LESSON PLAN

ON
APPENDICITIS
Programme : Bsc(N)

Course : Medical Surgical Nursing

Topic : APPENDICITIS

Group : Bsc(N) -II year

No of students : 50

Venue : Lecture hall- 5

Date : 22/10/2009

Duration : 1 hrs

Method of teaching : Lecture cum discussion

Av aids : black board, OHP. Chart.

Name of the Student teacher : Radhika. A.B.

Central objectives:

At the end of the class the students will be able to gain in-depth knowledge on Appendicitis
& develop desirable skill & attitude while taking care of Appendicitis patients

Specific objectives:

At the end of the class the students will be able to

• Define Appendicitis
• Discuss the incidence of Appendicitis
• List down the types of Appendicitis
• Enumerate the causes of Appendicitis
• Describe the pathophysiology of Appendicitis.
• Explain the clinical manifestation of Appendicitis
• Identify the diagnostic investigation of Appendicitis
• Elaborate the management of Appendicitis.
SL TIME SPECIFIC CONTENTS TEACHERS LEARNERS AV.AIDS EVALUATION
NO OBJECTIVE ACTIVITIES ACTIVITIES
APPENDICITIS

5min - introduce INTRODUCTION Writes the topic Listens Black Where the
the topic to Appendicitis is a common on the black board Appendix is
the students. condition that affects 7% of the population, board. & situated?
according to the American Academy of Introduces the
Family Physicians. Persons of any age may topic by
be affected, with the highest incidence narration.
occurring during the second and third
decades of life. Rare cases of neonatal and
prenatal appendicitis have been reported.
Increased vigilance in recognizing and
treating potential cases of appendicitis is
required for the very young and old who
have a higher rate of complication.

5min - enumerate MEANING

the meaning The appendix is a narrow tubular Explains the Listening & Black What is
of pouch attached to the intestines. When the meaning of Notes board Appendicitis?
Appendicitis appendix
. is blocked, it becomes inflamed Appendicitis taking
and results in the condition known as
appendicitis. If the blockage continues, the
inflamed tissue becomes infected with
bacteria and begins to die from a lack of
blood supply, which finally results in the
 appendix bursting (perforated appendix).

5min -describe the CAUSES

causes of  There is no clear cause of Explains the Listening OHP Explain in detail
Appendicitis appendicitis. causes of and taking about the cause
 Fecal material is thought to be one Appendicitis notes. of Appendicitis?
possible obstructing object.
 Bacteria, viruses, fungi, and parasites
can be responsible agents of an
infection that leads to swelling of the
tissues of the appendix wall,
including Yersinia species,
adenovirus, cytomegalovirus,
actinomycosis, Mycobacteria species,
Histoplasma species, Schistosoma
species,
 pinworms, and Strongyloides
stercoralis. Also,
swelling of the tissue from inflammatory
bowel diseases such as Crohn's disease may
cause appendicitis.
 It appears that appendicitis is not
hereditary or transmittable from
person to person.
5min -To describe inPATHOPHYSIOLOGY pathophysiology Listens and Chart Explain the
detail about of Appendicitis discusses pathophysiology
pathophysiolo The appendix becomes inflamed and of
gy of edematous Appendicitis?
Appendicitis

The appendix becomes kinked or occluded

by a fecalities ,tumor,or foreign body.

The inflammation process increases

intraluminal pressure

Initiating a progressively sever generalized

or upperabdominal pain

Later the inflamed appendix fills with pus.

5min -To explain SIGNS AND SYMPTOMS Explains the Listens and Black What are the
in detail  Appendicitis typically begins with a signs and takes notes. board signs and
about signs vague pain in the middle of the symptoms of symptoms of
& symptoms abdomen often near the navel or Appendicitis. Appendicitis.
of "belly button" (umbilicus).
Appendicitis  The pain slowly moves to the right
 lower abdomen (toward the right
hip) over the next 24 hours.
 In the classic description, abdominal
pain is accompanied with nausea,
vomiting,
 lack of appetite, and
 fever.
 All of these symptoms, however,
occur in fewer than half of people
who develop appendicitis. More
commonly, people with appendicitis
have any combination of these
symptoms.
Symptoms of appendicitis may
take 4-48 hours to develop. During this
time, someone developing appendicitis
may have
 varying degrees of loss of appetite,
 vomiting, and
 abdominal pain.
 Some may have constipation,
 diarrhea, or
 there may be no change in bowel
habits.
Early symptoms are often hard to
separate from other conditions including
 gastroenteritis (an inflammation of
 the stomach and intestines). Many
people admitted to the hospital for
suspected appendicitis leave the
hospital with a diagnosis of
gastroenteritis; true appendicitis is
often mis-diagnosed as gastroenteritis
initially. Children and the elderly often
have fewer symptoms, which makes
their diagnosis less obvious and the
incidence of complications more
frequent.

