Appendicitis & Appendectomy

APPENDICITIS
DEFINITION OF TERMS

 APPENDIX – a small finger like appendages
about 10cm long that is attached to the
cecum just below the ileocecal valve.

 APPENDICITIS – is the inflammation of the
vermiform appendix caused by an
obstruction of the intestinal lumen from
infection, stricture, fecal mass, foreign
body, or tumor.

 ROVSING’S SIGN – an indication of acute
appendicitis in which pressure on the left
lower quadrant of the abdomen causes
pain in the right lower quadrant.
 LAPAROSCOPY – technique to examine the
abdominal cavity with a laparoscope
through one or more small incision in the
abdominal wall, usually at the umbilicus.
 PERITONITIS –inflammation of the
peritoneum.
 ABSCESS - collection of purulent
ANATOMY
PATHOPHYSIOLOGY
 The appendix becomes inflamed and
edematous as a result of becoming kinked
or occluded by a fecalith, tumor, or foreign
body.
 The inflammatory process increases
intraluminal pressure, initiating a
progressively severe, generalized or
periumbilical pain that become localized to
the right lower quadrant of the abdomen
within few hour.
 The inflamed appendix fills with pus.

RISK FACTORS:


 Age

 Gender

CLINICAL MANIFESTATIONS
 Periumbilical pain progresses to right lower
quadrant pain and is usually accompanied
by a low grade fever and nausea.

 Loss of appetite

 Rebound tenderness

 Rovsing’s sign

 Constipation

ASSESSMENT AND
DIAGNOSTIC FINDINGS
 COMPLETE BLOOD COUNT
 - it demonstrate an elevated WBC count
with an elevation of the neutrophils.

 Abdominal x-ray films

 Ultrasound

 CT scan


COMPLICATIONS
 Perforation

 Abscess

 Peritonitis

MEDICAL MANAGEMENT

Immediate surgery

 Administration of IV fluids and antibiotic
 - To correct or prevent fluid and electrolyte
imbalance, dehydration and sepsis until
surgery is performed.

NURSING
RESPONSIBILITIES
 Relieving Pain

 Preventing Fluid Volume Deficit

 Reducing Anxiety

 Eliminating Infection

 Maintaining Skin Integrity

 Attaining Optimal Nutrition
APPENDECTOMY
Definition
v
vRemoval of the appendix
v
v
vPerformed as soon as possible to decrease
the risk of perforation
2 Ways To Perfomed:

 Laparotomy

 Laparoscopy
INSTRUMENTS USED
 Basic Set

 Basic Sharps

 AP

 OS

 Babcock

 Silk

HOW IT IS DONE?
 During an appendectomy, an incision two to

three inches in length is made through the
skin and the layers of the abdominal wall in
the area of the appendix. The surgeon enters
the abdomen and looks for the appendix,
usually located in the right lower abdomen.
After examining the area around the
appendix to be certain that no additional
problem is present, the appendix is removed.

 This is done by freeing the appendix from its
attachment to the abdomen and to the
colon, cutting the appendix from the colon,
and sewing the over the hole in the colon.
If an abscess is present, the pus can be
drained with drains (rubber tubes) that go
from the abscess and out through the skin.
The abdominal incision then is closed.

 Newer techniques for removing the appendix
involve the use of the laparoscope. The
laparoscope is a thin telescope attached to a
video camera that allows the surgeon to inspect
the inside of the abdomen through a small
puncture wound (instead of a larger incision). If
appendicitis is found, the appendix can be
removed with special instruments that can be
passed into the abdomen, just like the
laparoscope, through small puncture wounds.

 The benefits of the laparoscopic technique
include less post-operative pain (since
much of the post-surgery pain comes from
incisions) and a speedier recovery. An
additional advantage of laparoscopy is that
it allows the surgeon to look inside the
abdomen to make a clear diagnosis in
cases in which the diagnosis of
appendicitis is in doubt. For example,
laparoscopy is especially helpful in
menstruating women in whom a rupture of
an ovarian cysts may mimic appendicitis.
 If the appendix is not ruptured (perforated)
at the time of surgery, the patient
generally is sent home from the hospital in
one or two days. Patients whose appendix
has perforated generally are sicker than
patients without perforation. After surgery,
their hospital stay often is prolonged (four
to seven days), particularly if peritonitis
has occurred.
Intravenous antibiotics are given in the
hospital to fight infection and assist in
resolving any abscess
 Occasionally, the surgeon may find a
normal-appearing appendix and no other
cause for the patient's problem. In this
situation, the surgeon may remove the
appendix. The reasoning in these cases is
that it is better to remove a normal-
appearing appendix than to miss and not
treat appropriately an early or mild case of
appendicitis.

PREOPERATIVE MANAGEMENT
 All diagnostic tests and procedures are
explained to promote cooperation and
relaxation.
 The patient is prepared for the type of surgical
procedures as well as the post operative
care.
 Measures to prevent postoperative
complication are taught, including coughing,
turning, and deep breathing using splint at
the incision site.
 I.V fluids or total parenteral nutrition before
surgery maybe ordered to improved fluid and
electrolyte balance and nutritional status.
 Intake and output is monitored.

 Preoperative laboratory are obtained.
 Bowel cleansing will be initiated 1 to 2 days
before surgery for better visualization.
 Antibiotics are ordered to decrease the
bacterial growth in the colon.
 Patient may not have anything by mouth after
midnight the night before surgery.
Medication may be withheld, if ordered. This
will keep the GI tract clear.
INTRAOPERATIVE NURSING
CARE
 Position the patient on the OR table
 Skin preparation
 Induction of anesthesia
 Procedures done aseptically
 Closing of the incision
 Dressing of the site


POST OPERATIVE
MANAGEMENT AND NURSING
CARE
 Monitor vital signs for sign of infection and
shock such as fever, hypotension and
tachycardia.
 Monitor I and O for sign of imbalance,
dehydration, and shock.
 Assess abdomen for increased pain,
distention, rigidity, and rebound tenderness
because these may indicate postoperative
complications.
 Evaluate dressing and incision.
 Evaluate the passing of flatus or feces.
 Monitor for nausea and vomiting.
 Laboratory values are monitored and patient
is evaluated for sign and symptoms of
electrolyte imbalances.
 Wound drains, I.V, and all other catheter are
monitored and evaluated for signs of
infections.
 Turning , coughing, deep breathing, and
incentive spirometry are performed every 2
hours.
 Diet is advanced as ordered.
 Administration of medications as ordered

 Patient Education and Health Maintenance
o
o Instruct patient to avoid heavy lifting for 4 to
6 weeks after surgery.
o
o Instruct patient to report symptoms of
anorexia, nausea, vomiting, fever,
abdominal pain, incisional redness and
drainage postoperatively.

Reported by:
Mhay Del Poso
and
Vanessa Duncil

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APPENDICITIS

 During an appendectomy, an incision two to

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