Appendicitis

The appendix is a small, finger-like appendage attached to the cecum just below the
ileocecal valve. Because it empties into the colon inefficiently and its lumen is small, it is
prone to becoming obstructed and is vulnerable to infection (appendicitis). The
obstructed appendix becomes inflamed and edematous and eventually fills with pus. It
is the most common cause of acute inflammation in the right lower quadrant of the
abdominal cavity and the most common cause of emergency abdominal surgery.
Although it can occur at any age, it more commonly occurs between the ages
of 10 and 30 years.
Pathophysiology
Lower right quadrant pain usually accompanied by low grade fever, nausea, and
sometimes vomiting; loss of appetite is common; constipation can occur.
At McBurneys point (located halfway between the umbilicus and the anterior spine of
the ilium), local tenderness with pressure and some rigidity of the lower portion of the
right rectus muscle.
Rebound tenderness may be present; location of appendix dictates amount of
tenderness, muscle spasm, and occurrence of constipation or diarrhea.
Rovsings sign (elicited by palpating left lower quadrant, which paradoxically causes
pain in right lower quadrant).
If appendix ruptures, pain becomes more diffuse; abdominal distention develops from
paralytic ileus, and condition worsens.

Diagnostic Findings
Diagnosis is based on a complete physical examination and laboratory and imaging
tests.
Elevated WBC count with an elevation of the neutrophils; abdominal radiographs,
ultrasound studies, and CT scans may reveal right lower quadrant density or localized
distention of the bowel.

Nursing Management
Nursing goals include relieving pain, preventing fluid volume deficit, reducing anxiety,
eliminating infection due to the potential or actual disruption of the GI tract, maintaining
skin integrity, and attaining optimal nutrition.
Preoperatively, prepare patient for surgery, start IV line, administer antibiotic, and
insert nasogastric tube (if evidence of paralytic ileus). Do not administer an enema or
laxative (could cause perforation).
Postoperatively, place patient in high Fowlers position, give narcotic analgesic as
ordered, administer oral fluids when tolerated, give food as desired on day of surgery (if
tolerated). If dehydrated before surgery, administer IV fluids.
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 (eg, fever,
tachycardia, and increased leukocyte count).

Health Teaching
Teach patient and family to care for the wound and perform dressing changes and
irrigations as prescribed.
Reinforce need for follow-up appointment with surgeon.
Discuss incision care and activity guidelines.

 Refer for home care nursing as indicated to assist with care and continued monitoring
of complications and wound healing.
Drugs
Metronidazole
Clindamycin