden relief of preoperative pain may signal rupture of the distended and edematous appendix. Patients pain provides important clues about the diagnosis and possible complications such as rupture of the appendix or peritonitis. Asses patient 30m after giving pain medications
Acute pain for Appendicitis.
Appendicitis in a pregnant woman is a complex problem. Which statement is true based on the given premise? A. Appendicitis is the most common surgical presentation in pregnant women. B. Appendicitis does not occur in pregnant women. C. Appendicitis will cause fetal death. D. A pregnant woman will have surgery postpartum.
Answer: A Rationale: Acute appendicitis is the most common surgical presentation in pregnant women. It can be successfully managed by the surgical and obstetrical teams. A recent study has found that appendicitis during pregnancy can be managed successfully without any dangerous fetal outcomes.
The nurse is caring for a client admitted for a ruptured appendix. Which information should the nurse expect to provide to this client? (Select all that apply.) A. A laparotomy will be performed. B. Intravenous fluids will be provided. C. Antibiotic medication will be provided before and after the surgery. D. Pain medication will be provided after the surgery. E. A laparoscopic appendectomy will be performed.
Answer: A, B, C, D Rationale: For a ruptured appendix, a laparotomy will be performed. The client will receive antibiotics before and after the surgery to prevent the development of infection from fecal contents, which have spilled into the abdominal cavity. Intravenous fluids will be provided to maintain fluid and electrolyte balance. Pain medication will be provided after the surgery. A laparoscopic appendectomy is performed for clients whose appendix has not ruptured.
The nurse is providing discharge teaching to a client who is recovering from an uncomplicated appendectomy. Which information should the nurse include? (Select all that apply.) A. Caring for the wound B. Recognizing manifestations of infection C. Increasing physical activity D. Notifying the healthcare provider with changes E. Avoiding nonsteroidal anti-inflammatory drugs (NSAID)
Answer: A, B, C, D Rationale: The client with uncomplicated appendectomy is often discharged home the day of the surgery or the day after. Postoperative teaching includes wound care, including hand hygiene and dressing changes as indicated; to report to the healthcare provider fever, increased abdominal pain, swelling, redness, drainage, bleeding, or warmth of the operative site; activity limitations (e.g., lifting); and return to work if appropriate. The client can take NSAIDs for pain.
A teenage girl is being assessed for the possibility of appendicitis. Which other condition should the nurse consider? (Select all that apply.) A. Pelvic inflammatory disease B. Ovulation C. Menstruation D. Urinary tract infection E. Ruptured ectopic pregnancy
Answer: A, B, E Rationale: In adolescent and young women, symptoms must be differentiated from those associated with ovulation, ruptured ectopic pregnancy and pelvic inflammatory disease. Although a urinary tract infection may cause abdominal pain, it typically does not present in the same way as appendicitis. Menstruation does not have the same symptoms as appendicitis.
For which collaborative therapy for peritonitis following a ruptured appendix should the nurse prepare the client? (Select all that apply.) A. Antibiotics B. A low-fat, high-calorie diet C. Passive range of motion D. Fluid resuscitation E. Surgery
Answer: A, D, E Rationale: Clinical therapies for the treatment of peritonitis include removal of the ruptured appendix, antibiotics, and fluid resuscitation. A low-fat, high-calorie diet and passive range of motion are not therapies used to treat peritonitis after a ruptured appendix.
A client presents with suspected appendicitis. The nurse should prepare the client for which collaborative intervention? A. Chest x-ray B. Abdominal ultrasound C. Electrolytes D. Complete blood count (CBC)
Answer: B Rationale: Abdominal ultrasound is the most effective test for diagnosing acute appendicitis. Electrolyte testing provides information relating to the mineral balance in the body. A CBC would be drawn, but it is not a definitive test to diagnose acute appendicitis. Chest x-rays are not used to diagnose abdominal conditions.
Which statement by a client diagnosed with acute appendicitis leads the nurse to believe the client needs teaching about dietary interventions? A. "I eat raw vegetables for a snack several days per week." B. "I don't like fruits and vegetables." C. "I prefer to have meat with each meal." D. "I eat fruit with breakfast every day."
Answer: B Rationale: Certain dietary habits may reduce the risk of developing acute appendicitis. Eating foods that contain high fiber content, such as fresh fruits and vegetables, decreases the incidence of appendicitis.
For which intervention are African American children with appendicitis less likely to receive in the emergency department? A. IV fluids B. Adequate pain medication C. Postoperative teaching D. Surgical intervention
Answer: B Rationale: African American children are less likely to receive adequate medication in emergency departments for pain during episodes of appendicitis. Nurses should advocate for appropriate pain management for all clients.
Appendicitis almost always results from an obstruction in the appendiceal lumen. Which problem should the nurse identify as the cause of this obstruction? A. Monolith B. Fecalith C. Tonsillolith D. Ptyalith
Answer: B Rationale: The obstruction is often caused by a hard mass of feces (fecalith). Ptyalith is a calculus in the salivary gland. Tonsillolith is a calculus in the tonsil. A monolith is a large stone used in sculpture.
