Exemplar - Appendicitis

Basic Patho: The appendix is a small hollow appendage that extends off the cecum, and although it is made of
lymphatic tissue, it has no known function. Appendicitis usually occurs as a result of a fecalith or other foreign
body blocking the opening, leading to inflammation and subsequent infection. Other, less common causes may
include malignant tumors, twisting and kinking of the appendix, edema of the bowel wall, adhesions, and other
infections.

Manifestations Labs/Diagnostics

 When the opening to the appendix is
blocked, the mucosa begins to secrete
fluid, leading to engorgement that
increases pressure and restricts blood
flow. Bacterial invasion occurs and
gangrene can occur as little as 24-36
hrs and is life threatening.
 Perforation can occur as little as 24
hrs, but the risk increases after 48 hrs
and can result in peritonitis, and this
is too life threatening.
 WBC (may have a moderate increase
w/ acute appendicitis). If the WBC is
elevated >20,000, a perforated
appendix should be suspected.
 An ultrasound may reveal an enlarged
appendix.
 But, a CT scan is the most commonly
used diagnostic test.

Treatments/Interventions
 There is no medical management for
acute appendicitis. A surgical consult
should be obtained ASAP.
 Laparoscopic removal of the
Post op teaching:
appendix.
 Administer IV fluids (because of an
increase of fluid loss due to vomiting
and fever).  preop and postop
 Provide comfort measures
 If the pt is suspected of having
appendicitis, the nurse should
NEVER apply heat because this
increases blood flow and
inflammation to the area and can
cause a rupture.
Teaching
 Laxatives and enemas should be
avoided because they can increase
intra-abdominal pressure that my
result in perforation of the appendix.
 Turn, cough, deep breathe and
incentive spirometer 10 times an hour
while awake.
 Early ambulation
 Take full course of antibiotics despite
lack of fever or pain
 Teach wound care if needed (usually
involves a moist saline dressing two
to three times a day).