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Wednesday, November 23, 2011

Nursing Care Plan for Preoperative and Postoperative Appendectomy

Definition of Appendicitis


Appendicitis is an inflammation that often occurs in the appendix which is a serious case of abdominal surgery are the most common.


Appendectomy

An appendectomy is the surgical removal of the vermiform appendix. This procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis. In the absence of surgical facilities, intravenous antibiotics are used to delay or avoid the onset of sepsis; it is now recognized that many cases will resolve when treated perioperatively. In some cases the appendicitis resolves completely; more often, an inflammatory mass forms around the appendix, causing transruptural flotation. This is a relative contraindication to surgery.


Etiology of Appendicitis

Appendicitis is a bacterial infection caused by obstruction or blockage due to:
  1. Hyperplasia of lymphoid follicles
  2. Fecalith presence in the lumen of the appendix
  3. Appendix tumor
  4. The presence of foreign objects such as ascariasis worm.
  5. Appendix mucosal erosion due to parasites such as: E. Histilitica.

According to research, epidemiology suggests eating foods low in fiber will cause constipation which can cause appendicitis. This will increase intra-caecal pressure, causing a functional obstruction appendix and increase the growth of germs in the colon flora.


Pathophysiology of Appendicitis

Signs and Symptoms of Appendicitis

Pain, felt in the lower abdominal quadrant and is usually accompanied by mild fever, nausea, vomiting and loss of appetite. Local tenderness at the point Mc. Burney, when done pressure. Tenderness may be found out.

The degree of tenderness, muscle spasm, and whether there is constipation or diarrhea does not depend on the severity of infection and location of the appendix. If the appendix at the back of the cecum circular, pain and tenderness can be felt in the lumbar region; when one end was in the pelvis, these signs can only be known on rectal examination. Pain on defecation shows that the tip of the appendix is close to the bladder or ureter. The existence of muscle stiffness in the bottom right of the rectum may occur.

Rovsing sign can arise with left lower quadrant palpation, which causes pain felt in the lower right quadrant. If the appendix has ruptured, the pain can be more spread out; abdominal distension due to paralytic ileus and the client's condition worsened.


Complications of Appendicitis

The main complication of appendicitis is perforation of the appendix, which can lead to peritonitis or abscess. The incidence of perforation is 105 to 32%. The incidence is higher in young children and the elderly. Perforation generally occurs 24 hours after the onset of pain. Symptoms include a fever with a temperature of 37.7 ° C or higher, continuous abdominal tenderness.


Management of Appendicitis

In acute appendicitis, the best treatment is surgery the appendix. Within 48 hours must be performed. Patients in the observation, rest in Fowler's position, given antibiotics and given food that does not stimulate peristalsis, if there is perforated drain given the lower right stomach.
  1. Preoperative Appendectomy, including patients in hospital, given antibiotics and compress, to reduce the temperature of the patient, the patient is asked to bed rest and fasted.
  2. Operative action; Appendectomy
  3. Postoperative Appendectomy, one day post surgery clients are encouraged to sit upright in bed for 2 x 30 minutes, the next day soft food and stand upright outside the room, the seventh day stitches removed, the client's home.
Preoperative and Postoperative Appendectomy


Nursing Care Plan Appendicitis

Nursing Assessment
  1. The identity of the client
  2. History of Nursing
    • Current medical history; complaints of pain in postoperative wound appendectomy, nausea, vomiting, increased body temperature, increased leukocytes.
    • Past medical history
  3. Physical Examination
    • Cardiovascular System: To determine vital signs, presence or absence of jugular venous distension, pallor, edema, and abnormal heart sounds.
    • Hematologic System: To determine whether there is an increase in leukocytes is a sign of infection and bleeding, nosebleeds splenomegaly.
    • Urogenital System: Whether or not the tension of the bladder and lower back pain complaints.
    • Musculoskeletal System: To determine whether there is difficulty in movement, pain in bones, joints and there is a fracture or not.
    • The immune system: To determine whether there is lymph node enlargement.
  4. Investigations
    •   Routine blood tests: to determine an increase in leukocytes is a sign of infection.
    •   Abdominal examination photo: to know the existence of post-surgical complications.

Nursing Diagnosis Preoperative and Postoperative Appendectomy

Preoperative Appendectomy

1. Risk for deficient fluid volume related to preoperative vomiting.

2. Acute pain related to distention of the intestinal tissue by inflammation.

3. Anxiety related to change in health status.

Postoperative Appendectomy

1. Acute pain related to the presence of postoperative wound appendectomy.

2. Impaired nutrition less than body requirements related to reduced anorexia, nausea.

3. Risk for infection related to surgical incision.

4. Deficient knowledge: about the care and diseases related to lack of information.


Nursing Interventions


1. Preparation of general surgery

This can be done by the nurse when the client entered the operating room nurse before surgery:
  • Introducing the client and close relatives of hospital facilities to reduce the anxiety of clients and their relatives (the orientation of the environment).
  • Measuring vital signs.
  • Measure weight and height.
  • Collaboration is an important laboratory tests (hematocrit, serum glucose, Urinalisa).
  • The interview.
2. Preoperative Interventions
  • Observation of vital signs
  • Assess fluid intake and output
  • Auscultation of bowel sounds
  • Assess the status of pain: the scale, location, characteristics
  • Teach relaxation techniques
  • Give fluids intervena
  • Examine the level of anxiety
  • Give information about the disease process and actions

PostoperativeIinterventions
  • Observation of vital signs
  • Assess the scale of pain: characteristics, scale, location
  • Assess the state of the wound
  • Advise to change position as tilted to the right, left and sat down.
  • Assess nutritional status
  • Auscultation of bowel sounds
  • Give wound care information and disease.

Evaluation
  1. Impaired sense of comfort: pain is resolved
  2. No infection
  3. Overcome nutritional deficiencies
  4. The client understands about care and illness
  5. Weight loss does not occur
  6. Vital signs within normal limits

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