ASRAT WOLDEYES HEALTH SCIENCE
CAMPUS
ASRAT WOLDYES HEALTH SCIENCE CAMPUS, SCHOOL OF NURSING
AND MIDWIFERY, DEPARTEMENT OF SURGICAL NURSING
CURRICULUM
NEBAY YILIKAL ..ID:- 1402138 Submitted to:- Bekahegn G(BBSC, MSC)
Insractur Name Nebay Yilikal Date 25/07/2017 E.C
Department BSc. Surgical Year/ Semister 2025/semister 2
Nursing
Module Title Surgical Nursing Module Code SuNu-M 3293
II
Crdit hr. 22 Number of students Male-12 Female-9
Total-22
Topic Acute Appendicitis
General Learning Objective Students will be able to understand, asses, recognize its mgt and provide
appropriate nursing intervention including pri-oprative assessments for a
patient with acute appendicitis who undergo a surgery.
Specific Learning Objectives By the end of this session students will be able to:-
a) Explain the general anatomy and physiology of the appendix.
b) Know the definition, epidemiology risk factor & etiology of acute
appendicitis.
c) Explain its pathophysiology of the disease process of acute appendicitis.
d) Recognize about the typical and atypical clinical manifestation of acute
appendicitis.
e) Perform comprehensive history talking and focused abdominal assessment.
f) Understand its differential & the diagnostic methods used to confirm a
diagnosis of appendicitis.
g) Know about Medical, surgical & nursing management of appendicitis
h) Understand the potential complications of untreated appendicitis.
i) Know what is the role of surgical nurses in peri-operative assessment
2
Lesson plan
Teaching Lecturer Activity Tim Students Activity Assessment Resorces
Phases i n methods
min.
Introduction Give a brief interview of learning objective & brief 2 -Active listening and Talking short Drills -Picture of the appendix
explanation of anatomy, physiology and uses of note location on the
appendix. -Respond to interactive questions PowerPoint
-PPT note
Development Explain the definition, epidemiology, risk factor & 2 -Active listening and Talking short Asking questions Learning materials
etiology of appendicitis. note
-Respond to interactive questions
-Ask any ambiguity in the learning
process
Explain PP, atypical sign & symptoms of acute 2 -Active listening and Talking short Based on Cause PPT
appendicitis note study ask a
-Respond to interactive questions question students
-Ask any ambiguity in the learning
process
Show how to take Hx taking & Perform abdominal 2 -actively listening & follow steps how Drills Steps of Hx taking &
Px examination the lecturer perform those activity Px examination on PPT
-practice & document the findings
Discuss potetial complication 1 Activly listening drills PPT
Explain medical, surgical & nursing management of 2 Brian storming about nursing mgt Randomly asking PPT
appendicitis Active listening & taking note a question
Display on the slide the case senario 2 Answering the +ve & -ve pertinent Ask based on the Case senario
finding from the case scenario
Conclusion / Summarize key points from the session 1 Actively listening Oral quiz Oral questions
summery
Giving teaching material 1 Plus with lecturer material search Give Reference books
other reference books independent
3 reading
OUTLINE
q Objective
q Anatomy and physiology of appendix
q Definition of appendicitis
q Epidemology & risk factors of Appendicitis
q Etiology of Appendicitis
q Pathophysiology of Appendicitis
q Symptoms of Appendicitis
q Clinical Investigations of Appendicitis
q Differential Diagnosis of Appendicitis
q Complications of Appendicitis
q Medical management of Appendicitis
q Surgical managment of Appendicitis
q Peri- oprative nursing intervantion of Appendicitis
OBJECTIVES
q By the end of this session, all of you will be able to:
a) Define appendicitis and describe its risk factors, etiology,
pathophysiology, and clinical presentation.
b) Identify the signs and symptoms of appendicitis.
c) Understand its differential & the diagnostic methods
used to confirm a diagnosis of appendicitis.
