Appendicitis and Peritonitis Presentation PDF

APPENDICITIS Dr. Sibi Peter,PhD,RN,CCRN  APPENDICITIS Inflammation of the appendix Most common in young adults Morbidity and mortality rates are higher in patients over 70  Etiology & Pathophysiology Most common cause of appendicitis is obstruction of lumen by: Fecal...

APPENDICITIS Dr. Sibi Peter,PhD,RN,CCRN  APPENDICITIS Inflammation of the appendix Most common in young adults Morbidity and mortality rates are higher in patients over 70  Etiology & Pathophysiology Most common cause of appendicitis is obstruction of lumen by: Fecalith (accumulated feces) Foreign bodies Tumor of the cecum or appendix Excessive growth of lymphoid tissue Obstruction often results in Distention Venous engorgement Gangrene & perforation Clinical Manifestations Periumbilical pain  right lower quadrant at McBurney’s point Pain is persistent and continuous Anorexia Nausea & vomiting Localized or rebound tenderness Muscle guarding Pain upon sneezing, coughing or deep inhalation Rovsing’s sign Possible fever  Diagnostic Studies History & Physical Examination (palpation) Differential WBC count WBCs elevated Urinalysis Rule out genitourinary conditions CT scan Ultrasound Complications & Treatment If diagnosis and treatment are delayed, complications may occur. Ruptured appendix Peritonitis Antibiotic therapy Parenteral fluids Given 6-8 hours before the appendectomy to prevent sepsis and dehydration. Abscess The treatment of appendicitis is immediate surgical removal (appendectomy)  Nursing Management Keep the patient NPO until the patient can be seen by a health care provider. Antibiotics and fluid resuscitation before surgery Ice the area Do not heat! May cause rupture Enemas and laxatives are not the solution! Increased peristalsis may cause perforation of appendix  Postoperative Care Patient will receive a laparotomy Observe for signs of peritonitis Ambulation begins as early as the day of surgery or the first postoperative day Advance diet as tolerated Short recovery Discharge 1-2 days postoperative Normal activities resumed in 2-3 weeks Peritonitis Dr. Sibi Peter,PhD,RN,CCRN  Etiology & Pathophysiology Peritonitis is the inflammation of the peritoneum Occurs when intestinal contents and/or bacteria irritate the normally sterile peritoneum. Initially chemical peritonitis followed by bacterial peritonitis Inflammatory response results in massive fluid shifts (peritoneal edema) and adhesions as the body attempts to wall off the infection  Etiology & Pathophysiology There are primary & secondary causes Primary Secondary Blood borne organisms Appendicitis with rupture Genital tract organisms Diverticulosis with rupture Cirrhosis with ascites Blunt/penetrating trauma to abdominal organs Ischemic bowel disorders Pancreatitis Perforated intestine, peptic ulcer Postoperative complications (breakage of anastomosis)  Clinical Manifestations Abdominal Pain Tenderness over the involved area (universal sign) Rebound tenderness Muscular rigidity and spasms Shallow breaths and lack of movement Abdominal distention or ascites Fever Tachycardia Tachypnea Nausea & vomiting Altered bowel habits  Complications Hypovolemic shock Sepsis Intraabdominal abscess formation Paralytic ileus Acute respiratory distress If treatment is delayed, Peritonitis may become fatal  Diagnostic Studies CBC elevated WBCs ?? Hemoconcentration (concentration of cells & solids) Analyze fluid in peritoneal cavity via peritoneal aspiration Bile, pus, bacteria, fungus and amylase X-ray of abdomen Dilated loops of bowel, free air, or air and fluid levels Ultrasound CT scan Peritoneoscopy Direct examination with biopsy  Collaborative Care Surgery Locate cause of inflammation Drain purulent fluid Repair damage Antibiotics NG suction Analgesics IV fluid administration  Nursing Assessment Patient’s pain Location, level, length of time Bowel sounds Presence and quality Appearance of abdomen Abdominal guarding Nausea Fever Manifestations of hypovolemic shock  Nursing Diagnosis Acute pain related to inflammation of the peritoneum & abdominal distention. Risk for deficient fluid volume related to fluid shifts into the peritoneal cavity secondary to trauma, infection, or ischemia Imbalanced nutrition: less the body requirements related to anorexia, nausea and vomiting Anxiety related to uncertainty of cause of outcome of condition and pain  Planning The nursing goals for a patient with peritonitis Resolution of inflammation Relief of abdominal pain Freedom from complications (especially hypovolemic shock) Normal nutritional status  Nursing Implementation IV line inserted Fluid replacement Access for antibiotics administration Monitor patient for pain & analgesic response Position patient with knees flexed to increase comfort I&O Antiemetics Decrease nausea, vomiting and resulting fluid & electrolyte loss NPO & possible NG tube insertion Decrease gastric distention and further leakage of contents Post surgical patient will need drains inserted in  NCLEX QUESTION! "The nurse is caring for a patient in the emergency department with complaints of acute abdominal pain, nausea, and vomiting. When the nurse palpates the patient's left lower abdominal quadrant, the patient complains of pain in the right lower quadrant. The nurse will document this as which of the following diagnostic signs of appendicitis? 1. Rovsing sign 2. referred pain 3. Chvostek's sign 4. rebound tenderness  Answer 1) Rovsing Sign In patients with suspected appendicitis, Rovsing sign may be elicited by palpation of the left lower quadrant, causing pain to be felt in the right lower quadrant.  NCLEX QUESTION! A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location? 1. Left lower quadrant 2. Left upper quadrant 3. Right upper quadrant 4. Right lower quadrant  Answer Correct answer: 4. Right lower quadrant Rationale: The pain of acute appendicitis localizes in the right lower quadrant (RLQ) at McBurney's point, an area midway between the umbilicus and the right iliac crest. Often, the pain is worse when manual pressure near the region is suddenly released, a condition called rebound tenderness.  NCLEX QUESTION! A male client had abdominal surgery and the nurse suspects he has peritonitis. Which assessment data support the diagnosis of peritonitis? 1. Absent bowel sounds & potassium level of 3.9 mEq/L 2. Abdominal cramping & hemoglobin of 14 g/dL 3. Profuse diarrhea & stool specimen shows Campylobacter. 4. Hard, rigid abdomen & white blood cell count 22,000/mm^3  Answer 4. A hard, rigid abdomen indicates an inflamed peritoneum (abdominal wall cavity) resulting from an infection, which results in an elevated WBC level. 1. absent bowel sounds indicate paralytic ileus, not peritonitis. K level is normal) 2. abdominal cramping is not peritonitis. hgb is normal 3. this bug does cause acute diarrhea - not peritonitis