Dimas, Janelle A.

BSN-3B
APPENDICITIS
A. Definition:
a. Appendicitis occurs when the appendix becomes inflamed. It’s the most common
major surgical emergency. More precisely, this disorder is an inflammation of the
vermiform appendix, a small, fingerlike projection attached to the cecum just
below the ileocecal valve.
B. Pathophysiology
a. The appendix becomes inflamed and edematous as a result of becoming kinked or
occluded by a fecalith (i.e., hardened mass of stool), lymphoid hyperplasia
(secondary to inflammation or infection), or rarely, foreign bodies (e.g., fruit
seeds) or tumors. The inflammatory process increases intraluminal pressure,
causing edema and obstruction of the orifice. Once obstructed, the appendix
becomes ischemic, bacterial overgrowth occurs, and eventually gangrene or
perforation occurs (Craig, 2015; Saccomano & Ferrara, 20Q13).
C. Risk Factors / Causes
a. Causes of appendicitis include:
● mucosal ulceration
● fecal mass (fecalith)
● stricture
● barium ingestion
● viral infection
D. Comprehensive Assessment
a. Initially, the patient may manifest these signs and symptoms:
● abdominal pain, generalized or localized in the right upper
abdomen, eventually localizing in the right lower abdomen
(McBurney’s point)
- To elicit McBurney’s sign, help the patient into a supine
position, with his knees slightly flexed and his abdominal
muscles relaxed. Then palpate deeply and slowly in the
right lower quadrant over McBurney’s point—located
about 2” (5 cm) from the right anterior superior spine of the
ilium, on a line between the spine and the umbilicus. Point
pain and tenderness, a positive McBurney’s sign, indicates
appendicitis.
● anorexia
● nausea and vomiting
● boardlike abdominal rigidity
● retractive respirations
● increasingly severe abdominal spasms and rebound spasms.
● (Rebound tenderness on the opposite side of the abdomen suggests
peritoneal inflammation.)
b. Later symptoms include:
● constipation (although diarrhea is also possible)
● fever of 99o to 102o F (37.2o to 38.9o C)
● tachycardia

E. Diagnosis
 a. The CBC demonstrates an elevated white blood cell count with an elevation of the
neutrophils. C-reactive protein levels are typically elevated.
b. A CT scan may reveal a right lower quadrant density or localized distention of the
bowel; enlargement of the appendix by at least 6 mm is suggestive of
appendicitis.
c. Ultrasound of the abdomen and pelvis can help diagnose a non perforated
appendix.
F. Collaborations
a. Medical, Surgical and Nursing interventions are performed to eradicate the
infection and to prevent complications.
i. Appendectomy or the surgical removal of the appendix is performed as
soon as it is possible to decrease the risk of perforation.
ii. Laparotomy and laparoscopy. Both of these procedures are safe and
effective in the treatment of appendicitis with perforation.
G. Treatment and Care
a. Immediate surgery is typically indicated if appendicitis is diagnosed (Craig, 2015;
Saccomano & Ferrara, 2013).
b. Conservative nonsurgical medical management for uncomplicated appendicitis
(i.e., absence of gangrene or perforation of the appendix, empyema or abscess
formation, or peritonitis) has been instituted in some instances with a reduced risk
of complications and similar hospital length of stay as appendectomy (Salminen,
Paajanen, Rautio, et al., 2015).
c. To correct or prevent fluid and electrolyte imbalance, dehydration, and sepsis,
antibiotics and IV fluids are given until surgery is performed.
d. Appendectomy (i.e., surgical removal of the appendix) is performed as soon as
possible to decrease the risk of perforation.
H. Complications
a. The major complications of appendicitis are gangrene or perforation of the
appendix, which can lead to peritonitis, abscess formation, or portal pylephlebitis,
which is septic thrombosis of the portal vein caused by vegetative emboli that
arise from septic intestines.
I. Nursing Considerations
a. Goals include relieving pain, preventing fluid volume deficit, reducing anxiety,
preventing or treating surgical site infection, preventing atelectasis, maintaining
skin integrity, and attaining optimal nutrition.
b. The nurse prepares the patient for surgery, which includes an IV infusion to
replace fluid loss and promote adequate renal function, antibiotic therapy to
prevent infection, and administration of analgesic agents for pain (Saccomano &
Ferrera, 2013).
i. An enema is not given because it can lead to perforation.
c. After surgery, the nurse places the patient in a high Fowler position to reduce the
tension on the incision and abdominal organs, helping to reduce pain. It also
promotes thoracic expansion, diminishing the work of breathing, and decreasing
the likelihood of atelectasis.
d. The nurse auscultates for the return of bowel sounds and queries the patient for
passing of flatus.
e. Urine output is monitored to ensure that the patient is not hampered by
postoperative urinary retention and to ensure that hydration status is adequate.
f. The patient is encouraged to ambulate the day of surgery to reduce risks of
atelectasis and venous thromboemboli (VTE) formation.
 J. Patient Teaching
a. The patient is educated on the use of an incentive spirometer and encouraged to
use it at least every 2 hours while awake.
b. The nurse instructs the patient to make an appointment to have the surgeon
remove any sutures and inspect the wound between 1 and 2 weeks after surgery
(Evans & Curtin, 2014).
c. Incision care and activity guidelines are discussed; heavy lifting is to be avoided
postoperatively, although normal activity can usually be resumed within 2 to 4
weeks.

