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- Appendicitis: Causes, Symptoms, Diagnosis, Management, Nursing Interventions
Appendicitis is inflammation of the vermiform appendix caused by an obstruction of the intestinal lumen from infection, stricture, faecal mass, foreign body, or tumour.
Pathophysiology and Causes of Appendicitis
1. Obstruction is followed by oedema, infection, and ischemia.
2. As intraluminal tension develops, necrosis and perforation usually occur.
3. Appendicitis can affect any age group; most common in adolescents/young adults, especially males.
Signs and Symptoms of Appendicitis
1. Generalized or localized abdominal pain in the epigastric or periumbilical areas and upper right abdomen. Within 2 to 12 hours, the pain localizes in the right lower quadrant and intensity increases.
2. Anorexia, moderate malaise, mild fever, nausea, and vomiting.
3. Usually constipation occurs, occasionally diarrhoea.
4. Rebound tenderness, involuntary guarding, generalized abdominal rigidity.
Diagnostic Evaluation of Appendicitis
1. Physical examination consistent with clinical manifestations.
2. WBC count reveals moderate leukocytosis (10,000 to 16,000/ mm3 ) with shift to the left (increased immature neutrophils).
3. Urinalysis to rule out urinary disorders.
4. Abdominal x-ray may visualize shadow consistent with faecal lith in appendix; perforation will reveal free air.
5. 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.
Management of Appendicitis
1. Surgery (appendectomy) is indicated.
a. Simple appendectomy or laparoscopic appendectomy in absence of rupture or peritonitis.
b. An incisional drain may be placed if an abscess or rupture occurs.
2. Preoperatively maintain bed rest, NPO status, IV hydration, possible antibiotic prophylaxis, and analgesia.
Complications of Appendicitis
1. Perforation (in 95% of cases).
Nursing Assessment of Appendicitis
1. Obtain history for location and extent of pain.
2. Auscultate for the presence of bowel sounds; peristalsis may be absent or diminished.
3. On palpation of the abdomen, assess for tenderness anywhere in the right lower quadrant, but usually localized over McBurney’s point (point just below the midpoint of line between the umbilicus and iliac crest on the right side). Assess for rebound tenderness in the right lower quadrant as well as referred rebound when palpating the left lower quadrant.
4. Assess for positive psoas sign by having the patient attempt to raise the right thigh against the pressure of your hand placed over the right knee. Inflammation of the psoas muscle in acute appendicitis will increase abdominal pain with this manoeuvre.
5. Assess for positive obturator sign by flexing the patient’s right hip and knee and rotating the leg internally. Hypogastric pain with this manoeuvre indicates inflammation of the obturator muscle.
Nursing Interventions of Appendicitis
1. Monitor pain level, including location, intensity, pattern.
2. Assist patient to comfortable positions, such as semi-Fowler’s and knees up.
3. Restrict activity that may aggravate pain, such as coughing and ambulation.
4. Apply ice bag to abdomen for comfort.
5. Give antiemetics and analgesics, as ordered, and evaluate response.
6. Avoid indiscriminate palpation of the abdomen to avoid increasing the patient’s discomfort.
1. Monitor frequently for signs and symptoms of worsening condition indicating perforation, abscess, or peritonitis: increasing severity of pain, tenderness, rigidity, distention, ileus, fever, malaise, and tachycardia.
. Administer antibiotics, as ordered. 3. Promptly prepare the patient for surgery.