Inflammation of the vermiform appendix (a blind pouch located near the ileocecal
valve in the right lower quadrant of the abdomen) is known as appendicitis. It may
be due to obstruction from stool. The mucosal lining of the appendix continues to
secrete fluid, which will increase the pressure within the lumen of appendix, caus-
ing a restriction of the blood supply to the appendix. This decrease in blood sup-
ply may result in gangrene or perforation as the pressure continues to build. Pain
localizes at McBurney’s point, located midway between the umbilicus and right
anterior iliac crest. Appendicitis may occur at any age, but the peak occurrence is
from the teenage years to 30.
PROGNOSIS
Rupture of the appendix is more likely to occur in acute appendicitis within the
first 36 to 48 hours. Symptoms of peritonitis (inflammation of the peritoneum—
the membrane lining the abdominal cavity) may occur as a complication of appen-
dicitis. Rapid diagnosis and surgical intervention are necessary to avoid rupture of
the appendix.
SIGNS AND SYMPTOMS
• Rigidity of the abdomen (abdomen feels more firm when palpating)
• Fever due to infection
• Nausea, vomiting, loss of appetite
• Right lower quadrant pain that improves with flexing the right hip suggests
perforation
TREATMENT
• Surgical removal of the appendix—appendectomy (may be done via laparo-
scopy or open laparotomy).
• NPO—nothing by mouth to avoid further irritation of the intestinal area, and
prep for surgery.
• Intravenous fluids until diet resumed.
• Pain medications after surgery as needed; pain medication is used cautiously
preoperatively to maintain awareness of increase in pain due to possible rup-
ture of appendix.
• Antibiotics postoperatively if needed.
NURSING DIAGNOSES
• Acute pain
• Hyperthermia
• Nausea
NURSING INTERVENTION
• Monitor vital signs for fever, increased heart rate, respiratory rate, and decrease
in blood pressure.
• Assess pain level for changes.
• Monitor surgical site for appearance of wound, drainage.
• Monitor abdomen for distention, presence of bowel sounds.
• Monitor intake and output.
• Monitor bowel function.
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