APPENDICITIS

Definition of Appendicitis

·         Appendicitis is the inflammation of the vermiform appendix that develop most commonly in adolescents and young adults

·         Appendicitis affects 6-12% of population, most commonly to clients between 20-30 years of age. It is more common in males than females and rarely occurs in middle adulthood.

Causes /Risk Factors of Appendicitis

·         Fecal calculus or stone that occludes the lumen of the appendix

·         Kinking of the appendix

·         Swelling of the bowel wall

·         Fibrous conditions in the bowel wall

·         External Occlusion Of The Bowel By Adhesions

Pathophysiology

1. The appendix becomes inflamed due to organisms
2. It may be ulcerated, gangrenous or perforated

Changes Of The Appendix

1. Red colour – Early appendicitis
2. Yellow colour – Severe appendicitis
3. Green or black – gangrenous 

 Signs and Symptoms of a Patient with Appendicitis 

·         Acute generalized abdominal pain that is of wavelike pattern.

o   Within few hours the pain becomes localized in the right lower quadrant of the abdomen. As the inflammation spread to the serosa layer of the bowel, the pain becomes steady and relieves when the patients assumes dorsal recumbent position as it lessen tension on the abdominal muscles.

·         Vomiting that proceeds the pain

·         Low grade fever

Diagnostic Evaluation 

Physical examination

• Laboratory findings – a complete blood count is performed and will demonstrate elevated white blood cells count, leucocytes may exceeds 10000/mm³    and neutrophills may exceed 75%
• Abdominal x- rays and ultra sound studies may reveal a right lower quadrant density or localized distension of the bowel

Nursing Care  to a Patient with Appendicitis

• Administer antibiotic to combat infection
• Insert iv fluids to correct or prevent fluid/ electrolyte balance and dehydration
• Administer analgesics after the diagnosis is made

Pre operative preparations

• Correct dehydration by i.v fluid
• Give prophylactic antibiotics iv and prenteral analgesics to relieve pain

o   Pass NGT to relieve abdominal distension and urethral catheter to prevent bladder distension

Post Operative Care

o   Place the patient in fowlers position as soon as he/she recovers from anesthesia

o   Administer the prescribed opiate analgesics 4 hourly

o   Start oral fluids as soon as peristalsis return. Foods may be given within 48 hours

o   The patient may be discharged after 48 hours and stitches removed on the 7^th day

Complictions Following Surgery

·         Peritonitis

·         Pelvic abscess

·         Subphrenic abscess

·         Paralytic ileus