Treatment for Acute Appendicitis
Appendectomy
- Surgical removal of the appendix (standard treatment for appendicitis)[1].
- Potential complications from appendectomy include wound infection, intraabdominal abscess, and intraabdominal adhesions[1].
- For patients with complicated acute appendicitis with peritonitis or abscess, combination of antibiotic therapy and fluid therapy could be used for 6 to 8 hours prior to appendectomy to prevent sepsis and dehydration[2].
- Types of appendectomy:
- Laparoscopic appendectomy[3].
- Open appendectomy[3].
- New emerging technologies: single incision laparoscopic appendectomy and natural orifice transluminal endoscopic surgery (NOTES)[3].
Laparoscopic Appendectomy: three small incisions at the umbilicus, left lower quadrant, and lower midline of abdomen. At these incision sites, camera and surgical instruments are inserted to remove the appendix.
Open Appendectomy: single incision at the right lower quadrant of abdomen (traditional surgical procedure).
Open Appendectomy: single incision at the right lower quadrant of abdomen (traditional surgical procedure).
Clicking this image opens a new window for a WebMD video about appendectomy procedure at http://www.webmd.com/digestive-disorders/video/appendectomy
Preoperative and Postoperative Management for Appendicitis
Preoperative Management
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Postoperative Management
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Common prophylactic antibiotics
Most commonly used antibiotics are cephalosporin and imidazole derivatives for surgical prophylaxis[4].
Lexicomp, 2016 (online source)
antibiotic_therapy.pdf | |
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Nursing interventions to prevent infection
- Administer prophylactic antibiotics during preoperative care to reduce infection[2].
- Monitor for signs of infection: abdominal tenderness, fever, and increased abdominal pain[2].
- Avoid applying heat and palpating abdomen to prevent rupture or wound dehiscence, reducing further complication[2].
Nursing interventions for postoperative pain
- Encourage patient to rest in semi-fowler’s position to reduce surgical pain[2].
- Encourage walking on the first postoperative day to stimulate peristalsis. Once patient passes flatus, abdominal discomfort will be reduced[2].
- Administer analgesic to relieve pain[2].
- Place ice bag to desensitize the nerve endings on abdomen and relieve pain (Do not apply heat)[2].
- Encourage deep breathing exercises[2].
References
1. Wilms, IM., De Hoog, DE., De Visser, DC., Janzing, HM. (2011). Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev., 9(11): 1-33
2. Lewis, S.M, Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I. (2014). Medical-surgical nursing in Canada: Assessment and management of clinical problems. (3rd ed.) (M.A. Barry, S. Goldsworthy & D. Goodridge, Canadian Editors). Toronto: Elsevier Mosby.
3. Bhangu, A., Soreide, K., Di Saverio, S., Assarsson, JH., Drake, FT. (2015). Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet, 386: 1278-87
4. Daskalakis, K., Juhlin, C., & Pahlman, L. (2013). The use of pre- or postoperative antibiotics in surgery for appendicitis: a systematic review. Scandinavian Journal of Surgery, 103: 14-20
1. Wilms, IM., De Hoog, DE., De Visser, DC., Janzing, HM. (2011). Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev., 9(11): 1-33
2. Lewis, S.M, Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I. (2014). Medical-surgical nursing in Canada: Assessment and management of clinical problems. (3rd ed.) (M.A. Barry, S. Goldsworthy & D. Goodridge, Canadian Editors). Toronto: Elsevier Mosby.
3. Bhangu, A., Soreide, K., Di Saverio, S., Assarsson, JH., Drake, FT. (2015). Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet, 386: 1278-87
4. Daskalakis, K., Juhlin, C., & Pahlman, L. (2013). The use of pre- or postoperative antibiotics in surgery for appendicitis: a systematic review. Scandinavian Journal of Surgery, 103: 14-20