Appendicitis
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Study Tools For Appendicitis
Mcburneys Point, Appendicitis (Image)
Appendix, Appendicitis (Image)
Laparoscopic Appendectomy (Image)
Anatomy of the Digestive Tract (Image)
Appendectomy Appendicitis (Image)
Abdominal Pain – Assessment (Cheatsheet)
Appendicitis – Assessment (Mnemonic)
Appendicitis Interventions (Picmonic)
Appendicitis Assessment (Picmonic)
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Outline
Overview
- Inflammation of appendix
- Most common cause of abdominal surgery in childhood
- Average age 10 yrs
Nursing Points
General
- Perforation is more common in children due to difficulties with diagnosis.
- Can lead to peritonitis and sepsis
- Inflammation of the abdominal lining due to infection
- Can lead to peritonitis and sepsis
- Diagnosis
- Physical Exam
- CBC ↑ WBC
- CT Scan
- Challenges with diagnosis
- Pain is non-specific
- Rebound tenderness is less reliable
- Surgical removal is the only treatment
Assessment
- Abdominal pain
- Begins as general, or central
- Moves to RLQ
- Sudden relief of pain indicates perforated appendix
- McBurney’s point = primary point of pain
- Nausea and vomiting
- Decreased appetite
- Referred pain
- Rebound tenderness
- Fever
Therapeutic Management
- Appendectomy
- Standard pre-op concerns
- Avoid heat – can cause rupture
- Position for comfort
- Right side, low Fowler’s
- Post Op
- IV Fluids
- IV abx
- Pain management
- Monitor bowel sounds
- NPO until 十 bowel sounds
- Change dressings as prescribed
- Standard pre-op concerns
Nursing Concepts
- Gastrointestinal/Liver Metabolism
- Elimination
- Comfort
Patient Education
- Do not use heat packs because they may cause the appendix to perforate.
References:
Hockenberry, M., Wilson, D. & Rodgers, C. (2017). Wong’s essentials of pediatric nursing (10th ed.) St. Louis, MO: Elsevier Limited.
Lissauer, T. & Carroll, W. (2018). Illustrated textbook of pediatrics (5th ed.) Europe: Elsevier Limited.
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ADPIE Related Lessons
Related Nursing Process (ADPIE) Lessons for Appendicitis
Transcript
Hey everybody in this lesson we’re going to be talking about appendicitis as it occurs in pediatric patients. I know you have already come across this topic in your adult courses so I really just want to focus on the things that can be just a little bit different when children have appendicitis.
Appendicitis is actually the most common cause of emergency abdominal surgery in childhood.
Just as quick refresher, the appendix is this little pouch that extends beyond the cecum that you see here and it’s located in the right lower quadrant of the abdomen. And what happens in appendicitis is that the appendix becomes inflamed and infected. The appendix may eventually rupture or perforate, which allows stool to leak into the abdomen. This causes inflammation to spread to the entire abdomen and can lead to shock. Now this is a complication that can happen in adults as well as children, but there is an increased risk for perforation in kids. This is because diagnosis of appendicitis can be a little tricky in kids and is often delayed. Generally, appendicitis is diagnosed with a thorough physical exam, a CBC looking for signs of infection and a CT Scan of the abdomen, but kids have a difficult time explaining their pain to others so this makes it difficult to get an accurate clinical picture.
Let’s talk a little bit more about how the abdominal pain associated with appendicitis is a little bit different for children. The first thing to know is that the pain for kids is actually pretty non-specific and is described as being in the centre of the abdomen or around the belly button rather than the right lower quadrant (RLQ) pain we associate with appendicitis. Over time, the pain does usually move to RLQ, but initially it’s more central.
In adults it’s common to check for rebound tenderness to help diagnose appendicitis, but this is really difficult to test for in children who are extremely anxious and in a lot of pain. Paying attention to the child’s posture and movement is a one of the ways to get a sense of how bad their abdominal pain is. Most kids who have severe pain will lie motionless and rigid on their bed because they are afraid to move. You may also notice a decreased range of motion in the right hip.
One thing to note is that if the pain suddenly goes away this can be a sign that the appendix has burst, which is not good and makes treatment a lot more complicated.
Other symptoms that are associated with appendicitis in kids as well as adults are vomiting, decreased appetite, and potentially a fever.
So treatment for appendicitis is to remove that inflamed appendix. Prior to surgery our nursing care is going to be all about managing the child’s pain and prepping them for surgery. This means keeping them in a comfortable position, making them NPO and probably starting fluids. Make sure heat packs are not used for pain relief because this could cause the appendix to burst!
