Appendicitis

Appendicitis

1. Expected Findings: Abdominal pain; generalized pain begins at peri-umbilical area and localized to the RLQ; pain that increases with movement;rigid abdomen, Fever, Tachycardia, Possible vomiting, constipation, and/or diarrhea, anorexia, pallor, lethargy, and or irritability.

2. Definition: Inflammation of the appendix caused by obstruction of appendix opening, possibly caused by fecal matter, swollen lymphoid tissue, or a parasite.

3. LABS: Serum electrolytes consistent with changes due to vomiting. Decreased sodium and potassium levels . Increased pH and bicarb due to metabolic alkalosis. Elevated BUN indicates dehydration CBC may show elevated WBC about 10K with shift to left (increased immature neutrophils

4. DIAGNOSTICS - CT of abdomen shows enlarged diameter of appendix, as well as thickening of the appendiceal wall.

5. PROCEDURE - Surgical removal of appendix via laparascopic or open method.

6. COMPLICATIONS - PERITONITIS which occurs ehn intestinal lining and/or peritoneum is perforated and contents spill into peritoneal cavity. Often occurs within 48 hours of onset of appendiciitis.

   • NURSING ACTIONS - Assess peritronitis: Rigid board-like sounds, Severe pain, Severe pain, Fever, Increased WBCs, Possible shock and death, Pain management: Assess with appropriate tool for age, Administer analgesic as prescribed, Manage and admin IV fluids, Admin IV antibiotics for infection, Mange nasogastric tube suction, Provide preop and postop care, Provide surgical wound care, Provide surgical wound care, Provide psychosocial support, Educate parents about need for NPO status and pain medication, Educate child/parent about early ambulation, advancement of diet, wound care, and monitoring for infection.

7. PREOPERATIVE ACTION - Maintain NPO, Monitor IV fluids, Encourage semi-fowlers position, Avoid laxatives/enemas, Avoid application of heat.

8. COMPLICATIONS (monitor for): Fever, tachycardia, dehydration, nausea/vomiting, rebound tenderness, Hiccups, Distended/board-like Abdomen.

9. ATI: EXPECTED FINDINGS- Oral Temp 38.4 (101.1C), Nausea or Vomiting, Right lower quadrant pain, Higher WBC like 10000-18000