Appendectomy

Reported by: Reblando, Henna R. Cruz, John Rouke

Appendix
A small, fingerlike appendage about 10cm(4in) long that is attached to the cecum just below the ileocecal valve. Fills with food and empties regularly into the cecum. Because it empties inefficiently and its lumen is small, the appendix is prone to obstruction and particularly vulnerable to infection (Apppendicitis).

The Appendix

Appendicitis
The most common cause of acute surgical abdomen in US., is the most common reason for emergency surgery. Although it can occurs between the ages of 10 and 30 years. (NIH, 2007).

Pathophysiology

Clinical manifestation
Vague epigastric or periumbilical pain Low-grade fever Nausea and vomiting Loss of appetite Local tenderness Constipation or diarrhea Pain on defecation Pain in urination

Rovsings sign
Palpation of left iliac region Displacement of colonic gas and small bowel towards inflamed appendix Pain on right iliac region

Blumberg sign:
Rebound tenderness at Mc Burneys point

Psoas (Copes psoas) sign

Pain in attempt to extend the hip flexed due to irritation of psoas major in retrocecal appendicitis)

Obturator (Copes obturator) sign:

Flexion and medial rotation at hip produces pain due to irritation of obturator muscle in pelvic appendicitis.

 Aarons sign: Pain or pressure in epigastrium or anterior chest with persistent firm pressure applied to McBurneys point. Cough tenderness: Differentiates from right sided ureteric colic. Rigidity and Guarding in Right Iliac Fossa (RIF) Rectal examination: Tenderness in right rectal wall

Assessment and diagnostic findings

CBC Abdominal X-ray films Ultrasound studies CT scans Laparoscopy

Appendectomy
Surgical removal of the appendix. Is performed as soon as possible to decrease the risk of perforation. It may be performed using general or spinal anesthesia with a low abdominal incision (Laparotomy) or by laparoscopy. Both Laparotomy and laparoscopy are safe and effective in the treatment of appendicitis with perforation. Recovery after laparoscopic surgery is generally quicker. Consequently, laparoscopic appendectomy is more common.

 When perforation of the appendix occurs, an abscess may be formed. If this occurs, the patient may be initially treated with antibiotics, and the surgeon may place a drain in the abscess. After abscess is drained and there is no further evidence of infection, an appendectomy is then typically performed.

Preoperative Management
All diagnostic tests and procedures are explained to promote cooperation and relaxation. The patient is prepared for the type of surgical procedures as well as the post operative care. Measures to prevent postoperative complication are taught, including coughing, turning, and deep breathing using splint at the incision site. I.V fluids or total parenteral nutrition before surgery maybe ordered to improved fluid and electrolyte balance and nutritional status.

 Intake and output is monitored. Preoperative laboratory are obtained. Bowel cleansing will be initiated 1 to 2 days before surgery for better visualization. Antibiotics are ordered to decrease the bacterial growth in the colon. Patient may not have anything by mouth after midnight the night before surgery. Medication may be withheld, if ordered. This will keep the GI tract clear.

Intraoperative Nursing Care

Position the patient on the OR table Skin preparation Induction of anesthesia Procedures done aseptically Closing of the incision Dressing of the site

Post Operative Management And Nursing Management And Nursing Care

Monitor vital signs for sign of infection and shock such as fever, hypotension and tachycardia. Monitor I and O for sign of imbalance, dehydration, and shock. Assess abdomen for increased pain, distention, rigidity, and rebound tenderness because these may indicate postoperative complications. Evaluate dressing and incision. Evaluate the passing of flatus or feces.

 Monitor for nausea and vomiting. Laboratory values are monitored and patient is evaluated for sign and symptoms of electrolyte imbalances. Wound drains, I.V, and all other catheter are monitored and evaluated for signs of infections. Turning , coughing, deep breathing, and incentive spirometry are performed every 2hours. Diet is advanced as ordered. Administration of medications as ordered

 Patient Education and Health Maintenance Instruct patient to avoid heavy lifting for 4 to6 weeks after surgery. Instruct patient to report symptoms of anorexia, nausea, vomiting, fever, abdominal pain, incisional redness and drainage postoperatively