Appendicitis Nursing Interventions

The vermiform appendix is a narrow, tube-like organ attached to the cecum. Although it is connected to the digestive tract, it has no known digestive function, rather, it has lymphatic tissues that are for infection control.

Appendicitis, appendix + –itis (inflammation), is a medical condition wherein the appendix is inflamed caused by obstruction of the intestinal lumen. The obstruction is commonly due to fecal mass, tumor, stricture, and presence of a foreign body in the latter part of the colon.

Appendicitis may affect all age groups, but, is mostly common to males aged 12-35 years old.

Clinical Manifestations

• Localized (McBurney’s point) or generalized pain (extending to the periumbilical area)
• Increasing pain intensity
• Mild fever
• Nausea and vomiting
• Aure-Rozanova’s sign (rebound tenderness)
• Obturator sign (hypogastric pain upon flexing and internal rotation of the hip)
• Psoas sign (RLQ pain upon passive extension of the patient’s right hip or active flexion of the right hip while in a supine position
• Usually, constipation occurs
• Occasional diarrhea

Diagnostic Evaluation

• Leukocytosis (WBC is above 10,000 per cubic millimeter)
• Urinalysis to rule out urinary problems
• Pelvic sonogram to rule out ovarian cyst
• An abdominal x-ray shows the presence of fecalith in the appendix

Management

1. Surgery is the only option

• Traditional Appendectomy (McBurney’s incision)
• Laparoscopic Appendectomy (use of cuts and camera)
• Midline incision (commonly used for ruptured appendix)

2. Pre-operative

• Maintain or initiate NPO
• Bed rest
• Initiate and maintain patent IV hydration
• Antibiotic prophylaxis
• Analgesia once the diagnosis is final
• Monitor for signs of a ruptured appendix
• Do routine pre-operative laboratory workouts

Appendicitis Nursing Interventions

1.    Preoperative

a. Pain

• Monitor level, location, intensity, pattern
• Apply ice bag
• Avoid further palpation once assessed
• Assist to a more comfortable position
• Restrict activities that aggravate pain

b. Preventing infection

Administer ordered antibiotics
Monitor signs of a worsening condition
-increasing pain, tenderness, fever, malaise, abdominal rigidity

c. Preoperative care

2.    Postoperative

a. Complete physical assessment

• Vital signs
• I and O and hydration
• Bowel sounds and movement or flatus
• Incision site and dressing

b. Monitor laboratory results
c. Maintain patent IVF
d. Administration of ordered antibiotics and analgesia
e. Wound dressing
f. Encourage deep breathing and coughing exercises
g. Assist in early ambulation
h. Observe proper diet-high fiber, protein and vitamin C