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Nursing Care Plan (NCP) for Appendicitis

Nursing Care Plan (NCP) for Appendicitis

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Included In This Lesson

Study Tools
Outline
Transcript
Additional Lessons

Study Tools For Nursing Care Plan (NCP) for Appendicitis

Appendicitis Interventions (Picmonic)
Appendicitis Assessment (Picmonic)
Appendicitis Pathochart (Cheatsheet)

Outline

Lesson Objective for Appendicitis Nursing Care Plan

  • Recognize Signs and Symptoms:
    • Identify the key clinical manifestations of appendicitis, including abdominal pain, nausea, vomiting, and localized tenderness. Understand the importance of early recognition for prompt intervention.
  • Understand Diagnostic Procedures:
    • Comprehend the diagnostic procedures used to confirm appendicitis, such as physical examination, laboratory tests, and imaging studies. Recognize the significance of these assessments in guiding treatment decisions.
  • Grasp Surgical Intervention:
    • Gain knowledge of the surgical intervention commonly employed for appendicitis—appendectomy. Understand the indications for surgery, potential complications, and the postoperative care required for optimal recovery.
  • Comprehend Postoperative Care:
    • Understand the essential components of postoperative care following an appendectomy, including monitoring vital signs, assessing for complications, and providing pain management. Recognize the importance of early ambulation and resumption of oral intake.
  • Educate on Home Recovery:
    • Educate individuals on self-care measures and signs of complications during the home recovery period. Empower them to actively participate in their recovery process and seek prompt medical attention if needed.

Pathophysiology of Appendicitis

 

  • Obstruction of the Appendiceal Lumen:
    • Appendicitis often begins with obstruction of the appendiceal lumen, commonly by fecaliths (hardened fecal matter) or lymphoid hyperplasia. This obstruction leads to increased pressure within the appendix.
  • Bacterial Proliferation and Inflammation:
    • The blocked lumen creates an environment conducive to bacterial overgrowth. Bacteria multiply rapidly, leading to infection and inflammation of the appendix wall. Common bacterial species involved include Escherichia coli and Bacteroides.
  • Increased Intraluminal Pressure:
    • The accumulation of mucus, bacteria, and inflammatory exudate increases intraluminal pressure. This pressure rise compromises venous and lymphatic drainage, exacerbating inflammation and contributing to ischemia of the appendix.
  • Progression to Ischemia and Necrosis:
    • The combination of inflammation and compromised blood supply can progress to ischemia and necrosis of the appendix. This intensifies the severity of symptoms and may lead to perforation if left untreated.
  • Potential Perforation and Peritonitis:
    • In advanced cases, the necrotic appendix may rupture, releasing its contents into the peritoneal cavity. This can result in peritonitis, a severe and potentially life-threatening inflammation of the abdominal lining.

Etiology of Appendicitis

  • Obstruction of Appendiceal Lumen:
    • The primary cause of appendicitis is often the obstruction of the appendiceal lumen. This obstruction can occur due to the presence of fecaliths (hardened fecal matter), lymphoid hyperplasia, or other foreign bodies.
  • Bacterial Infection:
    • Bacterial infection plays a crucial role in the development of appendicitis. Once the appendiceal lumen is obstructed, bacteria present in the gastrointestinal tract, such as Escherichia coli and Bacteroides, proliferate and lead to infection.
  • Genetic Factors:
    • There may be a genetic predisposition to appendicitis, suggesting that individuals with a family history of the condition may have an increased risk. However, the exact genetic factors involved are not fully understood.
  • Gastrointestinal Inflammation:
    • Inflammation in the gastrointestinal tract, possibly due to conditions like inflammatory bowel disease, may contribute to the development of appendicitis. Chronic inflammation can increase the likelihood of appendiceal obstruction.
  • Age and Gender:
    • Appendicitis is more common in adolescents and young adults, but it can occur at any age. There is a slightly higher incidence in males compared to females. The reasons for these age and gender associations are not fully elucidated.

Desired Outcome for Appendicitis Nursing Care Plan

  • Timely Diagnosis and Intervention:
    • Achieve early recognition of appendicitis symptoms, leading to prompt diagnosis and intervention. The goal is to minimize the risk of complications such as perforation and peritonitis.
  • Successful Appendectomy and Recovery:
    • Ensure a successful appendectomy (surgical removal of the appendix) with appropriate preoperative, intraoperative, and postoperative care. Facilitate a smooth recovery process with minimal postoperative complications.
  • Resolution of Symptoms:
    • Attain the resolution of acute symptoms such as abdominal pain, nausea, and vomiting post-appendectomy. Monitor for any signs of persistent or recurrent symptoms that might indicate complications.
  • Prevention of Complications:
    • Prevent complications associated with appendicitis, including abscess formation, peritonitis, and postoperative infections. Timely and effective management contributes to the prevention of adverse outcomes.
  • Patient Education for Future Wellness:
    • Educate the patient on signs of potential complications, the importance of postoperative care, and measures for preventing future occurrences. Empower the individual with knowledge for long-term well-being and early recognition of any related symptoms.

