Appendicitis

The nurse is evaluating teaching provided to a client with chronic appendicitis. Which observation indicates that teaching has been​ effective?

Client eats fruit with breakfast and a salad for lunch Chronic appendicitis has periods of exacerbation. Ingesting foods with high fiber​ content, such as fresh fruits and​ vegetables, can help to decrease the incidence of fecaliths and subsequent bouts of acute appendicitis.​ Exercise, sleep, and social activities will not help reduce the risk of developing acute appendicitis.

During a physical​ assessment, the nurse becomes concerned that​ 75-year-old Hattie Jackson is experiencing acute appendicitis. Which assessment finding supports this​ diagnosis?

Confusion The leading manifestation of acute appendicitis in the older adult is confusion. Hyperactive bowel sounds are not a manifestation of acute appendicitis. Appendicitis is not associated with a palpable mass. Appendicitis is associated with an increase in abdominal pain that occurs when the right hip is either extended or internally rotated.

During a physical​ assessment, the nurse becomes concerned that​ 75-year-old Hattie Jackson is experiencing acute appendicitis. Which assessment finding supports this​ diagnosis?

Confusion: The leading manifestation of acute appendicitis in the older adult is confusion.

Why is a heating pad not applied to the abdomen for acute appendicitis?

Encouraged perforation. heat should not be applied to the abdomen since this increases circulation to the appendix and could cause perforation.

The nurse is caring for a client is admitted for a burst appendix. Which information is appropriate for the nurse to provide to this​ client? 1. a laparotomy will be performed 2. Antibiotic medication will be provided before and after the surgery 3. IV fluids will be provided 4. Pain meds will be provided after surgery

For a burst​ 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 burst.

The nurse is identifying goals of care with a client seeking treatment for appendicitis. Which outcomes are appropriate for the nurse to include in the plan of​ care? 1. Abdominal pain will be relieved with pain meds 2. The abdominal wound will heal without infection 3. Questions about surgical procedure will be maintained 4. Fluid and electrolyte balance will be maintained.

Goals of care for a client with appendicitis should focus on treatment approaches and the​ client's response. For​ appendicitis, surgery will most likely be​ performed, so goals should focus on answering questions about the surgical​ procedure, healing of the wound without​ infection, maintaining fluid and electrolyte​ balance, and relieving abdominal pain with medication. Perfusion status is not a priority problem for the client with appendicitis.

pharmacologic therapy in adjunct to surgery.

IV fluids: administered before therapy, they help maintain or restore vascular volume and prevent electrolyte imbalance antibiotics: third generation cephalosporins such as cefobid administered b4 surgery to prevent infection with gram negative bacteria. antibiotic therapy continues during surgery and for 48 hrs postop analgesics: Pain meds is not used before surgery bc it can mask a sudden disappearance of pain that indicates rupture of the appendix

A​ 16-year-old female client is brought to the emergency department experiencing severe right lower quadrant abdominal pain. In addition to​ appendicitis, which other health problems will the nurse also assess for during the​ examination? 1. Ectopic Pregnancy 2. Mittelschmerz (one sided, lower abdominal pain associated with ovulation) 3. Pelvic Inflammatory disease

In adolescent and young adult​ females, the symptoms of appendicitis must be differentiated from the pain of ovulation or​ mittelschmerz, possible ruptured ectopic​ pregnancy, and pelvic inflammatory disease. A fecalith is one cause for appendicitis. A kidney stone will not cause severe right lower quadrant abdominal pain.

what can occur in the pregnant client?

In the pregnant client, periumbilical or right subcostal pain can occur bc the appendix is displaced by the expanding uterus

The nurse is evaluating a client recovering at home after an emergency appendectomy. Which observations indicate that​ self-care has been​ effective? 1. client plans to recover at home until cleared by the surgeon 2. Client performs abdominal wound care appropriately 3. Client used a pillow to splint incision before coughing

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 clinical manifestation is expected with acute appendicitis?

Rebound tenderness: one manifestation of acute appendicitis is localized and rebound tenderness of McBurney's point upon palpation (high fever=manifestation of a perforated appendix. Ambulation increases pain in appendicitis)

During an​ assessment, the nurse becomes concerned that a client is experiencing early signs of acute appendicitis. Which assessment finding causes this​ concern?

Right lower quadrant abdominal pain aggravated by coughing The first manifestation of acute appendicitis is​ continuous, mild, generalized pain or upper abdominal pain. The pain eventually intensifies and localizes in the right lower abdominal quadrant. The pain is aggravated by​ moving, walking, or coughing.​ Mid-epigastric, left​ lower, or​ mid-lower quadrant abdominal pain is not associated with acute appendicitis.

