A CASE STUDY OF

RUPTURED
APPENDICITIS

PREPARED BY:
JOMEL F. AVELINO
BSN III
PREPARED TO:
MA. CHRISTINA E. BAY, RN, MAN
I. Introduction
Appendicitis
Definition:
Appendicitis is an inflammation of the appendix, which is the worm-shaped pouch
attached to the cecum, the beginning of the large intestine. The appendix has no
known function in the body, but it can become diseased. Appendicitis is a
medical emergency, and if it is left untreated the appendix may rupture and
cause a potentially fatal infection.

Objectives:
o Establish an accurate diagnosis through a focused history any physical
exam, environmental history. Assess Appendicitis control. Describe the
medication method. Propose management plan for patients with acute
exacervation.
At the end of four weeks practicum we will be able to:
Identify the disease condition prevalent in the hospital
Gain the knowledge about the disease condition and its
comparative relation with the patient.
Provide nursing care for the patient and family within the hospital by
the application of nursing process.
Perform activities to maintain and promote optimum health of the
patient.
Provide health teaching and evaluate total care study.
Specific objectives:
To indentify the disease condition
To take health history and record of finding and to physical
examination.
To formulate appropriate nursing diagnosis and nursing care plan
according to the nursing theory and priority the patients needs.
To write nursing management to be performed during the patients
hospitalization.
To perform nursing activities for reducing discomfort or pain of the
patient.
To indentify the needs of the patient.
To conduct different health techniques according to the need and in
the level of understanding.
To promote basic information to the patient and the family.
 Goal:
Is the treatment the patient having the appendicitis and give the medicine to the
right dose. And caring patient carefully.

II. Past and Present medical history

III. Chief complain:
Pain abdomen since 2 days back(peri umbilical pain and later right side pain more
than left)
1 episode of fever upto 101F
1 episode of vomitting

Present history:
Patient complaints of acute abdomen pain (generalised) since evening a day back.The
pain was associated with an episode of fever and vomitting diminished by medicine later
on.
Later on the pain persist on the right illac fossa of the patient so he was brought to the
hospital for further management.
IV. Anatomy And Physiology
Anatomy and physiology are the studies of how a body structure is built, and then
how that structure works. I've always found anatomy and physiology to be two
sides of the same coin - I learned anatomy by figuring out how something works,
and I learned physiology by studying how something was built.

Stomach colon rectum diagram.

The gut is wonderful in this regard as it not only has to somehow propel food
down a twenty foot tube, but it also has to break that food up into molecules,
break the molecules into smaller molecules, and then absorb the smaller
molecules into the blood stream, all while filtering out toxins, maintaining a
balance of good and bad bacteria, and even holding onto waste products until
elimination is convenient (and safe). It is just remarkable.

Gut wall.
To that end, the entire GI tract is a long tube with several layers (layers of bowel
wall), wrapped by muscles (bowel muscles) and lined with a variety of cells that
seal the body from the contents (bowel mucosa), have an absorptive surface,
make antibodies (GI antibodies), and which generate hormones that respond to
the contents and adjust the entire system (the neuroendocrine system).

The appendix is a small eddy off of the GI tract. It still contains all of the
important elements of the GI anatomy and physiology, but is adapted to be off
the beaten path. In order to better appreciate the anatomy and physiology of the
appendix, I find it convenient to break it down a bit; to start large and then work
our way into smaller bits and see how they work together.

Anatomy

The appendix is a smal tubular extension of the right side of the colon, right near
where the small intestine also inserts into the colon. Its length is quite variable,
from an inch or so to up to 8 or nine inches in length. Most of the time is looks
like a stubby #2 pencil.

The colon has three outer longitudinal muscle bands, called the tenia, that run
the lenvth of the colon as strips, equidistant around the circumference of the
colon. The appendix arises from the blind pouch of the cecum where the three
tenia merge. In fact, the easiest way of finding the appendix in surgery is usually
to pull up the colon, find a tenia, then run it backwards until the appendix is
found.

The appendix has its own blood supply in leaves of fat arising off the mesentery
of the cecum. There is a small appendiceal artery that runs as an arcade along
the lower edge of the organ.
V. Pathophysiology
Obstruction starts to fill with mucous and acts as a closed-loop obstruction. This
leads to distension and an increase in intraluminal and intramural pressure. As
the condition progresses, the resident bacteria in the appendix rapidly multiply.
The most common bacteria in the appendix are Bacteroidesfragilis and
Escherichia coli.

Distension of the lumen of the appendix causes reflex anorexia, nausea and
vomiting, and visceral pain.

As the pressure of the lumen exceeds the venous pressure, the small venules
and capillaries become thrombosed but arterioles remain open, which leads to
engorgement and congestion of the appendix. The inflammatory process soon
involves the serosa of the appendix, hence the parietal peritoneum in the region,
which causes classical right lower quadrant pain.

