Nursing care before and after appendicitis

Care for a patient with appendicitis as you would any surgical patient, with these considerations.

Preoperative care. Your patient may have extreme discomfort, so explain why these measures are necessary to encourage his cooperation.

  • Teach him about using a pain intensity rating scale and encourage him to request medication before the pain becomes loo intense. Also discuss nonpharmacologic pain management techniques such as repositioning and avoiding quick movements. Administer opioids as ordered, and monitor their effectiveness.
  • Monitor his vital signs with special attention to signs of perforation, such as a temperature greater than 102° F (39° C).
  • Administer I.V. fluids and antibiotics as ordered.
  • Avoid applying heat to the abdomen or administering cathartic medications or enemas, which could trigger perforation.
  • Teach your patient what the surgery entails and what to expect postoperatively, such as early ambu
    lation, coughing and deep breathing with wound splinting, and the use of incentive spirometry.

Postoperative care. Assess your patient for complications and help him prepare for discharge,

  • Monitor his vital signs, pulse oximetry readings, and lab results, especially his WBC count.
  • Assess his incision site for signs of infection, such as erythema and discharge, and make sure it’s intact with no evidence of bleeding or dehiscence.
  • Perform a head-to-toe physical assessment, with a special focus on the abdomen, including bowel sounds and the presence of distension. Ask whether he’s been passing flatus or had a bowel movement. Document your findings.
  • Assess him for nausea or vomiting and administer antiemetics as ordered.
  • Continue assessing his pain, using the same pain scale you used preoperatively, and administer pain medications as ordered.
  • Help him walk as ordered to prevent deep vein thrombosis and other complications.
  • Teach him to splint his wound and encourage him to cough and deep-breathe while sitting on the side of the bed.
  • While he’s in bed, place him in high Fowler’s position to encourage full lung expansion. Encourage him to use the incentive spirometer every hour to expand his lungs and prevent atelectasis.

When your patient’s bowel function returns, he can gradually start taking food and fluids by mouth. A patient who’s had an uncomplicated laparoscopy to remove a nonperforated appendix is usually discharged from the hospital within 24 hours.

Special care for perforation and abscess. Your patient’s recovery will be much longer and his nursing care more complex if his condition included an abscess or a perforated appendix. If he had an abscess, his wound may be closed with a drain in place. In the case of perforation, the wound may be left unsutured and packed. He also may have a nasogastric tube in place to decompress his stomach and prevent distension. Follow facility policies and procedures to keep it patent, and suction as ordered. Administer I.V. antibiotics as ordered to treat infection.

Preparing for discharge

Discharge teaching for a patient who’s undergone appendectomy should include the following:

  • Teach him to observe his wound for any signs of infection, such as redness, warmth, and drainage, and to take his temperature daily. Tell him to immediately report any abnormalities to the surgeon.
  • Advise him to resume eating normally as tolerated and to include protein-rich foods to promote healing.
  • Warn him not to lift anything that weighs more than 5 pounds (2.25 kg).
  • Provide information about his discharge medications, including instructions on when to take them and possible adverse reactions to watch for.
  • Give him the surgeon’s phone number and instruct him to make a follow-up appointment 2 weeks from his discharge date. Encourage him to ask questions, and give him written instructions he can refer to at home.

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