Appendicitis Nursing Diagnosis and Nursing Care Plan

Appendicitis Nursing Care Plans Diagnosis and Interventions

Appendicitis NCLEX Review and Nursing Care Plans

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 Diagnosis for Appendicitis

Nursing Care Plan for Appendicitis 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.

Nursing Interventions for Appendicitis	Rationale
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 for Appendicitis 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.

Nursing Interventions for Appendicitis	Rationales
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 for Appendicitis 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).

Nursing Interventions for Appendicitis	Rationales
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.

Nursing Care Plan for Appendicitis 4

Risk for Deficient Volume

Nursing Diagnosis: Risk for Deficient Volume related to decreased fluid intake secondary to appendicitis as evidenced by reduced urine output and concentrated urine.

Desired Outcomes:

• The patient will learn to exhibit lifestyle modifications to avoid further dehydration advancement.
• The patient will exhibit comprehension regarding the causal variables and actions necessary to repair fluid deficiency.

Nursing Interventions for Appendicitis	Rationale
Encourage the patient to consume the recommended amount of fluid. Educate them about the fluids that they may consider when they experience fluid deficiency.	Oral fluid substitution is recommended for minor fluid deficits and is a cost-effective technique of maintenance therapy. Moreover, older individuals have a diminished sensation of thirst and may require frequent reminders to drink. Therefore, a fluid replacement can be facilitated by being creative in picking fluid resources such as sports drinks, flavored gelatin, and frozen juice bars. As needed, oral hydrating remedies can be utilized.
Administer intravenous fluid as indicated. Consider if individuals with aberrant vital signs require an IV fluid intervention with an urgent infusion of fluids. Monitor input and output strictly along with the administration of fluids and electrolytes.	Fluids are necessary to maintain the body hydrated. The kind and volume of liquid to be restored and the patient’s conditions will determine the infusion rate. Thus, this method is necessary if oral rehydration fluids are not enough to combat dehydration.
Establish precautions against severe electrolyte loss, such as resting the GI tract and administering antipyretics as recommended by the physician. Take note of the signs and symptoms of deficient volume.	Diarrheal fluid losses should be addressed concurrently with anti-diarrheal drugs, as indicated. Antipyretics can reduce temperature and fluid loss caused by diaphoresis.
Instruct the patient on the probable reasons and implications of fluid loss or inadequate fluid intake, and highlight the importance of a good diet and hydration.	This intervention strengthens the patient’s understanding and will aid in preventing and managing the problem. As a result, having enough knowledge allows the patient to participate in their treatment regimen.
Refer the patient to home care or a personal nurse for assistance, as needed, and devise an emergency treatment plan, including when to seek assistance.	The utilization of community resources promotes the continuum of care. Furthermore, some problems of low fluid volume are life-threatening and cannot be rectified at home. Patients who are on the verge of hypovolemia will require immediate care.
Auscultate and record heart sounds. Take note of heart rate, rhythm, and any other cardiac abnormalities.	Cardiac irregularities such as abnormal heart rhythms can be caused by hypovolemic shock or an electrolyte imbalance, and most prevalently hypocalcemia. Common cardiovascular complications include pericardial effusion with/without tamponade, Myocardial infarction, and pericarditis.

Nursing Care Plan for Appendicitis 5

Anxiety related to Impending Surgical Procedure (Appendectomy)

Nursing Diagnosis: Anxiety related to disturbed, nervous, and/or upset mood prior to surgery secondary to appendicitis as evidenced by an abnormal heart rhythm, dizziness, stomachache, breathlessness, and sleep disturbances.

Desired Outcome: The patient will be able to relax and will learn to deal with his or her anxious mind prior to impending surgical procedure which is appendectomy.