CROHN'S DISEASE

A. Definition:
a. It is a subacute and chronic inflammation of the GI tract wall that extends through
all layers (i.e., transmural lesion). Although its characteristic histopathologic
changes can occur anywhere in the GI tract, it most commonly occurs in the distal
ileum and the ascending colon.
B. Pathophysiology
a. In Crohn’s disease, inflammation spreads slowly and progressively. Here’s what
happens:
● Lymph nodes enlarge and lymph flow in the submucosa is blocked.
● Lymphatic obstruction causes edema, mucosal ulceration, fissures, abscesses and,
sometimes, granulomas. Mucosal ulcerations are called skipping lesions because
they aren’t continuous as in ulcerative colitis.
● Oval, elevated patches of closely packed lymph follicles — called Peyer’s patches
— develop on the lining of the small intestine.
● Fibrosis occurs, thickening the bowel wall and causing stenosis, or narrowing of
the lumen.
○ As Crohn’s disease progresses, fibrosis thickens the bowel wall and
narrows the lumen. Narrowing — or stenosis — can occur in any part of
the intestine and causes varying degrees of intestinal obstruction. At first,
the mucosa may appear normal but, as the disease progresses, it takes on a
“cobblestone” appearance.
C. Risk Factors / Causes
a. The exact cause of Crohn’s disease is unknown. Possible causes include allergies,
immune disorders, lymphatic obstruction, infection, and genetic factors.
D. Comprehensive Assessment
a. In acute disease, look for right lower abdominal quadrant pain, cramping,
tenderness, flatulence, nausea, fever, diarrhea, and bleeding (usually mild but may
be massive).
b. In chronic disease, look for diarrhea, four to six stools per day, right lower
quadrant pain, steatorrhea, marked weight loss, possible weakness and, rarely,
clubbing of fingers.
E. Diagnosis
a. Laboratory findings typically indicate increased WBC count and erythrocyte
sedimentation rate (ESR), hypokalemia, hypocalcemia, hypomagnesemia, and
decreased hemoglobin levels.
b. A barium enema showing the string sign (segments of stricture separated by
normal bowel) supports this diagnosis.
 c. Sigmoidoscopy and colonoscopy may show patchy areas or inflammation, thus
helping to rule out ulcer ative colitis.
d. Biopsy results confirm the diagnosis.
e. Upper GI series with small-bowel examination helps determine disease in the
ileum.
F. Collaborations
a. Multidisciplinary team, including medical, surgical, nursing, nutrition and
dietetics and radiologic technicians are all involved in the diagnosis and
management of Crohn’s Disease. The general goals of management or therapy of
it are the following:
i. First is treating the inflammatory process and its associated complications
(e.g., abscesses, fistulas, strictures, intestinal obstructions) with the goal of
achieing and maintaining remission.
ii. Second is minimizing the negative health impacts from Crohn's disease
itself and the therapies used to treat it.
G. Treatment and Care
a. TPN helps to maintain nutrition while resting the bowel of a debilitated patient.
Surgery can correct bowel perforation, massive hemorrhage, fistulas, or acute
