Appendicitis Overview and Diagnosis

Appendicitis

• Inflammation of the appendix
• Most common in young adults
• Morbidity and mortality rates higher in patients over 70

Etiology & Pathophysiology

• Most frequent cause of appendicitis is obstruction of the lumen:
  • Fecalith (accumulated feces)
  • Foreign bodies
  • Tumor of the cecum or appendix
  • Excessive lymphoid tissue growth
• Obstruction often leads to:
  • Distention
  • Venous engorgement
  • Gangrene and perforation

Clinical Manifestations

• Periumbilical pain, right lower quadrant at McBurney's point
• Persistent and continuous pain
• Anorexia
• Nausea and vomiting
• Localized or rebound tenderness
• Muscle guarding
• Pain upon sneezing, coughing, or deep inhalation
• Rovsing's sign
• Possible fever

Diagnostic Studies

• History and physical examination (palpation)
• Elevated white blood cell (WBC) count
• Differential WBC count
• Urinalysis
• Rule out genitourinary conditions
• CT scan
• Ultrasound

Complications & Treatment

• Delayed diagnosis and treatment can result in complications:
  • Ruptured appendix
  • Peritonitis
  • Abscess
  • Sepsis and dehydration
• Treatment involves immediate surgical removal (appendectomy)
• Antibiotics and intravenous fluids are given 6–8 hours before appendectomy to prevent sepsis and dehydration

Nursing Management

• Keep the patient NPO until evaluated by a healthcare provider
• Antibiotics and fluid resuscitation before surgery
• Ice the area (do not apply heat; it may cause rupture)
• Enemas and laxatives are contraindicated; increased peristalsis may cause appendix perforation

Postoperative Care

• Patient receives a laparotomy
• Observe for peritonitis
• Ambulation begins on or soon after the day of surgery
• Advance diet as tolerated
• Discharge 1–2 days postoperatively
• Normal activities resume in 2–3 weeks

Peritonitis

• Inflammation of the peritoneum
• Occurs when intestinal contents or bacteria irritate the normally sterile peritoneum
• Initially chemical peritonitis, followed by bacterial peritonitis
• Inflammatory response leads to fluid shifts (peritoneal edema) and adhesions as the body attempts to wall off the infection

Etiology & Pathophysiology (Peritonitis)

• Primary causes:
  • Blood-borne organisms
  • Genital tract organisms
  • Cirrhosis with ascites
• Secondary causes:
  • Appendicitis with rupture
  • Diverticulitis with rupture
  • Blunt/penetrating abdominal trauma
  • Ischemic bowel disorders
  • Pancreatitis
  • Perforated intestine (e.g., peptic ulcer)
  • Postoperative complications (e.g., anastomosis breakage)

Clinical Manifestations (Peritonitis)

• Abdominal pain (tenderness over involved area)
• Rebound tenderness
• Muscular rigidity and spasms
• Shallow breathing and lack of movement
• Abdominal distention or ascites
• Fever
• Tachycardia
• Tachypnea
• Nausea and vomiting
• Altered bowel habits

Complications (Peritonitis)

• Hypovolemic shock
• Sepsis
• Intra-abdominal abscess formation
• Paralytic ileus
• Acute respiratory distress
• Peritonitis may become fatal if treatment is delayed

Diagnostic Studies (Peritonitis)

• CBC (elevated WBCs)
• Hemoconcentration (cell and solid concentration)
• Analyze fluid in peritoneal cavity via peritoneal aspiration
• X-ray of abdomen (dilated bowel loops, free air, or air and fluid levels)
• Ultrasound
• CT scan
• Peritoneoscopy (direct examination with biopsy)

Collaborative Care (Peritonitis)

• Surgery to locate the cause of inflammation and drain purulent fluid
• Repair any damage
• Antibiotics
• Nasogastric (NG) suction
• Analgesics
• Intravenous (IV) fluid administration

Nursing Assessment (Peritonitis)

• Patient's pain (location, level, duration)
• Bowel sounds
• Presence and quality of abdominal guarding
• Appearance of the abdomen
• Nausea
• Fever
• Manifestations of hypovolemic shock

Nursing Diagnoses (Peritonitis)

• Acute pain related to inflammation of the peritoneum and abdominal distention
• Risk for deficient fluid volume related to fluid shifts into the peritoneal cavity from trauma, infection, or ischemia
• Imbalanced nutrition: less than body requirements related to anorexia, nausea, and vomiting
• Anxiety related to uncertainty about the cause, outcome, and pain associated with the condition

Planning (Peritonitis)

• Nursing goals:
  • Resolution of inflammation
  • Relief of abdominal pain
  • Freedom from complications (especially hypovolemic shock)
  • Normal nutritional status

Nursing Implementation (Peritonitis)

• IV line inserted for fluid replacement and access for antibiotics administration
• Monitor patient for pain and analgesic response
• Position patient with knees flexed for comfort
• Antiemetics to decrease nausea and vomiting, and correct fluid and electrolyte imbalance
• NPO (nothing by mouth) and possible NG tube insertion to decrease gastric distention and further leakage of contents
• Post-surgical patient will need drains to remove purulent drainage

NCLEX Questions and Answers:

(Question(s) and associated solution (s) related to acute appendicitis and peritonitis)

• Note: Specific questions and answers for different conditions are required for complete comprehension. Please provide the questions.