A. Andres Bsn 4

8/14/2019 A. Andres Bsn 4

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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 justbelow the ileocecal valve.

Long appendix fills with food and

empties regularly into the cecumbecause it empties inefficiently and itslumen is small, the appendix is proneto obstruction and is particularly



Pathophysiology The appendix become inflamed and

edematous as a result of either becomingkinked or occluded by a fecalith, tumor, orforeign body.

The inflammatory process increasesintraluminal pressure, initiating a

progressively severe, generalized or upperabdominal pain that become localized in theright lower quadrant of the abdomen withina few hours.



Clinical ManifestationVague epigastric or periumbilical pain progresses

to lower quadrant pain and usually accompanied bya low-grade fever and nausea and sometimes by

vomiting.Loss of appetite is common.

Local tenderness is elicited at McBurney’s pointwhen pressure is applied.

Rebound tenderness maybe present. The extent of tenderness and muscle spasm and

the existence of constipation and diarrhea dependnot so much of the severity of the appendeceal



If the appendix curls around behind the cecum,pain and tenderness maybe felt in the lumbarregion.

If its tip in the pelvis, this signs maybe elicitedonly on rectal examination

Rovsing’s sign maybe elicited by palpating thelower quadrant; this paradoxically cues pain tobe felt in the right lower quadrant.

Constipation can also occur with an acute

process such as appendicitis. Laxativesadministered in this instance may produceperforation of inflamed appendix.

In general, a laxative or cathartic should never



Assessment and

complete physical examination

Laboratory and X-ray findings.

The complete blood cell count demonstratesand elevated white blood cell count.

Leukocytes count may exceed 10,000cell/mm3

Neutrophil count may exceed 75%.Abdominal X-ray films, ultrasound studies, and

CT scan may reveal a right lower quadrantdensity or localized distension of the bowel.



COMPLICATIONS The major complication of appendicitis is

perforation of the appendix, which can lead toperitonitis or an abscess. The incidence of

perforation is 10% to 32%. The incidence is higher in young children and

elderly. Perforation generally occurs 24 hoursafter the onset of pain. Symptoms include a

fever of 37.7oC or higher, a toxic appearance,and continued abdominal pain or tenderness.



MEDICAL

Surgery is indicated if appendicitis isdiagnosed. To correct or prevent fluid andelectrolyte imbalance and dehydration, anti-

biotics and intravenous fluids are administereduntil surgery is performed. Analgesics can beadministered after the diagnosis is made.

Appendectomy (surgical removal of appendix)

is performed as soon as possible to decreasethe risk of perforation. It may be performedunder a general or spinal anesthetic with a lowabdominal incision or by laparoscopy.



NURSING MANAGEMENT:

Relieving pain

Preventing fluid volumedeficitReducing anxiety

Maintaining skin integrityAttainting optimal nutrition



NURSINGNURSINGINTERVENTIONINTERVENTION



Preoperative CareAdministered Intravenous Fluids

(IV)Administer opioid analgesics

The client should not receivelaxatives or enema.

Prepare for surgery and



Operative ProceduresAppendectomy – is the removal of

inflamed appendix.

Most uncomplicated appendectomies

today are done via laparoscopy



Postoperative CareIf peritonitis was present, a nasogastric

(NG) tube is placed to decompress thestomach and prevent abdominal distension.

IV antibiotics are typically prescribed if peritonitis is present.

Opioid analgesics are administered for pain

as neededMost client can return to usual activities in

1 to 2 weeks.

A. Andres Bsn 4

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