Nursing alert Rupture of the appendix is more likely to occur in acute
appendicitis within the first 36 to 48 hours and can result in peritonitis, which
is inflammation of the peritoneum, the membrane lining the abdominal cavity.
Rapid diagnosis and surgical intervention are necessary to avoid rupture of the
appendix.Signs and Symptoms
Abdominal pain begins periumbilical and travels to right lower quadrant.
Rebound pain,pain when pressure on the abdomen is quickly removed,
occurs with peritoneal inflammation.
Guarding, protecting the abdomen from painful exam.
Rigidity of the abdomen (abdomen feels more firm when palpating).
Fever due to infection.
Nausea.
Vomiting.
Loss of appetite.Nursing alertRight lower quadrant pain that improves with flexing the right
hip suggests perforation.Test Results
Serum: Elevated white blood cell count.
Computed tomography (CT) scan: Shows enlarged appendix.
Ultrasound: May show enlarged appendix.Treatment
Surgical removal of the appendix (appendectomy).
Intravenous fluids until diet resumed.
Pain medications after surgery as needed; pain medication is used cau-
tiously preoperatively to maintain awareness of increase in pain due to
possible rupture of appendix.
Antibiotics postoperatively if needed.Nursing alert Nothing by mouth to avoid further irritation of the intestinal
area and to prepare for surgery.Nursing Intervention
Monitor vital signs.
Assess pain level for changes.
Monitor surgical site for appearance of wound, drainage.CHAPTER 11/ Gastrointestinal Conditions^233