NCP Appendectomy

 APPENDECTOMY

An inflamed appendix may be removed using a laparoscopic approach with laser. However, the presence of multiple adhesions, retroperitoneal positioning of the appendix, or the likelihood of rupture necessitates an open (traditional) procedure.
Studies indicate that laparoscopic appendectomy results in significantly less postoperative pain, earlier resumption of solid foods, a shorter hospital stay, lower wound infection rate, and a faster return to normal activities than open appendectomy.

CARE SETTING

Although many of the interventions included here are appropriate for the short-stay patient, this plan of care addresses the traditional appendectomy care provided on a surgical unit.

RELATED CONCERNS

Peritonitis
Psychosocial aspects of care
Surgical intervention

Patient Assessment Database (Preoperative)

ACTIVITY/REST

May report:
Malaise

CIRCULATION

May exhibit:
Tachycardia

ELIMINATION

May report:
Constipation of recent onset
Diarrhea (occasional)

May exhibit:
Abdominal distension, tenderness/rebound tenderness, rigidity
Decreased or absent bowel sounds

FOOD/FLUID

May report:
Anorexia
Nausea/vomiting

PAIN/DISCOMFORT

May report:
Abdominal pain around the epigastrium and umbilicus, which may have an insidious onset and become increasingly severe; pain may localize at McBurney’s point (halfway between umbilicus and crest of right ileum) and be aggravated by walking, sneezing, coughing, or deep respiration. Increasingly severe, generalized pain or the sudden cessation of severe pain (suggests perforation or infarction of the appendix).
Varied reports of pain/vague symptoms (due to location of appendix [e.g., retrocecally or next to ureter] or due to onset of peritonitis)

May exhibit:
Guarding behavior; lying on side or back with knees flexed; increased right lower quadrant (RLQ) pain with extension of right leg/upright position
Rebound tenderness on left side (suggests peritoneal inflammation)

RESPIRATION

May exhibit:
Tachypnea; shallow respirations

SAFETY

May exhibit:
Fever (usually low-grade)

TEACHING/LEARNING

May report:
History of other conditions associated with abdominal pain, e.g., acute pyelitis, ureteral stone, acute salpingitis, regional ileitis
May occur at any age

Discharge plan considerations:
DRG projected mean length of inpatient stay: 4.2 days/short stay: 24 hours
May need brief assistance with transportation, homemaker tasks
Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES
WBC: Leukocytosis above 12,000/mm3, neutrophil count often elevated to greater than 75%.
Abdominal x-rays: May reveal hardened bit of fecal material in appendix (fecalith), localized ileus.
Ultrasound or CT scan: May be done for differentiation of appendicitis from other causes of abdominal pain (e.g., perforating ulcer, cholecystitis, reproductive organ infections) or to localize drainable abscesses.

NURSING PRIORITIES

1. Prevent complications.
2. Promote comfort.
3. Provide information about surgical procedure/prognosis, treatment needs, and potential complications.

DISCHARGE GOALS

1. Complications prevented/minimized.
2. Pain alleviated/controlled.
3. Surgical procedure/prognosis, therapeutic regimen, and possible complications understood.
4. Plan in place to meet needs after discharge.