Appendicitis

Question 0

Perforation Vs. Rupture

Answer 0

1. Rupture is when the appendix bursts and the pain subsides
2. Perforation is when pain intensifies and Pt manifests a fever

Question 1

1 Nursing Priority for Appendicitis

Answer 1

1. Start IV access to hydration fluids

Question 2

What fluids or meds does PT get in ER?

Answer 2

1. After IV access give Pt:
   - Normal Saline
   - Rocefin (broad spectrum antibiotic)

Question 3

Antibiotic Protocol for Appendicitis

Answer 3

1. Pt will receive broad spectrum antibiotic 8 hours before surgery and 48 hours after surgery

Question 4

Elderly and Infection?

Answer 4

1. Elderly are ALWAYS at risk for INFECTION

Question 5

Appendicitis in Children

Answer 5

1. Appendicitis is usually missed in children because they cannot communicate the problem.
   - Usually caught after rupture

Question 6

Appendicitis

-Dx Testing

Answer 6

1. Ultrasound is hallmark test for appendicitis **
2. Pelvic Exam
   - Differentiate between ovarian cyst and appendicitis
   - PREGNANCY TEST

Question 7

Appendectomy

-Pre-op Check list

Answer 7

1. Vital signs / PT EDUCATION
2. Allergies
3. NPO
4. Foley Insertion
5. Witness consent form
6. Pt Education
   - Tell pt they will be in pain but opioids will be given to manage pain

Question 8

Appendectomy

-Different Procedures

Answer 8

1. Laparoscopic
   - Very small incision and patient should be home w/in 24 hours
2. Laparotomy
   - Cut abdomen open to see inside
   - Usually done when appendix ruptures
   - Use sterile NS to clean out abdomen
   - Usually admitted for 3-4 days

Question 9

Appendectomy

-D/C Teaching for Laparoscopic

Answer 9

1. Finish full prescription of antibiotics
2. Narcotics Pt Education
   - Increase fluids, possible stool softener, Exact Dose and what dose not to exceed in 24 hours
3. Do not lift more than 15-25 lbs (activity intolerance)
4. Pt’s usually return to work around 4-5 days
5. Diet Consideration
   - Start with liquids and increase

Question 10

Pt Returning from Laporotomy

-Nursing Priority

Answer 10

1. VS’s q15/1hr, q30/2hr, & q4
2. Look at wound dressing for saturation
   - Mark corners of wound and see if they expand
3. Urine output I&O’s
   - If bowels are nicked in surgery BP will be Low (HYPOVOLEMIA)
4. Bowel sounds returning
5. Pain mgmt