Appendicitis

Appendicitis Nursing Diagnosis Interventions and Care Plans

Appendicitis NCLEX Review Care Plans

Nursing Study Guide on Appendicitis

Appendicitis is a medical condition that occurs when there is an inflammation of the finger-shaped pouch near the colon called appendix.

The appendix is a part of the immune system in younger people as it has an abundance of lymphoid cells that can fight infection.

However, it stops to do this when the other parts of immune system become more developed.

The main symptom of appendicitis is pain that usually starts around the navel area, and radiates to the lower right abdomen, where the appendix is located.

Worsening inflammation can be determined when the intensity of pain increases.

Appendicitis is common in ages between 10 and 30, although it can affect people of any age.

The treatment for appendicitis is appendectomy, or the removal of the inflamed appendix.

Signs and Symptoms of Appendicitis

  • Sudden pain – may start on the lower right abdomen, or around the navel and then radiates to the lower right abdomen; may worsen if the patient coughs, walks, or do other jarring motions; pregnant women may feel the pain on the upper right abdomen
  • Fever – starts at low grade but intensifies as the appendix becomes more inflamed
  • Constipation or diarrhea
  • Abdominal bloating
  • Nausea and vomiting
  • Loss of appetite
  • Flatulence

Causes and Risk Factors of Appendicitis

A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis.

The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus.

If not treated promptly, the appendix can rupture.

Appendicitis is often caused by the blockage of the appendix, particularly its lining, that leads to infection.

There is a rapid multiplication of the bacteria, causing the appendix to swell and be pus-filled.

The appendix may rupture if not removed urgently.

The risk factors that may predispose a person to appendicitis include:

  1. Sex – there are more cases of appendicitis involving men than women
  2. Age – most affected patients are between 10 to 30 years old
  3. Family history of appendicitis
  4. Young patients with cystic fibrosis

Complications of Appendicitis

  1. Rupture of the appendix and peritonitis. If not removed urgently, the inflamed appendix may rupture, causing the bacteria to spread throughout the abdominal cavity. This could lead to peritonitis, which can be fatal. The surgical team will have to urgently remove the appendix and cleanse the whole abdominal cavity.
  2. Abdominal abscess. A ruptured appendix may also lead to the development of a pocket of pus known as abscess in the abdominal cavity. This requires tube drainage of the abscess that is usually in place for 2 weeks with antibiotic therapy.

Diagnosis of Appendicitis

  1. Physical exam – patient’s description of pain such as location and intensity; palpation of the abdomen where in the sudden release of pressure will result to worsening of the pain; checking for abdominal rigidity; digital rectal exam may also be done
  2. Pelvic exam – for women of childbearing age; to rule out any gynecological conditions that may cause the pain
  3. Blood test – elevated white blood cell (WBC) count may indicate an ongoing infection
  4. Urinalysis – to rule out any urinary tract infection or presence of kidney stones
  5. Imaging – abdominal X-ray, ultrasound, CT scan, or MRI to visualize the abdomen and confirm diagnosis

Treatment for Appendicitis

  1. Appendectomy. The standard treatment for appendicitis is to remove the appendix surgically. There are two types of appendectomy based on the technique used:
  2. Laparotomy or open appendectomy – an open surgery wherein the surgeon uses one long abdominal incision of about 5 to 10 centimetres; ideal for ruptured appendix because it allows the surgeon to clean the whole abdominal cavity
  3. Laparoscopic surgery – a procedure wherein the surgeon uses a few, small incisions on the abdomen, guided by a video camera; allows for faster recovery with less scarring and pain
  4. Abscess drainage. If the appendix has ruptured and an abdominal abscess has formed, the latter needs to drained first before performing appendectomy. This can be done by tube drainage for about 2 weeks, while fighting the infection through antibiotic therapy.
  • Post-surgical care. The patient usually stays for a day or two as an in-patient post-surgery. After an appendectomy, the patient usually recovers after a few weeks. It is important to advise the following:
  • No strenuous activity for 3 to 5 days (laparoscopic surgery) or 10 to 14 days (open appendectomy)
  • Apply support on the abdomen when coughing, laughing, or moving by placing a pillow over the abdominal area
  • Inform the healthcare team if the pain medications are not working
  • Have enough rest periods, but ensure that the patient ambulates or performs short walks to prevent deep vein thrombosis (DVT)

