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AppendectomyReported by:

Reblando, Henna R.

Cruz, John Rouke

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Appendix A small, fingerlike appendage about 10cm(4in)

long that is attached to the cecum just below the

ileocecal valve.

Fills with food and empties regularly into the

cecum.

Because it empties inefficiently and its lumen is

small, the appendix is prone to obstruction and

particularly vulnerable to infection

(Apppendicitis).

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The Appendix

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Appendicitis The most common cause of acute surgical

abdomen in US., is the most common reason for

emergency surgery.

Although it can occurs between the ages of 10

and 30 years. (NIH, 2007).

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Pathophysiology

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Clinical manifestation Vague epigastric or periumbilical pain

Low-grade fever

Nausea and vomiting Loss of appetite

Local tenderness

Constipation or diarrhea Pain on defecation

Pain in urination

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Rovsings sign Palpation of left iliac region Displacement of

colonic gas and small bowel towards inflamed

appendix Pain on right iliac region

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Blumberg sign: Rebound tenderness at Mc Burneyspoint

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Psoas (Copes psoas) sign Pain in attempt to extend the hip flexed

due to irritation of psoas major in retrocecal

appendicitis)

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Obturator (Copes obturator) sign: Flexion and medial rotation at hip produces

pain due to irritation of obturator muscle in

pelvic appendicitis.

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Aarons sign: Pain or pressure inepigastrium or anterior chest with persistentfirm pressure applied to McBurneys point.

Cough tenderness: Differentiates from rightsided ureteric colic.

Rigidity and Guarding in Right Iliac Fossa(RIF)

Rectal examination: Tenderness in rightrectal wall

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Assessment and diagnostic findings CBC

Abdominal X-ray films

Ultrasound studies

CT scans

Laparoscopy

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Appendectomy Surgical removal of the appendix.

Is performed as soon as possible to decrease the risk of

perforation.

It may be performed using general or spinal anesthesia

with a low abdominal incision (Laparotomy) or bylaparoscopy.

Both Laparotomy and laparoscopy are safe and effective

in the treatment of appendicitis with perforation. Recovery after laparoscopic surgery is generally quicker.

Consequently, laparoscopic appendectomy is more

common.

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When perforation of the appendix occurs, anabscess may be formed. If this occurs, the patient

may be initially treated with antibiotics, and the

surgeon may place a drain in the abscess. After abscess is drained and there is no further

evidence of infection, an appendectomy is then

typically performed.

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Preoperative Management All diagnostic tests and procedures are explained to

promote cooperation and relaxation.

The patient is prepared for the type of surgical

procedures as well as the post operative care.

Measures to prevent postoperative complication are

taught, including coughing, turning, and deep

breathing using splint at the incision site.

I.V fluids or total parenteral nutrition beforesurgery maybe ordered to improved fluid and

electrolyte balance and nutritional status.

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Post Operative Management And NursingManagement And Nursing Care Monitor vital signs for sign of infection and shock

such as fever, hypotension and tachycardia.

Monitor I and O for sign of imbalance, dehydration,

and shock.

Assess abdomen for increased pain, distention,

rigidity, and rebound tenderness because these may

indicate postoperative complications.

Evaluate dressing and incision.

Evaluate the passing of flatus or feces.

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Monitor for nausea and vomiting.

Laboratory values are monitored and patient isevaluated for sign and symptoms of electrolyte

imbalances.

Wound drains, I.V, and all other catheter aremonitored and evaluated for signs of infections.

Turning , coughing, deep breathing, and incentive

spirometry are performed every 2hours.

Diet is advanced as ordered.

Administration of medications as ordered

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Patient Education and Health Maintenance Instruct patient to avoid heavy lifting for 4

to6 weeks after surgery.

Instruct patient to report symptoms

of anorexia, nausea, vomiting, fever,

abdominal pain, incisional redness anddrainage postoperatively

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