(25) CARE OF CLIENTS WITH
APPENDICITIS AND PERITONITIS
APPENDICITIS:
- An inflammation of the appendix
that prevents mucus from passing into the
cecum; if untreated, ischemia,
gangrene, rupture and peritonitis occur.
Appendicitis, the most common cause of
acute surgical abdomen in the United
States, is the most common reason for
emergency abdominal surgery. It can at
any age, it more commonly occurs
between the ages of 10 and 30 years.
PATHOPHYSIOLOGY:
- Appendix becomes inflamed and
edematous as a result of becoming kinked
or occluded by a fecalith (i.e., hardened
mass of stool), tumor, or foreign body. The
inflammatory process increases
intraluminal pressure, initiating a
progressively severe, generalized, or
periumbilical pain that becomes localized
to the right lower quadrant of the abdomen
within a few hours.
Subjective Cues:
 Diffused pain, localizes in lower right
quadrant
 Nausea/ vomiting
 Loss appetite
Laboratory / Diagnostic
Examination for appendicitis:
 CT scan shows enlarged appendix or
fecalith.
 Ultrasound may show enlarged
appendix.
Medication:
 Antibiotics/antipyretic as ordered
 Preoperatively to maintain
awareness of increase in pain due to
possible rupture of appendix.
PERITONITIS:
- A local or generalized inflammation
of part or the entire parietal and visceral
surface of the abdominal cavity
 Primary peritonitis occurs when
blood-borne organisms enter the
peritoneal cavity.
 Secondary peritonitis is much more
common. It occurs when abdominal
organs perforate or rupture and
release their contents (bile, enzymes,
and bacteria) into the peritoneal
cavity. Common causes include a
ruptured appendix, perforated gastric
or duodenal ulcer, severely inflamed
gallbladder, and trauma from
gunshot or knife wounds.
GENERAL SIGNS AND
SYMPTOMS FOR PERITONITS
Subjective Cues:
 Abdominal pain, rebound pain
 Nausea
 Loss of appetite
Laboratory / Diagnostic
Examination for peritonitis:
 Elevated white blood cell count
(WBC).
 Abdominal x-rays to show free air
from perforation.
 CT scan to identify causative
 problem (appendicitis, salpingiti
 (26) CARE OF CLIENTS WITH
PANCREATITIS
Pancreatitis:
- an inflammation process with
varying degrees of pancreatic edema, fat
necrosis or hemorrhage.
 occurs most often in the middle-aged
men and women
 Caused by alcoholism, biliary tract
disease, trauma, viral infection,
penetrating duodenal ulcer, abscess,
drugs(steroids, thiazide diuretics and
oral contraceptives), metabolic
disorders (Hyperparathyroidism,
Hyperlipidemia)
Pathophysiology:
- Proteolytic and lipolytic pancreatic
enzymes are activities in the pancreas
rather than in the duodenum, resulting in
tissue damage and auto digestion of the
pancreas.
- An abscess results if these growths
become infected.
- Growths called pseudocysts, containing
pancreatic enzymes and tissue debris,
form.
Subjective Cues:
 Pain located in the left upper
quadrant with radiation to back,
flanks, or substernal area, maybe
accompanied by difficulty of
breathing and is aggravated by
eating
 Nausea
 Fatigue
Laboratory / Diagnostic
Examination for pancreatitis:
 CT scan shows enlargement of the
pancreas
 Chest x-ray may show pleural
effusion.
 Elevated white blood cell count
(WBC) due to inflammation.
 Elevated cholesterol.
Medication:
 Analgesic to relive pain
 Anticholinergics (atropine,
propantheline bromide to decrease
pancreatic stimulation
 Administer vitamin
supplementation.
 Avoid morphine that may increase
pain due to spasm of the sphincter
of Oddi at the opening to the small
intestine from the common bile
duct.
 (27) CARE OF CLIENTS WITH INFLAMMATORY
BOWEL DISEASE (CROHN’S AND ULCERATIVE
COLITIS)
Inflammatory Bowel Disease (IBD):
- Refers to two chronic inflammatory
GI disorders: Crohn’s disease (i.e., regional
enteritis) and ulcerative colitis. Both
disorders have striking similarities but
also several differences.
Regional Enteritis (Crohn’s Disease):
- A chronic inflammatory bowel
disease that can affect both the large and
small intestine; terminal ileum, cecum,
and ascending colon most often affected.
 Characterize by granulomas that
may affect all the bowel wall layers
with resultant thickening, narrowing,
and scarring of the intestinal wall.
 Common in the Jewish population
 Two age peaks- 20-30 years, 40-60
years Cause unknown
 Contributing factors include food
allergies, autoimmune reactions,
psychological disorders
PATHOPHYSIOLOGY:
- 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.
- Fibrosis occurs, thickening the
bowel wall and causing stenosis, or
narrowing of the lumen.
- Eventually, diseased parts of the
bowel become thicker, narrower, and
shorter.
Subjective Cues:
 Right lower quadrant tenderness
and pain
 Increased peristalsis
 Bloating after meals
(postprandial)
 Abdominal cramping due to spasm
 Fatigue
Laboratory / Diagnostic
Examination for chron’s and
ulcerative colitis:
 CT scan shows abscess formation
and thickening of bowel wall due
to inflammation.
 Sigmoidoscopy or colonoscopy for
direct visualization of lower GI
tract or for biopsy.
Medication:
 Antimicrobial (especially
sulfasalazine)
 Administer vitamin B12 and folic
acid.
 Administer amino salicylates to
induce or maintain remission
 Administer methotrexate to induce
or maintain remission.
 (28) CARE OF CLIENTS WITH
CHOLECYSTISIS
CHOLECYSTISIS:
- An acute or chronic inflammation of
the gallbladder, most commonly
associated with gallstones.
 Inflammation occurs within the walls
of the gallbladder and creates a
thickening accompanied by edema.
 Cholelithiasis: formation of gallstone,
cholesterol stones most common
variety
 Most often occurs in women after age
40, in postmenopausal women on
estrogen therapy, in women taking
oral contraceptives and in the obese.
 Stone formation may be caused by
genetic defect of bile composition,
gallbladder/bile stasis, and infection
 Acute cholecystitis usually follows
stone impaction, adhesion; neoplasm
may also be implicated
PATHOPHYSIOLOGY:
- Caused by the formation of calculi
called gallstones. Gallstones are deposits—
small stones that form from bile, a fluid
that helps digestion.
 two major types of gallstones:
pigment stones, which contain an
excess of unconjugated pigments in
the bile, and cholesterol stones (the
more common form), which result
from bile supersaturated with
cholesterol.
 In acute cholecystitis,
inflammation of the gallbladder
wall usually develops after a
gallstone lodges in the cystic
duct.
Then this sequence of events takes
place:
 Edema of the gallbladder or cystic
duct occurs.
 Edema obstructs bile flow, which
chemically irritates the
gallbladder.
 Cells in the gallbladder wall
may become oxygen starved and
die as the distended organ presses
on vessels and impairs blood flow.
 An exudate covers ulcerated areas,
causing the gallbladder to adhere
to surrounding structures.
Subjective Cues:
 Epigastric pain or right upper
quadrant pain, precipitated by a
heavy meal and occurring at
night
Laboratory / Diagnostic
Examination for cholecystitis:
 Ultrasound of gallbladder shows
cholelithiasis, inflammation.
Medication:
 Narcotic analgesics (Demerol is
drug of choice) for pain
 Morphine sulfate is
 contraindicated because it causes
spasms of the sphincter of Oddi.
 (29) CARE OF CLIENTS WITH
CYSTISIS AND UROLITHIASIS