d) Explain the management of appendicitis.
e) Discuss the potential complications of untreated
appendicitis.
f) Recognize the importance of prompt diagnosis and
treatment to prevent complications and improve patient
outcomes in appendicitis cases
Anatomy and Physiology of Appendix?
q The appendix is a small, located at the tip of the
cecum portion of the large intestines, usually located in the right lower
quadrant of the abdomen.
q The inner lining of the appendix contains lymphoid tissue, which is a key
component of the immune system.
q The appendix is usually located at the lower right side of the abdomen.
q Blood supply Appendicular artery a branch of the ileo-colic artery
q Venous drainage Appendicular vein drains to the portal vein
q Its nerve supply is autonomic innervation of the appendix arises from the
superior mesenteric plexus
Location of appendix
v The attachment of the appendix to the base of the cecum is constant.
However, the tip may migrate to the retrocecal, subcecal, preileal,
postileal, and pelvic positions
Contd…
¥ Functions of the appendix
q debated
topic.
Today it is accepted that this organ may have
Ø Maintain gut flora: The digestive tract is filled with
"good" bacteria and yeast that help flush out
.
Ø Support the immune defense
Ø Because of this, it is histologically distinct from the
cecum & GIS
Definition Of Appendicitis ?
o Appendicitis is an inflammation of the appendix.
o The appendix is a finger-shaped pouch that sticks out from the
colon on the lower right side of the belly, also called the
abdomen.
o Appendicitis causes pain in the lower right abdomen. However,
in most people, pain begins around the belly button and then
moves
o As the appendix becomes engorged, the visceral afferent nerve
fibers entering the spinal cord at T8-T10 are stimulated, leading
to vague central or periumbilical abdominal pain
EPIDEMIOLOGY
Ø It is the most common acute abdominal inflammatory disorders
Ø Relatively rare in infants, and becomes increasingly common in childhood
and early adult life, reaching a peak incidence in the teens and early 20s.
Rrisk factors
ü About 2% of the population will have appendicitis at some time in their
lives; and teenagers more than adults
ü Age (most common b/n 10 & 30 Years)
ü Sex (M>F) Male to female ratio 2:1 in <25 yrs &1:1 in > 25 yrs
ü Economic status (high & middle social class)
Etiology ?
q Appendicitis may be caused by:
Ø various infections such as:
ü
ü
ü
Ø Traumatic injury
Ø A buildup of hardened stool
Ø Enlarged lymphoid follicles
Ø Tumors
q Inflammatory Conditions
q Genetic Factors
q Dietary factors
q Age and gender
Pathophysiology of Appendicitis?
Clinical Manifistation ?
q Abdominal pain is the most common initial symptom
q It is typically diffuse, periumblical or epigasric &
gnawing in character
q Pain shifts & becomes localized to RLQ (over 4-6 hrs)
q Site of pain may vary with anatomical position of the
appendix
ü Retrocecal - flank or back pain
ü Pelvic appendix - suprapubic pain, etc
ü During pregnancy - flank/ RUQ pain
q Anorexia nearly always occurs (most specific)
q NVD (nausea, vomiting, diarrhea ) & fever
q Perforation of the appendix may result in peritonitis or
localized abscess collection
contd...........
Generally sign and symptoms use this menimonics
v A Abdomenal pain
v P Poor appitite
v P Pain at point of McBurning
v E Elevated tempretur
v N Nousia & vomiting
v D Desire to side lying position side lying
v I Incresed WBC & inability to pass gas
v X eXperiece to rebound tenderness
Assessment and Diagnostic Findings?
q Diagnosis is based on the results of a complete history and
physical examination, laboratory findings, and imaging
studies.
q Complete history using (OLDCATRT)
q Physical Examination findings
q inspaction
q ausclutation
q palpation
q percution
Physical Examination ?
