Appendicitis Fadi Jehad Zaben RN MSN

1. Appendicitis FadiJehadZaben RN MSN

3. Indroduction: • The appendix is a small fingerlike appendage about 10 cm (4 in) long, attached to the cecum just below the ileocecal valve. • No definite functions can be assigned to it in humans. • The appendix fills with food and empties as regularly as does the cecum. • It is prone to become obstructed and is particularly vulnerable to infection (appendicitis) because it is small.

4. Facts about Appendicitis: • Appendicitis is the most common cause of acute inflammation in the right lower quadrant of the abdominal cavity. • About 7% of the population will have appendicitis at some time in their lives. • Males are affected more than females and teenagers more than adults. • It occurs most frequently between the age of 10 and 30. • It is more prevalent in countries in which people consume a diet low in fiber and high in refined carbohydrates.

5. Definition: Appendicitis is inflammation of the vermiform appendix caused by an obstruction attributable to infection, structure, fecal mass, foreign body, or tumor.

7. Pathophysiology of Appendicitis: • The appendix becomes inflamed andedematous as a result of becoming kinked or occluded by a fecalith, tumor, or foreign body. • The inflammatory process increasesintraluminal pressure, initiating a progressively severe, generalized or periumbilical pain that become localized to the right lower quadrant of the abdomen within few hour. • The inflamed appendix fills with pus.

8. Pathophysiology of Appendicitis:

9. Risk Factors: • Age. • Gender.

10. Clinical Manifestations: • Generalized or localized abdominal pain in the epigastric or periumbilical areas and upper right abdomen. • The pain localizes in the right lower quadrant and intensity increases with 2 to 12 hours. • Anorexia, moderate malaise, mild fever, nausea and vomiting. • Usually constipation occurs ; occasionally diarrhea. 5. Rovsing’s Sign: which pressure on the left lower quadrant of the abdomen causes pain in the right lower quadrant. 6. Rebound tenderness, involuntary guarding, generalized abdominal rigidity.

11. Diagnostic Evaluation: • Physical examination consistent with clinical manifestations. • WBC count reveal moderate leukocytosis (10,000 to 16,000/mm3). • Urinalysis rule out urinary disorders. • Abdominal x-ray may visualize shadow consistent with fecal in appendix; perforation will reveal free air. • Abdominal ultrasound or CT scan can visualize appendix and rule out other conditions, such as diverticulitis and crohn’s disease. • Focused appendiceal CT can quickly evaluate for appendicitis.

12. Treatment and Management: • Surgery. • Parenteral replacement. • Medication.

13. Continue……… Surgery: Appendectomy: • It is a surgery to remove of the appendix. • It is the effective treatment. • It is performed if appendicitis is diagnosed as soon as possible to decrease the risk of perforation. • Appendectomy may be performed under a general or spinal anesthetics with a low abdominal incisions or by laparoscopy which is recently highly effective method.

14. Continue…….. Treatment • Administration of IV fluids and antibioticto correct or prevent fluid and electrolyteimbalance, dehydration and sepsis untilsurgery is performed. • Administration of Antibiotics. • Analgesics can be administered after the diagnosed is made.

15. Complications: • Perforation of the appendix: • Peritonitis. • Abscess formation. • Portal pylephlebitis. • If left untreated, appendicitis may progress to abscess, perforation, subsequent peritonitis, and death

17. Nursing Interventions: • Monitor frequently for signs and symptoms of worsening condition, indicating perforation, abscess, or peritonitis (increasing severity of pain, tenderness, rigidity, distention, absent bowel sounds, fever, malaise, and tachycardia). • Notify health care provider immediately if pain suddenly ceases, this indicates perforation, which is a medical emergency. • Assist patient to position of comfort such as semi-fowlers with knees are flexed.

18. Continue………..Nursing Interventions • Apply ice bag to abdomen for comfort. • Avoid indiscriminate palpation of the abdomen to avoid increasing the patients discomfort. • Promptly prepare patient for surgery once diagnosis is established. • Explain signs and symptoms of postoperative complications to report-elevated temperature, nausea and vomiting, or abdominal distention; these may indicate infection. Do not give analgesics/antipyretics to mask fever, and do not administer cathartics because they may cause rupture.

19. Continue………..Nursing Interventions • Restrict activity that may aggravate pain, such as coughing and ambulation. • Instruct patient on turning, coughing, or deep breathing, use of incentive spirometer, and ambulation. Discuss purpose and continued importance of these maneuvers during recovery period. • Teach incisional care and avoidance of heavy lifting or driving until advised by the surgeon. • Advise avoidance of enemas or harsh laxatives; increased fluids and stool softeners may be used for postoperative constipation.

20. Discharge Planning: • Antibiotics for infection and analgesic agent can be given for pain after the surgery. • Within 12 hrs of surgery you may get up and move around. • Within 2-3 week usually can return to normal activities s after laparoscopic surgery. • To care wound perform dressing changes and irrigations as prescribe avoid taking laxative or applying heat to abdomen when abdominal pain of unknown cause is experienced. • Reinforce need for follow-up appointment with the surgeon and to call the physician if the pain increase at the incision site .

21. Continue……………Discharge Planning • Document bowel sounds and the passing of flatus or bowel movements (these are signs of the return of peristalsis. • Watch for surgical complications such as continuing pain or fever, which indicate an abscess . • Stitches removed between fifth and seventh day. • Liquid or soft diet until the infection subsides • Soft diet is low in fiber and easily breaks down in the gastrointestinal tract.

22. Nursing Responsibilities: • Relieving Pain. • Preventing Fluid Volume Deficit. • Reducing Anxiety. • Eliminating Infection. • Maintaining Skin Integrity. • Attaining Optimal Nutrition

23. Thanks