Your nursing priorities after surgery are to monitor for post op complications like an ileus, which is when the bowels stop moving and working, or post op infection. So your nursing interventions are focused on monitoring for the return of bowel sounds, getting the patient up and moving as quickly as possible and keeping them NPO until we know those bowels are moving again. They will also need IV Fluids and medications for pain management. For patients with a perforated appendix management is a little more complicated and recover takes a bit longer. Remember, when a perforation happens infection is spread all throughout the abdomen so, the bowels will be a slower to recover and IV antibiotics are a essential to help combat infection.
Your priority nursing Concepts for pediatric patient with appendicitis are gastrointestinal and liver metabolism, elimination, and comfort.
Ok so lets recap your major points for this lesson. Appendicitis is an inflamed appendix and this is the most common cause of abdominal surgery in children. Sometimes appendicitis can be a little bit more difficult to diagnose in our pediatric patients and this is because the pain can be more generalized and also kids just have a difficult time describing what they’re feeling. This delay in diagnosis increases the risk of perforation which really complicates recover. Treatment for appendicitis is an appendectomy which is just removal that inflamed appendix.
Our nursing care for appendicitis is all about preventing complications and the most common issues are peritonitis (or infection and inflammation in the abdomen), and ileus (which is lack of movement in the intestines). So we have to be on the lookout for signs of infection and also monitoring their bowel function really closely.
That’s it for a lesson on appendicitis in the pediatric patient. Make sure you check out all the resources attached to this lesson. Now go out and be your best self today and Happy Nursing!
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Alkalosis and Acidosis Nursing Mnemonic (Kick Up, Drop Down)
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Appendicitis – Assessment Nursing Mnemonic (PAINS)
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Complications of Spinal Cord Injuries Nursing Mnemonic (ABCDEFG)
Complications of Thoracentesis Nursing Mnemonic (Patients Sometimes Bleed Internally)
Nursing Care and Pathophysiology for Heart Failure (CHF)
COPD management Nursing Mnemonic (COPD)
Cor Pulmonale – Signs & Symptoms Nursing Mnemonic (Please Read His Text)
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Cushings Assessment Nursing Mnemonic (STRESSED)
Cyanotic Defects Nursing Mnemonic (The 4 T’s)
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Dementia Nursing Mnemonic (DEMENTIA)
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Drugs that Cause SJS Nursing Mnemonic (I C NASA)
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Electrolytes – Location in Body Nursing Mnemonic (PISO)
Emergency Drugs Nursing Mnemonic (LEAN)
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Epiglottitis – Signs and Symptoms Nursing Mnemonic (AIR RAID)
Episiotomy – Evaluation of Healing Nursing Mnemonic (REEDA)
Evaluation of Irregular Moles Nursing Mnemonic (ABCDE)
Exercise Guidelines Nursing Mnemonic (FIT)
Factors That Can Put a Pregnancy at Risk Nursing Mnemonic (RIBCAGE)
Fetal Distress Interventions Nursing Mnemonic (Stop MOAN)
Fetal Wellbeing Assessment Tests Nursing Mnemonic (ALONE)
Fire Safety 1 Nursing Mnemonic (PASS)
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Flu Symptoms Nursing Mnemonic (FACTS)
Fractures
GERD causes Nursing Mnemonic (Reflux Is Probably Mean)
Global Symptoms for Brain Tumors Nursing Mnemonic (HAS)
