Learning Apendicitis

Alright, I'm fed up of listening to people when they complain of pain during an activity after a large meal and said that they got appendix. Of course, everyone has not unless they undergone any surgical removal of the appendix. The appendix is a finger-like appendage about 4 inches long that is attached to the cecum, the pouch connected to the ascending colon of the large intestine. It is located below the ileocecal valve. The appendix fills with food and regularly empties into the cecum. Since it empties inefficiently and with a small lumen, the appendix is prone to obstruction and is highly vulnerable to infection, appendicitis. Appendicits is known to strike people between ages 10 to 30 years old. The most signature symptom is pain in the abdomen. Appendicitis pain is not like the type of pain you get from gas or indigestion. Pain starts in the navel area. It then moves into the lower right-hand (Right Lower Quadrant/RLQ pain) corner of the sufferer's abdomen. Pain increases as the disease progress. The pain then settles in an area that is near the appendix. This area is called the McBurney point. An inflamed appendix lies on the psoas muscle and the patient will lie with the right hip flexed for pain relief. Checking for a positive Psoas sign will assist in the diagnsis. Other than that lab works are performed to check for infection. A person should report any pain that persists and that is accompanied by loss of appetite, nausea, vomiting, and fever to a physician. Remember, it is an emergency condition and should be managed as early as possible. Surgery is indicated if appendicitis is diagnosed. Fluid and electrolytes imbalance and dehydration should be corrected through intravenous fluids and antibiotics prior to appendectomy, surgical removal of the appendix. Analgesics can be given after the diagnosis is made. Appendectomy can be performed either spinal or general anesthetic with a low abdominal incision or by laparoscopy, Caution should be observed in the elderly population since classic signs and symptoms are altered and may vary greatly. Pain may be absent or minimal. Symptoms may be vague, suggesting bowel obstruction or the like. Thus, diagnosis and prompt treatment may be delayed, which heightens the probablity of potential complications and worse, mortality.

Complications

• Perforation of the appendix

• Peritonitis

Lab Findings (Click here for normal lab values)

• Elevated white blood cell count

• Leukocyte might exceed 10,000 cells/ cubic mm

• Neutrophils exceeds 75%

Diagnostics (Click here for diagnostic procedures)

• Abdominal X-Ray

• Ultrasound studies

• CT Scan

Impression: RLQ density or localized distension of the bowel

Nursing Management
Goals:

• Relieving pain
• Preventing fluid volume deficit
• Reducing Anxiety
• Eliminating infection from potential or actual disruption of GI tract
• Maintaining skin integriy
• Optimal Nutrition

Nursing Intervention (N/I):

• Prepare client for surgery

• NO ENEMA it can lead to perforation

• Post-OP patient in Semi-Fowler's position, reduces pain and tension on the incision and abdominal organs

• Opioid analgesic is prescribed to relieve pain

• When tolerated, oral fluids are given

• Food given as desired and tolerated on the day of surgery

• Check temperature and should be maintained within normal limits

• Patient is discharged on the day of surgery if client illicits normal temperature, no undue discomfort, and appendectomy was uncomplicated

Discharge Teaching:

• Instruct to make an appointment with the surgeon to remove sutures between 5th and 7th days after surgery

• Incision care and dressing changes
  

• Activities can resume within 2 to 4 weeks