Appendicitis Symptoms, Examination, Nursing Assessment | NCLEX Review Appendectomy and Peritonitis

Appendicitis is the inflammation of the appendix. The appendix is a finger-like projection off the cecum of the large intestine. Its function is to store good bacteria, helping to maintain healthy gut flora, especially after diarrheal illnesses.

The main cause of appendicitis is obstruction of the appendix lumen. Common obstructions include a fecalith (hardened stool), parasites, foreign bodies, or swollen lymph nodes due to viral/bacterial infections (like Crohn's, mononucleosis, gastroenteritis). Trauma or injury can also contribute.

Obstruction leads to increased pressure within the appendix as mucosal lining secretes mucus and fluids, and bacteria multiply. This pressure can cause venous obstruction, leading to stagnant blood flow, coagulation, and ischemia. The appendix walls weaken and can rupture, spilling contents into the abdominal cavity, causing peritonitis, abscess formation, and potentially septic shock and death. Rupture typically occurs within 48-72 hours if untreated.

Key signs and symptoms include: Abdominal pain (dull around belly button, radiating to right lower quadrant), P for McBurney's Point tenderness (most intense pain), Poor appetite, Elevated temperature, Nausea and vomiting, Desire to be in the fetal position, Increased white blood cells, Inability to pass gas or stool (though some may have diarrhea), and eXperience of rebound tenderness or abdominal rigidity.

Nurses should monitor vital signs, assess pain levels (sudden relief may indicate rupture), look for signs of peritonitis (increased heart rate, rapid breathing, fever, distended abdomen), keep the patient NPO, and provide pain relief. Crucially, avoid applying heat to the abdomen as it can increase the risk of rupture. Enemas and laxatives should also be avoided.

Post-op care includes monitoring vital signs (especially temperature for infection), checking the surgical site for infection, and maintaining drains if present (positioning on the right side helps drainage). Encourage ambulation, use of incentive spirometer, coughing, and deep breathing to prevent complications like blood clots and pneumonia. Administer IV antibiotics if the appendix ruptured and pain medication as ordered. Maintain an NGT if present until bowel sounds return. Monitor bowel sounds and ask about passing gas; a bowel movement is expected within 2-3 days. Gradually advance diet from clears to solids, recommending a high-fiber diet. For laparoscopic surgery, inform patients about potential shoulder pain from gas inflation.