Nursing Diagnosis, Care Plan, and Interventions for Appendicitis-A Student’s Guide
What is Appendicitis
Appendicitis is inflammation of the appendix, a portion of the large intestine that connects to the small intestine and is attached to the beginning of the large intestine.
Appendicitis causes abdominal pain in children and adolescents, which can be sudden and severe or may come on slowly over several days. It is so acute in children because they have not had any experience with abdominal pain; therefore, they do not know how to describe what kind of pain it is.
The patient will feel better after vomiting but then return with more moderate-severe pain along with nausea and anorexia (loss of appetite).
In adults, appendicitis usually develops gradually over several hours or days, with symptoms similar to those seen in children. In some cases, the patient may experience right lower abdominal pain radiating up to the back between the shoulder blades. Symptoms in adults are not always that painful, and it is often difficult to know whether the problem is appendicitis. In this article, we’ll learn about the signs and symptoms, causes, nursing diagnosis, nursing care plan and interventions, and prevention measures for appendicitis. As you read, keep in my mind that our premium writers are ready to help with that nursing assignment. All you need to do is to place an order with us.
Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
Signs and Symptoms of Appendicitis
Signs and symptoms of appendicitis include:
- A sudden onset, severe pain in the lower right abdomen that eventually spreads to both hips and the area around your navel. This pain is worse when you cough, sneeze or move around (aggravating) and gets better (or at least lessens) when you lie down.
- Loss of appetite, nausea, and vomiting. In the case of appendicitis, these symptoms may come and go.
- A feeling of fullness in the abdomen that is worsened when you move (the pain).
- It can become hard to go to the bathroom as your colon becomes filled up from the build-up of bacteria in your bowels. This usually happens after several days of symptoms.
- Pain that spreads to your back over time making it hard to sleep, especially on an empty stomach.
- When the illness is not treated properly may lead to possible developing loss of blood supply in your intestines, resulting in gangrene. In some instances, if untreated, appendicitis can paralyze its surrounding muscles resulting in life-long disability. If it is not treated, the infection can spread to your bloodstream [which may result in bacteremia(bacteria present in your bloodstream)]
- There may be nausea and vomiting after 24-48 hours of experiencing these symptoms (appendicitis). A fever starts at 101 degrees Fahrenheit, which may go as high as 104 or higher after several days have passed.
- A person with this condition feels weak and easily exhausted.
Causes of Appendicitis
Several causes can be attributed to appendicitis. Some of these include:
- Traumatic causes due to a blow to the abdomen.
- Fecal material in the appendix increases pressure with increased inflammation of the lining of the appendiceal wall causing it to burst, resulting in a perforation.
- Irritation from ingrown hair or a similar foreign body may cause infection and inflammation.
- Tumor may also be a cause of appendicitis, but this is rare.
- Infection in the bowel or from an ingrown hair, appendix cancer (rare)
- Eating disorders like bulimia and anorexia can also cause this condition.
- Drinking alcohol may also play a role. Alcoholic cirrhosis of the liver and chronic pancreatitis are common causes of appendicitis because of toxic substances like acetaldehyde in the large intestine.
- The condition may develop in children when tubes are inserted into their intestinal tract to drain fluid or waste products build-up. Appendicitis can also occur after surgery.
- A ruptured appendix is also a common cause.
Nursing Diagnosis for Appendicitis
Imaging
Imaging tests play an important role in providing clear pictures of the appendix to help determine if appendicitis is present. Some of these tests may include:
- Upper GI series X-rays, CT scans, MRI (magnetic resonance imaging), or ultrasound, but none are 100% sensitive and specific for detecting appendicitis. This is why surgeons recommend imaging tests to rule out the infection rather than confirm it.
Physical examination
During a physical evaluation, the doctor will first examine the patient’s abdomen by touching, feeling, and pressing on different parts of it. The doctor will then ask the patient certain questions, such as when he last had a bowel movement or ate food. A physical exam may also include listening to the heartbeat, testing reflexes in addition to checking for signs of jaundice (yellowing of eyes).
Medical history
Getting a complete medical history of the patient is also important in establishing whether he has had similar problems before or not.
