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Pre-op diagnoses: - Altered Comfort: Acute Pain r/t obstruction on the lumen of the inflammed appendix secondary to appendicitis - Anxiety r/t impending surgery - Risk for fluid volume deficit r/t oral restriction and vomiting

Risk Factors: - Fecalith formation -kinking of the appendix -swelling of the bowel wall -external occlusion of bowel by adhesion

Pre-op Nursing Interventions -relieve anxiety and offer emotional support - provide knowledge and clarify patient's doubts about the procedure and condition - relieve pain through relaxation techniques and othe non-pharmacologic techniques - address body image issues before surgery - offer spiritual support - start IVF as ordered -insert FBC and monitor urine output - give anitbiotic therapies as ordered - put on CBR status - NPO - do skin preparation of the abdomen - make sure informed consent is obtained - transport patient to the Operating Room shifting of fluids

-RLQ abdominal pain -rebound tenderness - rise in Temp= >37.5 0C - nausea and vomiting - rigidity of the lower portion of t right rectus muscle

Obstruction on the lumen of the appendix

increase accumulation of mucus

increase intraluminal pressure

decrease blood flow / supply

Diagnostic Period Nursing Interventio - make patient comfortable and relieve an - relieve pain through relaxation technique non-pharmacologic techniques - address body image issues before surger - offer spiritual support - start IVF as ordered - NPO ! do not give laxatives ! withhold Analgesics ! Do not apply hot compress on abdom

venous congestion Thrombosis of the luminal blood vessels

ulceration of lume

edema ischemia Diagnostic Exams: 1. CBC= increase in WBC and Neutrophils ---infection 2. Urinalysis 3. X-ray/ CT scan of abdomen : imflammed appendix 4. Peritoneal Lavage: * increase in amylase level * presence of bacteria * presence of bile and fecal material * RBC= > 100, 000

purulent exudates form

tissue necrosis

further distention of the appendix

perforation/ rupture of the appendix

gangrene

gangrene

appendix

POST-OP Nursing Interventions For unruptured Appendicitis 1. Assess for: - Bowel sounds - bowel movement - passing of flatus - nausea - boardlike abdominal rigidity - vital signs (Temperature) - incision site 2. Give pain medications as ordered 3. Offer clear fluids in the morning after surgery 4. remove IVF if patient is able to eat and drink 5. monitor s/s of infection 6. do wound care 7. encourage mobility 1-2 days postop; 8. expect ambulation 4-5 days postop 9. monitor urine output

For ruptured Appendicitis 1. Assess for: - Bowel sounds - bowel movement - passing of flatus - nausea - boardlike abdominal rigidity - vital signs (Temperature) - incision site 2. Place in high- fowler's position 3. give morphine sulfate for pain 4. if bowel sounds is ok, provide food, as ordered 5. for NPO status patients, pat OS or tissue on lips to prevent crackings and dryness 6. Assess for infection and do wound care 7. for patients using diapers, encourage changing as often 8. watch out for complications 9. turn and position patient every 2 hours 10. teach patient how to support and splint site upon movement 11. teach deep breathing 12. encourage early mobility and ambulation 13. give ordered supplements

Legend: Pathology

Nursing Interventions

laboratory exams

Clinical manifestations

Medical interventions Nursing Diagnoses

Possible Post-op complications

release of exudates with E.coli, Klebsiella, Proteus, Pseudomonas bacteria to peritoneal cavity

localized inflammation of the peritoneum

Post-op diagnoses: - Altered Comfort: Pain of incision site on abdo - Altered Nutrition: Les requirement r/t NPO st - Risk for infection r/t b skin secondary to App

Appendectomy and Peritoneal Lavage

Complications 1. Peritonitis           2 Wound infection             3. Ileus (Paralytic and Mechanical)  

Nursing Intervention

- Observe for abdominal tenderness, vomiting, abdominal rigidity and tac - Employ constant nasogastric suctio - Correct dehydration as prescribed - Administer antibiotic agent as pres   - Assess incision site for undesirable pus formation - Assess for pain - Change dressing as frequently as n - Observe for fever and tachycardia - Administer antibiotic agent as pres   - Assess for bowel sounds - Employ nasogastric intubation and - Replace fluids and electrolytes by I prescribed - Prepare for surgery, if diagnosis of ileus is established

Medical interventions Nursing Diagnoses

Possible Post-op complications

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