intestinal obstruction. The patient with extensive disease of the large intestine and
rectum may require colectomy with ileostomy.
b. Effective drug therapy requires important changes in lifestyle: physical rest, a
restricted-fiber diet (low in fruit and vegetables), and elimination of dairy
products for lactose intolerance. Drug therapy may include:
● anti-inflammatory corticosteroids and antibacterials, such as sulfasalazine
(Azulfidine) and mesalamine (Asacol)
● metronidazole (Flagyl)
● opium tincture and diphenoxylate (Lomotil) to help combat diarrhea
(contraindicated in patients with significant intestinal obstruction)
● immunosuppressants, such as azathioprine (Imuran), cyclosporin
(Sandimmune), and 6-mercaptopurine (Purinethol), for patients who can’t
be controlled on steroid therapy
● infliximab (Remicade), a tumor necrosis factor-alpha, to promote closure
of fissures and treat refractory Crohn’s disease flare-ups, given in a
monitored setting by I.V. infusion in a cycle of three treatments (at weeks
1, 2, and 6).
H. Complications
a. Complications of Crohn’s disease include intestinal obstruction or stricture
formation, perianal disease, fluid and electrolyte imbalances, malnutrition from
malabsorption, and fistula and abscess formation.
b. Patients with colonic Crohn’s disease are also at increased risk of colon cancer
I. Nursing Considerations
a. Record fluid intake and output (including the amount of stool), and weigh the
patient daily.
b. Watch for dehydration and maintain fluid and electrolyte balance.
c. Be alert for signs of intestinal bleeding (bloody stool). Check stool daily for
occult blood.
d. If the patient is receiving steroids, watch for adverse reactions such as GI
bleeding. Remember that steroids can mask signs of infection. Check hemoglobin
levels and hematocrit regularly. Also check the WBC count if the patient is on
 immunomodulators. Give iron supplements, blood transfusions, and analgesics as
ordered.
e. Watch for fever and pain on urination, which may signal bladder fistula.
Abdominal pain, fever, and a hard, distended abdomen may indicate intestinal
obstruction.
f. Before ileostomy, arrange for a visit by an enterostomal therapist.
g. For postoperative care
• Evaluate the patient. After successful treatment for Crohn’s disease, he
will maintain optimal nutrition, hydration, and skin integrity. He’ll use positive
coping mechanisms to deal with a changed body image. He should be able to
identify and avoid foods likely to cause distress. Make sure he can demonstrate
proper care of an ostomy, if required, and uses appropriate support groups.
Evaluate his understanding of the need for follow-up care and when to seek
immediate attention.

K. Patient Teaching
a. Teach stoma care to the patient and his family. Realize that ileostomy changes the
patient’s body image; offer reassurance and emotional support.
b. Stress the need for a severely restricted diet and bed rest, which may be difficult,
particularly for the young patient.
c. Encourage the patient to try to reduce tension. If stress is clearly an aggravating
factor, refer him for counseling.
d. Teach the patient to follow a low-residue diet, exercise, and seek family support.