There are two ways of getting information about the previous health of patients they can either ask the patient directly or gather information from medical records.
The medical record forms an important part of gathering information during assessment because it contains all diagnostic tests that have been done on the patient previously. This includes x-rays, scans, laboratory findings, and other diagnostic aids.
Asking the patient directly about his previous health is also a good way of getting information. It gives the physician insight into how cooperative and reliable the patient may be.
Urinalysis
A urine test is also a powerful diagnostic tool in establishing whether the patient has appendicitis or not. Testing is done to rule out symptoms of urinary tract infection which can be confused with appendicitis, especially in children and women. Urinalysis is an analysis of the urine to detect properties such as glucose, proteins, ketones, and white blood cells. The test may also show other abnormalities like bacteria or red blood cells in the urine if present from infections unrelated to appendicitis.
The results usually take 1-2 days for completion.
Blood test
Blood tests are also done during the assessment of a patient with appendicitis. Although blood tests cannot conclusively confirm or rule out appendicitis, they can help determine if an infection is present and in what organs it may affect. The doctor may use certain screening tests such as:
Complete Blood Count (CBC) determines the white and red blood cells, platelets, and hemoglobin levels.
Sedimentation rate (ESR) tells the doctor about inflammation in different parts of the body, including the heart, lungs, joints, digestive tract, and kidneys.
Nursing Care Plan and Interventions for Appendicitis
Preparation of the patient
Before administering any anesthesia:
- Tell the patient about what will be done.
- Ensure that he is comfortable.
- Properly inform him about all the known risks attached to the procedure.
Before undergoing an appendectomy or colectomy (removing appendix), ask patients if they have had any previous surgeries; this can affect postoperative recovery time. During a preoperative meeting with the surgeon, discuss the type of surgery and how it will be done in detail.
The patient should also understand any changes in daily routines required after discharge, such as medicines, diet limits, activities no longer allowed, etc. The surgeon would also request your recommendation regarding which pain relief technique best suits a particular person’s needs. This requires you to have a thorough knowledge of pain relief techniques (analgesic) available and the appropriate one for your patient.
Patient teaching is also an important part of your nursing responsibilities. The patient should be able to understand why certain medications are given, how they work, and what side effects they may cause. Special attention should be used in educating new mothers on breastfeeding during the postoperative period.
Preparation of child patients by applying topical anesthesia cream around their navels at least 20 minutes before surgery, so it is completely absorbed by the skin. The nurse should explain to the parents not to rub any cream off as this might irritate the area by increasing its temperature high enough that it causes a burning sensation (Mention the complications).
Postoperative period
The duration of a surgical procedure depends on the type of surgery that has been performed, level of expertise, anesthetic used, and age of the patient. The healing time after appendix surgery is usually 3-5 days.
The common types of pain relief used in this care plan are: Painkillers such as paracetamol [acetaminophen], NSAIDs [nonsteroidal anti-inflammatory drugs], opiates or local anesthetics, along with oral antibiotics can be given to help relieve pain right after the anesthesia wears off until patient’s recovering well enough to switch from oral medication to decrease the risk of vomiting or nausea.
Encourage patients who have undergone surgery for appendicitis to perform range-of-motion exercises. This can help reduce joint stiffness and prevent blood clots from forming in the legs, leading to a condition called deep vein thrombosis (DVT).
Administering pain medication for cancer patients, such as opioids, helps relieve pain, but it also has various unwanted side effects, including drowsiness, nausea, confusion, or constipation. Regular monitoring of a patient’s response to pain medication is very important because these medications are highly addictive if taken over long periods.
Patients who receive surgery for appendicitis lose one litre of blood during that procedure and after that may require a blood transfusion if there isn’t enough hemoglobin in their body. Managing a patient’s blood level is one of your important tasks during postoperative care.
You may also check other examples of care plans/interventions for common conditions, such as Asthma
How is appendicitis treated?
After identifying appendicitis, the patient is admitted to the operating room or prepared in the pre-registration area. Before administering anesthesia, a spinal anesthetic will be given for high surgery abdomen until level T12 so that after removal of the appendix, it won’t cause pain and discomfort. The patient will be asked to lie on a trolley or surgical bed, then wheeled into the surgery area.
