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Appendicitis

Inflammation of the veniform appendix I. Causes/risk factors       Fecalith – fecal stone ( obstruct the mucosa of the appendixes) Kinking of the appendix – ineffective emptying of the appendix Swelling of the bowel –Fibrous conditions in the bowel wall – causes obstruction and ineffective emptying External occlusion of the bowels by adhesions – appendix is unable to empty Age (10-30y/o or 20-30 y/o) – increase activity Sex (males) – increase physical activity

II. Signs and Symptoms         Pain gradually becomes localized in RLQ/ Mc Burney’s point – pain that is relive by passing out stool Rebound tenderness - pain is felt upon release of pressure Psoas sign – pain is elicited with Right hip extension Rovsing’s sign – upon palpating the LLQ there is paradoxical pain in the RLQ Decrease or absent bowel sounds Nausea and vomiting – due to pain in which it stimulate the vomiting center Low grade fever - inflammatory process release of pyrogens Mild leukocytosis – release of WBC

III. Complication Perforation of the bowel is the most common complication. Antibiotics and surgical drainage are required if perforation occurs, peritonitis may develop after perforation. IV. Diagnostic test Ultrasound scanning is commonly used in small children to test for appendicitis in order to avoid exposing the child to radiation from CT scans.
Nursing Responsibilities and Considerations

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Explain the purpose of the procedure to the patient. Assess if the pt had an X-ray with contrast material such as barium within the past 2 days. Barium that remains in the intestines can interfere with the ultrasound test.

Obtain counseling or support services for the patient as indicated. Instruct the patient to lie very still while the ultra sound is being done. Provide privacy During:    Assist the patient in the correct position for accurate results.    Assess if the pt is to latex so that a latex-free cover can be put on the transducer before it is used Ask the client to completely empty the bladder Prepare an enema before the test. combative. Fasting is usually not required. Accompany clients who are confused. Ask the patient to take a breath and hold it for several seconds during the test. Assess pregnancy status. After:   Explain the results of the ultrasound Document properly. CT scan may show dilation and edema of the intestines or free air or fluid in the abdominal cavity. Inform the patient that he or she may hear a clicking noise during the procedure. Instruct the patient not to move the head and to lie still throughout the procedure. Nursing Responsibilities for Non-Contrast CT-scan: Before:        During: Obtain a written consent. . or ventilator-dependent. Assess for claustrophobia. Assess the need for sedation especially for pediatric clients.  After:  Nursing Responsibilities for Contrast CT-scan: Before:  Obtain a written consent. Support client and family in light of their fears and apprehension about being tested and awaiting results. Orient the client about the procedure.

Obtain counseling or support services for the patient as indicated..000 – 15.000/mm3) Nursing Responsibilities: Prior:      Explain the procedure to the patient Inform the patient that there are no fluid/food restrictions but shall avoid exercise Inform the patient that the test requires blood sample Inform the patient who will perform the test and when it will be performed Inform the patient that there will be discomfort from needle puncture and pressure from the tourniquet . Assess pregnancy status. If the test is scheduled at p. or ventilator-dependent.  After:      CBC WBC may reveal slight leukocytosis (from 10. salty or metallic taste. Accompany clients who are confused. Assess for presence of hematoma or signs of IV infiltration along the injection site. Obtain history for allergies to iodine or contrast material. Support client and family in light of their fears and apprehension about being tested and awaiting results. Observe the client for allergic reactions. Instruct the client to increase fluid intake to promote the excretion of contrast medium. Assess for neurologic function especially if the client was sedated. Also tell the client that a feeling of warmth along the site of IV infusion will be felt and may taste a fishy. Inform the patient that he or she may hear a clicking noise during the procedure.  Orient the client about the procedure. Advise and keep the client on NPO status 4 hours before the procedure. Obtain a history of renal disease and secure a request for serum creatinine to assess renal function.m. Assess the need for sedation especially for pediatric clients. the client can have minimal amounts of liquid or a light breakfast and can take oral medications before placing the client on NPO status.      Assess for claustrophobia. combative.  During: Instruct the patient not to move the head and to lie still throughout the procedure.

