Appendicitis – Pathophysiology, Podcast, and Nursing Care Plan

appendicitis

Appendicitis

The appendix is a small appendage that is located at the beginning of the large intestine. Appendicitis is an inflammation to the inner lining of the appendix most often occurring in patients between age 10 – 30. Appendicitis is thought to start when the appendix becomes blocked by feces, a foreign body, or sometimes even a tumor.

 

appendicitis

 Complications

Serious complications can develop from appendicitis:

  • Perforation of the appendix: This can lead to abscess ( collection of infected pus), or even peritonitis (infection of the entire lining of the abdomen).
  • Obstruction (less common): the inflammation surrounding the appendix can cause the intestinal wall to stop working, preventing intestinal contents from passing.

 Signs and Symptoms

Signs and symptoms of appendicitis can include the following:

  • Abdominal pain: lower right side of abdomen.
  • Pain that worsens with coughing or even walking
  • Sudden pain around belly button that then starts to radiate to the lower right abdomen.
  • Fever: this tends to get worse as appendicitis progresses
  • Constipation or even diarrhea
  • abdominal bloating
  • Loss of appetite
  • Nausea and vomiting
  • Chills
  • Abdominal rigidity

For nursing exams: tests will usually refer to various signs, however, diagnosis will be made by lab and radiology studies.  The signs you may see on a test are as follows:

  • Rovsing sign: RLQ abdominal pain with palpation of the LLQ
  • Obturator sign:  RLQ abdominal pain with internal and external rotation of the flexed right hip.
  • Psoas sign: RLQ abdominal pain with extension of the right hip or with flexion of the right hip against resistance.
  • McBurney’s point: McBurney’s point is defined as pain with palpation, located in between the belly button and the right lower quadrant of the abdomen.

Diagnostics

Since the patient signs and symptoms can vary, after the history and physical are done, the healthcare provider may order the following exams:

  • Blood tests
  • Urine analysis to rule out a kidney stone or UTI
  • X-Ray
  • CT exam
  • Abdominal Ultrasound

Treatments

Treatment will include:

  • Antibiotics to fight infection
  • Drainage of abscess: this usually needs to be done first if an abscess has formed.
  • Appendectomy: surgery to remove appendix.

Podcast

 

 

Nursing Care Plan

Nursing Diagnosis

1. Acute pain related to inflammatory process of the appendicitis as evidenced by patient rates pain at 8/10 on pain scale and states abdominal cramping and tenderness in abdomen.

Desired outcomes:

Patient will report a decrease in pain from 8 to 0 on the pain scale by discharge.

InterventionsRationals
InterventionsRationals
Assess level of pain using appropriate pain scale. Assess pain 30 minutes before and after pain medication is given.Using an appropriate age pain rating scale will help the healthcare providers monitor the level of pain and adjust pain medications as needed.
Administer pain medications as prescribed and indicated.Analgesics are helpful in relieving pain and helping in the recovery process.
Have patient maintain limited bedrest and activityThis will help to minimize pancreatic secretions and pain.
Incorporate nonpharmacologic measures to assist with control of pain.Ideally, the use of comfort measures will distract the patient from pain and may increase the effectiveness of pharmacological measures.

2. Risk for Infection related to development of inflammatory process or worsening appendicitis.

Desired outcomes:

By discharge, the patient will remain free signs and symptoms of infection.

InterventionsRationals
InterventionsRationals
Assess vital signs including temperature every 4 hours and as needed. Report any abnormal findings to the healthcare provider.Fever is often one of the first signs of infection.
Assess mental status and level of consciousnesses every 4-6 hours.Mental status changes, confusion, or any deterioration from baseline can signify infection.
Report and note any abnormal laboratory values (i.e. elevated WBC count) to the healthcare provider.Certain abnormal laboratory results could be an indicator of infection.

Other possible nursing diagnosis:

Risk for imbalanced fluid volume

Impaired gas exchange

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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