Appendectomy

Interval vs. Traditional

Gil Rubia
NUR 4115

TOPICS

Pathophysiology or background relating to the topic.

Identify complications or long term consequences related to the topic.
Identify appropriate primary, secondary and/or tertiary level of prevention and why.

Patient care, nursing interventions, patient teaching and hospital policies (if
applicable).

Synthesize the findings into a recommendation for nursing practice; either a change
or validation.

Pathophysiology
Appendicitis is the inflammation of the

appendix, a narrow blind tube that extends

from the inferior part of the cecum.

It is the most common cause of acute

abdominal pain. It is usually caused by the

obstruction of the lumen by a fecalith, an
accumulated feces. This can result in venous
engorgement, abdominal distention,
accumulation of bacteria and mucous, which
can lead to perforation, gangrene, and
peritonitis.

(Lewis, 2014, pg. 973-974)

Complications or Long Term Consequences

Peritonitis can be a serious complication of appendicitis. Bursting of the appendix

may cause a systemic infection throughout the abdomen, causing nausea, vomiting,
fever, and sever abdominal tenderness.

(Digestive & Information, 2010)

Interventions
Traditional Approach

Interval Approach

- This approach can be done as an

open or laparoscopic appendectomy.
Both of these are the surgical
removal of the appendix.

- This approach involves the

administration of antibiotics and IV
fluids. Weeks later, once the
inflammation is under control, elective
surgery is performed to remove the
appendix.

(Hansen & Dolgin, 2016)

(Fawkner-Corbett, Jawaid, McPartland,

& Losty, 2014)

Traditional Approach
Advantage

Disadvantage

- It is safe, and feasible, allowing early

diagnosis and treatment of unexpected
pathology.

- Possible complications such as

- Avoiding the need for readmission for

interval appendectomy

- Lower cost

(Hansen & Dolgin, 2016)

peritonitis

- Surgical incision infection

Traditional Approach Statistics

Open and laparoscopic appendectomy was associated with shorter length of
stay. The length of stay was about 2-3 days.

No intraoperative complications
One wound infection
1,936 for non emergent appendectomy.
(Fawkner-Corbett, Jawaid, McPartland, & Losty, 2014)

Interval Approach
Advantage

Disadvantage

- The approach can be

noninvasive, if it is resolved with
conservative treatment.

- Recurrent Appendicitis

- No incisional possibility of
infection
(Hansen & Dolgin, 2016)

- Risk of perforation
- Possible of longer hospital
stay
- Higher cost due to the
common emergent
appendectomies.

Interval Approach Statistics

In a study by Fawkner of 69 patients, 61 (88%) was discharged for a planned

Interval Appendectomy after conservative treatment.

Eight Children (12%) had an emergency readmission and appendectomy for
recurrent appendicitis.
Emergent appendectomy cost 2,171.
Hospital stay was 21 days, a longer length of stay compared to the traditional
approach.
(Fawkner-Corbett, Jawaid, McPartland, & Losty, 2014)

Patient Teaching
Appendicitis usually begins with periumbilical pain, followed by anorexia,
nausea, and vomiting. The pain becomes persistent, shifting to the right
lower quadrant.

Encourage the patient to avoid self-treatment such as laxative and enemas,

which can result in perforation.

Call healthcare provider.

(Lewis, 2014, pg. 973-974)

Primary, Secondary Tertiary Prevention

There are no proven measures to prevent appendicitis medically.

Diet and nutrition may aid gastrointestinal health, however, researchers have not
found its role in causing or preventing appendicitis.

(Digestive & Information, 2010)

Patient Care

Complete history
Physical examination, and a differential
The WBC count is mildly to moderately elevated in most cases.
A urinalysis is done to rule out genitourinary conditions that mimic the
manifestations of appendicitis.

A CT scan is the gold standard test for differentiation of appendicitis from other
causes of abdominal pain

(Doenges, 2010, pg. 346)

Patient Care Cont.

Keep patients on NPO status until they can be seen by a doctor.

