Faculty of nursing and health Science

MEDICAL SURGICAL 334

Concept map

.subject:Appendicitis
.Prepared by:saja fareed ayyash

. Presented to:salam awad

.Student No:1202190

.Semester:Spring 2014
 Pre-op diagnoses:
Altered Comfort: Acute Pain to -
bstruction on the lumen of the
inflammed appendix secondary to
appendicitis- Anxiety impending
surgery- Risk for fluid volume
deficit oralrestriction and vomiting
Diagnostic Period Nursing
Intervention
- make patient comfortable and reliev
- knowledge and clarify patient's
relieve pain through relaxation technon-
pharmacologic techniques- address
body image issues before s- offer
spiritual support- start IVF as
ordered- NPO
! do not give laxatives!
withhold Analgesics! Do
not apply hot compress
Thrombosis
Ulceration of luminal bloodvessels
lumin Diagnostic Exams:
1. CBC= increase in WBC and Neutrophils
---infection
2. Urinalysis.
3. X-ray/ischemia
CT scan of abdomen : imflammed
appendix .
4. Peritoneal Lavage:
:* increase in amylase level
* presence of bacteria
* presence of bile and fecal material
* RBC= > 100, 000gangreneperforation/ rupture appendix
of theappendix
gangrenerosis
Risk Factors:
Fecalith formation -
kinking of the appendi swelling of-
the bowel wallexternal
.occlusion of bowel byadhesion
Obstruction on the lumen of the
appendix
increase accumulation of mucus
increase intraluminal pressure
sdecrease blood flow / supply
venous congestion
of the
edema
Purulent exudates
form
Perforation \ rupture of the
appendix
Further distention of the
RLQ abdominal pain
-rebound tenderness
- rise in Temp= >37.5c
nausea and vomiting
- rigidity of the lower
portioright rectus muscle
Pre-op Nursing Interventions
-relieve anxiety and offer
emotional support- provide
doubts aboutthe procedure and
condition- relieve pain through
relaxation techniques and
othenon-pharmacologic
techniques- address body image
issues before surgery- offer
spiritual support- start IVF as
ordered-insert FBC and monitor
urine output- give anitbiotic
therapies as ordered- put on
CBR status- NPO- do skin
preparation of the abdomen-
make sure informed consent is
obtained- transport patient to the
Operating Roomulceration of
lischemitissue .
Shifting of fluids
 POST-OP Nursing
Interventions
1. Peritonitis 2
Wound infection 3.
Ileus (Paralytic
andMechanical)
- Observe for abdominal
tendervomiting, abdominal
rigidity an-
Employ constant
nasogastric- Correct
dehydration as prescri-
Administer antibiotic agent as-
Assess incision site for
Localized inflammation of
undesipus formation-
Assess for pain- Change
dressing as frequently- Observe
for fever and tachyca-
Administer antibiotic agent as-
Assess for bowel sounds-
Employ nasogastric
intubation- Replace fluids and
electrolyteprescribed- Prepare
Appendectomy and peritoneal
Post-op Nursing interventions
For ruptured Appendicitis For unruptured
Appendicitis
1. Assess for:- Bowel
Release of exudates with sounds- bowel movement-
passing of flatus- nausea-
1. Assess for:- Bowel
E.coli .klebsilla .proteus . sounds- bowel
boardlike abdominal
pseudomonas bacteria to movement- passing of
rigidity- vital signs
.peritoneal cavity (Temperature)- incision site flatus- nausea- boardlike
2. Place in high- fowler's
abdominal rigidity- vital
position
3. give morphine sulfate
signs (Temperature)-
for pain incision site
4. if bowel sounds is 2. Give pain medications
ok, provide food,as ordered as ordered
the peritoneum 5. for NPO status patients, pat 3. Offer clear fluids in the
OS ortissue on lips to prevent
crackingsand dryness
morningafter surgery
4. remove IVF if
6. Assess for infection
and do woundcare patient is able to
7. for patients using eatand drink
diapers,encourage changing 5. monitor s/s of
as often
Appendectomy and
8. watch out
infection
peritoneal lavage for complications 6. do wound care
9. turn and position 7. encourage mobility
patient every 2hours 1-2 days post-op;
10. teach patient how to 8. expect ambulation 4-5
support andsplint site days post-op
upon movement 9. monitor urine output.
11. teach deep breathing
12. encourage early
lavage
mobility

Nursing intervention
complications

Legend:
observe for abdominal tenderness ,vomiting , .1 peritonitis.1
abdominal rigidity
.

. Employ constant nasogastric .2

. Administration antibiotic agent .3

Asees incision site for undesierpus formation - wound infection .2

Asess for pain-

.Chang dressing as frequently-

. Observe for fever and tachycardia -

.Administration antibiotic agent ileus(paralytic and mechanical ).3

Asess for bowel sound -

Employ nasogastric intubation

.Replace fluids and electrolyte prescribed -