 A condition characterized by

inflammation of the appendix.

 most common cause of acute
inflammation in the right lower
quadrant of the abdominal cavity.
 prevalent in countries in which
people consume a diet low in
fiber and high in refined
carbohydrates.
•The appendix is located
in the lower quadrant of
the abdomen, or, more
specifically, the right iliac
fossa.

•It is a slender, worm-

shaped pouch, averaging
5—10cm in length.
RACIAL & DIETARY FACTORS:-
 MORE COMMON IN WHITE RACES.
 YOUNG MALES ARE AFFECTED MORE OFTEN
 DIET RICH IN MEAT PRECIPITATES APPENDICITIS
 FAMILIAL TENDENCY

SOCIO-ECONOMIC STATUS
 IT IS COMMON IN MIDDLE CLASS & RICH PEOPLE.

OBSTRUCTION OF THE LUMEN

 A) IN THE LUMEN-INTESTINAL WARM e.g. ROUND
WORM,THREDWORM ETC VEGETABLE,FRUIT SEED,
FECES MATERIAL, BARIUM

 B) IN THE WALL-STRUCTURE, NEOPLASM

 Pathophysiology:

Non-modifiable
•Age: all age groups old
•Gender: male(male- female =2:1)
•Hereditary: tumor formation in the
opening of the appendix
Modifiable
•Diet: People whose diet is low in
fiber and rich in refined
carbohydrates
•Infections: Gastrointestinal
infections such as Amoebiasis,
Bacterial Gastroenteritis
 Episodes of constipation

Occlusion of appendix by fecalith

Decreased flow/drainage of mucosal secretions

vasoncongestion

Decreased blood supply in the appendix

Decreased O2 supply in the appendix

Appendix starts to be necrotic: bacteria invade the appendix

Disruption of cell membrane of appendix

 Start of Inflammatory Process

Release of Chemical Mediators Activation of the Neutrophils to

Vomiting center in the area
medulla
Histamine, Prostaglandin,
Leukotrienes, Bradykinin Pus Formation
Stimulation of Suppression of (phagocytized
Swelling of Appendix Vagus Nerve Sympathetic GI bacteria and
function dead cells)
Prostaglandin, Bradykinin
N/V
Pain in the RLQ of Abdomen Anorexia

Risk for
Risk for infection
Acute pain
Deficient Fluid (if appendix
Volume ruptures)
Interleukin-1 Risk for Imbalanced
Nutrition less than
Increased WBC body requirements
 Inflammation of Appendix

Appendectomy

Open Wound Tissue Trauma

Noriceptors of the
Dermis
Disruption of Cell
Membrane

Start of Send Impulse to CNS

Inflammatory
Process

Release of Pain on Surgical Site

Prostaglandin/
Bradykinin
Activity Intolerance
Rebound
tenderness
Pain felt upon the release of the pressure
Indicates rebound tenderness
 Guarding
1. Voluntary guarding occurs the
moment the doctor’s hand touches
the abdomen.
2. Involuntary guarding occurs before
the doctor actually makes contact.
Rovsing’s sign
• Pressure to the lower left side of the abdomen.
• Pain felt on the lower right side of the
abdomen upon the release of pressure on the left
side.
Psoas sign
Check for the psoas sign by applying resistance to
the right knee as the patient tries to lift the right
thigh while lying down.
 •A doctor tests for the obturator
sign by asking the patient to lie
down with the right leg bent at
the knee.

•Moving the bent knee left and

right requires flexing the
obturator muscle and will
cause abdominal pain if the
appendix is inflamed.

Obturator sign
Local tenderness
at McBurney’s
point w/ pressure
Others…
Mild Fever
Dry Tongue
Constipation
Nausea and Vomiting

Abdominal Rigidity
 LABS AND DIAGNOSTICS
Laboratory & Diagnostic Test Result
CBC WBC count reveal moderate
leukocytosis (10,000 to 16,000/mm3)
with shift to the left
Ultrasound studies & CT scans May reveal right liver quadrant
density or localized distention of the
bowel.

Abdominal x-ray visualize shadow consistent with

fecalith in appendix; perforation will
reveal free air.
Acute Pain

NURSING
DIAGNOSIS
Planning/Implementation
PRE-OPERATIVE MANAGEMENT
 NPO diet in preparation for surgery.
 An intravenous drip is used to hydrate the patient.
 Antibiotics given intravenously such as Cefuroxime and
Metronidazole .
 If the stomach is empty (no food in the past six hours)
general anesthesia is usually used.
 Otherwise, spinal anesthesia may be used.
 Removal of the appendix.
 Performed as soon as possible to decrease the
risk of perforation.

