Nursing management for appendicitis Pain y y y Determine clients general condition (critically ill, sedated, cognitively impaired) affecting

ability to report pain parameters Determine causes of pain (inflammation, tissue trauma/fractures, surgery, infection, angina) Note location of surgical incisions and procedures done as this can influence the amount of postoperative pain experienced; for example, vertical/diagonal incisions are more painful than transverse or S-shaped. Use pain rating scale appropriate for age and cognition if client is coherent and responsive enough. (note facials expressions and grimaces to determine pain rate) Acknowledge the pain experienced. Pain is subjective and cannot be felt by others. Observe not verbal cues/pain behaviors (observations may not be congruent with verbal reports or may be only indicator present when client is unable to verbalize Note when pain occurs, its duration and intensity (during ambulation, movement of affected body part, every evening, prolonged, short stabbing pain) Provide comfort measures (touch, repositioning, use of heat/ cold packs, nurse s presence, environmental comfortability) Teach for deep breathing techniques and other relaxation techniques such as imaging, music therapy. Encourage diversionary activities (watching TV; radio, socialization)

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Preoperative care y y y y y y y Teach him about using a pain intensity rating scale and encourage him to request medication before the pain becomes too intense. Discuss nonpharmacologic pain management techniques such as repositioning and avoiding quick movements. Administer opioids as ordered, and monitor their effectiveness. Monitor his vital signs with special attention to signs of perforation, such as a temperature greater than 102 F (39 C). Administer I.V. fluids and antibiotics as ordered. Avoid applying heat to the abdomen or administering cathartic medications or enemas, which could trigger perforation. Teach your patient what the surgery entails and what to expect postoperatively, such as early ambulation, coughing and deep breathing with wound splinting, and the use of incentive spirometry.

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Recommend routine preoperative body shower or scrubs to minimize possible contamination and infection and reduce bacterial colonization. Maintain sterility for all invasive procedures (e.g. IV, urinary catheter, pulmonary suctioning, NGT) Review to client procedures/ expectations and tell client when treatment may cause pain to reduce concern of the unknown and associated muscle tension. Administer analgesics, as indicated, to maximum dosage, as needed.

Postoperative care y Assess your patient for complications and help him prepare for discharge, y Monitor his vital signs, pulse oximetry readings, and lab results, especially his WBC count. y Assess his incision site for signs of infection, such as erythema and discharge, and make sure it s intact with no evidence of bleeding or dehiscence. y Perform a head-to-toe physical assessment, with a special focus on the abdomen, including bowel sounds and the presence of distension. Ask whether he s been passing flatus or had a bowel movement. Document your findings. y Assess him for nausea or vomiting and administer antiemetics as ordered. y Continue assessing his pain, using the same pain scale you used preoperatively, and administer pain medications as ordered. y Help him walk as ordered to prevent deep vein thrombosis and other complications. y Teach him to splint his wound and encourage him to cough and deep-breathe while sitting on the side of the bed. y While he s in bed, place him in high Fowler s position to encourage full lung expansion. Encourage him to use the incentive spirometer every hour to expand his lungs and prevent atelectasis. y Change surgical wound dressings as necessary, following the sterile techniques for changing/ disposing of contaminated materials to prevent infection. y When your patient s bowel function returns, he can gradually start taking food and fluids by mouth. A patient who s had an uncomplicated laparoscopy to remove a nonperforated appendix is usually discharged from the hospital within 24 hours. y Emphasize the importance of hand hygiene specially when handling or caring for the wounds. y Encourage early ambulation, deep breathing, position changes and early removal of endotracheal and/or nasal/oral feeding tubes. y Maintain adequate hydration. y Proper monitoring of medication regimen, make sure that it is given at proper time and dose.

Special care for perforation and abscess Your patient s recovery will be much longer and his nursing care more complex if his condition included an abscess or a perforated appendix. If he had an abscess, his wound may be closed with a drain in place. In the case of perforation, the wound may be left unsutured and packed. He also may have a nasogastric tube in place to decompress his stomach and prevent distension. Follow facility policies and procedures to keep it patent, and suction as ordered. Administer I.V. antibiotics as ordered to treat infection. Preparing for discharge Discharge teaching for a patient who s undergone appendectomy should include the following: y Teach him to observe his wound for any signs of infection, such as redness, warmth, and drainage, and to take his temperature daily. Tell him to immediately report any abnormalities to the surgeon. y Review individual nutritional needs, appropriate exercise program, sleep and rest. y Teach client and SO techniques to protect the integrity of the skin, care for lesions, and prevention of spread of infection. y Emphasize that medications (antivirals/antibiotics) should be taken on full course of therapy. y Smoking and alcohol consumption should be avoided. y Advise him to resume eating normally as tolerated and to include protein-rich foods to promote healing. y Warn him not to lift anything that weighs more than 5 pounds (2.25 kg). y Provide information about his discharge medications, including instructions on when to take them and possible adverse reactions to watch for. y Instruct him to make a follow-up appointment 2 weeks from his discharge date. Encourage him to ask questions, and give him written instructions he can refer to at home. y Encourage visits to nearest health care provider as necessary for prophylactic therapy as indicated. y Encourage adequate rest periods to prevent fatigue y Review ways to lessen pain, including therapeutic touch and relaxation skills.

Nursing goals include relieving pain, preventing fluid volume deficit, reducing anxiety, eliminating infection due to the potential or actual disruption of the gastrointestinal tract, maintaining skin integrity, and attaining optimum nutrition.