APPENDICITIS

DEFINITION
 A condition characterized by
inflammation of the appendix.
 most common cause of acute
inflammation in the right
lower quadrant of the
abdominal cavity.
 prevalent in countries in
which people consume a diet
low in fiber and high in
refined carbohydrates.
 APPENDIX
•The appendix is
located in the lower
quadrant of the
abdomen, or, more
specifically, the right
iliac fossa.

•It is a slender, worm-

shaped pouch,
averaging 5—10cm in
length.
 ETIOLOGY
ETIOLOGY
RACIAL & DIETARY FACTORS:-
 MORE COMMON IN WHITE RACES.
 YOUNG MALES ARE AFFECTED MORE OFTEN
 DIET RICH IN MEAT PRECIPITATES APPENDICITIS
 FAMILIAL TENDENCY

SOCIO-ECONOMIC STATUS
 IT IS COMMON IN MIDDLE CLASS & RICH PEOPLE.

OBSTRUCTION OF THE LUMEN

 A) IN THE LUMEN-INTESTINAL WARM e.g. ROUND
WORM,THREDWORM ETC VEGETABLE,FRUIT SEED,
FECES MATERIAL, BARIUM

 B) IN THE WALL-STRUCTURE, NEOPLASM

 Pathophysiology:
Non-modifiable
•Age: all age groups old
•Gender: male(male- female
=2:1)
•Hereditary: tumor formation in
the opening of the appendix
Modifiable
•Diet: People whose diet is low
in fiber and rich in refined
carbohydrates
•Infections: Gastrointestinal
infections such as Amoebiasis,
Bacterial Gastroenteritis
 Episodes of constipation

Occlusion of appendix by fecalith

Decreased flow/drainage of mucosal secretions

vasoncongestion

Decreased blood supply in the appendix

Decreased O2 supply in the appendix

Appendix starts to be necrotic: bacteria invade the appendix

Disruption of cell membrane of appendix

 Start of Inflammatory Process

Release of Chemical Mediators Activation of the Neutrophils to

Vomiting center in the area
medulla
Histamine, Prostaglandin,
Leukotrienes, Bradykinin Pus Formation
Stimulation Suppression of (phagocytized
Swelling of Appendix of Vagus Sympathetic bacteria and
Nerve GI function dead cells)
Prostaglandin, Bradykinin

N/V
Pain in the RLQ of Anorexia
Abdomen
Risk for
Risk for infection
Acute pain
Deficient (if appendix
Fluid Volume ruptures)
Interleukin-1 Risk for Imbalanced
Nutrition less than
Increased WBC body requirements
 Inflammation of Appendix

Appendectomy

Open Wound Tissue Trauma

Noriceptors of the
Dermis
Disruption of Cell
Membrane

Start of Send Impulse to

Inflammatory CNS
Process

Release of Pain on Surgical Site

Prostaglandin/
Bradykinin
Activity Intolerance
 TO M S
S Y MP
G N S &
SI
Rebound
tenderness
Pain felt upon the release of the pressure
Indicates rebound tenderness
 Guarding
1. Voluntary guarding occurs the
moment the doctor’s hand touches
the abdomen.
2. Involuntary guarding occurs before
the doctor actually makes contact.
Rovsing’s sign
• Pressure to the lower left side of the abdomen.
• Pain felt on the lower right side of the
abdomen upon the release of pressure on the left
side.
Psoas sign
Check for the psoas sign by applying resistance to
the right knee as the patient tries to lift the right
thigh while lying down.
 •A doctor tests for the obturator
sign by asking the patient to lie
down with the right leg bent at
the knee.

•Moving the bent knee left and

right requires flexing the
obturator muscle and will
cause abdominal pain if the
appendix is inflamed.

Obturator sign
Local tenderness
at McBurney’s
point w/
pressure
Others…
Mild Fever
Dry Tongue
Constipation
Nausea and Vomiting

Abdominal Rigidity
 LABS AND
DIAGNOSTICS
Laboratory & Diagnostic Test Result
CBC WBC count reveal moderate
leukocytosis (10,000 to
16,000/mm3) with shift to the left
Ultrasound studies & CT scans May reveal right liver quadrant
density or localized distention of
the bowel.

Abdominal x-ray visualize shadow consistent with

fecalith in appendix; perforation
will reveal free air.
 Acute Pain
Risk for Imbalanced Nutrition: less
than
than body
body requirements
requirements

Risk for infection

Impaired Tissue Integrity

NURSING
Activity Intolerance DIAGNOS
IS
 NURSING
MANAGEMENT
Planning/Implementation
PRE-OPERATIVE MANAGEMENT
NPO diet in preparation for surgery.
An intravenous drip is used to hydrate the patient.
Antibiotics given intravenously such as Cefuroxime
and Metronidazole .
If the stomach is empty (no food in the past six hours)
general anesthesia is usually used.
Otherwise, spinal anesthesia may be used.
 Appendectomy
Appendectomy
 Removal of the appendix.
 Performed as soon as possible to decrease the
risk of perforation.

