APPENDICITIS

Introduction
Appendicitis is the inflammation of the vermiform appendix, a finger-shaped pouch that projects
from your colon on the lower right side of your abdomen. It typically presents acutely, within 24
hours of onset, but can also present as a more chronic condition. Classically, appendicitis initially
presents with generalized or periumbilical abdominal pain that later localizes to the right lower
quadrant.

Causes and Risk Factors

Causes:

A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The
bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not
treated promptly, the appendix can rupture.

Many things can potentially block your appendix, including:

 a buildup of hardened stool

 enlarged lymphoid follicles
 intestinal worms
 traumatic injury
 tumors

Risk Factors:

Appendicitis can affect anyone. But some people may be more likely to develop this condition than
others. Risk factors for appendicitis include:

 Age. Appendicitis most often affects teens and people in their 20sTrusted Source, but it can
occur at any age.
 Sex. Appendicitis is more common in males than females.
 Family history. People who have a family history of appendicitis are at heightened risk of
developing it.

Nursing Assessment
Classically, appendicitis presents as an initial generalized or periumbilical abdominal pain that then
localizes to the right lower quadrant.  As the appendix becomes more inflamed, and the adjacent
parietal peritoneum is irritated, the pain becomes more localized to the right lower quadrant. Pain may
or may not be accompanied by any of the following symptoms:
  Decreased appetite
 Nausea/vomiting
 Fever (40% of patients)
 Diarrhea or constipation
 Generalize malaise
 Urinary frequency or urgency


Physical exam findings are often subtle, especially in early appendicitis.

As inflammation progresses, signs of peritoneal inflammation develop. Signs include:

 Right lower quadrant guarding and rebound tenderness

 Right lower quadrant pain elicited by palpation of the left lower quadrant
 Increased abdominal pain with coughing or movement
 Rigid abdomen and involuntary guarding

The time course of symptoms is variable but typically progresses from early appendicitis at 12 to 24
hours to perforation at greater than 48 hours. Seventy-five percent of patients present within 24 hours
of the onset of symptoms.

The risk of rupture is variable but is about 2% at 36 hours and increases about 5% every 12 hours after
that.

Pathology
Appendicitis is thought to result from obstruction of the appendiceal lumen, typically by lymphoid
hyperplasia but occasionally by a fecalith, foreign body, or even worms. The obstruction leads to
distention, bacterial overgrowth, ischemia, and inflammation. If untreated, necrosis, gangrene, and
perforation occur.

Nursing Priorities and Consideration

 Assessing and relieving pain through medication administration as well as nonpharmacologic
interventions.
 IMPORTANT: Do not apply heat to the appendicitis patient’s abdomen as this could lead to
rupture.
 Prevent fluid volume deficit. If tolerated and the patient is not NPO, oral fluid intake should be
encouraged, and intake and output recorded.
 Prevent infection. Maintain a clean environment, provide wound care to the postoperative
patient, and assess incision frequently for signs of infection. Monitor patient temperature and
heart rate for signs of potential infection. Administer antibiotics as prescribed by the provider.
 Reduce patient anxiety by keeping the patient informed of the plan of care and ensure the
patient is aware of diagnosis and treatment options. 
  Encourage patients to walk as able/ permitted to maintain circulation. If the patient is immobile,
the use of serial compression devices (SCD) and TED hose should be implemented to avoid
DVT/clots.
 Monitor for adequate bowel movements. Opioids can be necessary for pain control, but they
often lead to constipation. Encourage adequate water intake and use of a stool softener.

Prevention and Treatment.

Treatment:

The doctor will recommended treatment plan for appendicitis will most likely
involve antibiotics followed by surgery to remove your appendix. This is known as an appendectomy.

Treatment may also include one or more of the following:

 needle drainage or surgery to drain an abscess before undergoing surgery, if your abscess has
not ruptured
 pain relievers
 IV fluids
 liquid diet

In rare cases, mild appendicitis may get better with antibiotics alone. But in most cases, the patient will
need surgery to remove your appendix.

Prevention:

There’s no sure way to prevent appendicitis. But the patient might be able to lower your risk of
developing it by eating a fiber-rich diet. Although more research is needed on the potential role of diet,
appendicitis is less common in countries where people eat high-fiber diets.