The nurse is evaluating a client recovering at home after an emergency appendectomy. Which observation indicates that self-care has been effective? (Select all that apply.) A. The client snacks on pretzels and club soda during the visit. B. The client plans to recover at home until cleared by the surgeon. C. The client uses a pillow to splint the incision before coughing. D. The client performs abdominal wound care appropriately. E. The client requests a prescription for more pain medication.
Answer: B, C, D Rationale: Observations that indicate that the client is appropriately providing self-care after an appendectomy include using a pillow to splint the incision before coughing, performing wound care appropriately, and planning to recover at home until cleared by the surgeon. Observations that indicate that self-care could improve include the need for more pain medication and ingesting a less-than-nutritious snack.
Which assessment finding leads the nurse to suspect that an older client may have appendicitis? (Select all that apply.) A. Pain migrating from the lower left to the upper right quadrant B. Tenderness when pressing McBurney point C. Confusion D. No abdominal pain E. Internal rotation of the left hip increases pain
Answer: B, C, E Rationale: Fewer than 30% of older adults who have appendicitis present with classic symptoms. Classic signs of acute appendicitis are pain that is aggravated by moving or walking, rebound tenderness of McBurney point, and extension or internal rotation of the right hip that increases pain and confusion. A little less than half demonstrate no rebound or involuntary guarding. Pain typically migrates down to the lower right quadrant in appendicitis.
A client is admitted with acute appendicitis. Which nursing diagnosis may be appropriate for this client? (Select all that apply.) A. Nutrition, Imbalanced: Less than Body Requirements B. Fluid Volume: Deficit, Risk for C. Tissue Perfusion: Peripheral, Ineffective D. Infection, Risk for E. Pain, Acute
Answer: B, D, E Rationale: A client with acute appendicitis would experience pain at the site. Any patient who has undergone surgery is at risk for fluid depletion and infection of the wound. Nutritional status and change in peripheral perfusion are not nursing problems appropriate for the client with appendicitis.
A client telephones the health clinic with complaints of generalized abdominal pain which is aggravated by moving or walking. The client has not been able to eat for a day and is nauseated. Which advice should the nurse provide to this client? A. "Take a warm shower and apply a heating pad to the abdomen." B. "Rest in bed and drink warm fluids." C. "Seek immediate medical attention." D. "Take an over-the-counter laxative."
Answer: C Rationale: The initial characteristic manifestation of acute appendicitis is continuous, mild, generalized or upper abdominal pain. Over the next 4 hours, the pain intensifies and localizes in the right lower quadrant of the abdomen. Pain associated with appendicitis is aggravated by moving, walking, or coughing. If medical attention is not provided, gangrene can develop within 24dash36 hours. The client should be instructed to seek immediate medical attention. Resting in bed and drinking warm fluids is not going to prevent the appendix from developing gangrene. When appendicitis is suspected, the client should be instructed to avoid laxatives and not to apply heat to the abdomen because heat could encourage the appendix to rupture.
Which clinical manifestation does the nurse expect with acute appendicitis? A. High fever B. Nausea and vomiting C. Rebound tenderness D. Pain relieved with ambulation
Answer: C Rationale: One manifestation of acute appendicitis is localized and rebound tenderness of McBurney point upon palpation. A high fever is a manifestation of a perforated appendix. Nausea and vomiting are generalized symptoms and are not present exclusively with appendicitis. Ambulation increases pain in appendicitis.
A teenage boy presents with suspected appendicitis. The caregiver asks, "Why did my son get this?" Which response by the nurse is the most appropriate? A. "Your son has been eating too much fiber." B. "Your son is eating too many fruits and vegetables." C. "Your son has not been getting enough exercise." D. "Your adolescent son is in a risk group."
Answer: D Rationale: Adolescent boys are at greatest risk for appendicitis. Appendicitis cannot be prevented, but certain dietary habits may reduce the risk of developing this condition. Eating foods that contain high fiber content, such as fresh fruits and vegetables, decreases the incidence of appendicitis.
A client had a laparoscopic appendectomy last night. Which assessment finding should concern the nurse? A. Dry wound B. Adequate fluid intake C. Pain D. Fever
Answer: D Rationale: Fever would be an indication of a possible infection. Postoperative pain is expected. Adequate fluid intake and a dry wound are positive recovery signs.
A client with acute appendicitis asks the nurse, "Why don't you give me a heating pad? I think that will help me with my pain." The nurse's response should be based on which reason? A. It increases the need for fluids. B. It increases the spread of infection. C. It reduces white blood cell count. D. It encourages perforation.
Answer: D Rationale: Heat should not be applied to the abdomen since this increases circulation to the appendix and could cause perforation. It is not true that heat is avoided in acute appendicitis because it increases the need for fluids, increases the spread of infection, or reduces white blood cell count.
Which condition prompts the nurse to recommend a clear liquid diet to a postappendectomy client? A. Client denies any nausea B. Client no longer reports pain C. Client is afebrile D. Client's bowel sounds have returned
Answer: D Rationale: Once bowel sounds return, a client can begin taking clear fluids. The postoperative client is expected to be afebrile. Pain will subside as healing continues. Nausea would be subsided for the client to resume a PO diet, but it is the presence of bowel sounds that would indicate the gastrointestinal tract's ability to handle digestion.