Gluten Free Diet Nursing Mnemonic (BROW)
Heart Failure – Right Sided Nursing Mnemonic (HEAD)
Heart Failure-Left-Sided Nursing Mnemonic (CHOP)
Heart Failure-Origin Nursing Mnemonic (Left – Lung|Right – Rest)
Heart Sounds Nursing Mnemonic (APE To Man – All People Enjoy Time Magazine)
HELLP Syndrome – Signs and Symptoms Nursing Mnemonic (HELLP)
Hemodynamics
Nursing Care and Pathophysiology for Hemorrhagic Stroke (CVA)
Hemorrhagic Stroke Risk Factors Nursing Mnemonic (HATS)
Hiatal Hernia Symptoms Nursing Mnemonic (Her Belly Really Hurts Following Dinner)
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High Risk Behavior Nursing Mnemonic (HEADSS)
Hypercalcemia – Signs and Symptoms Nursing Mnemonic (GROANS, MOANS, BONES, STONES, OVERTONES)
Hyperglycemia Management Nursing Mnemonic (Dry and Hot – Insulin Shot)
Hyperkalemia – Causes Nursing Mnemonic (MACHINE)
Hyperkalemia – Management Nursing Mnemonic (AIRED)
Hyperkalemia – Signs and Symptoms Nursing Mnemonic (Murder)
Hypernatremia – Causes Nursing Mnemonic (MODEL)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (FRIED)
Hypernatremia – Signs and Symptoms 2 Nursing Mnemonic (SWINE)
Hypernatremia – Signs and Symptoms 3 Nursing Mnemonic (SALT)
Hypertension – Nursing care Nursing Mnemonic (DIURETIC)
Hypertension- Complications Nursing Mnemonic (The 4 C’s)
Hypocalcemia – Definition, Signs and Symptoms Nursing Mnemonic (CATS)
Hypoglycemia – Signs and Symptoms Nursing Mnemonic (TIRED)
Hypoglycemia Management Nursing Mnemonic (Cool and Clammy – Give ‘Em Candy)
Hypoglycemia symptoms Nursing Mnemonic (DIRE)
Hypokalemia – Signs and Symptoms Nursing Mnemonic (6 L’s)
Hyponatremia- Definition, Signs and Symptoms Nursing Mnemonic (SALT LOSS)
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Hypoxia – Signs and Symptoms Nursing Mnemonic (RAT BED)
IADLS (Instrumental Activities of Daily Living) Nursing Mnemonic (SCUM)
Increase MAP Nursing Mnemonic (VAK)
Inflammation- Signs and Symptoms Nursing Mnemonic (HIPER)
Insulin Mnemonic (Ready, Set, Inject, Love)
Interventions for Aphasia Nursing Mnemonic (PROP)
Intra Uterine Device – Potential Problems Nursing Mnemonic (PAINS)
Intrarenal Causes of Acute Kidney Injury Nursing Mnemonic (TONIC)
Leukemia – Signs and Symptoms Nursing Mnemonic (ANT)
Levels of consciousness Nursing Mnemonic (Never Carry Dirty Socks Or Smelly Clothes)
Lidocaine Toxicity – Signs and Symptoms Nursing Mnemonic (SAMS)
Low Pressure Vent Alarms Nursing Mnemonic (Cake Everyday)
Lymphoma – Signs and Symptoms Nursing Mnemonic (NURSE For Pete’s Sake)
Management of Glomerulonephritis Nursing Mnemonic (Please Help Deliver Diuretics)
Management of Lyme Disease Nursing Mnemonic (BAR)
Management of Pressure Ulcers (Pressure Injuries) Nursing Mnemonic (SKIN)
Manic Attack – Signs and Symptoms Nursing Mnemonic (DIG FAST)
MAO Inhibitors Nursing Mnemonic (TIPS)
Medication Classess for IBD Nursing Mnemonic (Sometimes I Can’t Answer)
Medications for Pancreatitis Nursing Mnemonic (Please Make Tummy Better)
Medications to Prevent Seizures Nursing Mnemonic (Pretty Little Liars Forever)
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Mnemonic for Organ Systems (MR DICE RUNS)
Multiple Sclerosis Symptoms Nursing Mnemonic (DEMYELINATION)
Murmur locations Nursing Mnemonic (hARD ASS MRS. MSD)
Nursing Care and Pathophysiology of Myocardial Infarction (MI)
Myocardial Infarction Nursing Mnemonic (MONATAS)
OB Non-Stress Test Results Nursing Mnemonic (NNN)
OLD CARTS Mnemonic (OLD CARTS)
Oral Birth Control Pills – Serious Complications Nursing Mnemonic (Aches)
Pain Assessment Questions Nursing Mnemonic (OPQRST)
Nursing Care and Pathophysiology for Parkinsons
Asthma
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pharmacokinetics Nursing Mnemonic (ADME)
