Appendicitis for Certified Emergency Nursing (CEN)

Appendicitis:

Definition/Etiology:

An appendicitis is an inflammation of the appendix. It occurs when an obstruction of the appendiceal lumen (basically the inside of the appendix), results in a decreased blood supply which, if left untreated, may progress to necrosis, perforation and peritonitis.

Pathophysiology:

The patho of an appendicitis seems to stem from an obstruction of the appendiceal lumen. The cause of this can differ in different age groups. The obstruction can be caused by infections of benign or malignant tumors and a few other uncommon causes. This obstruction can cause mucus to build up which in turn causes increased pressure. This pressure causes the wall of the appendix to become ischemic and necrotic. Bacteria grows rampant and if the appendix bursts, these organisms venture off into the peritoneal cavity and cause peritonitis.

Clinical Presentation:

Classic presentation is mild fever and periumbilical pain which moves to the right lower quadrant at McBurney’s point. It is accompanied usually by fever, and nausea and vomiting.

There are several common signs we can assess for. Rebound tenderness over McBurney’s Point. Rovsing’ sign: Rt lower quadrant pain elicited by palpation of the left lower quadrant. And one you may not be familiar with: Psoas sign: to check this, we extend the right thigh of someone lying on their back or their side with the kneed extended. Now have the patient lay flat then flex her/her right thigh at the hip, If RLQ pain results, it’s a “positive” sign.

Collaborative Management:

• Line and Labs
• NPO
• Frequent abdominal assessments
• Most will resolve on their own
• If not, obtain IV access and be ready to admin fluids
• Parenteral analgesics and antiemetics PRN
• Broad spectrum antibiotics
• Possible surgery

Evaluation | Patient Monitoring | Education:

• Hemodynamic monitoring
• Pain level
• Be aware of complete resolution of pain, could be sign of perforation
• If surgical intervention is called for, prepare patient as per your hospital policy

Linchpins: (key Points)

• Know the signs
• Inflammation
• OR ready