Ambulation may begin the day of surgery or the first postop day.
The diet is as tolerated
Patient may resume regular activities two to three weeks after surgery.

(Lewis, 2014, pg. 975)

Possible Nursing Diagnosis and Interventions

Nursing Diagnosis

Nursing Diagnosis

Risk for infection related to invasive procedure as evidenced by

increase in temperature

Acute pain related to disruption of skin and tissues

evidenced by reports of pain and changes in vital signs

Nursing Interventions

Assess vital signs frequently, noting unresolved or progressing

hypotension, decreased pulse pressure, tachycardia, fever, and
tachypnea. Rationale: Signs of impending septic shock.
Circulating endotoxins eventually produce vasodilation, shift of
fluid from circulation, and a low cardiac output state.
Examine skin for breaks or irritation and signs of infection.
Rationale: Disruptions of skin integrity at or near the operative
site are sources of contamination to the incision. Careful
shaving or clipping as close as possible to incision time will
prevent skin abrasions, which potentiate skin infection.

Nursing Interventions
Assess pain, noting location, characteristics, and intensity

using scale appropriate to clients age. Rationale: Helps

evaluate degree of discomfort and effectiveness of analgesia

Administer medications as indicated. Rationale: Relieves

pain, enhances comfort, and promotes rest.

(Doenges, 2010)

Hospital Policy

Call 911 anytime you think you may need emergency care. For example, call
if:

You passed out (lost consciousness)

You have a new, severe, belly pain and feel weak.

Call your doctor now or seek immediate medical care if:

Obtained through IRIS. Care

instructions adapted under
license by Bon Secours.

You have pain bellow your belly button on the right side of your belly.
You have belly pain that gets worse when you move, walk or cough.
Your belly pain does not get better after a few days.
You have a fever over 100 degrees Fahrenheit

You are sick to you stomach or cant keep fluids down.

You have trouble passing gas or stools.
Your belly is bloated or swollen

(Healthwise,

Incorporated, 2013)

Recommendation For Nursing Practice

In a study by Salminen, antibiotic treatment did not prove to be inferior to
immediate appendectomies. Neither treatments showed increased in
complications (Salminen et al., 2015). However other studies have shown
that one of the treatments are more beneficial in terms of lessening
complications.

Further research needs to be done. Traditional and interval appendectomies

seem to have its risks and benefits. Educating the clients about the risks and
benefits is the main goal, until a more conclusive evidence is shown.

Pledge
I have neither given nor received aid on this assignment.
- Gil Anthony Rubia

References
Digestive, N., & Information, D. (2010). What is appendicitis?. 122(1), 18. Retrieved from http://www.niddk.nih.gov/health-information/healthtopics/digestive-diseases/appendicitis/Documents/appendicitis_508.pdf
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2010). Nursing care plans: Guidelines for individualizing client care across the life span. Philadelphia: F.A.
Davis.

Fawkner-Corbett, D., Jawaid, W. B., McPartland, J., & Losty, P. D. (2014). Interval appendectomy in children clinical outcomes, financial costs and patient
benefits. Pediatric Surgery International, 30(7), 743746. http://doi.org/10.1007/s00383-014-3521-y
Hansen, L. W., & Dolgin, S. E. (2016). Trends in the Diagnosis and Management of Pediatric Appendicitis. Retrieved from
http://pedsinreview.aappublications.org/content/pedsinreview/37/2/52.full.pdf
Healthwise Incorporated, (2013). Appendicitis, retrieved from file://ads/shares/healthwise/spfiles/content/ud2117en-us.htm
Lewis, S., & Dirksen, S. (2014). Medical-surgical nursing: assessment and management of clinical problems (Ninth ed.). Mosby, an imprint of Elsevier.
Salminen, P., Paajanen, H., Rautio, T., Nordstrm, P., Aarnio, M., Rantanen, T., Grnroos, J. M. (2015). Antibiotic Therapy vs Appendectomy for Treatment
of Uncomplicated Acute Appendicitis. Jama, 313(23), 2340. http://doi.org/10.1001/jama.2015.6154