ULCERATIVE COLITIS
A. Definition:
a. Ulcerative colitis is a chronic ulcerative and inflammatory disease of the mucosal
and submucosal layers of the colon and rectum that is characterized by
unpredictable periods of remission and exacerbation with bouts of abdominal
cramps and bloody or purulent diarrhea.
B. Pathophysiology
a. Ulcerative colitis affects the superficial mucosa of the colon and is characterized
by multiple ulcerations, diffuse inflammations, and desquamation or shedding of
the colonic epithelium. Bleeding occurs as a result of the ulcerations. The mucosa
becomes edematous and inflamed. The lesions are contiguous, occurring one after
the other. Eventually, the bowel narrows, shortens, and thickens because of
muscular hypertrophy and fat deposits. Because the inflammatory process is not
transmural (i.e., it affects the inner lining only), abscesses, fistulas, obstruction,
and fissures are uncommon in ulcerative colitis.
C. Risk Factors / Causes
a. The cause of ulcerative colitis is unknown. Risk factors include a family history
of the disease; bacterial infection; allergic reaction to food, milk, or other
substances that release inflammatory histamine in the bowel; overproduction of
enzymes that break down the mucous membranes; and emotional stress.
Autoimmune disorders, such as rheumatoid arthritis, hemolytic anemia, erythema
nodosum, and uveitis, may heighten the risk.
D. Comprehensive Assessment
a. Recurrent bloody diarrhea and symptom-free remissions are the hallmarks of
ulcerative colitis. The stool typically contains pus and mucus. Assess the patient
for other signs and symptoms, such as:
 ● spastic rectum and anus
● abdominal pain
● irritability
● weight loss
● weakness
● anorexia
● nausea and vomiting
● fever
● occasional constipation (in elderly patients)
E. Diagnosis
a. Sigmoidoscopy shows increased mucosal friability, decreased mucosal detail, and
thick inflammatory exudate. Biopsy during sigmoidoscopy helps confirm the
diagnosis.
b. Colonoscopy helps determine the extent of disease and evaluate strictured areas,
pseudopolyps, and precancerous changes.
c. A barium enema helps to assess the extent of the disease and to detect
complications, such as strictures and carcinoma.
d. A stool specimen may reveal leukocytes, ova, and parasites.
e. The ESR will be increased in proportion to the severity of the attack.
f. Decreased serum levels of potassium, magnesium, hemoglobin, and albumin as
well as leukocytosis and increased PT support the diagnosis.
F. Collaborations
a. Treatment for ulcerative colitis is multifaceted and includes the use of medication,
alterations in diet and nutrition, and sometimes surgical procedures to repair or
remove affected portions of your GI tract.
i. The optimal goal of management is a sustained and durable period of
steroid-free remission, accompanied by appropriate psychosocial support,
normal health-related quality of life (QoL), prevention of morbidity
including hospitalization and surgery, and prevention of cancer.
G. Treatment and Care
a. Treatment seeks to control inflammation, replace nutritional losses and blood
volume, and prevent complications.
b. Supportive treatment includes bed rest, I.V. fluid replacement, and a clear liquid
diet.
c. For a patient awaiting surgery or showing signs of dehydration and debilitation
from excessive diarrhea, TPN is administered to rest the intestinal tract, decrease
stool volume, and restore positive nitrogen balance. The patient may also need
blood transfusions or iron supplements to correct anemia.
d. Drug therapy to control inflammation includes adrenocorticotropic hormone and
adrenal corticosteroids, such as prednisone, prednisolone (Prelone),
hydrocortisone (Cortef), and budesonide (Entocort EC).
e. If disease is limited to the left side of the colon, topical mesalamine suppositories
or enemas or hydrocortisone enemas may be effective.
f. Sulfasalazine and mesalamine (Asacol), which have anti-inflammatory and
antimicrobial properties, may also be used.
g. Antispasmodics, such as tincture of belladonna, and antidiarrheals, such as
