MEDICAL MANAGEMENT, NURSING MANAGEMENT AND NCP FOR ACUTE APPENDICITIS

MEDICAL MANAGEMENT

The medical management of acute appendicitis typically involves several key steps to address
the inflammation, infection, and symptoms associated with the condition. However, it's important to note
that the primary treatment for acute appendicitis is surgical removal of the inflamed appendix
(appendectomy), which is considered the gold standard.

1. Initial Assessment and Diagnosis:

 A thorough medical history, physical examination, and relevant laboratory tests are conducted to
diagnose acute appendicitis.
 Imaging studies, such as abdominal ultrasound or computed tomography (CT) scans, may be
performed to confirm the diagnosis and assess the severity of the condition.

2. Pain Management:
 Analgesic medications are administered to relieve severe abdominal pain. These may include
opioids and non-steroidal anti-inflammatory drugs (NSAIDs).
 Pain management helps improve patient comfort while awaiting surgery or if the decision is made
to manage the condition conservatively.

3. Intravenous (IV) Fluids:

 Intravenous fluids are administered to correct dehydration, maintain hydration, and provide
necessary electrolytes and nutrients.
 This step helps prepare the patient for surgery and addresses any fluid and electrolyte
imbalances caused by vomiting or fever.

4. Antibiotics:
 Broad-spectrum antibiotics are often prescribed to control or prevent infection associated with
acute appendicitis.
 Antibiotics are used both before surgery (prophylactically) and in cases of perforation to treat
established infections.
 Common antibiotics used include cefoxitin, cefotetan, or a combination of ciprofloxacin and
metronidazole.

5. Nausea and Vomiting Control:

 Antiemetic medications may be administered to alleviate nausea and vomiting.
 Observation and Monitoring:
 Patients with a confirmed diagnosis of uncomplicated acute appendicitis may be observed in the
hospital for a period to assess their response to medical management.
 Monitoring includes tracking vital signs, clinical symptoms, and laboratory results.
6. Surgery (Appendectomy):
 Surgical removal of the inflamed appendix (appendectomy) is the definitive treatment for acute
appendicitis.
 In many cases, surgery is performed as soon as possible after diagnosis to prevent
complications, such as appendiceal rupture.
 Laparoscopic (minimally invasive) or open surgical techniques may be used, depending on the
patient's condition and surgeon's preference.

7. Postoperative Care:
 After surgery, patients receive appropriate pain management, resume oral intake gradually, and
are monitored for signs of infection or surgical complications.
 Recovery time varies, but most patients can return to normal activities within a few weeks. It's
essential for individuals with symptoms suggestive of acute appendicitis, such as severe abdominal pain,
to seek prompt medical attention. Timely diagnosis and appropriate management, which often involves
surgical intervention, are crucial for a favorable outcome and preventing complications associated with
this condition.

NURSING MANAGEMENT

Nursing management of acute appendicitis is crucial to provide comprehensive care to patients

before and after surgery. Nurses play a vital role in assessing, monitoring, and supporting patients
throughout their treatment journey. Here's an overview of nursing management for acute appendicitis:

