Nursing Management for Appendicitis - Before Surgery and After Surgery

Appendicitis 

DEFINITION

Appendicitis is an infection of the appendix due to obstruction of the lumen by fecaliths (fecal stones), hyperplasia of lymphoid tissue, and intestinal worms. Obstruction of the lumen is the main cause of appendicitis. Erosion of the mucous membrane of the appendix can occur due to parasites such as Entamoeba histolytica, Trichuris trichiura, and Enterobius vermicularis (Ovedolf, 2006).

Appendicitis is an inflammation of the vermiform appendix, because of its twisted structure, the appendix is an ideal place for bacteria to gather and multiply (Chang, 2010).

Appendicitis is an inflammation of the appendix that can occur without a clear cause, after obstruction of the appendix by feces or due to twisting of the appendix or its blood vessels (Corwin, 2009).

EXAMINATIONS

Examinations for patients with Appendicitis according to Betz (2002), Catzel (1995), Hartman (1994), include:

1. Anamnesis

Symptoms of appendicitis are established by anamnesis, there are 4 important things are:

Pain, first in the epigastrium (visceral pain) which some time later radiates to the lower right abdomen.

Vomiting due to visceral pain.

Fever (because of germs that settle in the intestinal wall).

Other symptoms are weak body and lack of appetite, the patient looks sick, avoids movement, feels pain in the stomach.

2. Radiological Examination

Radiological examination on the photo can not help to establish the diagnosis of acute appendicitis, except when peritonitis occurs, but sometimes the following picture can be found: There is a slight fluid level due to the presence of air and fluid. Sometimes there are fecolit (blockage). In perforation, there is free air in the diaphragm.

3. Laboratory

Blood examination: mild leukocytes generally in simple appendicitis more than 13000/mm3 generally in perforated appendicitis. The absence of leukocytosis does not exclude appendicitis.

Count type: there is a shift to the left.

Urine examination: sediment can be normal or there are leukocytes and erythrocytes more than normal if the inflamed appendix is attached to the ureter or vesika.

Laboratory examination: Leukocytes increase as a physiological response to protect the body against invading microorganisms.

In acute appendicitis and perforation, there will be even higher leukocytosis. Hb (hemoglobin) appears normal. The erythrocyte sedimentation rate (ESR) increases in the presence of infiltrating appendicitis. Routine urine is important to see if there is an infection in the kidneys.

Appendicitis Management

Appendicitis Management (Brunner & Suddarth, 2010), namely:

1. Before Surgery:

a. Observation

Within 8-12 hours after the appearance of complaints, need to be observed closely, because the signs and symptoms of appendicitis are not clear. The patient was asked to rest and fasted. Laxatives should not be given if appendicitis is suspected. The diagnosis is made by the location of pain in the right lower quadrant after the onset of complaints.

b. Antibiotics

Gangrenous appendicitis or perforated appendicitis require antibiotics, unless uncomplicated appendicitis does not require antibiotics. Delaying surgery while giving antibiotics can result in abscess or preforation.

2. Surgery

Surgery / surgery to remove the appendix is appendectomy. Appendectomy should be performed immediately to reduce the risk of perforation. Appendectomy can be performed under general anesthesia with lower abdominal surgery or by laparoscopy. Laparoscopy is the newest method that is very effective (Brunner & Suddarth, 2010).

Appendectomy can be performed using two surgical methods, namely the open technique (conventional laparotomy surgery) or the laparoscopic technique which is a minimally invasive surgical technique with the latest highly effective method (Brunner & Suddarth, 2010).

a. Laparotomy

Laparotomy is a vertical procedure of the abdominal wall into the abdominal cavity. This procedure allows the doctor to see and feel the internal organs to make a diagnosis of what is wrong.

With non-invasive diagnostic techniques, laparotomy is being used less and less than before. This procedure is only performed if all other procedures that do not require surgery, such as a minimally invasive laparoscopy, also make laparotomy less frequent. When a laparotomy is performed, once the internal organs can be seen in which the problem is identified, surgical treatment should be instituted immediately.

Laparotomy is required when there is an abdominal emergency. Laparotomy surgery is performed when there are serious health problems in the abdominal area, such as abdominal trauma. If the client complains of severe pain and other symptoms of a serious internal problem and the possible cause does not appear to be appendicitis, perforated peptic ulcer, or a gynecological condition then surgery is performed to find and correct it before it gets worse. Laparotomy can progress to major surgery followed by blood transfusion and intensive care (David et al, 2009).

3. After surgery

Observation of vital signs to determine the occurrence of internal bleeding, hyperthermia, shock or respiratory problems.

Place the client in a semi-Fowler's position. The client is said to be good if within 12 hours there is no disturbance, during which time the client is fasted until bowel function returns to normal. One day after surgery the client is advised to sit upright in bed for 2 x 30 minutes. The second day can be recommended to sit outside the room. The seventh day can be appointed and allowed to go home (Mansjoer, 2010).

Tag : Appendicitis, Nursing Management