Nursing management for appendicitis.pptx

objectives:
After the lecture the staffs will be able to recall the clinical assessment, management and the appropriate health teaching for patient before admission, during admission, in pre-operative phase, post-operative phase and lastly health teachings prior to discharge.

The staffs will be able to understand the importance of their role in patient successful recovery if proper assessment, planning, interventions, evaluation and appropriate nursing management are rendered.

Any part of the lower GI tract is susceptible to acute
inflammation caused by bacterial, viral, or fungal infections.

Appendicitis (also known epityphlitis) is the inflammation of the appendix which is a small finger-like appendage attached to the cecum just below the ileocecal valve.

Because the appendix empties into the colon inefficiently and its lumen is small, it is prone to becoming obstructed and is vulnerable to infection (appendicitis).

Any part of the lower GI tract is susceptible to acute
inflammation caused by bacterial, viral, or fungal infections.

Pathophysiology
Appendicitis (also known epityphlitis) is the inflammation of the appendix which is a small finger-like appendage attached to the cecum just below the ileocecal valve.

Clinical Manifestations
Signs and symptoms of appendicitis are:

Pain. Vague epigastric or periumbilical pain progresses to right lower quadrant pain usually accompanied by low-grade fever, nausea,and sometimes vomiting.

Tenderness. In 50% of presenting cases, local tenderness is elicited at McBurney’s point when pressure is applied.

Rebound tenderness. Rebound tenderness or the production or intensification of pain when pressure is released.

Rovsing’s sign. Rovsing’s sign may be elicited by palpating the left lower quadrant; this paradoxically causes pain to be felt at the right lower quadrant.

Because the appendix empties into the colon inefficiently and its lumen is small, it is prone to becoming obstructed and is vulnerable to infection (appendicitis).

Complications�
If appendicitis is left untreated, a complication could occur.

Perforation of the appendix. This is a major complication of appendicitis, which can lead to peritonitis, abscess formation, or portal pylephlebitis.

Perforation generally occurs 24 hours after the onset of pain.

Symptoms include a fever of 37.7⁰C or greater, a toxic appearance, and continued abdominal pain or tenderness.

Diagnostic Findings
Diagnosis is based on the results of a complete physical examination and on laboratory findings and imaging studies.

CBC count. A complete blood cell count shows an elevated WBC count, with an elevation of the neutrophils. (children under 2- >17,000, children over 2 and adults- >10,000)

Imaging studies. Abdominal x-ray films, ultrasound studies, and CT scans may reveal a right lower quadrant density or localized distention of the bowel.

Pregnancy test. A pregnancy test may be performed for women of childbearing age to rule out ectopic pregnancy

1. Objectives: After the lecture the staffs will be able to recall the clinical assessment, management and the appropriate health teaching for patient before admission, during admission, in pre-operative phase, post-operative phase and lastly health teachings prior to discharge. The staffs will be able to understand the importance of their role in patient successful recovery if proper assessment, planning, interventions, evaluation and appropriate nursing management are rendered.

2. Any part of the lower GI tract is susceptible to acute inflammation caused by bacterial, viral, or fungal infections . Appendicitis  (also known epityphlitis )   is the inflammation of the appendix which is a small finger-like appendage attached to the cecum just below the ileocecal valve . Because the appendix empties into the colon inefficiently and its lumen is small, it is prone to becoming obstructed and is vulnerable to infection (appendicitis).

3. Pathophysiology The simple pathophysiology of appendicitis follows the typical pathophysiology of infection.   Obstruction. The appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith , tumor, or foreign body . Inflammation. The inflammatory process increases intraluminal pressure, initiating a progressively severe, generalized, or periumbilical pain . Pain. The pain becomes localized to the right lower quadrant of the abdomen within a few hours . Pus formation. Eventually, the inflamed appendix fills with pus .

4. Clinical Manifestations Signs and symptoms of appendicitis are: Pain. Vague epigastric or periumbilical pain progresses to right lower quadrant pain usually accompanied by low-grade fever, nausea,and sometimes vomiting . Tenderness. In 50% of presenting cases, local tenderness is elicited at McBurney’s point when pressure is applied . Rebound tenderness. Rebound tenderness or the production or intensification of pain when pressure is released . Rovsing’s sign. Rovsing’s sign may be elicited by palpating the left lower quadrant ; this paradoxically causes pain to be felt at the right lower quadrant.

5. Complications If appendicitis is left untreated, a complication could occur . Perforation of the appendix. This is a major complication of appendicitis, which can lead to peritonitis, abscess formation, or portal pylephlebitis . Perforation generally occurs 24 hours after the onset of pain . Symptoms include a fever of 37.7⁰C or greater, a toxic appearance, and continued abdominal pain or tenderness.

6. Diagnostic Findings Diagnosis is based on the results of a complete physical examination and on laboratory findings and imaging studies. CBC count. A complete blood cell count shows an elevated WBC count , with an elevation of the neutrophils . (children under 2- >17,000, children over 2 and adults- >10,000) Imaging studies. Abdominal x-ray films, ultrasound studies, and CT scans may reveal a right lower quadrant density or localized distention of the bowel . Pregnancy test. A pregnancy test may be performed for women of childbearing age to rule out ectopic pregnancy and before x-rays are obtained . Laparoscopy. A diagnostic laparoscopy may be used to rule out acute appendicitis in equivocal cases . C-reactive protein. Protein produced by the liver when bacterial infections occur and rapidly increases within the first 12 hours.