Two ways performed:

1. Laparotomy
2. Laparoscopy
POST- OPERATIVE MANAGEMENT
 Assist patient to position of comfort such as semi-fowlers with knees
are flexed.
 Restrict activity that may aggravate pain, such as coughing and
ambulation.
 Apply ice bag to abdomen for comfort.
 Advise avoidance of enemas or harsh laxatives; increased fluids and
stool softeners may be used for postoperative constipation.
 Give narcotic analgesic as ordered and administer oral fluids when
tolerated.
 Monitor frequently for signs and symptoms of worsening condition,
indicating perforation, abscess, or peritonitis (increasing severity of
pain, tenderness, rigidity, distention, absent bowel sounds, fever,
malaise, and tachycardia).
 If a drain is left in place
at the area of the
incision, monitor
carefully for signs of
intestinal obstruction,
secondary hemorrhage,
or secondary abscesses
(e.g. fever, tachycardia,
and increased
leukocyte count).
 Complication Interventions
PERITONITIS •Observe for abdominal tenderness, fever, vomiting,
abdominal rigidity, and tachycardia.
•Employ constant nasogastric suction
•Correct dehydration
•Admin. Antibiotics as prescribed.

PELVIC ABSCESS •Evaluate for anorexia, chills, fever, and diaphoresis

•Observe for diarrhea, which may indicate pelvic
abscess
•Prepare pt for rectal exam
•Prepare pt for surgical drainage procedure

SUPHRENIC ABSCESS •Assess pt for chills, fever, diaphoresis

•Prepare for x-ray exam and surgical drainage of
abscess
PARALYTIC ILEUS •Assess bowel sounds
•Replace fluids and electrolytes by IV route
•Employ nasogastric intubation and suction.
DISCHARGE- METHOD

M
• Antibiotics for infection
• Analgesic agent (morphine) can be given for pain
after the surgery
DISCHARGE- METHOD

E
 Within 12 hrs of surgery you may get up and move
around.
 You can usually return to normal activities in 2-3
weeks after laparoscopic surgery.
DISCHARGE- METHOD

T
• Pretreatment of foods with lactase preparations
(e.g. lactacid drops) before ingestion can reduce
symptoms.
• Ingestion of lactase enzyme tablets with the first
bite of food can reduce symptoms.
 DISCHARGE- METHOD

H
 To care wound perform dressing changes and
irrigations as prescribe
 avoid taking laxative
 applying heat to abdomen when abdominal pain of
unknown cause is experienced.
 Reinforce need for follow-up appointment with the
surgeon.
 Call your physician for increased pain at the incision
site
 DISCHARGE- METHOD

O
 Document bowel sounds and the passing of flatus
or bowel movements (these are signs of the return
of peristalsis)
 Watch for surgical complications such as continuing
pain or fever, which indicate an abscess or wound
dehiscence
 Stitches removed between fifth and seventh day
(usually in physicians office)
DISCHARGE- METHOD

D
• Liquid or soft diet until the infection
subsides
• Soft diet is low in fiber and easily breaks
down in the gastrointestinal tract.
 M Antibiotics for infection
Analgesic agent (morphine) can be given for pain after the surgery
 E Within 12 hrs of surgery you may get up and move around.
You can usually return to normal activities in 2-3 weeks after laparoscopic surgery.
 T Pretreatment of foods with lactase preparations (e.g. lactacid drops) before ingestion can
reduce symptoms.
Ingestion of lactase enzyme tablets with the first bite of food can reduce symptoms.
 H To care wound perform dressing changes and irrigations as prescribe avoid taking laxative
or applying heat to abdomen when abdominal pain of unknown cause is experienced.
Reinforce need for follow-up appointment with the surgeon
Call your physician for increased pain at the incision site
 O Document bowel sounds and the passing of flatus or bowel movements (these are signs
of the return of peristalsis)
Watch for surgical complications such as continuing pain or fever, which indicate an
abscess or wound dehiscence
Stitches removed between fifth and seventh day (usually in physicians office)
 D Liquid or soft diet until the infection subsides
Soft diet is low in fiber and easily breaks down in the gastrointestinal tract.