DIAGNOSTIC TESTS
Lab work: Although no blood test can
5min -To enumerate confirm appendicitis, a blood sample is Explains the Listens and chart What are the
In detail about sent for laboratory analysis to check the investigation discusses diagnostic
Diagnosis of  white blood cell count, which is procedure for measures of
Appendicitis . typically elevated in an individual Appendicitis . Appendicitis.
with appendicitis. However,
normal levels can be present with
appendicitis, and elevated levels
can be seen with other conditions.
 A urine test may be performed to
exclude urinary tract infection (or
pregnancy) as the cause of the
symptoms.
Imaging tests: Appendicitis is diagnosed
 by the
 classic symptoms and the physical
exam (the doctor's examination of
the patient's abdomen). Imaging
tests are used when the diagnosis
is not readily apparent.
 Most medical centers now use a
CT scan of the abdomen and pelvis
to help evaluate abdominal pain
suspected of being caused by
appendicitis.
 Ultrasound scanning is currently
commonly used in small children
to test for appendicitis.

APPENDICITIS TREATMENT
10min -To discuss Self-Care at Home Explains about Listens OHP Explain the
in detail  There is no home care for treatment of Notes treatment
about the appendicitis. Appendicitis. taking. modalities of
treatment  If the condition is suspected, contact Appendicitis.
modalities of a doctor or go to an emergency
Appendicitis. department.
 Avoid eating or drinking as this may
complicate or delay surgery.
 If the person is thirsty, he/she may
rinse their mouth with water.
 Do not take (or give your child)
 laxatives, antibiotics, or pain
medications because these may
cause delay in diagnosis that
increases the risk of rupture of the
appendix or mask the symptoms,
which makes diagnosis more
difficult.
Surgery
 The best treatment for appendicitis
requires surgery to remove the
appendix (the operation is called an
appendectomy) before the appendix
opens or ruptures. While awaiting
surgery, the patient will be given IV
fluids to keep hydrated. The patient
will not be allowed to eat or drink
because doing so may cause
complications with the anesthesia
during surgery.
 Surgery is commonly done
laparoscopically (through small
incisions using a camera in the
abdominal cavity). However, in some
cases it may be necessary to do an
open abdominal procedure to take
the appendix out.
 Up to 20% of surgeries for
 appendicitis reveal a non-inflamed
appendix (negative appendectomy).
The difficulty in making a definite
diagnosis of this medical problem
and the risk of missing the acutely
inflamed appendix (and the patient
becoming very ill due to perforation)
makes a certain rate of misdiagnosis
inevitable. Women in particular have
a high rate of negative
appendectomy as ovarian and
uterine problems make the diagnosis
more difficult. CT scanning prior to
surgery has been shown to decrease
this percentage to closer to 7%-8%
in women.

5min -explains Follow-up

about the After an uncomplicated appendectomy,
follw-up and the patient may gradually resume a normal Explains about listens Black What are the
prevention
diet with a restriction in physical activity for prevention and board follow up and
of
Appendicitis at least two to four weeks. The doctor will follow up of preventive care
check the incision the following week to Appendicitis of the
look for possible wound infection. Appendicitis
5min Prevention
There is no way of predicting when
appendicitis will occur. It cannot be
prevented.
Write nursing
care plan on
3min NURSING MANAGEMENT OF appendicitis
APPENDICITIS
 Provide comfortable position.
 Give more oral fluids.
 Administer medication as per
prescription.
 Prepare the patient for
appendicectomy.

2min SUMMARY
Appendicitis is a common condition that
affects 7% of the population, according to
the American Academy of Family
Physicians. Persons of any age may be
affected, with the highest incidence
occurring during the second and third
decades of life. The appendix is a narrow
tubular pouch attached to the intestines.
When the appendix is blocked, it becomes
 inflamed and results in the condition known
as appendicitis. The treatment choice for
appendicitis is appendicectomy.

3min CONCLUSION
At the end of the class the student have gain
knowledge about appendicitis and its types,
risk factors, clinical features, diagnosis, and
its management

2min EVALUATION
Short answer question 5 x 3 = 15.
1) What is appendicitis?
2) Management of patient with
appendicitis.
3) Treatment and nursing management
of appendicitis.

ASSIGNMENT
2min
Write an assignment on nursing care plan
on appendicitis

BIBLIOGRAPHY
1. Student’s bibliography
 Brunner and suddarths, TEXT BOOK
OF MEDICAL SURGICAL NURSING,
10TH edition, Lippincott Williams and
 Wilkins.

 Lippincott, “MANNUAL OF NURSING

PRACTICE”, 8th edition, Lippincott
Williams and Willkins.

2. Teachers bibliography

 Brunner and suddarths, TEXT BOOK

OF MEDICAL SURGICAL NURSING,
10TH edition, Lippincott Williams and
Wilkins.

 Lippincott, “MANNUAL OF NURSING

PRACTICE”, 8th edition, Lippincott
Williams and Willkins.

 Long & Phipps -Medical Surgical

Nursing

 Luckman &Sorenson -Medical

Surgical Nursing