NURSING > STUDY GUIDE > MED SURG EXAM : STUDY GUIDE 3 - 2 (All)

MED SURG EXAM : STUDY GUIDE 3 - 2

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Appendicitis -Inflammation of the appendix, a narrow blind tube that extends from the inferior part of the cecum. -**Most common reason for emergency abdominal surgery -When the appendix becomes inflamed or infected, rupture may occur within a matter of hours, leading to peritonitis and sepsis. Etiology & Patho -Most common in individuals 10-30 years of age -Common cause of appendicitis is obstruction of the lumen by a fecalith (accumulated feces). -Obstruction results in distention; venous engorgement; & the accumulation of mucous & bacteria, which can lead to gangrene, perforation, & peritonitis. -Low fiber diet & high intake of refined carbs are risk factors Clinical Manifestations -Typically begins with dull periumbilical pain, followed by anorexia, nausea & vomiting -Pain is persistent & continuous, eventually shifting to the RLQ & localizing at McBurney’s point (halfway between the umbilicus & right iliac crest) -Low grade fever may develop -Further assessment reveals localized tenderness, rigidity, rebound tenderness, & muscle guarding -Coughing, sneezing, & deep inhalation worsen pain -Elevated WBC count -Pt in side lying position with abdominal guarding & legs flexed -Constipation or diarrhea -Older adults may report less severe pain, slight fever, & discomfort in the right iliac fossa Diagnostic Studies & Interprofessional Care -Pt examination includes complete history, physical exam, & a differential WBC count -Most pt’s have a mildly to moderately elevated WBC count -Urinalysis is done to rule out genitourinary conditions that mimic appendicitis -CT scan is the preferred diagnostic procedure -Ultrasound & MRI are also used -Leukocyte count greater than 10,000/mm 3, neutrophil count greater than 75%; abdominal radiographs, ultrasound studies, and CT scans may reveal right lower quadrant density or localized distention of the bowel. -If there is a delay in the diagnosis & treatment, the appendix can rupture & the resulting peritonitis can be fatal -Treatment of appendicitis is an immediate appendectomy (removal of appendix) -If inflammation is localized, surgery should be done as soon as diagnosis is made -Antibiotics & fluid resuscitation are started before surgery -If appendix has ruptured & there is evidence of peritonitis or an abscess, giving parenteral fluids & antibiotic therapy for 6-8 hours before the appendectomy helps prevent dehydration & sepsis Nursing Management: Appendicitis -Management focuses on preventing fluid volume deficit, relieving pain, & preventing complications -Keep the pt NPO until the HCP evaluates the pt -Monitor vitals & perform ongoing assessment to detect any deterioration -Administer IV fluids, analgesics, & antiemetics as ordered -Provide comfort measures Primary Nursing Diagnosis -Primary Preoperative Nursing Diagnosis -Pain (acute) related to inflammation

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