CYTISIS:
Subjective Cues:
- An inflammation of the bladder due
to bacterial invasion.
 Abdominal or flank
 More common in women
pain/tenderness, frequency and
urgency of urination
 Pain on voiding

Predisposing factors include:
 Stagnation of urine
 Obstruction
 Sexual intercourse
 High estrogen level
Interstitial cystitis:
- A chronic condition causing bladder
pressure, bladder pain and sometimes
pelvic pain. The pain
ranges from mild discomfort to severe
pain.
- The condition is a part of a spectrum
of diseases known as painful bladder
syndrome. Interstitial cystitis most often
affects women and can have a
long-lasting impact on quality of life.
Laboratory / Diagnostic
Examination for Cystisis:
 Urine culture and sensitivity
reveals specific organism (80% E.
Coli)
Medication:
 Systemic antibiotic: ampicillin,
cephalosporin, aminoglocydes
 Antibacterials:
methanamine(macrodantin),
methenamine
namdelate(mandelamine),
anlidixic acid ( NegGram)
Nephrolithiasis / Urolithiasis:
- Presence of stone anywhere in the
urinary tract

 Most often occurs in men age

20-55; more common in summer
 Uric acid
 Increased uric acid level

PATHOPHYSIOLOGY:

- Occurs after bacterial invasion of the

urothelium of the bladder from bacteria
migrating from the rectum as well as
colonized bacteria from the perineum and
vagina.
 (29) CARE OF CLIENTS WITH
CYSTISIS AND UROLITHIASIS
PATHOPHYSIOLOGY:
- Stones are formed in the urinary
tract when urinary concentrations of
substances such as calcium oxalate,
calcium phosphate, and uric acid increase.
- Referred to as supersaturation, this is
dependent on the amount of the substance,
ionic strength, and pH of the urine.
- Stones may be found anywhere from
the kidney to the bladder and may vary
in size from minute granular deposits,
called sand or gravel, to bladder stones as
large as an orange.
Stone formation is not clearly
understood, and there are a number
of theories about their causes.
 Deficiency of substances that
normally prevent crystallization in
the urine, such as citrate, magnesium,
nephrocarcinoma, and uropontin
 Fluid volume status of the patient
(stones tend to occur more often in
dehydrated patients).
 Certain factors favor the formation of
stones, including infection, urinary
stasis, and periods of immobility, all
of which slow renal drainage and
alter calcium metabolism
 Increased calcium concentrations in
the blood and urine promote
precipitation of calcium and
formation of stones
Subjective Cues:
 Abdominal or flank pain
 Renal colic
 Chills
 Urinary frequency
Laboratory / Diagnostic
Examination for Urolithiasis:
 Urinalysis: indicates presence of
bacteria, increased protein,
increased WBC and RBC
 IVP: identifies site of obstruction
and presence of nonradiopaque
stones
 KUB: pinpoints location, number,
and size of stones
Medication:
 Allopurinol (Zyloprim) as
ordered, to decrease uric acid
production
 Analgesic
 Nonsteroidal anti-inflammatory
drugs (NSAIDs) are effective in
treating
 Renal stone pain because they
provide specific pain relief