Foods that are high in fiber include:

 fruits
 vegetables
 lentils, split peas, beans, and other legumes
 oatmeal, brown rice, whole wheat, and other whole grains

The doctor may also encourage the patient to take a fiber supplement.

APPENDECTOMY
Types
There are 2 types of surgery to remove the appendix. The standard method is an open appendectomy. A
newer, less invasive method is a laparoscopic appendectomy.

 Open appendectomy. A cut or incision about 2 to 4 inches long is made in the lower right-hand
side of your belly or abdomen. The appendix is taken out through the incision.
 Laparoscopic appendectomy. This method is less invasive. That means it’s done without a large
incision. Instead, from 1 to 3 tiny cuts are made. A long, thin tube called a laparoscope is put
into one of the incisions. It has a tiny video camera and surgical tools. The surgeon looks at a TV
monitor to see inside your abdomen and guide the tools. The appendix is removed through one
of the incisions.

During a laparoscopic surgery, the provider may decide that an open appendectomy is needed. If the
appendix has burst and infection has spread, the patient may need an open appendectomy. A
laparoscopic appendectomy may cause less pain and scarring than an open appendectomy. For either
type of surgery, the scar is often hard to see once it has healed. Both types of surgery have low risk of
complications. A laparoscopic appendectomy has a shorter hospital stay, shorter recovery time, and
lower infection rates.

Risk
Some possible complications of an appendectomy include:

 Bleeding
 Wound infection
 Infection and redness and swelling (inflammation) of the belly that can occur if the appendix
bursts during surgery (peritonitis)
 Blocked bowels
 Injury to nearby organs

Pre and Post Operative Nursing Responsibilities

Pre-Operative:

 SIGNING A CONSENT – Explain to the patient what surgery all is about, what to expect and
possible management. Make sure that the patient or significant others signed the consent
before the surgery
 Prepare the skin or surgery site.
 NIL BY MOUTH – no foods, drinks or oral medications should be taken as soon as decision is
taken for an appendicectomy
 IV FLUIDS ADMINISTRATION – dehydration is probable due to vomiting being a normal symptom
of appendicitis
 VITAL SIGNS MONITORING – a fever over 38.5°C may be due to the rupture of the appendix
 NO ANALGESIA – pain needs to be monitored, not subsided, as it indicates what is happening
with the appendix; regular analgesia should be administered to help the patient feel more
comfortable prior to appendicectomy
 NO HEAT – increases the risk of perforation and rupture of the appendix
 NO LAXATIVES – induced peristalsis increases the risk of perforation and rupture of the appendix
 VOIDING – patient should be encouraged to void if undergoing surgery for which no bowel
preparation is recommended such as in appendicectomy, as avoiding incontinence during the
operation leads to a lesser chance of infection

Post Operative:

 If patient experiences peritonitis, antibiotics are administered IV to treat infection.

 A drain may be inserted during surgery. Monitor drainage, which should decrease in time…if
not, patient could be experiencing a hemorrhage.
 Patient should be encouraged to mobilize as soon as possible to prevent the formation of
emboli. In addition, anti-coagulants may be administered subcutaneously post-operatively, and
anti-embolism stockings should be worn.
 Patient may be started on food slowly only after bowel sounds can be heard, which proves good
function of bowels.
 If the patient had surgery, they need to continue to monitor the incision site for any signs of
infection such as redness, swelling, drainage, or increased pain and report these to their
surgeon. 
 They will likely have staples or sutures that will need to be removed in 5-7 days, but regardless
they must have a follow-up appointment scheduled with their surgeon or primary provider
before they are discharged to follow up for wound check and assessment.
 Normal activity can usually resume within a few days to a week. However, the patient should
avoid any strenuous activity and heavy lifting for the first 4-6 weeks, unless otherwise noted by
the provider. Frequent small walks should be encouraged.
 If antibiotics were prescribed, ensure adequate patient education to complete all antibiotics and
to take with a meal should stomach upset occur.
 If pain medication such as opioids was prescribed, ensure the patient knows not to drive or
operate machinery while taking and to take a stool softener to avoid constipation.