1. Assessment and History:

 Conduct a thorough assessment, including a detailed history of the patient's symptoms, pain
characteristics, and medical history.
 Assess vital signs, including blood pressure, heart rate, respiratory rate, and temperature.
 Perform a physical examination, focusing on abdominal tenderness, guarding, rebound
tenderness, and any signs of peritonitis.
2. Pain Management:
 Administer prescribed pain medications to alleviate severe abdominal pain.
 Monitor the patient's response to pain relief and assess for any adverse effects of pain
medications.
3. Monitoring and Observation:
 Continuously monitor vital signs, paying special attention to changes that may indicate worsening
of the condition or complications.
 Observe the patient for signs of nausea, vomiting, and bowel movement patterns.
4. Intravenous (IV) Fluids:
 Administer IV fluids to correct dehydration, maintain hydration, and provide necessary
electrolytes.
 Monitor fluid intake and output to assess the patient's fluid balance.
5. Antibiotics:
 Administer antibiotics as prescribed to control or prevent infection.
 Monitor the patient for any adverse reactions or allergies to antibiotics.
6. Nausea and Vomiting Control:
 Administer antiemetic medications as ordered to alleviate nausea and vomiting.
 Encourage the patient to sip clear fluids if tolerated.
7. Surgical Preparation:
 Prepare the patient physically and emotionally for surgery, explaining the surgical procedure and
what to expect.
 Ensure that the patient is NPO (nothing by mouth) before surgery to reduce the risk of aspiration
during anesthesia.
8. Preoperative Care:
 Ensure that the patient is properly prepped for surgery, including checking that they have
removed jewelry, are in a hospital gown, and have an IV line in place.
 Administer any preoperative medications as prescribed.
9. Postoperative Care:
 After surgery (appendectomy), monitor the patient's vital signs closely, paying attention to signs of
surgical complications.
 Assess the surgical incision site for signs of infection, bleeding, or dehiscence.
 Provide wound care as necessary and educate the patient on incision care instructions.
 Encourage early mobilization and deep breathing exercises to prevent complications such as
pneumonia and thrombosis.
10. Pain Assessment and Management Post-surgery:
  Continuously assess the patient's pain level and administer pain medications as prescribed.
 Monitor for any adverse effects of pain medications and report them promptly.
11. Education and Discharge Planning:
 Educate the patient and their family on postoperative care, including wound care, activity
restrictions, and signs of complications.
 Provide instructions on when to seek medical attention if symptoms worsen or new symptoms
develop.
12. Emotional Support:
 Offer emotional support and reassurance to the patient, as the diagnosis and surgery can be
stressful.
 Address any concerns or questions the patient may have about their condition or treatment.
13. Follow-Up Care:
 Ensure that the patient has a follow-up appointment with their healthcare provider to monitor their
recovery and remove any surgical sutures or staples.

Nursing management for acute appendicitis involves a comprehensive approach to care, focusing
on symptom relief, surgical preparation, postoperative care, and patient education. Nurses play a critical
role in ensuring the patient's comfort and safety throughout the entire treatment process.

NURSING CARE PLAN FOR ACUTE APPENDICITIS

Assessment Diagnosis Planning Nursing Interventions Rationale Evaluation

Subjective Data: Pain rating

Assess the patient's pain
Helps in monitoring decreased from
“Masakit ang tagiliran ko” as Acute Pain After 4 hours of intensity, location, and pain severity and 8/10 to 3/10 after
verbalized by the patient. related to nursing characteristics at regular
response to treatment. pain management
inflammation interventions, the intervals (e.g., every 2 hours).
interventions.
Patient reports severe of the patient will be
appendix as
abdominal pain located in the demonstrate use
right lower quadrant. Pain evidenced by of relaxation The patient
verbal reports
described as sharp, constant, skills and other Administer prescribed pain reported a
of severe methods to Provides pain relief
and worsening. medications as ordered (e.g., decrease in pain
abdominal promote comfort. opioids, NSAIDs) and evaluate and improves the intensity to a
Objective Data: pain, guarded patient's comfort.
the effectiveness of pain relief. manageable level
behavior, (3/10).
 rebound tenderness noted rebound
 + face grimace tenderness
 tenderness and facial
Encourage and assist the The patient
grimace.
 Guarded behavior patient in finding a comfortable Promotes patient reported feeling
 Weakness position, such as lying with comfort and may help less discomfort
 Guarded behavior knees bent, to minimize alleviate pain. when in a flexed
 Pain scale 8/10 abdominal discomfort. position.

VS taken as follows:
Deep breathing and The patient
 BP: 120/80 Teach and encourage deep relaxation techniques demonstrated
 CR: 78bpm breathing exercises and can help decrease correct deep
 RR: 19bpm relaxation techniques to muscle tension and breathing
manage pain and reduce promote relaxation, techniques and
 T: 36.1
anxiety. potentially reducing reported feeling
 Wt.: 60kg
pain perception. more relaxed.

No adverse effects
Monitor for any adverse effects Ensures patient safety
of pain
of pain medications, such as and allows for timely
medications were
respiratory depression, intervention if side
noted during
sedation, or nausea. effects occur.
monitoring.
Info were gathered from google sites