Indroduction:

• The appendix is a small fingerlike appendage

about 10 cm (4 in) long, attached to the
cecum just below the ileocecal valve.
• No definite functions can be assigned to it in
humans.
• The appendix fills with food and empties as
regularly as does the cecum.
• It is prone to become obstructed and is
particularly vulnerable to infection
(appendicitis) because it is small.
Facts about Appendicitis:
• Appendicitis is the most common cause of acute
inflammation in the right lower quadrant of the
abdominal cavity.
• About 7% of the population will have appendicitis
at some time in their lives.
• Males are affected more than females and
teenagers more than adults.
• It occurs most frequently between the age of 10
and 30.
• It is more prevalent in countries in which people
consume a diet low in fiber and high in refined
carbohydrates.
:Definition

Appendicitis is inflammation of the vermiform

appendix caused by an obstruction attributable

to infection, structure, fecal mass, foreign

body, or tumor.
Clinical Manifestations:
1. Generalized or localized abdominal pain in the
epigastric or periumbilical areas and upper right
abdomen.
2. The pain localizes in the right lower quadrant
and intensity increases with 2 to 12 hours.
3. Anorexia, moderate malaise, mild fever, nausea
and vomiting.
4. Usually constipation occurs ; occasionally
diarrhea.
5. Rebound tenderness, involuntary guarding,
generalized abdominal rigidity.
:Pathophysiology of Appendicitis
:Diagnostic Evaluation
Physical examination consistent with clinical
manifestations.
WBC count reveal moderate leukocytosis (10,000
to 16,000/mm3).
Urinalysis rule out urinary disorders.
Abdominal x-ray may visualize shadow consistent
with fecal in appendix; perforation will reveal
free air.
Abdominal ultrasound or CT scan can visualize
appendix and rule out other conditions, such as
diverticulitis and crohn’s disease.
Focused appendiceal CT can quickly evaluate for
appendicitis.
Treatment and Management:

1. Surgery.

2. Parenteral replacement.

3. Medication.
:Continue……… Surgery
Appendectomy:
It is a surgery to remove of the appendix.
It is the effective treatment.
It is performed if appendicitis is diagnosed as
soon as possible to decrease the risk of
perforation.
Appendectomy may be performed under a
general or spinal anesthetics with a low
abdominal incisions or by laparoscopy which
is recently highly effective method.
Continue…….. Treatment
 Intravenous fluids replacements and
electrolytes.
 Administration of Antibiotics.
 Analgesics can be administered after the
diagnosed is made.
Complications:
 Perforation of the appendix:

Peritonitis.

Abscess formation.

Portal pylephlebitis.

 If left untreated, appendicitis may progress to abscess,

perforation, subsequent peritonitis, and death

:Nursing Interventions
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).
Notify health care provider immediately if pain
suddenly ceases, this indicates perforation, which is a
medical emergency.
Assist patient to position of comfort such as semi-
fowlers with knees are flexed.
Continue………..Nursing Interventions
Apply ice bag to abdomen for comfort.
Avoid indiscriminate palpation of the abdomen to avoid
increasing the patients discomfort.
Promptly prepare patient for surgery once diagnosis is
established.
Explain signs and symptoms of postoperative
complications to report-elevated temperature, nausea
and vomiting, or abdominal distention; these may
indicate infection.
Continue………..Nursing Interventions
Restrict activity that may aggravate pain, such as
coughing and ambulation.
Instruct patient on turning, coughing, or deep
breathing, use of incentive spirometer, and
ambulation. Discuss purpose and continued
importance of these maneuvers during recovery
period.
Teach incisional care and avoidance of heavy
lifting or driving until advised by the surgeon.
Advise avoidance of enemas or harsh laxatives;
increased fluids and stool softeners may be used
for postoperative constipation.
:Discharge Planning
Antibiotics for infection and analgesic agent can
be given for pain after the surgery.
Within 12 hrs of surgery you may get up and
move around.
Within 2-3 week usually can return to normal
activities s after laparoscopic surgery.
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 and to call the physician if the pain
increase at the incision site .
Continue……………Discharge Planning

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 .
Stitches removed between fifth and seventh
day.
Liquid or soft diet until the infection subsides
Soft diet is low in fiber and easily breaks down
in the gastrointestinal tract.