diphenoxylate, are used only for patients whose ulcerative colitis is under control
but who have frequent, troublesome diarrheal stools. These drugs may precipitate
massive dilation of the colon (toxic megacolon) and are usually contraindicated.
 h. Immunomodulatory agents, such as azathioprine and 6-mercaptopurine, may be
effective for patients who have frequent flare ups of symptoms despite continuous
steroid therapy. Patients with severe disease have also been treated with
cyclosporine. These medications require careful monitoring along with serial
CBC with differential counts.
i. Surgery is the treatment of last resort if the patient has a toxic megacolon, fails to
respond to drugs and supportive measures,or finds symptoms unbearable. The
most common surgical technique is proctocolectomy with ileostomy. Total
colectomy with ileorectal anastomosis is done less often because of its associated
mortality (2% to 5%).
j. In pouch ileostomy, a pouch is created from a small loop of the terminal ileum
and a nipple valve formed from the distal ileum. The resulting stoma opens just
above the pubic hairline; the pouch empties through a catheter inserted in the
stoma several times each day.
k. Colectomy to prevent colon cancer is controversial in treatment for ulcerative
colitis.
H. Complications
a. Complications of ulcerative colitis include toxic megacolon, perforation, and
bleeding as a result of ulceration, vascular engorgement, and highly vascular
granulation tissue.
b. Patients with ulcerative colitis also have a significantly increased risk of
osteoporotic fractures due to decreased bone mineral density.
c. Patients with ulcerative colitis are also at increased risk for colon cancer.
I. Nursing Considerations
a. Accurately record intake and output, particularly the frequency and volume of
stools. Watch for signs of dehydration (poor skin turgor, furrowed tongue) and
electrolyte imbalances, especially signs of hypokalemia (muscle weakness,
paresthesia) and hypernatremia (tachycardia, flushed skin, fever, dry tongue).
b. Monitor hemoglobin level and hematocrit, and give blood transfusions as ordered.
c. Provide good mouth care for the patient who’s allowed nothing by mouth.
d. After each bowel movement, thoroughly clean the skin around the rectum.
e. Provide an air mattress or a sheepskin to help prevent skin breakdown.
f. Watch for adverse effects of prolonged corticosteroid or immunomodulator
therapy (hyperglycemia, hypertension, hirsutism, edema, gastric irritation). Be
aware that such therapy may mask infection.
g. Watch closely for signs of complications, such as a perforated colon and
peritonitis (fever, severe abdominal pain, abdominal rigidity and tenderness, cool,
clammy skin) and toxic megacolon (abdominal distention, decreased bowel
sounds).
h. Do a bowel preparation, as ordered. This usually involves keeping the patient on a
clear liquid diet, using enemas, and administering antimicrobials such as
neomycin.
i. Evaluate the patient. He should maintain optimal nutrition and hydration, report
his feelings about his changed body image, identify and avoid foods likely to
cause distress, demonstrate proper ostomy care, use appropriate support groups,
understand the need for follow-up care, and know when to seek immediate
attention.
J. Patient Teaching
a. Prepare the patient for surgery and inform him about ileostomy. Encourage him to
verbalize his feelings and provide emotional support.
 b. After a proctocolectomy and ileostomy, teach good stoma care. After a pouch
ileostomy, also teach the patient how to insert the catheter.
c. Instruct the patient about his disease, and teach him to watch for signs of
increased activity and flare-ups. Discuss adverse effects of medications,
especially immunomodulators.
d. Include instruction on self-administration of enemas and topical creams.
e. Explain the importance of a healthy, low-residue diet and an adequate intake of
protein, calcium, folate, and vitamin D.
f. Encourage the patient to have regular physical examinations because he’s at risk
for developing colorectal cancer.