Hemodilution with intravenous fluids causes a false decrease in the values of some tests After:    Apply pressure on the puncture site Send specimen immediately to the laboratory Proper documentation V. the client is usually discharged in 24 to 48 hours. Pain medications are withheld until the diagnosis is confirmed – mask rupture of appendix Surgical procedure: Appendectomy Surgical intervention involves removal of the appendix (appendectomy) within 24 to 48 hours of onset of the manifestations.5%. The surgery can be performed through a small open incision or a laparoscope ( a lighted scope used to visualize and remove the appendix.) when the operation is performed in time. advise that this test will be repeated several times to maintain progress  Ensure that the blood is taken from the arm or hand that has an intravenous line. delay usuall causes rupture of the organ and resultant peritonitis. IV and antibiotics are administered. Lifting is restricted for 2 to 6 weeks the client may resume all activities 4 to 6 weeks after surgery. Following a laparoscopic procedure. Pharmacological and non-pharmacological treatment    There is no medical treatment for the appendicitis Preoperatively. the mortality rate is less than 0. During: If patient is being treated from infection. Nursing responsibilities      Perform comprehensive assessment of pain ( an abrupt change in the character of pain preoperatively may indicate perforation especially sudden relief from pain) Encourage verbalization of pain Encourage participation from supportive system in alleviation of pain Avoid giving enema or laxative or apply heat to abdomen (may cause the appendix to rupture) Withhold pain medications until diagnosis is confirmed (relief from pain with the use of analgesic may mask abrupt relief from pain after perforation of appendix) .

Non-steroidal anti-inflammatory drugs (NSAIDs). When varices bleed. large intestine. they are unable to counteract the harsh effects of stomach acid.  Mallory-Weiss tear .  . When the mucous membranes break down. Upper GI bleeding  Peptic ulcer disease . hemorrhoids. and anal fissures most commonly cause the bleeding. Diverticular disease. alcohol. polyps. depending on their location in the GI tract. Bleeding can come from ingestion of caustic poisons or stomach cancer.A tear in the esophageal or stomach wall.Gastrointestinal Bleeding The many causes of gastrointestinal (GI) bleeding are classified into upper or lower. and anus. stomach. I. Breakdown of the walls results in damage to blood vessels.Swellings in veins of your esophagus or stomach usually result from liver disease.  Gastritis . causing bleeding. and trauma can cause gastritis. Blood in the stool can result from cancers. Varices most commonly result from alcoholic liver cirrhosis.  Esophageal varices . and infectious diarrhea. Helicobacter pylori are a type of bacteria that also promote formation of ulcers. Ulcers usually occur in the stomach or duodenum. inflammatory bowel disease.aspirin. angiodysplasia. Causes/ Risk Factor The many causes of gastrointestinal bleeding are classified into upper or lower. Lowergastrointestinal bleeding: Lower GI bleeding originates in the portions of the GI tract farther down the digestive system-the segment of the small intestine farther from the stomach. burns. alcohol. steroids.Peptic ulcers are localized erosions of the wall of the digestive tract. NSAIDs. often as a result of vomiting or retching. or duodenum (first part of theintestine). depending on their location in the GI tract. the bleeding can be massive and catastrophic and occur without warning. rectum. which can result in bleeding.  Uppergastrointestinal bleeding: Upper GI bleeding originates in the first part of the GI tract-the esophagus. and cigarette smoking promote gastric ulcer formation. Gastritis also results from an inability of the gastric lining to protect itself from the acid it produces.General inflammation of the stomach wall.

occurring mostly in people older than 40 years." Symptoms associated with blood loss can include the following:      Fatigue – blood components Hgb oxygen carrying capacity Weakness . or they may bleed slowly and go undetected. Massive bleeding is rare. Anal fissures. intermittent. anemia. Blood may look like "coffee grounds.  Angiodysplasia . Bright red or maroon stool can be from either a lower GI source or from brisk bleeding at an upper GI source. Bleeding from hemorrhoids is usually mild.blood components Hgb oxygen carrying capacity Pale appearance – excessive blood loss Vomiting of blood usually originates from an upper GI source. You may develop several pockets. tarry stools. which are more common in people who haveconstipation and strain at stool. Small outpockets. Colonic polyps may bleed rapidly. A small proportion of these polyps may transform into cancer. bloody bowel movements. black stools. The elderly and people with chronic kidney failure develop the disease most often. Forceful straining during passage of hard stool usually causes such tears. or diverticula.Lower GI bleeding  Diverticulosis .  Hemorrhoids and fissures . usually in a weakened area of the bowel wall.Along with diverticulosis.Hemorrhoids are swellings of veins in and around your rectum. . this is one of the most common causes of lower GI bleeding.  Polyps . Angiodysplasia is a malformation in the blood vessels in the wall of the GI tract.blood components Hgb oxygen carrying capacity Shortness of breath . also may trigger small amounts of bright red bleeding from the anus.Intestinal polyps are noncancerous tumors of the GI tract. Repeated stretching from straining at stool causes them to bleed. or black. and bright red. The sores are most common in the large intestine and often bleed. Signs and Symptoms Acute gastrointestinal bleeding first will appear as vomiting of blood.One of the most common causes of lower GI bleeding. or tears in the anal wall. or a positive test for microscopic blood. Long-term GI bleeding may go unnoticed or may cause fatigue. which can be very painful. form on part of the wall of your colon (large intestine). II.

