Ns.

HELENA PRYADINA, SKep

 Appendicitis, the inflamation of the

vermiform appendix, is a common cause of
acut abdominal pain and the most common
reason for emergency abdominal surgery in
the United States.
The appendix is a tubelike pouch attached to
the cecum just below the ileocecal valve. It is
usually located in the right iliac region, at an
area designated as McBurneys point. The
function of the appendix is not fully
understood, although it regularly fills and
empties with digested food.

 Appendicitis can occur at any age,

with the incidence rate at 1 to 2 per
1000. It is more common in
adolescents and young adults and
slightly more common in males than
females
(Thompson, Mc Farland,
& Hirsch,1993).
Approximately 200.000
appendectomies for acut appendicitis
are performed every year in the
United States (Way, 1994)

Pathophysiology
Appendicitis can be classified as simple,
gangrenous , or perforated, depending on
the stage of the process. In simple
appendicitis, the appendix is inflamed but
intact. When areas of tissue/necrosis and
microscopic perforations are present in the
appendix , the disorder is called
gangrenous appendicitis. With a perforated
appendix , there is evidence of gross
perforation of the appendix and
contamination of the peritoneal cavity.

Pathophysiology
Obstruction of the proximal lumen of the
appendix is apparent in approximately
two-hirds of acutely inflamed appendices
( Way, 1994 ). The obstruction is
often caused by a fecalith, or hard mass of
feces. Other obstructive causes include a
calculus or stone , a foreign body,
inflammations, a tumor, parasites or
edema of lymphoid tissue.

Pathophysiology
Following obstruction , the appendix becomes
distended with fluid secreted by its mucosa.
Pressure within the lumen of the appendix
increases, impairing its blood supply and leading
to inflammation, edema, ulceration, and infection.
Purulent exudates forms, further distending the
appendix. Within 24 to 36 hours, tissue necrosis
and gangrene results, leading to perforation if
treatment is not initited. Perforation results in
bacterial peritonitis, which may remain localized.

Pathophysiology
Upper abdominal pain is the initial
characteristic symptom of acute
appendicitis. Over the next 4 hours, the
pain intensifies and localizes in the right
lower quadrant of the abdomen. It is
aggravated by moving, walking , or
coughing. Extension or internal rotation
of the right hip increases the pain. In
addition to pain, the client typically
presents with low grade temperature,
anoxia, anorexia, nausea, and vomiting.

Pathophysiology
Perforation, peritonitis , abscess, and
pylephlebitits are possible complications of
acute appendicitis. Perforation is
manifested by increased pain and high
fever. It can result in a small, localized
abscees, local peritonitis, or significant
generalized peritonitis. Pylephlebitis is
inflammation of the portal venous system
with pus formation. Other conditions, such
as Chrons disease often cause symptoms
attributed to chronic appendicitis.

Collaborative care
Because the acutely inflamed appendix
can perforate within 24 hours, it is
important to establish the diagnosis
rapidly and initiate treatment. Because of
this urgency and because the low
incidence of morbidity associated with
surgical intervention , laboratory and
diagnostic testing and preoperative
treatment are limited. Once the diagnosis
is established, an appendectomy is
performed.

Laboratory and Diagnostic Tests

The following laboratory tests may be
ordered :
WBC count is measured to indicate the
presence of infection. With appendicitis,
the total white count is elevated
( 10.000/mm3 to 20.000/mm3 ).
Urinalysis is performed to determine
whether the urine contains erythrocytes
or leucocytes

Laboratory and Diagnostic Tests

The following diagnostic studies may be ordered :
Abdominal X-ray films are taken with the client in
the flat and upright position. A fecalith or calculus
may be noted in the right lower quadrant, or
localized ileus may be demonstrated.
Abdominal ultrasound is the most effective test
for establishing the diagnosis of acute
appendicitis. In this noninvasive test, highfrequency sound waves are reflected back to
Doppler by tissue of varying densities to create a
computer-generate image.

Surgery
The treatment of choice for acute
appendicitis is an appendectomy, surgical
removal of the appendix. An exploratory
laparotomy, surgical opening the abdomen
to allow direct examination of the organ,
may be performed even of the diagnosis
cannot be confirmed to rule out
appendicitis.

Surgery
In such cases, the appendix is usually
removed, even if it is not inflamed, to
avoid future risk of appendicitis. A
laparotomy may also be used to perform
an open appendectomy. A small transverse
incision is made of McBurneys point; the
appendix is isolated and ligated (tied off)
to prevent contamination of the side with
bowel contents, and then removed.
Recovery is generally uneventful.

Nursing Care
The client should not receive laxatives or
enemas, because is the procedure may
cause perforation of the appendix. No heat
should be applied to the abdomen; this
may increase circulation to the appendix
and also cause perforation. The nursing
diagnoses for the client with appendicitis
include Altered Tissue perfusion and Pain.

Nursing Care
In planning and implementing nursing care
of the client of appendicitis, the nurse
should consider the clients response to
emergency surgery. On admission, the
client will be experiencing abdominal pain,
and the nurse may have limited time for
preoperative teaching before the client is
taken to surgery.

Altered Tissue Perfusion :

Gastrointestinal
Nursing interventions :
Monitor for perforation and peritonitis
preoperatively.
Preoperatively and postoperatively, monitor the
clients vital sign, including blood pressure, pulse
rate, and rhythm, respiratory rate and
temperature.
Maintain intravenous fluid replacement
preoperatively and until client is able to drink
adequate amounts postoperatively.
Assess the clients wound, abdominal girth, and
pain status operatively.

Pain
Nursing interventions :
Assess the clients pain including its
characters locations, severity and
duration.
Administer prescribed pain medication.
Assess effectiveness of medication a half
hour after administration.
Provide alternative methods of pain relief,
including distraction, therapeutic touch,
massage, meditation .

Other Nursing Diagnosis

Fear related unknown diagnosis and
possibility of surgery.
Risk for infection related to
disruption of bowel integrity.
Impaired skin integrity relate to the
presents of abdominal incision.