While caring for a client recovering from an​ appendectomy, the nurse monitors urine​ output, intravenous fluid​ intake, and the amount of nasogastric drainage. Which nursing diagnosis is the nurse using to guide this client​'s ​care?

Risk for deficient fluid volume The interventions are all focused on measuring or monitoring fluid balance. The diagnosis most likely being used to guide this​ client's care is an increased risk for inadequate fluid balance. The​ nurse's actions are not addressing the risk for​ infection, abdominal​ pain, or perfusion and oxygenation.

A client telephones the health clinic with complaints of vague abdominal pain. The client has not been able to eat for a day and is nauseated. What advice should the nurse provide to this​ client?

Seek immediate medical attention Manifestations of appendicitis begin with vague abdominal pain. Nausea and anorexia are additional manifestations. If medical attention is not​ provided, gangrene can develop within 24 to 36 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.

The nurse identifies the potential for impaired gas exchange as a potential problem for​ 68-year-old Jorge​ Dominiquez, who is recovering from an appendectomy. Which intervention should the nurse select to support this​ client's oxygenation​ needs?

Splinting the incision when coughing For the client with potential for impaired gas​ exchange, the intervention of splinting the incision when coughing would be appropriate. Providing pain medication would be appropriate to address the​ client's level of pain. Assessing bowel sounds before changing the dressing would be appropriate to determine the onset of postoperative complications. Replacing nasogastric drainage with intravenous fluids will help maintain the​ client's fluid balance.

The nurse identifies the potential for impaired gas exchange as a potential problem for​ 68-year-old Jorge​ Dominiquez, who is recovering from an appendectomy. Which intervention should the nurse select to support this​ client's oxygenation​ needs?

Splinting the incision when coughing: for the client with potential impaired gas exchange, the intervention of splinting the incision when coughing would be appropriate.

Perforated

The appendix has ruptured, and the peritoneal cavity is contaminated with Gastrointestinal contents

in adolescent and young adult females what must be ruled out?

The symptoms of appendicitis must be differentiated form the pain of ovulation (mittelschmerz) possible ruptured ectopic pregnancy, and Pelvic inflammatory disease

what will the white blood cell count look like in appendicitis?

The total white blood cell count will be elevated!! with an increase in immature white blood cells.

The nurse is preparing to conduct a physical examination on a client experiencing vague abdominal pain. What should the nurse include in this​ assessment? 1. Presence of abdominal pain on palpation 2. Contour of the abdomen 3. Characteristics of bowel sounds 4. Current body temperature

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.

when is laparotomy used?

When the appendix has ruptured!!

most effective test to diagnose acute appendicitis?

abdominal ultrasound. this test reduces the incidence of exploratory surgery and improves the dx of appendicitis.

why is appendicitis a medical emergency?

bc the appendix can perforate within 24 hrs. -rapid diagnosis and treatment are imperative

first manifestation of acute appendicitis

continous, milk, generalized pain or upper abdominal pain. The pain in intensifies over the next 4 hours and localizes in the right lower abdominal quadrant. *pain is aggravated by moving, walking, or coughing

how man you reduce the risk of developing inflammation of the appendix?

eating a healthy diet can help to reduce the risk of developing inflammation of the appendix. Ingesting foods with high fiber content, such as fresh fruits and veggies, can help to decrease the incidence of fecaliths and subsequent appendicitis.

peritonitis

inflammation and bacterial infection of the entire abdominal area. When perforation (rupture) of the appendix occurs. The contents of the GI tract spill into the peritoneal space of the abdomen.

leading manifestation of acute appendicitis in the older adult:

is confusion! -almost half of older clients with the disorder are afebrile, and rebound tenderness or involuntary guarding is absent.

complications with acute appendicitis

perforation, peritonitis, and abscess formation.

appendectomy

surgical removal of the appendix. treatment of choice for acute appendicitis. either laparoscopic appendectomy or laparotomy. ff

Gangrenous

the appendix has areas of tissue necrosis and microscopic perforations

Simple appendicitis

the appendix is inflamed but intact

manifestations in the older client....

the pain and local tenderness of acute appendicitis are not as strong, and this can delay diagnosis. the course of the inflammation is more virulent in these clients and can increase the risk of mortality

appendicitis

when the appendix is obstructed, the appendix becomes distended with fluid secreted from its mucosa. This excess fluid causes an increase in pressure and impairs blood flow to the appendix. This causes inflammation, edema ulceration and infection

The mother of​ 7-year-old Peyton Henderson is upset because the child has not been given any medication for abdominal pain caused by acute appendicitis. Which explanation about the administration of pain medication is most​ appropriate?