PERITONITIS
A. Definition:
a. Peritonitis is inflammation of the peritoneum, which is the serous membrane
lining the abdominal cavity and covering the viscera.
b. Peritonitis can be categorized as (Daley, 2015):

1. Primary peritonitis, also called spontaneous bacterial peritonitis (SBP), occurs

as a spontaneous bacterial infection of ascitic fluid. This occurs most commonly
in adult patients with liver failure (see Chapter 49).

2. Secondary peritonitis occurs secondary to perforation of abdominal organs with

spillage that infects the serous peritoneum. The most common causes include a
perforated appendix (see later discussion), perforated peptic ulcer (see Chapter
46), perforated sigmoid colon caused by severe diverticulitis (see later
discussion), volvulus of the colon (see later discussion), and strangulation of the
small intestine (see later discussion). The major focus of this section is on
secondary peritonitis.

3. Tertiary peritonitis occurs as a result of a superinfection in a patient who is

immunocompromised. Tuberculous peritonitis in a patient with AIDS is an
example of tertiary peritonitis; these are rare causes of peritonitis.
B. Pathophysiology
a. Although the GI tract normally contains bacteria, the peritoneum is sterile. When
bacteria or chemical irritants invade the peritoneum because of inflammation and
perforation of the GI tract, peritonitis results. In chemical and bacterial
inflammation, accumulated fluids containing protein and electrolytes make the
transparent peritoneum opaque, red, inflamed, and edematous. Because the
peritoneal cavity is so resistant to contamination, infection is commonly localized
as an abscess.
b. Secondary peritonitis is caused by leakage of contents from abdominal organs
into the abdominal cavity, usually as a result of inflammation, infection, ischemia,
trauma, or tumor perforation. Bacterial proliferation occurs. Edema of the tissues
results, and exudation of fluid develops in a short time. Fluid in the peritoneal
cavity becomes turbid with increasing amounts of protein, white blood cells,
cellular debris, and blood. The immediate response of the intestinal tract is
hypermotility, soon followed by paralytic ileus with an accumulation of air and
fluid in the bowel (Daley, 2015; Grossman & Porth, 2014)
C. Risk Factors / Causes
 a. Peritonitis results from bacterial inflammation due to a ruptured appendix,
perforated bowel, a strangulated obstruction, an abdominal neoplasm, or a stab
wound.
b. It may also result from chemical inflammation, as in ruptured fallopian tubes or
bladder, perforated gastric ulcer, or released pancreatic enzymes.
D. Comprehensive Assessment
a. The main symptom of peritonitis is sudden, severe, diffuse abdominal pain that
tends to intensify and localize in the area of the underlying disorder. Also assess
the patient for:
• weakness, pallor(I), excessive sweating(I), and cold skin (Pa)
• decreased intestinal motility and paralytic ileus
• abdominal distention (Pa)
• an acutely tender abdomen associated with rebound tenderness (Pa)
• shallow breathing (I)
• diminished movement by the patient to minimize pain (I)
• hypotension, tachycardia, and signs of dehydration
• fever of 103° F (39.4° C) or higher
• possible shoulder pain and hiccups.
E. Diagnosis
a. Abdominal X-rays showing edematous and gaseous distention of the small and
large bowel support the diagnosis. With perforation of a visceral organ, the X-ray
shows air in the abdominal cavity.
b. Chest X-rays may show an elevated diaphragm.
c. Blood studies show leukocytosis (more than 20,000 leukocytes/μl).
d. Paracentesis reveals bacteria, exudate, blood, pus, or urine.
e. Laparotomy may be necessary to identify the underlying cause.
F. Collaborations
a. Approach to treatment usually involves medical, specifically pharmacologic
therapy, surgical, nursing interventions.
i. The goals of pharmacotherapy in patients with spontaneous bacterial
peritonitis (SBP) are to reduce morbidity and prevent complications.
Antibiotics are initially chosen empirically, as these patients may die from
overwhelming infection if treatment is delayed until culture results
become available.
ii. Nursing goals appropriate for a patient with peritonitis include: Reduce
