MSN TRANS FORMAT
BOLUSO, BRUSAS, CASTANARES, ELIZARDE, FRANCO, REYES, RUIZ, SALVO, SANCHEZ, UMLAS
MEDICAL MANAGEMENT
ANTIBIOTIC THERAPY
 Lowers the incidence of POSTOPERATIVE
WOUND INFECTIONS & INTRAPERITONEAL
ABSCESSES in perforated appendicitis, but their
role is less well defined in simple appendicitis.
 Antibiotic coverage is continued postoperatively for
3-5 days.
 For SIMPLE NON-PERFORATED AP → one pre-op
dose of a single broad-spectrum agent (CEFOXITIN)
or equivalent is sufficient.
- Cefoxitin – third generation cephalosporins would
be enough to cover the simple non-perforated
appendicitis.
 For PERFORATED OR GANGRENOUS
APPENDICITIS → combination regimens such as
Zosyn (piperacillin/tazobactam),
ticarcillin/clavulanate, or ceftriaxone/metronidazole
- double or triple regimen antibiotics
- Piperacillin – is a penicillin group; First antibiotic
to be generated that is why many organisms are
resistant to Penicillin alone that supposedly destroy
organism by binding its beta-lactam ring to the
organisms to destroy its cell wall. However, the
organism already developed an enzyme to destroy
the beta-lactam ring.
- Tazobactam – beta-lactamase inhibitors (enzyme
that destroys the beta-lactam ring) facilitate
prolonged effectivity of the Penicillin to the
organisms.
- Ceftriaxone – third generation cephalosporins;
with anti-protozoal to cover gram positive and
negative.
- Depending on the case. In some institutions, there
is only initial pre-op medication then will wait for the
histopathology analysis corresponds to its culture
and sensitivity in the gangrenous appendix to adjust
the antibiotic treatment on where the organism is
sensitive that is possibly seen on the appendix when
removed.
 Source: https://www.slideshare.net/JPATMD/acute-
appendicitis-76155952
APPENDECTOMY – NURSING MANAGEMENT
Appendectomy: Surgical removal of the appendix
PREOPERATIVE INTERVENTIONS
 Maintain NPO status
- Especially when the patient arrives at the hospital
in pain, localizing at the right lower quadrant and
manifesting the s/sx of appendicitis.
- Anytime patient is subject for operation.
 Administer fluids intravenously to prevent
dehydration.
MEDICAL-SURGICAL NURSING
 Monitor for changes in level of pain.
- Initially abdominal pain is vague and mistaken from
other area. Later on, around 2-12 hours since the
onset of pain, the tendency of the pain is to localize
at the right lower quadrant = intense and
progressive pain signifies patient having perforation
and possible peritonitis.
 Monitor for signs of ruptured appendix and
peritonitis.
- Progression of pain suggesting rupture of
appendix.
- Subject to OR to avoid proliferation of irritants that
can cause peritonitis.
 Position the client in a right side-lying or low semi-
Fowler’s position to promote comfort.
- Positioning where the pain is said to be helpful to
relieve the pain. But some clients are intolerable.
- Rule of thumb: ask client on preferred comfortable
position and assist them.
Signs of Bowel Perforation and Peritonitis
o Guarding of the abdomen
- Board-like abdomen in peritonitis.
o Increased fever and chills
- Initially low-grade fever in appendicitis
o Pallor
- Perforation may lead to bleeding;
Hypovolemic shock for some.
o Progressive abdominal distention and
abdominal pain
- Marked indication
o Restlessness
- Altered sensorium of patient more likely
when there is an internal bleeding because
of the perforation.
- Fluid movement/ shifting into the lumen of
intestine and in the peritoneal spaces (3 rd
spacing).
- Decrease blood volume in the
intravascular space leading to decreased
perfusion in the brain.
o Tachycardia and tachypnea
- because of decreased fluid volume in the
circulation.
 Monitor bowel sounds.
- Normally when peritoneum becomes inflamed
because of ruptured or persistently swollen
appendix. There is an increase likelihood to cause
alteration in the peristaltic activity of the small
intestine leading to paralytic ileus.
 Avoid the application of heat to the abdomen.
- Higher chance of appendix to rupture. Warm/Heat
promotes vasodilation. To avoid progressive
swelling leading to rupture.
MSN TRANS FORMAT MEDICAL-SURGICAL NURSING
BOLUSO, BRUSAS, CASTANARES, ELIZARDE, FRANCO, REYES, RUIZ, SALVO, SANCHEZ, UMLAS

 Apply ice packs to the abdomen for 20 to 30 minutes

every hour as prescribed.
- Promotes vasoconstriction; lowers
inflammation.
- Every hour for 20-30 minutes of application
- Start of prophylactic treatment before subjecting
the OR; depends on the doctor’s prescription.
 Administer antibiotics as prescribed.
 Avoid laxatives or enemas.
- May trigger the stimulation and build up of
pressure within the lumen of the colon Leading to
possible rapid perforation of inflamed appendix.
Avoid the application of heat to the abdomen of a client
with appendicitis. Heat can cause rupture of the
appendix leading to peritonitis, a life-threatening
condition.
OPEN APPENDECTOMY
LAPAROSCOPIC APPENDECTOMY
down
YOUTUBE VIDEOS
 Appendectomy (Open procedure)
https://www.youtube.com/watch?v=E8PLNhr184 By
MovieSurg – November 9,2016
 Laparoscopic Appendectomy Surgery | Nucleus
Health https://youtu.be/E1ljClS0DhM
By Nucleus Media Medical Media – February 26,
2015
POSTOPERATIVELY INTERVENTIONS
 Monitor temperature for signs of infection.
 Assess incision for signs of infection such as
redness, swelling, and pain.
- other signs including the edema formation
 Maintain NPO status until bowel function has
returned.
- Best indicator of peristaltic activity return post-
surgery (patients undergo anesthesia) is when there
is passage of flatus and stool. In order to conclude
its safety to initiate feeding while avoiding intestinal
obstruction secondary to paralytic ileus.
- Bowel sound is not enough assessment parameter
alone. It is sometimes hard to assess – need to
assess the four quadrants of abdomen for at least
one minute to determine if it is hypoactive or
hyperactive.
- Factors that contribute to difficulty assessing the
bowel sounds: Environment & Stethoscope
 Advance diet gradually as tolerated and as
prescribed when bowel sounds return.
- Clear liquids > General liquids > Soft diet > Diet as
tolerated (small frequent meals)
 If rupture of the appendix occurred, expect a
Penrose drain to be inserted, or the incision may be
left open to heal from the inside out.
- Penrose drain – “may opening, yung kabilang dulo
andun sa wound itself para magdrain yung nana (if
may nana pa yung sugat sa loob)”
Purpose: to dry and have healing from the inside
out. Healing will not take place if it always has
moisture or excessive amount of exudate that
should be drained.
MSN TRANS FORMAT MEDICAL-SURGICAL NURSING
BOLUSO, BRUSAS, CASTANARES, ELIZARDE, FRANCO, REYES, RUIZ, SALVO, SANCHEZ, UMLAS

 Expect that drainage from the Penrose drain may be

profuse for the first 12 hours.
 Position the client in a right side-lying or low to semi-
Fowler’s position, with legs flexed, to facilitate
drainage.
 Change the dressing as prescribed and record the
type and amount of drainage.
 Perform wound irrigations if prescribed.
 Maintain nasogastric suction and patency of the
nasogastric tube if present.
 Administer antibiotics and analgesics as prescribed.