Which condition may occur if the client does not seek medication attention for acute appendicitis within 24dash36 hours? (Select all that apply.) A. Seizure B. Constipation C. Nausea D. Peritonitis E. Perforation
Answer: D, E Rationale: If treatment is not initiated, tissue necrosis and gangrene result within 24-36 hours, leading to perforation (rupture). Perforation allows the contents of the gastrointestinal (GI) tract to flow into the peritoneal space of the abdomen, resulting in peritonitis. Appendicitis does not cause seizures, nausea, or constipation.
The nurse is preparing to conduct a physical examination on a client diagnosed with appendicitis. Which intervention should the nurse include in this assessment? (Select all that apply.) A. Characteristics of bowel sounds B. Presence of abdominal pain on palpation C. Presence of blood in the stool D. Contour of the abdomen E. Current body temperature
Answers: A, B, D, E Rationale: When conducting the physical assessment on a client with appendicitis, the nurse should include abdominal contour, current body temperature, characteristics of bowel sounds, and whether the client is experiencing tenderness to light palpation. Blood in the stool is not an area to assess in the client with appendicitis.
Inflammation of the vermiform appendix is a common cause of acute abdominal pain. Most common reason for emergency abdominal surgery.
Appendicitis
Perforation, peritonitis, and abscess are possible complications of acute appendicitis. Perforation is manifested by increased pain and a fever. An inflamed appendix can perforate within 24 hours so rapid diagnosis and treatment are important.
Complications.
Abdominal ultrasound is the most effective, Abdominal x-rays, IV pyelogram, urinalysis and a pelvic examination. In addition a WBC count with differential is obtained.
Diagnosis
Higher fiber intake is common, encouraging a diet high in fiber and low in animal fats.
Health Promotion.
24 to 48 hours. Which can lead to tissue perforation leading to bacterial peritonitis.
How quickly can tissue necrosis and gangrene occur?
It falls.
If sepsis is present does BP fall or increase?
Continuous mild or upper abdominal pain is the initial characteristic manifestation of acute appendicitis. During the first 4 hours the pain intensifies and localized in the RLQ of the abdomen. This pain is aggravated by moving, walking and coughing. Extension or internal rotation of the right hip increases the pain. Low grade fever, anorexia, nausea, and vomiting are often present. Pain and local tenderness may be less acute in older adults, delaying the diagnosis.
Manifestations.
Cephalosporin, cefotaxime, ceftazidime. The antibiotic is repeated during surgery and continued for at least 48 hours post op.
Medications.
Cephalosporin, cefotaxime (claforan), ceftazidime (fortaz) ceftriaxone (rocephin)
Meds.
It serves as a reservoir for beneficial intestinal bacteria. Obstruction is most often caused by fecal matter, stones or a foreign body, inflammation, tumor, parasites or edema of the lymphoid tissue. Pressure within the appendix increases cutting blood supply, this leads to ulceration, edema and infection. Within 24 to 36 hours, tissue necrosis and gangrene result leading to perforation if treatment is not initiated.
Pathophysiology.
Increased pain and a high fever.
Perforation is manifested by what symptoms?
peritonitis and perforation.
Pre op complications?
Keep patient NPO, do not administer enemas or laxatives, it could perforate the appendix. No heat should be applied to abdomen. This could increase blood circulation to that area and cause perforation.
Precautions to take for suspected appendicitis?
Assessing patient for signs of a ruptured appendix is the main priority, then beginning antibiotics, prevention of dehydration and maintaining fluids and electrolytes. Managing patients pre-op and post-op issues.
Priorities of Care.
Appendectomy. 1- direct visualization, 2. post op surgery heals faster, 3. post op complications are infrequent, 4. Recovery is faster. Lapartomy- is normally performed if the appendix ruptured.
Surgery.
Tachycardia and rapid shallow breaths may indicate perforation of the appendix with resulting peritonitis. Fever may develop as well, and the blood pressure may fall resulting in sepsis. No heat should be applied to the abdomen, keep patient with suspected appendicitis NPO and do not administer laxatives or enemas. Laxatives or enemas may cause perforation of the appendix. Swelling of the wound, increased abdominal girth or an increase in pain may indicate infection or peritonitis. Maintain intravenous infusion until oral intake is adequate.
Symptoms
With appendicitis the total WBC is 10,000 or 20,000
Total WBC count?
Improper wound care, risk of infection, abscess and possible peritonitis.
Post op complications of an appendectomy?
If the appendix ruptures or perforates the infected contents spill into the abdominal cavity.
What causes peritonitis?
Increasing pain, boardlike abdomen and abdominal distention.
What physical characteristic may indicate a developing peritonitis?
tachycardia, shallow breaths and fever.
What physical manifestations could indicate perforation?
On palpation, localized and rebound tenderness are noted at McBurney's point.
Where do you generally palpate?
McBurney's point
located halfway btw umbilicus and anterior iliac spine