Performing Appendectomy
Appendectomy ( appendix removal) surgery procedure consists of making a small incision in the skin above the belly button and cutting out the diseased appendix using surgical scissors, scalpel, or electrocautery (burning). The surgeon would then remove two inches of adjacent healthy tissue to prevent the spreading of infection from the abnormal appendix.
Types of appendectomy include open surgery and laparoscopic surgery.
Open surgery
During open surgery, the abdominal cavity is opened. The diseased appendix is removed after cutting the abdominal wall using surgical scissors or a scalpel while closing the wound to prevent bodily fluids from leaking (after removing the appendix). After the procedure, the patient would be treated with IV antibiotics for a few days to reduce the chances of infection and given pain relief medication like opiates or NSAIDs.
Laparoscopic surgery
Laparoscopic appendectomy involves a small incision that leads into a narrow tube called a trocar inserted into the abdomen through the endoscope. The latter is a thin tube-like instrument that contains light at one end, which illuminates the inside body to be viewed under magnification on a TV monitor. During the surgery, the patient will be put on general anesthesia, and the other end of that tube (endoscope) will be used to view inside the body cavity.
The laparoscopic technique is recommended for patients with early-stage appendicitis because it involves lesser time in recovery, cut hospital stay, prevents hernia formation than open surgery, and reduces the chance of getting infections or adhesions due to limited invasion of the abdominal wall. But this method is usually more expensive than open surgery.
Risks of Appendectomy
Despite appendectomy being a simple procedure, risk factors can make the surgery riskier or more difficult. Some of the risks of appendectomy include:
– the risk of surgical site infection
– the risk of bleeding due to disruption of blood vessels during surgery
– the risk of injury to nearby organs such as the bladder, intestine, or colon.
Use of Antibiotics
Antibiotics are also used to treat infection in persons with a ruptured appendix. However, their role is not clearly defined, and they are not widely used.
The following antibiotics have been tried for cases of appendicitis that do not respond to initial treatment: gentamicin, ciprofloxacin, metronidazole, chloramphenicol, and clindamycin. But their use has been limited because they often cannot be given at full dosage, as tolerance tends to decrease in cases of appendicitis compared with other forms of abdominal infections (such as intestinal or urinary tract infections).
As mentioned above, antibiotics are not widely used in the treatment of appendicitis. But suppose it becomes clear that the appendix is damaged or ruptured and that an infection has ensued (for example, because a person with an appendix abscess suddenly develops a fever). In that case, antibiotic therapy should be given to prevent septicemia.
In most cases, antiseptics are administered as suppositories for 3-4 days (or until drainage occurs) after surgery. The use of antibiotics in this way helps to prevent infections during healing.
We also recommend that you check the treatments for other common conditions/diseases such as Preeclampsia
Prevention of Future Cases of Appendix Inflammation or Infection (including diet):
Once the appendix is removed, measures must be taken to prevent the recurrence of the inflammation or infection.
It has been found that a low-fibre diet predisposes a person to appendicitis. This can be prevented by eating foods high in fats and proteins – such as eggs, meat, and fish. Foods high in carbohydrates should be avoided since they are digested slowly and can cause peristaltic movement of the colon, which presses against the appendix. This leads to inflammation of the organ and, in some cases, perforation.
There is usually no need to restrict physical activity after surgery. Most people who have had acute appendicitis should avoid straining their abdominal muscles for six weeks after surgery.
Pain in the abdominal area should also be reported to a doctor. While exercising after surgery, it is important to keep in mind that running or jumping can perforate the appendix.
Most cases of appendicitis occur between the ages of 10 and 30. At this age, people are usually more active physically as they play various sports and involve themselves in jobs that involve lifting, straining, or repetitive movements.
In a study in Canada, it was found that peritonitis (inflammation of the peritoneum) may be related to the perforation of the appendix. This is because peritonitis usually occurs when an appendicolith has moved through the appendix lumen into the peritoneal cavity.
Lastly, to enable you to position yourself as a leader in your nursing career, check our guide on leadership styles in nursing. You can also expand your knowledge in nursing philosophy by checking nursing metaparadigms.
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