Appendicitis

-the inflammation of the appendix (a finger like appendage, or accessory organ of the Digestive tract)

The appendix normally fills in with fecal matter and empties regularly into the cecum but because it empties inefficiently, and its lumen is small, it is likely to be prone to obstruction and is particularly vulnerable to infection. Possible causes of Appendicitis: A fecalith (fecal calculus or stone) Kinking of the appendix Swelling of the bowel wall

Risk Factors :
Age : Teenagers are more prone than adults although it can occur at any age Gender: Males are more likely to develop than females

Pathophysiology
Obstruction in the appendix hole

intraluminal pressure

venous drainage, edema and bacterial invasion

inflammatory process

Signs and Symptoms

The client at first experience mere discomfort that he will think would be relieved by farting or bowel movement. The pain starts in the epigastrium or periumbilical region then shifts to the right lower quadrant as the inflammatory process spreads. The pain then becomes severe and steady rather than intermittent and the client guards to protect the area by lying still and drawing the legs up to relieve tension to abdominal muscles Vomiting sometimes accompany low grade fever and anorexia Loss of Appetite Local tenderness at McBurneys point Rebound tenderness If the appendix curls around behind the cecum, pain and tenderness may be felt in the lumbar region. If its tip is in the pelvis, these signs may be elicited only on rectal examination. Pain on defecation suggests that the tip of the appendix is resting against the rectum; pain on urination suggests that the tip is near the bladder or impinges on the ureter. Some rigidity of the lower portion of the right rectus muscle may occur. Rovsings sign may be elicited by palpating the left lower quadrant; this paradoxically causes pain to be felt in the right lower quadrant If the appendix has ruptured, the pain becomes more diffuse; abdominal distention develops as a result of paralytic ileus, and the patients condition worsens. Rovsings sign (the pain is felt in the right lower quadrant when the left lower quadrant is palpated) Mild Leukocytosis (WBC between 10,000 and 18,000)

Diagnostics
Complete physical exams Laboratories (abdominal x-rays, CT scans (may reveal right lower quadrant density as well as localized bowel distention)

Complications
Perforation of the appendix that can lead to peritonitis or an abscess

Nursing Diagnoses
Acute Pain related to inflammation -apply pain control to the client if sudden change of pain character is felt because it could signal perforation and since no pain medication is given until surgery -never give enemas, laxatives or apply heat to the abdomen because it can further promote perforation Risk for deficient fluid volume related to vomiting -start IV Fluids as soon as the client is admitted -NGT may be inserted if the client vomits -carefully measure I/O Risk for infection relation to ruptured appendix -check vital signs regularly and monitor for increase in temperature, pulse rate or blood pressure that may signify ruptured appendix -administer preop antibiotics as ordered to reduce the risk of infection -Closely monitor the pain ( if the pain becomes generalized throughout the abdomen and it becomes rigid adn board like, the appendix must have been ruptured) -after the operation, if the client had infected wound due to the ruptured appendix, teach him on how to care for the wound at home for faster healing and recovery.

Surgical Management
Appendectomy - may be performed under a general or spinal anaesthetic with a low abdominal incision or by laparoscopy.

Nursing Management
Goals include relieving pain, preventing fluid volume deficit, reducing anxiety, eliminating infection from the potential or actual disruption of the GI tract, maintaining skin integrity, and attaining optimal nutrition. The nurse prepares the patient for surgery, which includes an intravenous infusion to replace fluid loss and promote adequate renal function and antibiotic therapy to prevent infection. If there is evidence or likelihood of paralytic ileus, a nasogastric tube is inserted. An enema is not administered because it can lead to perforation. After surgery, the nurse places the patient in a semi-Fowler position. This position reduces the tension on the incision and abdominal organs, helping to reduce pain. An opioid, usually morphine sulfate, is prescribed to relieve pain. When tolerated, oral fluids are administered. Any patient who was dehydrated before surgery receives intravenous fluids. Food is provided as desired and tolerated on the day of surgery. The patient may be discharged on the day of surgery if the temperature is within normal limits, there is no undue discomfort in the operative area, and the appendectomy was uncomplicated. Discharge teaching for the patient and family is imperative. The nurse instructs the patient to make an appointment to have the surgeon remove the sutures between the fifth and seventh days after surgery. Incision care and activity guidelines are discussed; normal activity can usually be resumed within 2 to 4 weeks. If there is a possibility of peritonitis, a drain is left in place at the area of the incision. Patients at risk for this complication may be kept in the hospital for several days and are monitored carefully for signs of intestinal obstruction or secondary hemorrhage. Secondary abscesses may form in the pelvis, under the diaphragm, or increasing the leukocyte count. When the patient is ready for discharge, the nurse teaches the patient and family to care for the incision and perform dressing changes and irrigations as prescribed. A home care nurse may be needed to assist with this care and to monitor the patient for complications and wound healing.