Nursing Interventions for Appendicitis	Rationale
Orient the patient with the surroundings and new procedures or individuals. Re-orient as needed.	Being familiar with the environment helps promote solace and may reduce the patient’s anxiousness. Anxiety can become panic-like if the patient feels threatened and unable to handle external stimuli. This intervention will help the patient to be mentally prepared for the impending surgical procedure (Appendectomy)
Encourage the patient to express his or her anxious feelings regarding the Appendectomy and, if possible, investigate other anxiety-inducing situations that contribute to his or her anxiousness.	Discussing anxiety-producing situations associated with symptoms can allow the patient to see the circumstances realistically and identify other factors contributing to anxiety.
Advise the patient to keep a record of all anxious episodes. Instruct them to describe what happened and the other events that led up to the incident. The patient should keep track of how quickly the anxiety subsides.	Recognizing and exploring factors that cause or reduce anxious feelings are critical steps in exploring sustainable responses. The patient may be oblivious of the connection between his or her emotional problems and anxiety. If the patient agrees, the log may be discussed with the healthcare professional, who may assist the patient in developing more effective coping mechanisms. Symptoms frequently provide relevant data to the health care provider about the level of anxiety being encountered.
Use nonmedical terminology, gentle and relaxed speech to discuss all patient activities, procedures, and matters. When feasible, do this ahead of time and verify the patient’s comprehension.	Patients who have received pre-admission patient education report less anxiety, emotional distress, and improved coping techniques because they know what will happen. Anxiety is exacerbated by ambiguity and a lack of predictability.
Motivate the patient to use optimistic self-talk such as “Anxiety will not destroy me,” “I can do this step by step,” “Right now, I need to take a deep breath and stretch,” and “I do not have to be perfect all the time.”	Behavioral therapy alters feelings and emotions by altering one’s personal opinions. It serves to lessen anxiety by displacing negative self-statements with affirmative self-talk. This approach will help the patient be positive and diminish anxiety while waiting for the day of the impending surgical procedure.
Educate patients on using relevant local resources in times of emergency (such as suicidal thoughts), like hotlines, emergency care, police departments, and judicial systems.	A structured, direct-screening procedure with promising prospects for institutionalization is the most efficient strategy of suicide prevention. This approach will help the patient realize that there are people or organizations that are willing to help them with their condition.

Nursing Care Plan for Appendicitis 6

Deficient Knowledge

Nursing Diagnosis: Deficient Knowledge related to an absence of exposure or recall, a misinterpretation of information, and an inadequate knowledge with data resources secondary to new diagnosis of appendicitis as evidenced by misapprehension statement, erroneous instruction follow-through, and the emergence of avoidable complications

Desired Outcomes:

• The patient will come to know to communicate his or her comprehension of the disease process, possible complications, and treatment needs.
• The patient will also be able to partake in the therapeutic regimen.

Nursing Interventions for Appendicitis	Rationale
Use the teach-back approach or return presentation to engage the patient in the learning experience.	One accurate and suitable method for determining whether the patient understands the information learned is to illustrate it to the patient and let them demonstrate the skill to the nurse or medical practitioner. For successful comprehension, have the patient perform the skill in an environment with direct feedback. It also makes the patient feel more comfortable knowing that someone is there to assist them through the learning process.
Allow the patient to contribute significantly to developing the healthcare plan and watch for potential barriers that could make learning more challenging.	Decision-making about the patient’s care plan provides the patient with independence. It is more likely that the patient will obey if they actively participate in preparing the treatment plan. Furthermore,  patients may struggle to learn due to mental or physical disabilities or economic disparities such as illiteracy. This intervention enables the care plan to be tailored to the individual.
Ascertain the patient’s learning techniques and offer various learning materials such as paper, presentation, or video clips.	There are various methods for learning the same relevant data. The patient’s learning approach determines specialized teaching and learning resources to impart knowledge. As previously stated, various learning materials will aid the patient’s capability of absorbing information. It is easier to keep the information studied with different media and see it differently.
Motivate the patient to ask any questions and develop a collaborative environment conducive to gaining knowledge.	The patient can participate in the learning process by asking questions. It indicates that the patient is paying attention to the information and is eager to learn. By posing questions, the patient partakes in his or her care plan and informs the healthcare team about what topics to cover next. Furthermore, obscure surroundings and ambiguity about a new health diagnosis can be challenging and dissuade a patient from learning. Feeling welcomed encourages the patient to open up and feel more at ease. The patient will be more open about his or her feelings and knowledge, resulting in a more efficient teaching plan.
Motivate the patient to speak with others who have had similar struggles and include the patient’s family in the treatment process.	A sense of community provides hope to the patient that they are not alone in dealing with their diagnosis or health condition, and it encourages them to keep learning about the disease process. Furthermore, it is frequently advantageous when family and friends are involved in the treatment plan and the learning process. Having someone intimately acquainted present through difficult times brings relief to the patient.
Ascertain which symptoms necessitate medical attention like increasing intolerable pain, swelling or redness of post-surgery wound, presence of drainage, and high fever.	Immediate intervention decreases the likelihood of serious complications. This approach will lessen the possibility of aggravation of the health condition.

Other Appendicitis Nursing Diagnosis

Activity Intolerance

Risk for Constipation

Risk for 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. (2022). 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. (2020). 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

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