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Appendicitis Nursing Notes

Appendicitis Nursing Notes

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Published by: FreeNursingNotes on Nov 26, 2009
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05/17/2012

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AppendicitisThe appendix is a small, finger-like appendage attached to the cecum just below theileocecal valve. Because it empties into the colon inefficiently and its lumen is small, it is prone to becoming obstructed and is vulnerable to infection (appendicitis). Theobstructed appendix becomes inflamed and edematous and eventually fills with pus. It isthe most common cause of acute inflammation in the right lower quadrant of theabdominal cavity and the most common cause of emergency abdominal surgery. Malesare affected more than females, teenagers more frequently than adults; the highestincidence is in those between the ages of 10 and 30 years.CLINICAL MANIFESTATIONS· Lower right quadrant pain usually accompanied by low-grade fever, nausea, andsometimes vomiting.· At McBurney’s point (located halfway between the umbilicus and the anterior spine of the ilium), local tenderness with pressure and some rigidity of the lower portion of theright rectus muscle.· Rebound tenderness may be present; location of appendix dictates amount of tenderness,muscle spasm, and occurrence of constipation or diarrhea.· Rovsing’s sign (elicited by palpating left lower quadrant, which paradoxically causes pain in right lower quadrant).· If appendix ruptures, pain becomes more diffuse; abdominal distention develops from paralytic ileus, and condition worsens.ASSESSMENT AND DIAGNOSTIC METHOD· Diagnosis is based on a complete physical examination and laboratory and radiologictests.· Leukocyte count greater than 10,000/mm3; neutrophil count greater than 75%;abdominal radiographs, ultrasound studies, and CT scans may reveal right lower quadrantdensity or localized distention of the bowel.GERONTOLOGIC CONSIDERATIONSIn the elderly, signs and symptoms of appendicitis may vary greatly. Signs may be veryvague and suggestive of bowel obstruction or another process; some patients mayexperience no symptoms until the appendix ruptures. The incidence of perforatedappendix is higher in the elderly because many of theses people do not seek health care asquickly as younger people.MEDICAL MANAGEMENT· Surgery is indicated if appendicitis is diagnosed and should be performed as soon as possible to decrease risk of perforation.· Administer antibiotics and intravenous fluids until surgery is performed.· Analgesic agents can be given after diagnosis is made.COMPLICATIONS OF APPENDECTOMY· The major complication is perforation of the appendix, which can lead to peritonitis or 

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