APPENDICITIS

APPENDICITIS

DEFINITION:-

It is an inflammation of veriform appendix (a small, finger like appendage attached to cecum just below the ileocaecal valve).

CAUSES/AETIOLOGY:-

  • Most common in emergency abdominal surgery.
  • Infections.
  • Obstruction of faecal matter.
  • Lymphoid hyperplagia.
  • Inflammation and fibrosis of colon


SIGN/SYMPTOMS:-

  • Acute abdominal pain (6-12 hr.) in right lower quadrant area.
  • Anorexia.
  • Pain at most common Burney's point (located half way between the umbilicus and the anterior spine of ilium).
  • Nausea/vomiting.
  • Fever (101°F).
  • Rovsing's sign (palpating the left lower-quadrant which paradoxically causes pain in right lower quadrant.
  • Constipation.
  • Abdominal distention.
  • Local tenderness with pressure.

PATHOPHYSIOLOGY:-

Due to infection or faecal stone and obstruction
↓
Obstruction in appendix lumen
↓
Increase intra-luminal pressure
↓
Disturb blood supply
↓
Edema or swelling in appendix
↓
Rupture of appendix

DIAGNOSTIC EVALUATION:-

  • Blood studies WBC increases
  • Urinalysis
  • Laproscopy
  • By positive sign and symptoms

COMPLICATIONS:-

  • Perforation
  • Abscess
  • Peritonitis

MEDICAL MANAGEMENT:-

  • Administer antibiotics and IV fluids until surgery is perfomed.
  • Analgesics agents can be given after diagnosis is made.
  • Ice bag therapy.
  • Comfortable position.

SURGICAL MANAGEMENT:-

  • Appendentomy (Removal of Appendix).

NURSING MANAGEMENT:-

  1. Preoperative care (before surgery).
  2. Intraoperative care (During procedure or surgery).
  3. Post-operative care (AfteMonitor for changes in level of pain surgery).

1. Preoperative Care:-

  1. Reassure the patient and relatives to decrease their anxiety.
  2. Maintain NPO status.
  3. Administer fluids intravenously to prevent dehydration.
  4. Monitor for changes in level of pain.
  5. Monitor for signs of ruptured appendix and peritonitis.
  6. Position right-side lying or low to semi fowler position to promote comfort.
  7. Monitor bowel sounds.
  8. Apply ice packs to abdomen every hour for 20-30 minutes as prescribed.
  9. Administer antibiotics as prescribed.

2. Intraoperative Care:-

  1. Paint the area of surgery with antiseptic solution.
  2. If small hair present clean or remove it.
  3. Maintain IV line as prescribed.
  4. Prepare for anaesthesia, check all cardiovascular, respiratory and neurological function.
  5. Provide comfortable rest and sleep.
  6. Put ice bag on right lower quadrant.
  7. Check and notify the hearing capacity of patient.
  8. Help during wearing hospital clothes to patient.
  9. Follow all instructions of surgeons.
  10. Transport patient to recovery room.
  11. Covers with blanket carefully.
  12. Shift patient on stretcher.

3. Post-operative Care:-

  1. Monitor temperature for signs of infection.
  2. Assess incision for signs of infection such as redness, swelling and pain.
  3. Maintain NPO status until bowel function has returned.
  4. Advance diet gradually or as tolerated or as prescribed when bowel sound return.
  5. If ruptured of appendix occurred, expect a Penros drain to be inserted, or the incision maybe left to heal inside out.
  6. Expect that drainage from the Penros drain maybe profuse for the first 2 hours.

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