Appendicitis
What are the clinical features of acute appendicitis? What is the immediate preoperative management? Draw out a nursing care plan for the first 48 hours post-opetrative period
Clinical Features
Abdominal pain - starting at the umbilical region may migrate to the right iliac fossa - mild to severe in nature - may be colicky
Vomiting
More of nause than voimiting
Lack of appetite
may present with diarrhoea, constipation, dysuria, only nausea
Low-grade fever - 99 - 100 °F
Tenderness in the RIF
Abdominal guarding - in the RIF - later generalised abdominal guarding
Rovsing's sign - pain in the RIF while pressur is applied in the LIF
Rebound Tenderness - pain in the RIF when pressing hand on the LIF is suddenly taken away - serious sign portending gangrene or strangulation
Late stage of generalised peritonitis - abdominal distention
Immediate Preoperative Management
After pain relief
Diagnosis
Investigations : - Hb, TC, DC, ESR, USGM, Plain X-ray abdomen, X-ray chest
Nil by mouth
Rest in a comfortable bed
Pain relief by analgesics, anti-inflammatories, if needed by narcotic analgesics
Anti emetics
IV fluids for the purpose of nutrition and rehydration if needed
Antibiotics and metronidazole to combat infection
prepare the patient for surgery - no enema nor bowel wash
xylocain test dose
Inj. TT
Nursing care plan for the first 48 hours after surgery
Semi-Fowler's position
Pain relief by narcotic analgesics
Oral fluids if tolerated
IV fluids
If the disease has been treated early food may be tolerated on the first day itself
If peritonitis had been there : any drain should be attended to
Dressing should be changed if any abscess forms at the site of incision after I&D
Suture removal : 5th or 7th day.