​"Pain medication will mask the change in pain if the appendix​ ruptures." In​ appendicitis, pain medication is not used before surgery because a sudden disappearance of pain indicates that the appendix has ruptured. The pain is real and does need to be​ treated, but it cannot be treated prior to surgery. The pain is not being caused by the child moving the legs. There are many analgesics available to help reduce the pain of appendicitis.

An older client with a ruptured appendix and peritonitis wants to know why the abdomen is swollen. Which explanation by the nurse is the most​ appropriate?

​"The contents of the appendix are causing inflammation of the abdominal​ cavity." When the appendix​ bursts, all of the infected contents of the appendix spread into the abdominal cavity. These contents cause inflammation and infection. The​ client's abdomen is not swelling because of chronic constipation. The nurse does not need to ask the physician to explain the health problem to the client. Fluids that the client is ingesting are not leaking into the abdominal cavity.

The mother of​ 7-year-old Peyton Henderson is upset because the child has not been given any medication for abdominal pain caused by acute appendicitis. Which explanation about the administration of pain medication is most​ appropriate?

"pain medication will mask the change in pain if the appendix ruptures." IN appendicitis, pain medication is NOT used before surgery bc a sudden disappearance of pain indicates that the appendix has ruptured

manifestations of appendicitis in infants:

-listlessness -inconsolability -vomiting -distended abdomen Rare in infants, may not be considered immediately, increases the risk of rupture and subsequent death

additional manifestations of appendicitis

-localized and rebound tenderness of MCBurney's point upon palpation -Increase in pain with extension or internal rotation of the right hip -Low grade fever -Anorexia -Nausea -Vomiting

Which therapies are used to treat peritonitis after a ruptured appendix?

1. Fluid resuscitation 2. Antibiotics 3. Surgery (low-fat, high calorie diet and passive range of motion are not therapies used to treat peritonitis after a ruptured appendix)

goals of pharmacologic therapy

1. Maintain fluid balance 2. Prevent infection 3. Control pain

nursing interventions are aimed at

1. Promoting respirations 2. Maintaining fluid balance 3. Preventing infection 4. managing pain 5. supporting psychological well-being 6. teaching self care prior to discharge

Appropriate nursing diagnoses are appropriate for acute appendicitis?

1. Risk for increased pain 2. Altered fluid balance 3. Risk for postoperative infection (nutritional status and change in blood flow are not nursing diagnoses appropriate for the client with appendicitis)

How is appendicitis classified?

1. Simple: the appendix is inflamed 2. Gangrenous: these are areas of necrotic tissue and small perforations that may be infected 3. Perforated: the appendix has ruptured.

Which risk factors contribute to the development of appendicitis?

1. adolescent male 2. low fiber diet 3. High carb diet

2 addition health problems can occur with appendicitis:

1. peritonitis: the appendix ruptures, causing bowel contents to leak into the abdominal cavity. client will demonstrate a high fever, acute severe abdominal pain, abdominal distention. client at risk for death 2. Chronic appendicitis: client experiences chronic, recurrent abdominal pain that occurs over several months

what are advantages of a laparoscopic appendectomy?

1. shorter hospitlaziton 2. Fewer complications (does not reduce postoperative pain. The use of IV fluids is not impacted by surgical approach used. wound irrigation is not needed)

what home care teaching is needed when surgery is not performed for acute appendicitis?

1. teaching the client about resuming a nutritious diet as tolerated 2. Recognizing the signs and symptoms of infection 3. When to seek treatment

A client with severe right lower quadrant abdominal pain says that the pain has suddenly stopped. Which nursing interventions are appropriate for this​ client? 1. Anticipate IV fluid administration 2. Notify the physician 3. Expect orders for IV antibiotics 4. Prepare the client for surgery

A sudden reduction in abdominal pain in appendicitis could indicate that the appendix has ruptured. The nurse needs to anticipate care for a ruptured appendix and potential peritonitis by notifying the​ physician, preparing the client for surgery to remove the​ appendix, expecting intravenous antibiotics to be​ prescribed, and expect intravenous fluids to be prescribed for fluid resuscitation.

which test is used to diagnose acute appendicitis?

Abdominal Ultrasound: the most effective test to diagnose appendicitis is an abdominal ultrasound.

The results of an abdominal ultrasound were inconclusive for a client experiencing vague right lower quadrant abdominal pain. Which diagnostic test will the nurse prepare the client for at this​ time?

Abdominal​ x-rays The abdominal ultrasound is the diagnostic test of choice for appendicitis. Since the results were​ inconclusive, an additional test to either confirm or rule out appendicitis would be abdominal​ x-rays. A myelogram is used for a neurologic health problem. Paracentesis is appropriate if fluid or ascites is present in the abdominal cavity. An upper gastrointestinal study is appropriate if the client was experiencing abdominal pain in the upper abdominal regions.