The Appendix

The appendix is a small pouch attached to the large intestine

It is located in the lower-right abdomen.
When the appendix becomes blocked, bacteria can multiply inside it.
This can lead to the formation of pus and swelling,
which can cause painful pressure in your abdomen

 What causes appendicitis?

> takes place when the appendix becomes inflamed, likely due to a blockage.
> when the tube that joins the large intestine and appendix is blocked or trapped by stool.
> It can be acute or chronic.
> Left untreated, appendicitis can cause the appendix to burst
> This can cause bacteria to spill into the abdominal cavity, which can be serious and
sometimes fatal.

Acute appendicitis

• is a severe and sudden case of appendicitis

• It is most common in children and young adults between the ages 10 and 30 years
• occurs more frequently in males than females
• Pain tends to develop and intensify quickly over 24 hours
• It requires immediate medical treatment
• it can cause the appendix to rupture.
• This can be a serious and even fatal complication.
• Acute appendicitis is more common

Chronic appendicitis

• Chronic appendicitis is less common than acute appendicitis.

• It occurs in only about 1.5 percent of all people who have already had a case of chronic
appendicitis
• symptoms may be relatively mild and are thought to occur following acute appendicitis
• Symptoms may disappear before reappearing again over a period of weeks, months, or even
years.

Symptoms

• Appendicitis pain starts off as mild cramping in the upper abdomen or bellybutton area
then moves to the lower right quadrant of your abdomen. This pain often:
• begins suddenly
 • gets worse when you move or cough
• It is so intense that it wakes you from sleep
• It is severe and different from other abdominal pain
• worsens within a few hours

•
Other symptoms may include:

• loss of appetite
• indigestion
• nausea
• vomiting
• abdominal swelling
• low-grade fever

•
Causes and risk factors

• In many cases, the exact cause of appendicitis is unknown.

• Experts believe it develops when part of the appendix becomes obstructed, or blocked
• Many factors can potentially can block the appendix

• a buildup of hardened stool

• enlarged lymphoid follicles
• intestinal worms
• traumatic injury
• tumors
• Appendicitis can affect anyone

Risk factors for appendicitis include:

• Age. Appendicitis most often affects teens and people in their 20`s 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.

Complications

• Appendicitis can cause serious complications if the appendix ruptures

• it can cause fecal matter and bacteria to spill into the abdominal cavity.
• A ruptured appendix can lead to painful and potentially life threatening infections,
including:
 • Peritonitis, abscess and sepsis
•
Peritonitis

➢ When the appendix bursts and bacteria spill into the abdominal cavity, the lining
of the abdominal cavity, or peritoneum, can become infected and inflamed.
➢ This is known as peritonitis. It can be very serious and even fatal.

Symptoms of peritonitis may include:

• fast heartbeat
• high fever
• shortness of breath or rapid breathing
• severe and continuous abdominal pain

• Treatment includes antibiotics and surgery to remove the appendix.

Abscesses

• An abscess is a painful pocket of pus that forms around a burst appendix.

• These white blood cells are the body’s way of attempting to fight the infection.
• The infection must be treated with antibiotics, and
• the abscess will need to be drained.

Drainage may occur during surgery or abscess will be drained before surgery using a
needle.

Sepsis
In some cases, bacteria from a ruptured abscess may travel through the bloodstream to other
parts of the body.

This condition is known as sepsis

Manifested by:
high or low temperature
confusion
severe sleepiness
shortness of breath

• Diagnostic Tests
Blood tests-
• CBC
• C-reactive protein test
• Urinalysis

• Pregnancy test
• Abdominal imaging tests

Treatment

• Medication- eg; antibiotics

• Surgery- appendectomy- removal of the appendix
• Nursing management
Goals include:
• Relieve pain
• Prevent fluid / electrolyte imbalance
• Reduce anxiety
• Maintain skin integrity
• Attain optimal nutrition
Pre-operative care
 Assessment and history taking
 Monitor vital signs
 NPO and IV liquids
 Monitor for signs of ruptured appendicitis and peritonitis
 Promote comfort
 Auscultate bowel sounds
 Administer antibiotics as prescribed
 Written consent for operation
Post –operative nursing care
Clear airway- proper breathing
• Provide safety and effective care to the patient
Care for surgical wound
• I and O
• Monitor vital signs
• Observe for return of bowel sounds
• Maintain on NPO until bowel sounds return

• Nursing Diagnosis
• Acute pain- maybe related to intestinal distention due to inflammation
• Risk for fluid volume deficit r/t vomiting or NPO
• Risk for infection r/t rupture of the appendix, abscess formation
• Knowledge Deficit r/t lack of exposure, unfamiliarity