Question

Pediatric nursing NCLEX

Appendicitis in pediatric population

1. What is appendicitis? What is pathophysiology?

2. What are the major clinical manifestations and what to look for as a nurse?

3. What are the nursing management and surgical management? What are the post operative care?

4. What are the major nursing diagnosis for appendicitis in pediatric population?

5. During abdominal assessment, what to look out for as a nurse?

6. What are the sequence of signs and symptoms of appendicitis?

Answer 1

1.

appendicitis is the inflammation of vermiform appendix( - citis = inflammation)

pathophysiology

due to viral infection and dehydration or fecalith, the appendix may obstruct as a result of lymphoid hyperplasia of submucosal follicles. so the organism trapped begin to multiply and appendix becomes distended. due to increased intraluminal pressure venous drainage become obstructed and as a result, appendix becomes congested and ischemic. The inflamed appendix due to infection and ischemia progress to necrosis and gangrene and then perforates. it takes only 72 hrs from necrosis to perforation.

after perforation, inflamed fluid and bacteria released into the peritoneal cavity and causes peritonitis.

2.

major clinical manifestation

• abdominal pain (Mc Burney point-right lower quadrant)
• anorexia
• nausea
• rebound tenderness

nurse should look for:

• fever
• abdominal distention
• paralytic ileus(if ruptured)

3.

nursing management

assessment

• collect history(pain, nausea or vomiting)
• check for anorexia or urge to pass flatus
• on palpation, check for rebound tenderness on the abdomen.
• pain on right lower quadrant
• check baseline temperature
• presence of bowel sounds

planning

• provide emotional support
• maintain fluid and electrolyte balance
• maintain semi-fowlers position( localize infection in the lower abdominal cavity in case of rupture)

Surgical management

• maintain fluid and electrolyte balance(replace fluid loss, adequate renal function)
• take consent from patient's parents
• administer antibiotics to prevent infection
• do not administer enema(lead to perforation)

postoperative management

• maintain high Fowler's position ( reduces tension on the incision and abdominal organs, to reduce pain).
• assess for fever, chills and diaphoresis
• when tolerated, oral fluids are administered.
• after bowel sounds heard oral foods provided
• administer antibiotics
• check for further complications

nursing diagnosis

• Acute pain related to perforated appendix secondary to inflammation as evidenced by abdominal tenderness
• imbalanced nutrition related to pain secondary to ruptured appendix as evidenced by nausea or vomiting.