A. Definiton
Acute appendicitis is the most common cause of acute inflammation in the lower right quadrant abdominal cavity, the most common cause for emergency abdominal surgery.
Appendicitis is a condition where the infection occurs in the appendix. In mild cases may recover without treatment, but many cases require laparotomy with removal of an infected appendix. If untreated, the mortality rate is high, due to peritonitis and shock when the infected appendix is destroyed.
Appendicitis is an inflammation caused by infection of the appendix. This infection can cause pus. If the infection gets worse, the appendix can rupture. Usu clogged intestinal tract is clogged and the protruding ends of the lower colon or cecum. Appendix about the little hand size and is located in the lower right abdomen. Other structure such as the intestine,. However, many of which always contain mucus glands.
B. Etiology
The occurrence of acute appendicitis is usually caused by bacterial infection. However, there are many factors trigger the disease. Among obstruction that occurs in the lumen of the appendix. Obstruction in the lumen of the appendix is usually caused due to an accumulation of hard stools, hyperplasia of lymphoid tissue, worm disease, a foreign object in the body, the primary cancer and stricture. However, the most frequent cause obstruction of the lumen of the appendix is fecalith and hyperplasia of lymphoid tissue.
C. Pathophysiology
Appendix inflamed and edematous as a result of the possibility of bent or clogged by fecalith or foreign objects. Inflammatory process increased intraluminal pressure, causing upper abdominal pain or severe spread progressively, be some hours in localized in the lower right quadrant of the abdomen. Finally, the appendix becomes inflamed pus.
D. Clinical Manifestations
Appendicitis has a unique combination of symptoms, which include: nausea, vomiting and severe pain in the lower right abdomen. Pain may be sudden starts in the upper abdomen or around the navel, then nausea and vomiting. After several hours, the nausea disappeared and the pain shifts to the lower right abdomen. If the doctor presses on this area, the patient felt a dull pain and if the pressure is released, the pain may increase sharply. Fever could reach 37.8 to 38.8 oC.
In infants and children, the pain was comprehensive, in all parts of the stomach. On parents and pregnant women, the pain is not too heavy and dulling of pain in this area is not too pronounced. If the appendix ruptures, pain and fever can be severe. Worsening of infections can cause shock.
Nursing Management of Appendicitis Pre Surgery and Post-Surgery
Pre Surgery
- Installation of nasogastric tube to decompress.
- Catheters to control urine production.
- Rehydration.
- Giving antibiotics with broad-spectrum, high doses given intravenously.
- Medicines for fever.
- If fever, must be lowered before anesthesia.
- Appendectomy.
- Appendix removed, if the appendix is perforated freely, then the abdomen was washed with physiological saline and antibiotics.
- Appendix abscess treated with IV antibiotics, its mass may shrink, or abscess may require drainage within a period of several days. Appendectomy performed elective surgery if the abscess is done after 6 weeks to 3 months.
- Observation of vital signs.
- Lift the nasogastric tube, if the patient had been aware of that aspiration of gastric fluid can be prevented.
- Put the patient in a semi-Fowler position.
- Patients are said to be good when in the last 12 hours without any disturbance, while the patient fasted.
- When the surgery is greater, for example on the perforation, fasting was continued until bowel function returned to normal.
- Give the drink began to 15ml / h for 4-5 hours and then raised it to 30 ml / hour. The next day strain and give food the next day given soft foods.
- One day after surgery patients are encouraged to sit up in bed for 2 × 30 minutes.
- On the second day the patient can stand and sit outside the room.
- Day-to-7 stitches can be removed and the patient allowed to go home.
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