Once the small arterioles are thrombosed, the area at the anti-mesenteric border
becomes ischaemic, and infarction and perforation ensue. Bacteria leak out
through the dying walls and pus forms (suppuration) within and around the
appendix. Perforations are usually seen just beyond the obstruction rather than
at the tip of the appendix.
Sign And Symptoms:
Loss of appetite.
Nausea and/or vomiting soon after abdominal pain begins.
Abdominal swelling.
Fever of 99-102 degrees Fahrenheit.
Inability to pass gas.
Dull pain near the navel
Abdominal pain
Appendicitis typically involves a gradual onset of dull, cramping, or aching pain
throughout the abdomen. As the appendix becomes more swollen and inflamed,
it will irritate the lining of the abdominal wall, known as the peritoneum. This
causes localized, sharp pain in the right lower part of the abdomen. The pain
tends to be more constant and severe than the dull, aching pain that occurs
when symptoms start. However, some people may have an appendix that lies
behind the colon. Appendicitis that occurs in these people can cause lower back
pain or pelvic pain.

Mild fever
Appendicitis usually causes a fever between 99F (37.2C) and 100.5F (38C).
You may also have the chills. If your appendix bursts, the resulting infection
could cause your fever to rise. A fever greater than 101F (38.3) and an
elevation in heart rate may indicate that the appendix has ruptured.

Digestive upset
Appendicitis can cause nausea and vomiting. You may lose your appetite and
feel like you cant eat. You may also become constipated or develop severe
diarrhea. If youre having trouble passing gas, this may be an indication of a
partial or total obstruction of your bowel. This may be related to underlying
appendicitis.
 VI.DIAGNOSTIC PROCEDURE

Laboratory
1. CBC may demonstrate an increased WBC count and RBC morphology
should be checked

2. Urinalysis may have increased white cells

Imaging Studies
1. Plain film of abdomen may show fecalith, ileus pattern, evidence of
constipation, or pneumonia.
2. Barium enema will show absence of filling of the appendix
3. Ultrasound and CT have been useful in certain situations.
VII.NURSING CARE PLAN

Preoperative nursing care plan

ASSESSMEN DIAGNOSI PLANNIN INTERVENTIO RATIONALE EVALUATIO
T S G N N
MASAKIT Acute pain . My goal assess the -Useful in monitoring . My goal
ANG TIYAN related to will status of effectiveness of was partially
KO SA distention of partially pain:the state, medication, progressi met.the
KANANG the met.the location and on of healing. patient was
characteristics Changes in
PARTE" as intestinal patient quiet
characteristics of
verbalized by tissue by was quiet pain may indicate relieved by
the patient inflammatio relieved developing the therapy
n. by the abscess/peritonitis, but not
Temp-39 therapy requiring prompt controlled.
BP-120/80 but not medical evaluation
RR-19 controlled and intervention.
PR-95
-Provide -Being informed
accurate, honest about progress of
information to situation provides
patient emotional support,
helping to decrease
anxiety

-Relief of pain
facilitates
-Administer
cooperation with
analgesics as
other therapeutic
indicated.
interventions, e.g.,
ambulation,
pulmonary toilet

-Provide
diversional
activities

-Keep
NPO/maintain
NG suction
initially.
VIII. Nursing Management
Nursing goals include relieving pain, preventing fluid volume deficit, reducing
anxiety, eliminating infection due to the potential or actual disruption of the GI
tract, maintaining skin integrity, and attaining optimal nutrition.
Preoperatively, prepare patient for surgery, start IV line, administer antibiotic, and
insert nasogastric tube (if evidence of paralytic ileus). Do not administer an
enema or laxative (could cause perforation).
Postoperatively, place patient in high Fowlers position, give narcotic analgesic
as ordered, administer oral fluids when tolerated, give food as desired on day of
surgery (if tolerated). If dehydrated before surgery, administer IV fluids.
If a drain is left in place at the area of the incision, monitor carefully for signs of
intestinal obstruction, secondary hemorrhage, or secondary abscesses (eg,
fever, tachycardia, and increased leukocyte count).

Discharge Goals

Complications are prevented or minimized.

Pain alleviated or controlled.
Surgical procedure, prognosis, treatment regimen,and possible complications
understood.
Plan in place to meet needs after discharge (follow-up).
Home and Community-Based Care

HEALTH TEACHING
Teaching Patients Self-Care

Teach patient and family to care for the wound and perform dressing changes
and irrigations as prescribed.
Reinforce need for follow-up appointment with surgeon.
Discuss incision care and activity guidelines.
Refer for home care nursing as indicated to assist with care and continued
monitoring of complications and wound healing.