Appendicitis

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Appendicitis
Definition:
Is an acute inflammation of the appendix
Causes:
The lumen of the appendix is quite small, making it liable to
incomplete emptying or obstruction which can lead to
infection.
Kinking of the appendix or obstruction by fecaliths (hardened
feces) or foreign bodies also may trigger the acute
inflammatory response.
Incidence:
Occurs most commonly in teen-agers and young adults
between the ages of 10 and 30 years.
Male are affected more commonly than females.
Signs and symptoms:
Typically begins with acute abdominal pain that come in
waves.
The pain typically starts in the epigastric or umbilical region.
But gradually become localized in the right lower quadrant of
the abdomen. Localization of McBurney's point (halfway
between the umbilicus and the anterior spine of the ileum).
The pain is intermittent at first but typically becomes steady and
severs over a short period.
Nausea, anorexia, and vomiting.
Rebound tenderness.
The person with appendicitis is noted to be lying side or back
with knee flexed in an attempt to decrease muscle strain on the
abdominal wall.
Elevation of temperature in the range of 38o to 40oC,
accompanied by an elevation in WBCs count.
Diagnosis:
A diagnosis of appendicitis is based on classic
signs and symptoms and white blood cell
count of 10.000 to 15.000/mm3.
Medical treatment:
When appendicitis is suspected, the patient is allowed:
Nothing by mouth.
Administer IV fluids as ordered
If tolerated advise the patient to maintain semifowler’s position.
A cold pack to the abdomen may be ordered.
Laxatives, enemas and heat applications should never
be given for patient with suspected or known
appendicitis. If the appendix is inflamed, heat or
laxative may cause it to rupture.
Once the diagnosis of appendicitis is confirmed and
surgery is scheduled, administer opioid analgesics and
antibiotic .
Surgical management
If rupture has not occurred, immediate surgical
treatment is indicated.
With a ruptured appendix, surgery may be delayed 6
to 8 hours while antibiotics and intravenous fluids are
given.
Nursing management
1. Assessment (before urgery):
The patient's chief complaint is usually pain. Assess
the location, severity, onset, duration, precipitating
factors, and alleviating measures in relation to the
pain.
In the past medical history, note previous
abdominal distress, chronic illnesses, and surgeries.
Record allergies and medications as well.
Record the presence of nausea and vomiting.
Significant data in the physical examination are
temperature; abdominal pain, distention, and
tenderness; and the presence and characteristics of
bowel sounds.
Postoperative care:
Postoperatively, the patient receives antibiotics,
intravenous fluids and possible gastrointestinal
decompression.
Assist the patient in turning, coughing, and deep
breathing to promote expansion of the lung.
Incentive spirometery also can be useful.
Show the patient how to splint the incision during deep
breathing.
Early ambulation is usually ordered to reduce the risk
of postoperative complications.
Assess the abdominal wound for redness, swelling
and drainage.
Provide wound care as ordered or according to
agency policy.
If there no complication, the patient is usually
discharged in a few days.
Normal activities can be resumed in 2-3 weeks.
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