Planning Community Health Interventions Nursing Mnemonic (PRECEDE-PROCEED)
Pneumonia Risk Factors Nursing Mnemonic (VENTS)
Pneumothorax Signs and Symptoms Nursing Mnemonic (P-THORAX)
Possible Infections During Pregnancy Nursing Mnemonic (TORCH)
Post-Partum Assessment Nursing Mnemonic (BUBBLE)
Postpartum Hemorrhage (PPH)
Preeclampsia: Signs, Symptoms, Nursing Care, and Magnesium Sulfate
Pregnancy Outcomes Nursing Mnemonic (GTPAL)
Probable Signs of Pregnancy Nursing Mnemonic (CHOP BUGS)
Process of Labor – Mom Nursing Mnemonic (4 P’s)
Process of Labor – Baby Nursing Mnemonic (ALPPPS)
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Prostate Nursing Mnemonic (FUN)
Proton Pump Inhibitors
Pulmonary edema treatment Nursing Mnemonic (MAD DOG)
Pupil Reactions Nursing Mnemonic (PERRLA)
Reactivation of Herpes Zoster Nursing Mnemonic (FICA)
Reasons for a Bronchoscopy Nursing Mnemonic (Please Assess His Weird Bronchoscopy Results)
Reasons for Chest Tube Nursing Mnemonic (Don’t Ever Fail)
Restrictive Lung Disease Causes Nursing Mnemonic (PAINT)
Rheumatoid Arthritis Assessment Nursing Mnemonic (RHEUMATOID)
Risk Factors for Cholelithiasis Nursing Mnemonic (5-F’s)
Risk Factors for Osteoporosis Nursing Mnemonic (ACCESS)
Safety Check Nursing Mnemonic (MADLE)
SBAR Communication Nursing Mnemonic (SBAR)
Schizophrenia
Scleroderma Symptoms Nursing Mnemonic (CREST)
Seizure Causes Nursing Mnemonic (VITAMIN)
Seizure Documentation Nursing Mnemonic (TDOC)
Senile Dementia – Assess for Changes Nursing Mnemonic (JAMCO)
Shock – Signs and symptoms Nursing Mnemonic (TV SPARC CUBE)
Nursing Care and Pathophysiology for SIADH (Syndrome of Inappropriate antidiuretic Hormone Secretion)
Signs of Osteoarthritis Nursing Mnemonic (OSTEO)
Sprains and Strains – Nursing Care Nursing Mnemonic (RICE)
SSRI’s Nursing Mnemonic (Effective For Sadness, Panic, and Compulsions)
Stages of Fetal Development Nursing Mnemonic (Proficiently Expanding Fetus)
Stages of Hepatitis Nursing Mnemonic (PIP)
Steps in the Nursing Process 1 Nursing Mnemonic (ADPIE)
Steps in the Nursing Process 2 Nursing Mnemonic (AAPIE)
Steps In The Nursing Process 3 Nursing Mnemonic (SOAPIE)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoke Assessments Nursing Mnemonic (FAST)
Symptoms of Hyperthyroidism Nursing Mnemonic (SWEATING)
Symptoms of Hypothyroidism Nursing Mnemonic (MOM’S SO TIRED)
Symptoms of Nephrotic Syndrome Nursing Mnemonic (NAPHROTIC)
Symptoms of Wernicke’s Encephalopathy Nursing Mnemonic (COAT)
TB Drugs Nursing Mnemonic (RIPE)
Toxicity Sepsis- Signs and Symptoms Nursing Mnemonic (The 6 T’s)
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Traction – Nursing Care Nursing Mnemonic (TRACTION)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Trauma – Assessment (Emergency) Nursing Mnemonic (ABCDEFGHI)
Trauma – Complications Nursing Mnemonic (TRAUMATIC)
Trauma Surgery – Medical History Nursing Mnemonic (AMPLE)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Triage Nursing Mnemonic (START)
Two pathways of the peripheral nervous system Nursing Mnemonic (SAME)
Types of Anemia Nursing Mnemonic (Always Introduce Special Patients)
Types of Hemorrhoids Nursing Mnemonic (Pie)
Ulcerative Colitis – Assessment Nursing Mnemonic (MADE 10)
Umbilical Cord Vasculature Nursing Mnemonic (2A1V)
Vascular Disease – Deep Vein Thrombosis Nursing Mnemonic (HIS Leg Might Fall off)
Vascular disease – Raynaud’s symptoms Nursing Mnemonic (COLD HAND)
Vasospasm Therapy Nursing Mnemonic (Triple H Therapy)
VEAL CHOP Nursing Mnemonic (Fetal Accelerations and Decelerations) (VEAL CHOP)
Vitamins – Fat Soluble Nursing Mnemonic (All Dogs Eat Kibble)
Vitamins – Water Soluble Nursing Mnemonic (Birth Control)
Walkers Nursing Mnemonic (Wandering Wilma Always Late)
Who Needs Dialysis Nursing Mnemonic (AEIOU)