Two ways performed:

1. Laparotomy
2. Laparoscopy
POST- OPERATIVE MANAGEMENT
 Assist patient to position of comfort such as semi-fowlers with
knees are flexed.
 Restrict activity that may aggravate pain, such as coughing and
ambulation.
 Apply ice bag to abdomen for comfort.
 Advise avoidance of enemas or harsh laxatives; increased
fluids and stool softeners may be used for postoperative
constipation.
 Give narcotic analgesic as ordered and administer oral fluids
when tolerated.
 Monitor frequently for signs and symptoms of worsening
condition, indicating perforation, abscess, or peritonitis
(increasing severity of pain, tenderness, rigidity, distention,
absent bowel sounds, fever, malaise, and tachycardia).
If a drain is left in place
at the area of the
incision, monitor
carefully for signs of
intestinal obstruction,
secondary hemorrhage,
or secondary abscesses
(e.g. fever, tachycardia,
and increased leukocyte
count).
 COMPLICATIONS
COMPLICATIONS
Complication Interventions
PERITONITIS •Observe for abdominal tenderness, fever,
vomiting, abdominal rigidity, and tachycardia.
•Employ constant nasogastric suction
•Correct dehydration
•Admin. Antibiotics as prescribed.

PELVIC ABSCESS •Evaluate for anorexia, chills, fever, and

diaphoresis
•Observe for diarrhea, which may indicate
pelvic abscess
•Prepare pt for rectal exam
•Prepare pt for surgical drainage procedure

SUPHRENIC ABSCESS •Assess pt for chills, fever, diaphoresis

•Prepare for x-ray exam and surgical drainage
of abscess
PARALYTIC ILEUS •Assess bowel sounds
•Replace fluids and electrolytes by IV route
•Employ nasogastric intubation and suction.
 DISCHARGE
DISCHARGE
DISCHARGE- METHOD
M.E.T.H.O.D.

M     
• Antibiotics for infection
• Analgesic agent (morphine) can be given for pain after
the surgery
 DISCHARGE
DISCHARGE
DISCHARGE- METHOD
M.E.T.H.O.D.
E 
Within 12 hrs of surgery you may get up and move around.
You can usually return to normal activities in 2-3 weeks
after laparoscopic surgery.
 DISCHARGE
DISCHARGE
DISCHARGE- METHOD
M.E.T.H.O.D.

T    
• Pretreatment of foods with lactase preparations (e.g.
lactacid drops) before ingestion can reduce symptoms.
• Ingestion of lactase enzyme tablets with the first bite of
food can reduce symptoms.
 DISCHARGE
DISCHARGE
DISCHARGE- METHOD
M.E.T.H.O.D.
H 

   

To care wound perform dressing changes and irrigations as

prescribe

avoid taking laxative

applying heat to abdomen when abdominal pain of unknown
cause is experienced.

Reinforce need for follow-up appointment with the surgeon.

Call your physician for increased pain at the incision site
 DISCHARGE
DISCHARGE
DISCHARGE- METHOD
M.E.T.H.O.D.

O  

 Document bowel sounds and the passing of flatus or bowel
movements (these are signs of the return of peristalsis)

Watch for surgical complications such as continuing pain or
fever, which indicate an abscess or wound dehiscence

Stitches removed between fifth and seventh day (usually in
physicians office)
 DISCHARGE
DISCHARGE
DISCHARGE- METHOD
M.E.T.H.O.D.

D   
• Liquid or soft diet until the infection subsides
• Soft diet is low in fiber and easily breaks down
in the gastrointestinal tract.
 DISCHARGE
DISCHARGE
 M     Antibiotics for infection
        Analgesic agent (morphine) can be given for pain after the surgery
 E     Within 12 hrs of surgery you may get up and move around.
       You can usually return to normal activities in 2-3 weeks after laparoscopic surgery.
 T     Pretreatment of foods with lactase preparations (e.g. lactacid drops) before ingestion can
reduce symptoms.
       Ingestion of lactase enzyme tablets with the first bite of food can reduce symptoms.
 H     To care wound perform dressing changes and irrigations as prescribe avoid taking laxative
or applying heat to abdomen when abdominal pain of unknown cause is experienced.
       Reinforce need for follow-up appointment with the surgeon
       Call your physician for increased pain at the incision site
 O     Document bowel sounds and the passing of flatus or bowel movements (these are signs
of the return of peristalsis)
       Watch for surgical complications such as continuing pain or fever, which indicate an
abscess or wound dehiscence
       Stitches removed between fifth and seventh day (usually in physicians office)
 D    Liquid or soft diet until the infection subsides
      Soft diet is low in fiber and easily breaks down in the gastrointestinal tract.