Appendicitis Nursing Care Plan

 

Subjective Data:

  • Abdominal pain – periumbilical that migrates to RLQ
  • Nausea
  • Chills
  • Anorexia
  • Diarrhea or constipation reported

Objective Data:

  • Fever, diaphoresis
  • Vomiting
  • Fetal position to reduce pain
  • Rebound tenderness at McBurney’s Point
  • Inflamed hemiscrotum (male infants and children)
  • Abnormal labs
    • ↑ WBC
    • ↑ CRP

Nursing Assessment for Appendicitis

  • History of Present Illness (HPI):
    • Obtain a detailed history of the current episode, including the onset, location, and nature of abdominal pain. Inquire about associated symptoms such as nausea, vomiting, anorexia, and changes in bowel habits.
  • Past Medical History:
    • Explore the patient’s medical history, focusing on any previous episodes of abdominal pain, gastrointestinal issues, or surgical procedures, especially appendectomy.
  • Physical Examination:
    • Perform a thorough physical examination, emphasizing abdominal assessment. Look for localized tenderness, rebound tenderness, guarding, and the presence of Rovsing’s sign (pain in the right lower quadrant upon left-sided pressure).
  • Vital Signs Monitoring:
    • Monitor vital signs, paying attention to any signs of systemic inflammation, such as fever and tachycardia. Elevated temperature and heart rate may indicate worsening inflammation or potential complications.
  • Laboratory Tests:
    • Order laboratory tests, including a complete blood count (CBC) to assess for leukocytosis, which may indicate infection. Elevated inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), may also be assessed.
  • Imaging Studies:
    • Utilize imaging studies, such as ultrasound or computed tomography (CT) scans, to confirm the diagnosis and assess the severity of appendicitis. Imaging helps in identifying complications like abscess formation.
  • Pain Assessment:
    • Evaluate the intensity and characteristics of abdominal pain using a pain scale. Assess the response to pain management interventions and document any changes.
  • Patient Observation:
    • Continuously observe the patient for signs of worsening symptoms, such as increasing pain, development of fever, or changes in bowel sounds. Promptly report any concerning findings to the healthcare team.

Implementation of Appendicitis Nursing Care Plan

  • Preoperative Preparation:
    • Collaborate with the surgical team to ensure the patient is adequately prepared for appendectomy. This includes administering preoperative medications, ensuring NPO (nothing by mouth) status, and addressing any concerns or questions the patient may have.
  • Monitor for signs of complications:
    • Prior to surgery, monitor for signs of rupture, including increase or sudden relief of pain, worsening fever or chills, increase in WBC count, decreased blood pressure and increased heart rate. Notify healthcare team immediately if ruptured appendix is suspected, as it can be life-threatening.
  • Pain Management:
    • Implement a comprehensive pain management plan, incorporating both pharmacological and non-pharmacological interventions. Administer prescribed analgesics, monitor pain levels, and adjust the plan as needed to promote patient comfort.
  • Infection Prevention:
    • Strictly adhere to infection prevention protocols. Ensure aseptic techniques during any invasive procedures, monitor for signs of infection, and administer prescribed antibiotics as indicated.
  • Postoperative Care:
    • Provide attentive postoperative care, closely monitoring the patient’s vital signs, incision site, and overall recovery. Administer postoperative medications, including antibiotics and analgesics, as prescribed.
  • Patient Education:
    • Educate the patient on postoperative care instructions, signs of complications, and the importance of follow-up appointments. Discuss activity restrictions, dietary considerations, and the gradual resumption of normal activities. Ensure the patient is informed and engaged in their recovery process.

Nursing Interventions and Rationales

 

  • Place in semi-Fowler’s position

 

This position allows gravity to assist by reducing abdominal stress and relieving discomfort

 

  • Monitor Labs

 

Abnormal labs are indications of illness progression. Monitor for:

  • CRP >1 mg/dL – indicates inflammation. Very high levels may indicate gangrene
  • WBC >10,500 – indicates infection
  • Neutrophils >75%

 

  • Monitor vital signs

 

  • Fever, chills, and diaphoresis are signs of infection, developing sepsis, abscess, or peritonitis
  • Hypotension with tachycardia may indicate dehydration if vomiting or diarrhea is severe

 

  • Prep for surgery to remove appendix (appendectomy)

 

  • Initiate IV access
  • Informed Consent obtained

 

  • Provide Post-Op care after appendectomy

 

  • Maintain NPO status to empty gastric contents and remain NPO post surgery until gag reflex has returned to reduce the risk of aspiration
  • Clear liquids, advance diet as tolerated

 

  • Assess and manage pain

 

  • Note location, severity and quality of pain and any changes in characteristics which may signify abscess or peritonitis
  • Administer analgesics as ordered for pain management
  • Place ice pack on RLQ to aid in pain relief – avoid using heat as it may cause the appendix to rupture

 

  • Encourage abdominal splinting

 

Education the patient on ways to protect abdomen before and after surgery by splinting with a pillow- this will aid in pain management and prevent dehiscence of incision.

