APPENDICITIS P 1020 1021 Definition Etiology and Pathophysiology Inflammation of the appendix 7 12 of population Most common in young adults Obstruction of the lumen by Accumulated feces Foreign bodies Tumor of cecum or appendix Intramural thickening caused by excess growth of lymph studies o o o o Obstruction leads to Distention Venous engorgement Accumulation of mucus and bacteria gangrene and perforation o o o Symptoms Pain o o o persistent and continuous to RLQ and localizing at McBurney s point Pain magnified by coughing sneezing and deep inhalation Periumbilical pain anorexia nausea vomiting Localized tenderness Rebound tenderness Muscle guarding Lying still with right leg flexed Low grade fever maybe Rovsing s sign palpation of the LLQ causing pain in the RLQ Complications of Acute Appendicitis Diagnostic and Collaborative Care Complete history and physical exam palpation of abdomen Differential WBC count mildly to moderately elevated Urinalysis to rule out genitourinary conditions CT scan Ultrasound Perforation Peritonitis Abscess Treatment Delay in diagnosis can result in appendix rupture peritonitis fatal Immediate surgical removal appendectomy for localized inflammation Rupture or abscess antibiotic therapy and parenteral fluids for 6 8 hours before appendectomy prevents sepsis and dehydration Encourage patient with abdominal pain to see HCP and avoid self treatment Laxatives and enemas are dangerous increased peristalsis can cause perforation Keep patient NPO before surgery Ice bag to the RLQ to decrease inflammation Heat can cause appendix rupture Surgery as soon as diagnosis is made Antibiotics and fluid resuscitation Nursing Management Postoperative Nursing Appendicitis risk of perforation septic shock Appendicitis fluid shifts to area of inflammation unable to ingest fluid hypovolemic shock Similar post op after laparotomy Observe for peritonitis Ambulation begins day of surgery or first post op day Diet advanced as tolerated Normal activities resumed 2 3 weeks after surgery
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