Appendicitis: Management (Nursing)

by Jackie Calhoun, DNP, RN, CPNP-AC, CCRN

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    00:00 So can appendicitis be prevented? And then how do we treat it? Nope. Unfortunately, we can't prevent appendicitis.

    00:08 We don't know what causes it so we can't prevent it.

    00:12 But as far as treatment goes, first, we can do some nursing interventions to help patients with appendicitis you know while they're recovering, either before surgery or before their antibiotics start working.

    00:25 So one thing that patients may ask for is a heat pack, which feels good.

    00:29 But we actually don't want to use this because there's a chance that that could actually cause that appendix to rupture or perforate.

    00:35 These patients will likely be NPO, or not able to take anything by mouth.

    00:41 And so they will need to have IV fluids administered as their source of hydration.

    00:47 And then we're going to treat these patients pain.

    00:50 So we can do that, both with nursing interventions, like treating them with comfort measures and with positioning, and then they also will likely get medications as well to help with that pain.

    01:06 So for some reason a patient has pain, and that pain suddenly goes away, that's a sign that the appendix may have ruptured, and this is when surgery is indicated.

    01:19 Otherwise, these patients are treated with antibiotics.

    01:23 If they're have appendicitis, and it's caught pretty early, and they had a nice imaging study that shows that it looks okay and not perforated or ruptured, you can usually just treat it with antibiotics and that inflammation will go away without any surgery involved.

    01:42 So let's work through all of that in like a little flowchart.

    01:46 The medical treatment for appendicitis includes antibiotics.

    01:51 We usually start with intravenous or IV antibiotics.

    01:55 Usually we give these to kids whether or not they're going into surgeries.

    01:58 But if they're going to surgery, they always get IV antibiotics just to kind of start reducing that inflammation.

    02:05 If there's no perforation seen during an operation or on the scan then no more antibiotics are needed.

    02:14 If for some reason when they go in and look during surgery, if that appendix is gangrenous like it looks infected, and parts of it are gangrenous usually means that like it's getting kind of rotten almost then the antibiotics will be continued after that appendix is removed, because this infection is usually starting to spread at that point beyond the appendix.

    02:41 If a patient is doing well, either if they got that dose of IV antibiotics, they didn't need surgery, they can actually go home on oral antibiotics, or after surgery and they got a few doses of IV antibiotics and things were looking better, they can also go home and finish a course with oral antibiotics.

    03:03 And then lastly, we want to make sure that they're able to eat and drink normally after the surgery or after they've given those first few doses of antibiotics.

    03:15 Additionally, like with anything, we want these patients to start to move around, which always helps with the healing process.

    03:23 Let's put everything together now in the clinical judgment model.

    03:28 And we'll look at layers two and three to form our hypotheses.

    03:35 And we'll start by recognizing those cues are the signs and symptoms.

    03:41 Let's review the signs and symptoms of appendicitis.

    03:47 The first is where the pain starts around the umbilicus or the belly button.

    03:53 It moves to the right lower quadrant, and then it spreads out or is diffused throughout the whole abdomen.

    04:00 The next symptom that usually happens is that patients become listless or irritable.

    04:07 So their mental status changes a bit just because they don't feel well.

    04:11 Their appetite has decreased because they don't want to eat when their abdomen hurts.

    04:17 They develop nausea and vomiting, and then the fever.

    04:21 And remember, these symptoms are all the same but in a different order than if the patient had viral gastroenteritis.

    04:29 And that would be starting with the fever, and the nausea and vomiting, and working backwards.

    04:34 So now let's analyze all those cues or signs and symptoms.

    04:38 So we have all the signs and symptoms, we think the patient probably has appendicitis, but let's actually find out for sure that they have it.

    04:44 So we'll draw the blood labs, the serum electrolytes and complete blood count.

    04:49 And then we'll start with trying to image it with the abdominal ultrasound.

    04:54 Then we'll either move to the CAT scan or MRI.

    04:58 If we didn't see the appendix on the ultrasound, and then lastly, they'll try to look at it in surgery.

    05:05 The surgeons will, if we're still not sure.

    05:09 Now, let's prioritize our hypotheses.

    05:12 We think our patient has appendicitis.

    05:15 And now we need to take action.

    05:18 Our action plan involves by treating the appendicitis.

    05:22 So we're going to do those treatment plans that we talked about.

    05:27 So we're going to avoid heat on the area to reduce the chance of appendix rupture.

    05:32 We are going to give those patients IV fluids as ordered because they're likely not going to be eating or drinking, especially if they need to have surgery.

    05:40 And then we're going to treat their pain both with nursing interventions and with pain medications.

    05:48 The patient also may be treated with surgery, especially if we have that sudden decrease in their pain level, which is a sign of appendix rupture.

    05:58 And then they're all going to get antibiotics usually have at least one dose of IV antibiotics, if not more.

    06:05 And then they'll finish with oral antibiotics to completely treat the appendicitis.

    06:11 So let's evaluate our outcomes of those actions.

    06:15 And these include an improvement in the patient's abdominal pain.

    06:20 We want their energy level to be back to normal and improvement in their nausea and vomiting.

    06:25 We want to make sure that that fever has gone away, which is always a good sign that the infection has gone away.

    06:33 And then lastly, we want to make sure that they're able to eat and drink normally.

    06:39 So that was our clinical judgment model.

    06:41 And that was our lecture on a pediatric appendicitis.

    06:44 Thank you for listening, and we'll see you next time.

    About the Lecture

    The lecture Appendicitis: Management (Nursing) by Jackie Calhoun, DNP, RN, CPNP-AC, CCRN is from the course Gastrointestinal Disorders – Pediatric Nursing.

    Included Quiz Questions

    1. The student nurse prepares a heat pack to give to the client.
    2. The student nurse reminds the client they cannot take anything by mouth.
    3. The student nurse offers the client PRN pain medication.
    4. The student nurse tells the client that there is no known method of preventing appendicitis.
    1. The first line of treatment is antibiotics.
    2. The first line of treatment is surgery.
    3. Intravenous antibiotics are only given if surgery is not indicated.
    4. Intravenous antibiotics are only given after surgery.
    1. Notifying the client’s healthcare provider.
    2. Holding the client’s scheduled pain medications.
    3. Rechecking the client’s pain in one hour.
    4. Documenting that the client’s antibiotic therapy is effective.

    Author of lecture Appendicitis: Management (Nursing)

     Jackie Calhoun, DNP, RN, CPNP-AC, CCRN

    Jackie Calhoun, DNP, RN, CPNP-AC, CCRN

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