Appendicitis : Nursing interventions

 Appendicitis 

Description

• 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.

Assessment 

• 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.

Peritonitis 

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 

Appendectomy 

 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.