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Acute Appendicitis

Definition

Is inflammation of the vermiform appendix caused by an obstruction attributable by infection, stricture, fecal mass, foreign body or tumor.

It can affect by either gender at any age, but is most common in males ages 10 to 30.

It is the most common disease requiring surgery. If left untreated, appendicitis may progress to abscess, perforation, subsequent peritonitis, and death.

Pathophysiology

Assessment 1. Generalized or localized abdominal pain occurs in the epigastric or periumbilical areas in the upper right abdomen. 2. Within 2 to 12 hours, the pain localizes in the right lower quadrant and intensity increases. 3. Anorexia, fever, nausea, vomiting, and constipation may also occur. 4. Bowel sounds may be diminished. 5. Tenderness anywhere in the right lower quadrant.
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Often localized at McBurneys point, just below midpoint of line between umbilicus and iliac crest on the right side.

Guarding and rebound tenderness to right lower quadrant and referred rebound when palpating the left lower quadrant.

6. Positive Psoas Sign.

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Have the patient attempt to raise the right thigh against the pressure of your hand placed over the right knee.

Increased abdominal pain indicates inflammation of the psoas muscle in acute appendicitis.

7. Positive Obturator Sign.

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Flex the patients right hip and knee and rotate the leg internally. Hypogastric pain indicates inflammation of the obturator muscle.

Diagnostic Evaluation 1. WBC count shows moderate leukocytosis (10,000 to 16,000/mm) with shift to the left (increased immature neutrophils) in WBC differential. 2. Urinalysis rules out urinary disorders. 3. Abdominal X-ray visualizes shadow consistent with fecalith in appendix. 4. Pelvic sonogram rules out ovarian cyst or ectopic pregnancy. Surgical Interventions 1. Surgical removal is the only effective treatment (simple appendectomy or laparoscopic appendectomy). 2. Preoperatively, maintain patient on bed rest, NPO status, I.V. hydration, possible anti-biotic prophylaxis, and analgesia, as directed.

Nursing Interventions 1. Monitor frequently for signs and symptoms of worsening condition, indicating perforation, abscess, or peritonitis (increasing severity of pain, tenderness, rigidity, distention, absent bowel sounds, fever, malaise, and tachycardia). 2. Notify health care provider immediately if pain suddenly ceases, this indicates perforation, which is a medical emergency. 3. Assist patient to position of comfort such as semi-fowlers with knees are flexed. 4. Restrict activity that may aggravate pain, such as coughing and ambulation. 5. Apply ice bag to abdomen for comfort. 6. Avoid indiscriminate palpation of the abdomen to avoid increasing the patients discomfort. 7. Promptly prepare patient for surgery once diagnosis is established. 8. Explain signs and symptoms of postoperative complications to reportelevated temperature, nausea and vomiting, or abdominal distention; these may indicate infection. 9. Instruct patient on turning, coughing, or deep breathing, use of incentive spirometer, and ambulation. Discuss purpose and continued importance of these maneuvers during recovery period. 10.Teach incisional care and avoidance of heavy lifting or driving until advised by the surgeon. 11.Advise avoidance of enemas or harsh laxatives; increased fluids and stool softeners may be used for postoperative constipation.