or through the rectum into the colon. and horseradish for 48 to 72 hours before the test as well as throughout the collection period. An endoscope is a long tube with a tiny camera on the end.III. If the patient must continue using this drugs. Instruct the patient to avoid contaminating the fecal specimen with toilet tissue or urine. Single digital office-based test may not be as accurate as serial home collected test. It may be passed through the nose into the stomach. depending on which test is used. After    Send the specimen to the laboratory or perform the test immediately. Nursing responsibilities: Prior: . Instruct the patient to maintain a high-fiber diet and to refrain from eating red meats. note this on the laboratory request. Inform the patient that he may resume his usual diet and medications as ordered. Diagnostic procedure Fecal occult blood To detect GI bleeding Nursing responsibilities Prior   Explain the patient that this test detects abnormal GI bleeding. it may be necessary to restrict them. Endoscopy The doctor may need to insert a tube through your nose into your stomach to help identify the source of the bleeding. During    Tell the patient that the test usually requires three fecal specimens but that sometimes only one sample is needed. to directly see the source of bleeding. turnips. Notify the laboratory and physician of drugs the patient is taking that may affect test results.

may have to take laxative the evening before and may feel an urge to defecate during the study.  Assess vital signs serious gastrointestinal bleeding can destabilize your vital signs. inform the patient that the scope will be inserted through the anus. For hemorrhoids or anal fissures. Nursing Responsibilities  Assess for any presence of blood in the stool Black or dark stools . your blood pressure may fall sharply and your heart rate will increase    The physician may need to resuscitate you with IV fluids and possibly a blood transfusion. Pharmacologic and Non. After    Instruct the patient to resume his usual diet and activity Monitor patient’s vital sign Monitor for signs for bleeding and signs and symptoms of perforation. you may need surgery Follow up with your physician on a regular basis to monitor progress.  Lab tests also can be helpful to determine the rate or severity of bleeding and to determine factors that may contribute to the problem.pharmacologic treatment  There is no home care for heavy gastrointestinal bleeding. eat a diet high in fiber and fluids to keep stools soft.   Secure the consent Note and report all allergy NPO for 6 to 8 hours During  For sigmoid EUS. For instance.   Advise the patient that an IV sedative may be given to help him relax before the endoscope is inserted. so that your doctor can prevent further progression and complications of your gastrointestinal bleeding. Explain that the test takes 30 to 90 min. IV. In some cases.

H.  Assess for any significant bleeding into the GI tract. Maintain a proper diet and take the medications prescribed to you as your doctor directs.   Avoid foods and factors.) Singapore: Saunders Elsevier http://www. Source/bibliography: Black. either vomited blood or blood through the rectum. & Hawks. which helps prevent diverticulosis and hemorrhoids.that increase gastric secretions. (2008). such as alcohol and smoking.emedicinehealth. Medical-Surgical Nursing: Clinical Management for Positive Outcomes (8th ed.htm .com/gastrointestinal_bleeding/page12_em. Eat a high-fiber diet to increase the bulk of the stool. J. J. should be evaluated in the emergency department. V.

R.N.. Group 37 Submitted to: Kristine S. Princess B. IV-10. July 25.N. M. Acute Gastrointestinal bleeding and Cholecystitis Submitted by: Masa. Patrick Manalastas.N. 2011 .Angeles University Foundation College of Nursing CASE REPORT: Appendicitis. Fernandez.S.

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