level of pain; Restore fluid and electrolyte balance; Prevent complications;
Restore normal GI functions.
iii. Surgical intervention: The goal of the open-abdomen technique is to
provide easy, direct access to the affected area. Source control is achieved
through repeated reoperations or through open packing of the abdomen.
This technique may be well suited for initial damage control in extensive
peritonitis.
G. Treatment and Care
a. Early treatment of GI inflammatory conditions and preoperative and postoperative
antibiotic therapy prevent peritonitis. After peritonitis develops, emergency
treatment aims to stop infection, restore intestinal motility, and replace fluids and
electrolytes:
b. Massive antibiotic therapy usually includes administration of cephalosporins with
an aminoglycoside according to the infecting organisms. Quinolones may also be
used.
 c. To decrease peristalsis and prevent perforation, the patient should be given
nothing by mouth and should receive supportive fluids and electrolytes
parenterally.
d. Supplementary treatment measures include preoperative and postoperative
analgesics, such as meperidine; NG intubation to decompress the bowel; and
possible use of a rectal tube to help passage of flatus.
e. When peritonitis results from perforation, surgery is performed as soon as the
patient can tolerate it. Surgery aims to eliminate the infection source by
evacuating the spilled contents and inserting drains.
f. Occasionally, paracentesis may be needed to remove accumulated fluid.
g. Irrigation of the abdominal cavity with antibiotic solutions during surgery may be
appropriate.
H. Complications
a. Complications of peritonitis include tertiary peritonitis, infection or dehiscence of
the surgical site, enterocutaneous fistula, abdominal compartment syndrome, and
enteric insufficiency.
I. Nursing Considerations
a. Regularly monitor vital signs, fluid intake and output, and the amount of NG
drainage or vomitus.
b. Place the patient in semi-Fowler’s position to help him deep breathe with less
pain, which helps to prevent pulmonary complications.
c. Blood pressure monitoring. The patient’s blood pressure is monitored by an
arterial line if shock is present.
d. Medications. Administration of analgesic and anti emetics can be done as
prescribed.
e. Pain management. Analgesics and positioning could help in decreasing pain.
f. I&O monitoring. Accurate recording of all intake and output could help in the
assessment of fluid replacement.
g. IV fluids. The nurse administers and closely monitors IV fluids.
h. Drainage monitoring. The nurse must monitor and record the character of the
drainage postoperatively.
J. Patient Teaching
a. Teach the patient about peritonitis, its cause (in his case), and necessary
treatments. If time allows before surgery, reinforce the surgeon’s explanation of
the procedure and its possible complications. Tell him how long he can expect to
be hospitalized; many patients remain hospitalized for 2 weeks or more after
surgery.
b. Review diet and activity limitations (depending on the type of surgery). Typically,
the patient must avoid lifting for at least 6 weeks postoperatively.
References:

Lippincott Williams & Wilkins. (2008). Medical-surgical nursing made incredibly easy!.
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth's textbook of medical-surgical
nursing (Edition 13.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

What are the goals of therapy for appendicitis? (medscape.com)

Appendicitis Nursing Care Management: Study Guide (nurseslabs.com)

Crohn's Disease: Diagnosis and Management - American Family Physician (aafp.org)

Rubin, David T. MD, FACG1; Ananthakrishnan, Ashwin N. MD, MPH2; Siegel, Corey A. MD,
MS3; Sauer, Bryan G. MD, MSc (Clin Res), FACG (GRADE Methodologist)4; Long, Millie D.
MD, MPH, FACG5 ACG Clinical Guideline: Ulcerative Colitis in Adults, The American Journal
of Gastroenterology: March 2019 - Volume 114 - Issue 3 - p 384-413doi:
10.14309/ajg.0000000000000152

Ulcerative Colitis Treatment Options | Crohn's & Colitis Foundation

What are the goals of drug treatment for spontaneous bacterial peritonitis (SBP)?
(medscape.com)

Peritonitis Nursing Care Management and Study Guide (nurseslabs.com)

What are the complications of peritonitis? (medscape.com)