Trinity University of Asia St.

Lukes College of Nursing

ACUTE RAPTURED APPENDICITIS

(A CASE ANALYSIS)

Submitted by: Mananguit, Micah G.

Submitted to: Prof. Leticia Eslabra

JULY 19,2011

Introduction The appendix is a small fingerlike appendage about 10 cm (4 in) long, attached to the cecum just below the ileocecal valve. No definite functions can be assigned to it in humans. The appendix fills with food and empties as regularly as does the cecum, of which it is small, so that it is prone to become obstructed and is particularly vulnerable to infection (appendicitis). Appendicitis is the most common cause of acute inflammation in the right lower quadrant of the abdominal cavity. About 7% of the population will have appendicitis at some time in their lives, males are affected more than females, and teenagers more than adults. It occurs most frequently between the age of 10 and 30. The disease is more prevalent in countries in which people consume a diet low in fiber and high in refined carbohydrates. The lower quadrant pain is usually accompanied by a low-grade fever, nausea, and often vomiting. Loss of appetite is common. In up to 50% of presenting cases, local tenderness is elicited at Mc Burneys point applied located at halfway between the umbilicus and the anterior spine of the Ilium. Rebound tenderness (ex. Production or intensification of pain when pressure is released) may be present. The extent of tenderness and muscle spasm and the existence of the constipation or diarrhea depend not so much on the severity of the appendiceal infection as on the location of the appendix. If the appendix curls around behind the cecum, pain and tenderness may be felt in the lumbar region. Rovsings sign maybe elicited by palpating the left lower quadrant. If the appendix has ruptured, the pain become more diffuse, abdominal distention develops as a result of paralytic ileus, and the patient condition become worsens. Constipation can also occur with an acute process such as appendicitis. Laxative administered in the instance may result in perforation of the in flared appendix. In general a laxative should never be given when a persons has fever, nausea or pain.

Clinical Manifestations 1. Generalized or localized abdominal pain in the epigastric or periumbilical areas and upper right abdomen. Within 2 to 12 hours, the pain localizes in the right lower quadrant and intensity increases. 2. Anorexia, moderate malaise, mild fever, nausea and vomiting. 3. Usually constipation occurs ; occasionally diarrhea. 4. Rebound tenderness, involuntary guarding, generalized abdominal rigidity. Diagnostic Evaluation 1. Physical examination consistent with clinical manifestations. 2. WBC count reveal moderate leukocytosis (10,000 to 16,000/mm3) with shift to the left (increased immature neutrophils). 3. Urinalysis rule out urinary disorders. 4. Abdominal x-ray may visualize shadow consistent with fecalith in appendix; perforation will reveal free air. 5. Abdominal ultrasound or CT scan can visualize appendix and rule out other conditions, such as diverticulitis and crohns disease. Focused appendiceal CT can quickly evaluate for appendicitis. Medications Analgesics Intravenous fluids replacements Treatment Appendectomy is the effective treatment if peritonitis develops treatment involves. GI Intubation Parenteral replacement of IV fluids and electrolytes Administration of Antibiotics

Surgery is indicated if appendicitis is diagnosed. Antibiotics and IV fluids are administered until surgery is performed analgesics can be administered after the diagnosed is made. An appendectomy (surgical removal of the appendix) is performed as soon as possible to decrease the risk of perforation. T he appendectomy may be performed under a (general or spinal anesthetics) with a low abdominal incisions or by (laparoscopy) which is recently highly effective method. Complications The major complication of appendicitis is perforation of the appendix, which can lead to peritonitis, abscess formation (collection of purulent material), or portal pylephlebitis, which is septic thrombosis of the portal vein caused by vegetative emboli that arise from septic intestines. Perforation generally occurs 24 hours after the onset of pain symptoms include a fever of 37.7 degree Celsius or 100 degree Fahrenheit or greater, a toxic appearance and continued abdominal pain or tenderness. Nursing Interventions 1. Monitor frequently for signs and symptoms of worsening condition, indicating perforation, abscess, or peritonitis (increasing severity of pain, tenderness, rigidity, distention, absent bowel sounds, fever, malaise, and tachycardia). 2. Notify health care provider immediately if pain suddenly ceases, this indicates perforation, which is a medical emergency. 3. Assist patient to position of comfort such as semi-fowlers with knees are flexed. 4. Restrict activity that may aggravate pain, such as coughing and ambulation. 5. Apply ice bag to abdomen for comfort. 6. Avoid indiscriminate palpation of the abdomen to avoid increasing the patients discomfort. 7. Promptly prepare patient for surgery once diagnosis is established.

8. Explain signs and symptoms of postoperative complications to report-

elevated temperature, nausea and vomiting, or abdominal distention; these may indicate infection. 9. Instruct patient on turning, coughing, or deep breathing, use of incentive spirometer, and ambulation. Discuss purpose and continued importance of these maneuvers during recovery period. 10. Teach incisional care and avoidance of heavy lifting or driving until advised by the surgeon. 11. Advise avoidance of enemas or harsh laxatives; increased fluids and stool softeners may be used for postoperative constipation. Discharge Planning M Antibiotics for infection Analgesic agent (morphine) can be given for pain after the surgery E Within 12 hrs of surgery you may get up and move around. You can usually return to normal activities in 2-3 weeks after laparoscopic surgery. T Pretreatment of foods with lactase preparations (e.g. lactacid drops) before ingestion can reduce symptoms. Ingestion of lactase enzyme tablets with the first bite of food can reduce symptoms. H To care wound perform dressing changes and irrigations as prescribe avoid taking laxative or applying heat to abdomen when abdominal pain of unknown cause is experienced. Reinforce need for follow-up appointment with the surgeon Call your physician for increased pain at the incision site O Document bowel sounds and the passing of flatus or bowel movements (these are signs of the return of peristalsis) Watch for surgical complications such as continuing pain or fever, which indicate an abscess or wound dehiscence Stitches removed between fifth and seventh day (usually in physicians office) D Liquid or soft diet until the infection subsides Soft diet is low in fiber and easily breaks down in the gastrointestinal tract