Evaluation for Appendicitis Nursing Care Plan

 

  • Surgical Outcome Assessment:
    • Evaluate the success of the appendectomy by assessing the completeness of the surgical intervention and the absence of complications. Monitor for any signs of infection, bleeding, or other postoperative issues.
  • Pain Management Effectiveness:
    • Assess the effectiveness of the pain management plan by evaluating the patient’s pain levels and their response to analgesic interventions. Adjust the pain management strategy as needed to ensure optimal comfort.
  • Resolution of Symptoms:
    • Evaluate the resolution of preoperative symptoms such as abdominal pain, nausea, and vomiting. Monitor for any signs of recurrent or persistent symptoms that may indicate complications.
  • Wound Healing and Infection Control:
    • Assess the incision site for signs of proper healing and absence of infection. Monitor for any redness, swelling, or discharge, and promptly address any concerns related to wound care.
  • Patient Education Understanding:
    • Evaluate the patient’s understanding of postoperative care instructions, including activity restrictions, dietary recommendations, and the importance of follow-up appointments. Clarify any misconceptions and ensure the patient is equipped to manage their recovery at home.

References

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Transcript

In this care plan, we will explore appendicitis. 

 

So, in this appendicitis care plan, we’re going to talk about the desired outcome, the subjective and objective data in the nursing interventions, along with the rationales. 

 

So, our medical diagnosis is appendicitis. Appendicitis is the obstruction and inflammation of the inner lining of the appendix. Infection will eventually occur leading to necrosis, gangrene, perforation of the appendix, which can cause peritonitis out in the abdominal cavity. So, obstruction of the appendix results from fecal matter that might get stuck in there, um, cancer infection or foreign body, anything that could block that opening of the appendix. Bacteria multiplies causing inflammation and infection in the appendix. So, our desired outcome is optimal pain relief and the patient will be free from infection. 

 

Now, let’s look at the care plan. We’ll start with the subjective data. So, your patient might be experiencing abdominal pain, especially in that right lower quadrant where the appendix is located due to the inflammation and possible rupture of the appendix. Your patient might be experiencing nausea and chills. If it’s ruptured, your patient might be also experiencing diarrhea or constipation because of that inflammation and possibly infectious appendix, which is located in the intestines causing irritation. So, this irritation might also cause your patient to experience some anorexia where they just aren’t eating like they should be. 

 

Now, let’s look at the objective data. So, the patient might experience a fever or elevated white blood cells in CRP due to inflammation and infection. This will worsen when it ruptures, a patient may experience vomiting due to that GI irritation and infection. While assessing the patient, you might notice rebound tenderness at McBurney’s point, which is the location of the inflamed Appendix. The patient might curl up into a fetal position to try to help reduce that pain. 

 

Now, let’s look at our nursing interventions for appendicitis. You will assess and manage your patient’s pain levels. It’s important to look at the level of severity, quality and timing of the pain, because these can all indicate different things on what’s going on. So, severe pain from the inflammation that suddenly goes away can indicate that the appendix has ruptured after time. When the infection spreads into the peritoneum, the patient will start to have more pain, which may indicate peritonitis. Treat accordingly with pain medications ordered by the doctor. So, you may want to place the patient in a semi Fowler’s position because gravity helps to reduce abdominal stress and relieves pain. 

 

Monitor the patient’s lab values, especially the white blood cells, which will determine infection and CRP because elevated CRP will show you that there’s some inflammation going on. Monitor your patient’s vital signs. Fever is a sign of infection, peritonitis, and even sepsis. Hypotension and tachycardia indicate dehydration. You will prep the patient for an appendectomy because surgery to remove the appendix is the only treatment for appendicitis. You have to get it out. So, initiate IV access and get informed consent from your patient. After surgery, provide post-op care. Your patient is going to need to maintain the NPO status until their gag reflex returns to avoid aspiration. You’ll advance their diet as tolerated per doctor order. Our last nursing intervention is to encourage abdominal splinting. This is before and after surgery. This is going to help aid in pain management and prevent a dehiscence of that incision. 

 

We love you guys. Now go out and be your best self today and as always, happy nursing!

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