IDEAL MANAGEMENT

Nursing Interventions and

Management Rationale/Results

APPENDICITIS:

Administer IV fluids until surgery is To correct or prevent fluid and

performed. electrolyte imbalance, dehydration,

sepsis.

Administer antibiotics until surgery is To eliminate infection due to the

performed potential or actual disruption of the GI

tract.

Analgesic agents can be given after To relieve pain

diagnosis is made.

Treatment options for Appendicitis:

• Appendectomy is performed as • To decrease the risk of perforation

soon as possible and treat appendicitis.

• Needle drainage or surgery to • To drain pus from an abscess and

drain an abscess to clean out the abscess more

thoroughly

Pre-operatively:

• Prepare patient for surgery and • To replace fluid loss and promote

start IV line adequate renal function

• Administer antibiotic, and insert • To prevent infection

 nasogastric tube (if evidence of

paralytic ileus)

• Do not administer an enema or • To prevent perforation.

laxative (could cause

perforation).

Post-operatively:

• Place patient in high Fowler’s • This position reduces the tension

position on the incision and abdominal

organs, helping to reduce pain

• Give narcotic analgesic as • To relieve pain

ordered

• Administer oral fluids when • To attain optimal nutrition

tolerated, give food as desired

on day of surgery (if tolerated).

• If dehydrated before surgery, • To correct dehydration and

administer IV fluids. maintain hydration status

• If a drain is left in place at the • To eliminate the risk of possible

area of the incision, monitor peritonitis

carefully for signs of intestinal

obstruction, secondary

hemorrhage, or secondary

abscesses (eg, fever,

tachycardia, and increased

 leukocyte count).

PERITONITIS:

Fluid, colloid, and electrolyte Hypovolemia occurs because massive

replacement with an isotonic solution amounts of fluid and electrolytes move

is the major focus of medical from the intestinal lumen into the

management. peritoneal cavity and deplete the fluid

in the vascular space.

Administer Analgesics as prescribed To relieve pain

Administer Antiemetics as prescribed To relieve nausea and vomiting

Intestinal intubation and suction To relieve abdominal distention and

promote intestinal function

Oxygen Therapy by nasal cannula or

mask, but airway intubation and To improve ventilatory assistance and

ventilatory assistance may be required promote adequate oxygenation

if peritonitis leads to septic shock

Large doses of a broad-spectrum

antibiotic are administered

intravenously until the specific To identify the organism causing

organism causing the infection is infection, fight the infection and

identified and appropriate antibiotic prevent it from spreading

therapy can be identified.

Surgery is directed toward excision To remove infected tissue, treat the

(appendix), resection (intestine), underlying cause of the infection, and

repair (perforation), or drainage prevent the infection from spreading,

(abscess). especially if peritonitis is due to a

ruptured appendix, stomach or colon.

Ultrasound-guided and CT-guided For avoidance or delay of surgical

peritoneal drainage of abdominal and therapy until the acute septic process

extraperitoneal abscess. has subsided.

Monitor the patient’s blood pressure Signs of impending septic shock.

by arterial line if shock is present. Circulating endotoxins eventually

produce vasodilation, shift of fluid from

circulation, and a low cardiac output

state.

Monitor central venous or pulmonary To differentiate the relative magnitude

artery pressures and urine output of pulmonary and cardiovascular

frequently. dysfunction.

Provide ongoing assessment of pain, To monitor a patient’s progress and

GI function, and fluid and electrolyte response to therapy.

balance.

Assess nature of pain, location in the Changes in location or intensity are

abdomen, and shifts of pain and not uncommon but may reflect

location. developing complications. Pain tends

to become constant, more intense,

and diffuse over the entire abdomen

 as inflammatory process accelerates;

pain may localize if an abscess

develops.

Administer analgesic medication and To help relieve pain

position for comfort.

The patient is placed on the side with This position decreases the tension on

knees flexed the abdominal organs.

Accurate recording of all intake and To assist in calculating fluid

output and central venous pressures replacement.

and pulmonary artery pressures

Monitor for signs of decrease in Signs that indicate that peritonitis is

temperature and pulse rate softening subsiding

of the abdomen, return of peristaltic

sounds, passing of flatus, and bowel

movements.

HYPERTENSION:

Non pharmacologic approaches

include:

• Weight reduction • Blood pressure often increases

as weight increases. Losing even

a small amount of weight

reduces blood pressure.

• Dietary Sodium Reduction • Lowering sodium intake can

 lower blood pressure and this

reduce the risk of cardiovascular

diseases and stroke

• Moderate of alcohol • Drinking more than moderate

consumption amounts of alcohol can actually

raise blood pressure by several

points. It can also reduce the

effectiveness of blood pressure

medications.

• Regular exercise and relaxation • Regular physical activity can

bring the blood pressure down to

safer levels.

• A DASH diet high in fruits, • Eating a diet that is rich in whole

vegetables, and low-fat dairy grains, fruits, vegetables and

products low-fat dairy products and skimps

on saturated fat and cholesterol

can lower blood pressure.

2-drug combination for most (usually Diuretics are considered first-line

THIAZ and ACE-I, or ARB, or BB, or medications for uncomplicated stage I

CCB) or II hypertension and may be used

alone or in association with other

drugs (such as beta-blockers) to

reduce BP in patients with relatively

 normal renal function.

Support and teach patient to adhere to To monitor progress or identify and

the treatment regimen by treat any complications of disease or

implementing necessary lifestyle therapy.

changes, taking medications as

prescribed, and scheduling regular

follow-up appointments with the health

care provider.