Append

Append PREPARED BY

A. ANDRES BSN 4

Appendix

Appendix The appendix is a small, finger-like

appendage about 10 cm (4in) long that is attached to the cecum just below the ileocecal valve. Long appendix fills with food and empties regularly into the cecum because it empties inefficiently and its lumen is small, the appendix is prone to obstruction and is particularly vulnerable to infection.

Pathophysiology The appendix become inflamed and

edematous as a result of either becoming kinked or occluded by a fecalith, tumor, or foreign body. The inflammatory process increases intraluminal pressure, initiating a progressively severe, generalized or upper abdominal pain that become localized in the right lower quadrant of the abdomen within a few hours. Eventually, the inflamed appendix fills with

Clinical Manifestation Vague epigastric or periumbilical pain progresses

to lower quadrant pain and usually accompanied by a low-grade fever and nausea and sometimes by vomiting. Loss of appetite is common. Local tenderness is elicited at McBurney’s point when pressure is applied. Rebound tenderness maybe present. The extent of tenderness and muscle spasm and the existence of constipation and diarrhea depend not so much of the severity of the appendeceal infection as on the location of the appendix.

If the appendix curls around behind the cecum,

pain and tenderness maybe felt in the lumbar region. If its tip in the pelvis, this signs maybe elicited only on rectal examination Rovsing’s sign maybe elicited by palpating the lower quadrant; this paradoxically cues pain to be felt in the right lower quadrant. Constipation can also occur with an acute process such as appendicitis. Laxatives administered in this instance may produce perforation of inflamed appendix. In general, a laxative or cathartic should never be given while the person has fever, nausea, or

Assessment and Diagnostic Findings

complete physical examination Laboratory and X-ray findings. The complete blood cell count demonstrates

and elevated white blood cell count. Leukocytes count may exceed 10,000 cell/mm3 Neutrophil count may exceed 75%. Abdominal X-ray films, ultrasound studies, and CT scan may reveal a right lower quadrant density or localized distension of the bowel.

COMPLICATIONS The major complication of appendicitis is

perforation of the appendix, which can lead to peritonitis or an abscess. The incidence of perforation is 10% to 32%. The incidence is higher in young children and elderly. Perforation generally occurs 24 hours after the onset of pain. Symptoms include a fever of 37.7oC or higher, a toxic appearance, and continued abdominal pain or tenderness.

MEDICAL MANAGEMENT Surgery is indicated if appendicitis is diagnosed. To correct or prevent fluid and electrolyte imbalance and dehydration, antibiotics and intravenous fluids are administered until surgery is performed. Analgesics can be administered after the diagnosis is made. Appendectomy (surgical removal of appendix) is performed as soon as possible to decrease the risk of perforation. It may be performed under a general or spinal anesthetic with a low abdominal incision or by laparoscopy.

NURSING MANAGEMENT: GOALS Relieving pain Preventing fluid volume

deficit Reducing anxiety Maintaining skin integrity Attainting optimal nutrition  

NURSING INTERVENTION

Preoperative Care Administered Intravenous Fluids

(IV) Administer opioid analgesics The client should not receive laxatives or enema. Prepare for surgery and anesthesia

Operative Procedures Appendectomy – is the removal of

inflamed appendix. Most uncomplicated appendectomies

today are done via laparoscopy

Postoperative Care If peritonitis was present, a nasogastric

(NG) tube is placed to decompress the stomach and prevent abdominal distension. IV antibiotics are typically prescribed if peritonitis is present. Opioid analgesics are administered for pain as needed Most client can return to usual activities in 1 to 2 weeks.