Appendicitis Overview and Diagnosis

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Questions and Answers

What is the most common cause of appendicitis?

Genetic predisposition

Obstruction of the lumen (correct)

Viral infection

Excessive growth of lymphoid tissue

Which age group has higher morbidity and mortality rates related to appendicitis?

Young adults

Middle-aged adults

Children under 10

Patients over 70 (correct)

What symptom is typically observed in a patient with appendicitis?

Chest pain during exercise

Persistent right lower quadrant pain (correct)

Sudden headache

Localized joint pain

Which diagnostic tool is not typically used for appendicitis diagnosis?

X-ray of the abdomen (A) Signup and view all the answers

What initial management step is crucial for a patient suspected of having appendicitis?

Keeping the patient NPO (B) Signup and view all the answers

What is a potential complication of delayed treatment for appendicitis?

Abscess formation (A) Signup and view all the answers

What sign is associated with appendix irritation during physical examination?

Rovsing’s sign (A) Signup and view all the answers

What is the primary treatment method for appendicitis?

Immediate surgical removal (C) Signup and view all the answers

Which type of peritonitis is indicated when there is a direct infection from blood or genital tract organisms?

Primary peritonitis (D) Signup and view all the answers

What is one of the universal signs indicating abdominal involvement in peritonitis?

Tenderness over the involved area (D) Signup and view all the answers

Which of the following can be a secondary cause of peritonitis?

Blunt trauma to the abdomen (B) Signup and view all the answers

Which symptom is associated with hypovolemic shock as a complication of peritonitis?

Tachycardia (A) Signup and view all the answers

What diagnostic study can help visualize dilated loops of bowel in a suspected case of peritonitis?

X-ray of the abdomen (B) Signup and view all the answers

What is a primary goal of collaborative care in managing peritonitis?

Finding the source of inflammation (C) Signup and view all the answers

Which nursing assessment is important in evaluating the presence of peritonitis?

Evaluating bowel sounds (A) Signup and view all the answers

What nursing diagnosis relates to the inflammation of the peritoneum and abdominal distention?

Acute pain (C) Signup and view all the answers

What complication should be particularly monitored for in a patient with peritonitis?

Hypovolemic shock (D) Signup and view all the answers

What nursing intervention is important for managing nausea and vomiting in a patient with peritonitis?

Providing antiemetics (C) Signup and view all the answers

Which sign is associated with appendicitis when palpation of the left lower quadrant elicits pain in the right lower quadrant?

Rovsing sign (B) Signup and view all the answers

What is a key nursing goal for a patient diagnosed with peritonitis?

Resolution of inflammation (C) Signup and view all the answers

Where is rebound tenderness generally assessed in a patient with acute appendicitis?

Right lower quadrant (A) Signup and view all the answers

What is a common symptom of nutritional imbalance in a patient with peritonitis?

Nausea and vomiting (C) Signup and view all the answers

Which of the following positions is recommended to enhance comfort for a patient with abdominal pain?

Knees flexed position (C) Signup and view all the answers

What indicates a need for possible NG tube insertion in a patient with peritonitis?

Abdominal distention (A) Signup and view all the answers

Study Notes

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)

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Description

This quiz covers the essential aspects of appendicitis, including its etiology, clinical manifestations, and diagnostic studies. Learn about the common causes and symptoms, as well as how this condition is identified and treated. Engage with key questions to test your understanding of this important health topic.