Question

Appendicitis

Pathophysiology

Clinical Manifestations

Assessment and Diagnostic Findings

Complications

Gerontologic Considerations

Medical Management

Nursing Management

Answer 1

APPENDICITIS:

Appendicitis it is the information of appendix usually associated with infection of the appendix. It often causes fever loss of appetite and pain. Appendicitis may be suspected because of the medical history and physical examination. The pianist appendicitis can be located in various area of the belly.

PATHOPHYSIOLOGY OF APPENDICITIS:

Appendicitis is usually caused by blockage of the lumen of the appendix. Obstruction causes the mucus produced by workers appendix suffered Dam. The longer the mucus is more and more, but the elastic wall of the appendix has limitations that lead to increased intraluminal pressure. This These pressures sirf in period the floor length result in mucosal edema and ulceration. At that time there was Mark focal acute appendicitis with epigastric pain. At that time there was marked focal acute appendicitis with epigastric pain

When mucus secretion continuous the pressure will continue to increase. This will cause Venus obstruction, increased edema and bacteria will penetrate the walls so that inflammation of the peritoneum arising widespread and can cause pain in the lower right abdomen is called acute suppurative appendicitis.

If the floor is distributed atrial wall infarction will occur followed by gangrene appendix. This stage is called appendicitis gangrenosa. Is the appendix fragile, there will be a perforation called perforated appendicitis.

When the process is from the momentum and adjacent ball will move towards the appendix to appear appendicular is infiltrates.

In children because it shorten the omentum and appendix is longer thinner walls. The situation is coupled with the immune system that is still less easy to occur perforation wherewhere as in elderly prone to occur because there is blood vessel disorder.

CLINICAL MANIFESTATIONS:

Signs and symptoms of appendicitis:

PAIN epigastric artery amplifier pain progress to recover quadrant pain and usually accompanied by low grade fever nausea and sometimes vomiting.

TENDERNESS in 50% of presenting cases local tenderness is atMcBurneyspoint when pressure is applied.

REBOUND TENDERNESS rebound tenderness or the production or intensification of pain and pleasure is released.

ROVSING SIGN it may be allocated by palpating the left lower quadrant.

COMPLICATIONS

*Perforation of the appendix, this is major complication of appendicitis which can lead to peritonitis abscess formation.

*Perforation generally occur 24 hours after the onset of pain.

*Symptoms include a fever of 37.7 degrees centigrade or greater toxic appearance and continued abdominal pain or tenderness.

ASSESSMENT AND DIAGNOSTIC FINDINGS

Diagnosis is based on the results of complete physical examination and on Laboratory findings and imaging studies: * CBC count there is an increase in WBC count with

elevation of the neutrophils

*Imaging studies- abdominal x-ray film ultrasound studies and CT Scan may reveal this condition.

*Pregnency test-a pregnancy test can be performed for women of childbearing age rule out ectopic pregnancy and before X-rays are obtained.

*Laparoscopy

* C-Reactive protein.

MEDICAL MANAGEMENT

Medical management should be performed carefully to avoid alterating the presenting symptoms.

*IV FLUIDS to correct the fluid and electrolyte imbalance and dehydration IV Fluids are administered prior to surgery.

ANTIBIOTIC THERAPY-to prevent sepsis antibiotics are administrated until surgery is performed

*DRAINAGE-when perforation of the appendix occur and access my form and patient is initially treated with antibiotics and the surgeon may place drain in the he abscess.

NURSING MANAGEMENT.

Nursing assessment

Assessment of a patient with appendicitis maybe both objective and subjective

*Assess The level of pain

*Assess relevant laboratory findings

*Access patient vital sign in preparation for surgery

NURSING IINTERVEINTION

Preoperative interventions

*Maintain NPO status

*Administer Fluids intravenously to prevent dehydration

*Monitor for changes in the level of pain

*Monitors for science of ruptured appendix and peritonitis.

*Position right side lying or low to semi fowler's position to promote comfort.

*Monitor bowel sounds

*Apply ice packs to abdomen every hour for 20 to 30 minutes as prescribed.

*Administer antibiotics as prescribed

*Avoid the application of heat in the abdomen.

Post-operative interventions

*Monitor temperature for signs and symptom of infection.

*Assess for signs of infection such as redness swelling and pain

*Advanced diet gradually or as tolerated when bowel sound return

*Is ruptured of appendix occurred expect a penros drain to be inserted.

*Expect that drain from the penros drain maybe profuse for the first 2 hours.