7. Medical Management Medical management should be performed carefully to avoid altering the presenting symptoms . IV fluids. To correct fluid and electrolyte imbalance and dehydration, IV fluids are administered prior to surgery . Antibiotic therapy. To prevent sepsis, antibiotics are administered until surgery is performed . Drainage. When perforation of the appendix occurs, an abscess may form and patient is initially treated with antibiotics and the surgeon may place a drain in the abscess.

8. Surgical Management Immediate surgery is typically indicated if appendicitis is diagnosed. Appendectomy. Appendectomy or the surgical removal of the appendix is performed as soon as it is possible to decrease the risk of perforation . Laparotomy and laparoscopy. Both of these procedures are safe and effective in the treatment of appendicitis with perforation.

9. Nursing implications Preoperative care Prepare a patient several hours pre-surgery. The patient may be dehydrated due to symptoms such as vomiting. It may be necessary to administer IV fluids. The patient’s vital signs should be recorded every 2-4 hours. The nurse should not apply any heat over the area of pain while the patient is awaiting diagnosis as this could cause the appendix to rupture Analgesia should not be administered before examination because this can lead to an inaccurate diagnosis as the pain may subside and the examination will be ineffective.

10. Laxatives should also be avoided as induced peristalsis may cause perforation. If appendicitis has been diagnosed regular analgesia, usually an opioid depending on pain severity, should be given to make the patient comfortable before treatment. They may feel anxious so the nurse or surgical team should fully explain the procedure. The operation site will be washed and shaved before surgery, depending on local procedures.

11. Postoperative care The severity of the patient’s pain assessed with the use of a pain scale. Appropriate pain relief can then be administered. Vital signs should be regularly monitored at half-hourly intervals for two hours postoperatively, hourly for two hours and, if stable, every four hours while the patient is recovering in hospital . Review the patient on recovery and decide when they may eat and drink . Drain should be recorded every 24 hours. The drain can be removed when there is minimal drainage - usually 50ml or less . The wound should be managed aseptically. If the wound is covered with a dry dressing then it should be changed every 1-2 days.

12. Clips/stitches should be removed 10 days postoperatively. Before discharge, the patient must be confident in how to manage their wound and have details of who they should contact in case of concern. The patient should be encouraged to get up and out of bed as soon as possible to prevent the formation of emboli. Anticoagulants are usually administered before surgery and postoperatively. Antiembolism stockings should be worn. The patient will not be able to commence food and fluids for a few days, this is to enable the bowel to regain normal function. The hospital stay for patients who have undergone an uncomplicated appendectomy is usually 2-3 days. In most cases the patient will be discharged when their temperature is normal and their bowels have started to function again (Peterson, 2002).

13. Nursing Management

14. Nursing Assessment Assessment of a patient with appendicitis may be both objective and subjective. Assess the level of pain. Assess relevant laboratory findings. Assess patient’s vital signs in preparation for surgery . Diagnosis Based on the assessment data, the most appropriate diagnoses for a patient with appendicitis are: Acute pain related to obstructed appendix. Risk for deficient fluid volume related to preoperative vomiting, postoperative restrictions. Risk for infection related to ruptured appendix.

15. Planning & Goals Goals for a patient with appendicitis include: Relieving pain. Preventing fluid volume deficit. Reducing anxiety. Eliminating infection due to the potential or actual disruption of the GI tract. Maintaining skin integrity. Attaining optimal nutrition. Nursing Interventions The nurse prepares the patient for surgery. IV infusion. An IV infusion is made to replace fluid loss and promote adequate renal functioning. Antibiotic therapy. Antibiotic therapy is given to prevent infection. Positioning. After the surgery, the nurse places the patient on a High-fowler’s position to reduce the tension on the incision and abdominal organs, thereby reducing pain. Oral fluids. When tolerated.

16. Evaluation Relieved pain. Prevented fluid volume deficit. Reduced anxiety. Eliminated infection due to the potential or actual disruption of the GI tract. Maintained skin integrity. Attained optimal nutrition.

17. Discharge and Home Care Guidelines Reinforce Discharge teaching for patient and family especially wound care : You may shower, avoid soaking your incision in a tub for a week or so. Cleanse incision gently with a mild soap and water, rinse thoroughly-pat dry.   There are no specific dietary restrictions associated with this surgery. Avoid foodsthat make you constipated and cause you to strain against your incision. It is safe to use a mild laxative. DO SO if your bowels have not moved by the third day after surgery. Lift only as much weight as you can manage easily. No lifting over 15 pounds for 6 weeks. Keep your back straight and allow your legs to do most of the work. Moderate exercise is healthy. You may walk as much as you like. You are permitted to go up and down stairs slowly while using a handrail. Resume normal activity after 10-14 days. You may drive when you are comfortable enough to react and move quickly in an emergency (usually 1-2 weeks after surgery). Long trips over 25 miles are not advised. DO NOT drive if you are taking prescription pain medication.

18. Seek Medical Attention If: There is redness, swelling, or increasing pain in the wound not controlled with medication . There is drainage, blood, or pus coming from the wound lasting longer than one day or sooner If there is concern. An unexplained temperature above 101.0 develops . You develop signs of generalized infection including muscle aches, chills, fever, or a general ill feeling. There is a breaking open of a wound (edge not staying together) after the sutures, staples or steri ‐strips have been removed. You develop dizzy episodes or fainting while standing . You develop persistent nausea or vomiting.

19. Seek Immediate Medical Attention If: You develop a rash. You have difficulty breathing. You develop any reaction or side effects to medication given

20. King Solomon