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Saturday, October 10, 2020

Appendicitis : Nursing interventions



  • Inflammation of the appendix.
  • When the appendix becomes inflamed or infected, perforation may occur within a matter of hours, leading to peritonitis, sepsis, septic shock, and potential death.
  • Treatment is surgical removal of the appendix before perforation is occurs.

  • Pain in periumbilical area that descends to the right lower quadrant.
  • Abdominal pain that is most intense at McBurney's point.
  • Referred pain indicating the presence of peritoneal irritation. 
  • Rebound tenderness and abdominal rigidity. 
  • Elevated white blood cell count.
  • Side-lying position with abdominal guarding (leg flexed) to relive pain.
  • Difficulty walking and pain in the right hip.
  • Low-grade fever. 
  • Anorexia, nausea, and vomiting after the pain develops.
  • Diarrhoea.


Results from perforated appendix

  • Increased fever.
  • Sudden relief of pain after the perforation and then a subsequent increase in pain accompanied by right guarding of the abdomen. 
  • Progressive abdominal distension 
  • Tachycardia and tachypnea
  • Pallor
  • Chills
  • Restlessness and irritability 


 Surgical removal of the appendix
  • Intervention preoperatively 
    • Maintain an NPO status.

    • Administer fluid and electrolyte intravenously as prescribed to prevent dehydration and correct electrolyte imbalance. 
    • Monitor for signs of an ruptured appendix and peritonitis. 
    • Administer antibiotics as prescribed. 
    • Monitor for changes in level of pain.
    • Avoid the use of pain medications so as not to mask pain changes associated with perforation. 
    • Monitor bowel sounds.
    • Position in a right side-lying low to semi Fowler's position to promote comfort 
    • Apply ice pack to the abdomen for 20 to 30 minutes every hour if prescribed. 
    • Avoid laxative or enema
  • Postoperative intervention 
    • Monitor vitals signs, particularly the temperature. 
    • Maintain an NPO status until bowel function has returned, advancing diet gradually as tolerated and as prescribed when bowel sound return.
    • Assess the incision for signs of infection, such as redness, swelling, drainage, and pain.
    • Monitor penrose drain drainage, inserted if perforation occurred, as prescribed. 
    • Change the dressing as prescribed, and record the type and amount of drainage. 
    • Perform wound irrigations if prescribed. 
    • Maintain nasogastric tube suction and patency of the tube if present. 
    • Administer antibiotics and analgesic as prescribed. 

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