appendectomy case study
Dr. Khalid AL-Mugheed
Appendectomy is the surgical removal of the
vermiform appendix, a small, finger-shaped projection
in the lower right abdomen at the juncture of the large
and small intestines.
The appendix, which protrudes from a section of the
large intestine(cecum), generally has been considered
an unessential organ that is removable without
significant loss of body function.
Surgical Removal
Surgical Removal of the appendix is the only
treatment for appendicitis. Without it, the appendix
can rupture, spilling infectious material into the
bloodstream and abdomen, which can be life-
threatening.
Client Profile
Mrs. Bennett is a 63-year-old woman with a history of
malabsorption related to gastric hemorrhage .
She is 5 foot 6 inches tall and weighs 100 pounds.
She arrives in the emergency department from a nursing
home with an elevated temperature and a decreased blood
pressure and heart rate from her baseline.
Her oxygen saturation is 89% on room air.
patient J.L.D is 31 year-old married woman who was
admitted at the Surgery Department last June 21, 2020 due
to severe pain at her right lower quadrant, the patient was
diagnosed with acute appendicitis.
the patient underwent emergency Appendectomy
NURSING DIAGNOSIS:
Acute pain related to obstructed appendix.
Risk for deficient fluid volume related to
preoperative vomiting, postoperative restrictions.
Risk for infection related to ruptured appendix.
Planning & Goals
Relieving pain.
Preventing fluid volume deficit.
Reducing anxiety.
Eliminating infection due to the potential or actual
disruption of the GI tract.
Maintaining skin integrity.
Attaining optimal nutrition.
Nursing Interventions
The nurse prepares the patient for surgery.
IV infusion. An IV infusion is made to replace fluid loss
and promote adequate renal functioning.
Antibiotic therapy. Antibiotic therapy is given to prevent
infection.
Positioning. After the surgery, the nurse places the patient
on a High-fowler’s position to reduce the tension on the
incision and abdominal organs, thereby reducing pain.
Oral fluids. When tolerated, oral fluids could be
administered.
Evaluation
Relieved pain.
Prevented fluid volume deficit.
Reduced anxiety.
Eliminated infection due to the potential or actual
disruption of the GI tract.
Maintained skin integrity.
Attained optimal nutrition.
Discharge and Home Care Guidelines
Removal of sutures. The nurse instructs the patient
to make an appointment with the surgeon to remove
the sutures between the 5th and 7th days after surgery.
Activities. Heavy lifting is to be avoided
postoperatively; however, normal activity can be
resumed within 2 to 4 weeks.
Home care. A home care nurse may be needed to
assist with incision care and to monitor the patient for
complications and wound healing.
A positive Rovsing’s sign is indicative of
appendicitis. The nurse knows to assess for this
indicator by palpating the:
A. Right lower quadrant.
B. Left lower quadrant.
C. Right upper quadrant.
D. Left upper quadrant.
During assessment, the nurse is looking for
positive indicators of appendicitis, which include
all of the following except:
A. A low-grade fever.
B. Abdominal tenderness on palpation.
C. Thrombocytopenia.
D. Vomiting.
On physical examination, the nurse should be
looking for tenderness on palpation at
McBurney’s point, which is located at the:
A. Left lower quadrant.
B. Left upper quadrant.
C. Right lower quadrant.
D. Right upper quadrant.
Preparation for an appendectomy includes:
A. An intravenous infusion.
B. Prophylactic antibiotic therapy.
C. Salicylates to lower an elevated temperature.
D. All of the above.
Any questions?