Nursing Care Plans for Appendicitis

Nursing Care Plan 1

Nursing Diagnosis: Acute Pain related to inflammation of the appendix as evidenced by  pain score of 10 out of 10, verbalization of sudden abdominal pain that starts around the navel and radiates to the lower right abdomen, guarding sign on the abdomen, abdominal rigidity, and restlessness

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.

InterventionsRationale
Administer prescribed pain medications.To alleviate the symptoms of acute abdominal pain. Pain on the right lower quadrant of the abdomen suggests the involvement of the appendix.
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.  To monitor effectiveness of medical treatment for the relief of abdominal pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.  
Elevate the head of the bed and position the patient in semi Fowler’s.To increase the oxygen level by allowing optimal lung expansion.
Place the patient in complete bed rest during severe episodes of pain. Perform non-pharmacological pain relief methods such as relaxation techniques such as deep breathing exercises, guided imagery, and provision of distractions such as TV or radio.To reduce gastrointestinal stimulations that may worsen abdominal pain. To provide optimal comfort to the patient.
Prepare the patient for appendectomy.The standard treatment for appendicitis is to remove the appendix surgically. If the appendix has ruptured and an abdominal abscess has formed, the latter needs to drained first before performing appendectomy.
Post-surgery, advise the patient to: Have no strenuous activity for 3 to 5 days (laparoscopic surgery) or 10 to 14 days (open appendectomy)   Apply support on the abdomen when coughing, laughing, or moving by placing a pillow over the abdominal area   Inform the healthcare team if the pain medications are not working    To reduce post-surgical pain and allow full recovery and healing.

Nursing Care Plan 2

Hyperthermia secondary to infective process of appendicitis as evidenced by temperature of 38.5 degrees Celsius, rapid breathing, profuse sweating, and chills

Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

InterventionsRationales
Assess the patient’s vital signs at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. Paracetamol) administered.
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed antibiotic and anti-pyretic medications.Use the antibiotic to treat bacterial infection (appendicitis), which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Care Plan 3

 Nursing Diagnosis: Risk for Infection

Desired Outcome: The patient will be able to avoid the rupture of appendix and spread of infection throughout the abdominal cavity (peritonitis or abscess formation).

InterventionsRationales
Assess vital signs and observe for any signs of infection as well as for any signs of respiratory distress, and gastrointestinal problems such as diarrhea, nausea, and vomiting.To assess for the evidence of ongoing infection. Sepsis or infection of the blood may develop from appendicitis and can be evidenced by fever accompanied by respiratory distress.
Perform a focused assessment on the abdominal region, particularly checking for abdominal pain, abdominal rigidity, diminishes or absent bowel sounds, and rebound tenderness.Appendicitis happens when there is an inflammation of the appendix. It is evidenced by sudden abdominal pain, abdominal rigidity, nausea and vomiting, and loss of appetite. Worsening inflammation can be determined when the intensity of pain increases.
Prepare the patient for appendectomy. If the appendix has ruptured and an abscess has formed, prepare for abscess drain.For surgical removal of the appendix. If the appendix has ruptured and an abdominal abscess has formed, the latter needs to drained first before performing appendectomy.
Teach the patient how to perform proper post-surgical care.To maintain patient safety and reduce the risk for cross contamination.
Administer antibiotics as prescribed.To treat the underlying infection with antibiotics. The doctor may prescribe broad-spectrum antibiotics to prevent the risk of developing sepsis in a patient with ruptured appendix.

Other possible nursing diagnoses:

Activity Intolerance

Risk for Constipation/ Diarrhea

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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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