Which nursing intervention should be the priority when caring for a client with appendicitis?
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Appendectomy is the surgical removal of the vermiform appendix. Appendicitis remains one of the more common surgical emergencies, though it has markedly decreased in recent years. Appendectomy remains the most common treatment for non-complicated appendicitis. The number of people who die and get sick has been going down, especially in the last few decades, thanks to antibiotics, early detection, and better anesthesia and surgical techniques.. As recently as 2014, more than 95% of U.S. clients with appendicitis underwent appendectomy. Although there have been several randomized trials of antibiotics for appendicitis in adults, the exclusion of important subgroups, small sample sizes, and questions about applicability to the general population have limited the use of this treatment. Clients with appendicitis always need an urgent referral and prompt treatment. An appendectomy should be considered for clients with a history of persistent abdominal pain, fever, and clinical signs of localized or diffuse peritonitis, especially if leukocytosis is present. If the clinical picture isn’t clear, a CT scan and a short period of “watchful waiting” (4-6 hours) may help improve diagnostic accuracy and speed up the process of finding out what’s wrong. For reasons of time and cost, open appendectomy was long the most common approach. However, an increasing number of surgeons have come to prefer laparoscopic appendectomy, especially in female clients, because of its diagnostic ability. Laparoscopic appendectomy has now been improved and standardized. It has some advantages over open appendectomy, including decreased postoperative pain, better aesthetic results, a shorter time to return to usual activities, and a lower incidence of wound infections or dehiscence. To understand the outcomes of appendectomy, it is warranted to review the pathophysiology of appendicitis. The appendix becomes blocked by feces, a foreign object, or a tumor. Obstruction, along with the continued secretion of mucus, causes the wall of the appendix to become distended, thereby reducing the blood supply to the wall. This results in ischemia and the accumulation of toxins. The wall of the appendix starts to break down, and normal bacteria are found in the gut attacking the decaying appendix. If left untreated, this may lead to necrosis and perforation of the appendix. There are no known contraindications for appendectomy in clients with suspected appendicitis, except in the case of a client with a long history of symptoms and signs of a large phlegmon. Certain contraindications exist for laparoscopic appendectomy, including extensive adhesions, radiation or immunosuppressive therapy, severe portal hypertension, and coagulopathies. It is also contraindicated in the first trimester of pregnancy. Nursing care planning for clients who underwent appendectomy requires the nurse’s knowledge of the procedure and its possible outcomes and complications. The following are nursing diagnoses associated with appendectomy.
Appendectomy Nursing Care PlanBelow are sample nursing care plans for the problems identified above. Risk for InfectionRegardless of the surgical technique (laparoscopic or open surgery), appendectomy remains a skeptical surgical intervention associated with a substantial risk of surgical site infections (SSIs). SSIs after appendectomy are postoperative nosocomial infections affecting the incision site, deep tissues, and organs at the operative site within 30 days after the surgical procedure. Healthcare-associated infections are acquired by clients when receiving care and are the most frequent adverse event affecting client safety worldwide. Nursing Diagnosis
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Desired OutcomesAfter implementation of nursing interventions, the client is expected to:
Nursing Interventions
Acute PainPostoperative pain is one of the most frequent complaints after surgery. Most people experience pain in postoperative periods, for various reasons. Inappropriate postoperative pain control is associated with client dissatisfaction, increased hospital stay and costs, increased morbidity, and risk of developing chronic pain. Inflammation has been proposed as one of the possible mechanisms of postoperative pain. Nursing Diagnosis
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Desired OutcomesAfter the implementation of nursing interventions, the client is expected to:
Nursing Interventions
Risk for Deficient Fluid VolumeDuring early acute appendicitis, clients frequently has not had sufficient oral intake and present with some degree of intravascular dehydration. Clients diagnosed with appendicitis usually require fluid boluses prior to operation in order to counteract dehydration. However, these clients need continued fluid resuscitation appropriate to their fluid status and severity of appendicitis. Nursing Diagnosis
Risk Factors
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Desired OutcomesAfter the implementation of nursing interventions, the client is expected to:
Nursing Interventions
References
Which intervention would be appropriate for a patient diagnosed with appendicitis?Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to treat infection.
What is the immediate management of acute appendicitis?Appendectomy remains first-line therapy for acute appendicitis, but treatment with antibiotics rather than surgery is appropriate in selected patients with uncomplicated appendicitis.
Which of the following position would increase comfort of the client with appendicitis?The patient with appendicitis usually prefers to lie still, often with the right leg flexed to decrease pain.
What is the nursing management after appendectomy?Keep NPO and maintain NG suction initially. Decreases discomfort of early intestinal peristalsis, gastric irritation and vomiting. Administer analgesics as indicated. Relief of pain facilitates cooperation with other therapeutic interventions (ambulation, pulmonary toilet).
What is important pre op teaching for a patient with acute appendicitis?- Preoperative care
It is important to prepare a patient several hours pre-surgery. The patient may be dehydrated due to symptoms such as vomiting. It may be necessary to administer IV fluids. The patient's vital signs should be recorded every 2-4 hours.
What are the nursing diagnosis for appendicitis?Based on the assessment data, the most appropriate diagnoses for a patient with appendicitis are: Acute pain related to obstructed appendix. Risk for deficient fluid volume related to preoperative vomiting, postoperative restrictions. Risk for infection related to ruptured appendix.
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