Minimizing the Perils of Appendicitis,

¶ … Minimizing the perils of appendicitis, by Joan Dell Rocca, CRNP, CCRM, MSN, it is very important for nurses to know how to act quickly when treating patients who are threatened by the dangerous condition of appendicitis. The appendix is a fingerlike organ that is attached to the cecum. The appendix has no know function, but when it becomes inflamed it can be very serious. Obstruction of the appendix lumen, most commonly by a hard fecal mass is typically what triggers this inflammation known as Appendicitis. Unsuccessful fluid drainage from the appendix lumen has been thought to let bacteria invade the appendix wall, which triggers infection. If an infected appendix isn't removed quickly, it can perforate and cause peritonitis. Perforation is most likely to occur within 48 hours after appendicitis develops (Rocca, 2007).

Abdominal pain is the characteristic symptom of appendicitis. It is often accompanied by additional signs and symptoms. Pain usually begins in the periumbilical region but often moves around. As inflammation increases, the pain often becomes more severe and localized in the right lower side. Patients who have rebound tenderness often are suffering from acute appendicitis and peritoneal inflammation. If the doctor applies firm, slow pressure to the abdomen at a point away from the reported pain and quickly releases it, this triggers severe pain and rebound tenderness is present. It is reported that patients often have nausea and vomiting. There is usually a temperature elevation of 99° F (37" C) to l00° F (38" C), but a normal temperature can be present. A patient will usually have an elevated white blood cell (WBC) count of greater than 10,000/mm. Signs and symptoms of perforation include a WBC count of 20,000/mm or greater: a tense, rigid abdomen; and a temperature of 102° F (39" C) or higher. Older adults with altered pain perception delay seeking treatment and are more likely to develop perforation because they don't seek immediate treatment (Rocca, 2007).

A patient that is suffering from appendicitis should be treated as would any surgical patient. Nurses should be aware that patients may have extreme discomfort. Patients need to be taught how to use a pain intensity rating scale and encouraged to ask for medication before the pain becomes too intense. Nurses must also discuss non-drug pain management techniques such as repositioning and avoiding quick movements. Pain medication should be administered as ordered, and monitor for its effectiveness. Patient's vital signs should be monitored with special attention given to signs of perforation. I.V fluids and antibiotics should be administered as prescribed. Applying heat to the abdomen or administering cathartic medications or enemas, which could trigger perloration, should b e avoided. Patient's should be taught what the surgery entails and what to expect afterwards, such as early ambulation, coughing and deep breathing with wound splinting, and the use of incentive spirometry (Rocca, 2007).