A) Rovsing’s Sign
v Patient will experience right
lower quadrant (RLQ) pain (in
region of McBurney’s Point)
when left lower quadrant
(LLQ) is palpated called +ve
Rovsign’s sign.
Ø Referred rebound tenderness:
right lower quadrant pain on
quick withdrawal of the LLQ
pressure.
Contd…
B) Rebound tenderness
Ø Press deeply on the
Ø abdomen with your hand.
Ø After a moment, quickly
release pressure.
Ø If it hurts more when you
release, the patient has
rebound tenderness.
Contd…
C) Psoas Sign
can be assese in 2 methods
1st; Place your hand just above
the patient’s right knee
Ask the patient to raise that
thigh against your hand (extending
right thigh)
2nd; Ask the patient to turn onto
the left side
Then extend the patient’s right leg
at the hip
Flexion of the leg at the hip makes
the psoas muscle contract;
extension stretches it
Contd…
D) Obturator Sign
Ø Internally rotate right leg at
the hip with the knee at 90
degrees of flexion will
produce pain if inflamed
appendix is in pelvis.
Contd…
E) McBurney's point
Tenderness is described
as maximal tenderness at
1.5 to 2 inches from the
anterior superior iliac
spine (ASIS) on a
straight line from the
ASIS to the umbilicus
(Sensitivity 50 to 94%;
specificity 75 to 86%
Lab & Imaging Investigations ?
q The white blood cell (WBC) count will elveted
q C-reactive protein levels are typically elevated
q A CT scan or ultrasound is used to confirm the diagnosis
q CT scan diagnostic test of choice the most sensetive & spaecific
q ultrasound diagnostic test of choice for pregnant wemon & young chilidren
q A pregnancy test may be ordered for women of childbearing age to rule out
ectopic pregnancy and before radiologic studies are done.
q As an alternative, a transvaginal ultrasound may be used to confirm the diagnosis.
q A urinalysis is usually obtained to rule out urinary tract infection or renal calculi.
Complications ?
q Perforation
q Abscess formation
q Sepsis
q Gangrene
q Bowel obstruction
q Adhesive intestinal obstruction
Medical Management ?
Goal of medical management includes
Ø To treat infections
Ø To prevent further complications
Medication therapy includes
Ø Antibiotics(e.g Cephalosporins)
Ø Anti inflammatory drugs
Ø Analgesics
Ø Fluid Therapy
Surgical Management ?
] The surgical procedure for the removal of the appendix is called
an appendectomy.
] Appendectomy definative tretment can be performed through
open or laparoscopic surgery.
] Laparoscopic appendectomy has several advantages over open
appendectomy as an intervention for acute appendicitis.
] In Ethiopia currently we usually use open appendectomy.
Appendectomy - is the treatment in most cases.
Appendicial mass: conservative treatment with broad
spectrum IV antibiotics
Appendicial abscess: surgical drainage and IV
antibiotics
Peritonitis: laparatomy & peritoneal lavage with
warm saline
PERI-OPRATIvE NURSINg CARE ?
Preoperative Preparation
q Assessment: Informed Consent
q Preparation Instructions
q Psychological Support
q Baseline Vital Signs
q Laboratory Tests
q IV Access
q Preoperative Medications
q Documentation
Intraoperative
q Patient Transfer
q Positioning
q Preparation of Surgical Field
q Assist with Anesthesia
q Monitoring
q Instrumentation and Equipment
q Closure and Dressing Application
Postoperative
q Immediate Postoperative Assessment
q Pain Management
q Fluid Management
q Wound Care
q Mobility and Ambulation
q Nutritional Support
q Medication Management
q Documentation
Case senario
John, a 25-year-old male patient cames from DBT, arrived at DBHGH
& kept the emergency department with the complian of severe
abdominal pain that had started 12 hours earlier. Initially, he
experienced a dull pain around his umblicus, which gradually
migrated to the RLQ side of his abdomen and became more intense.
associated with this, he also reported nausea, vomiting, and a loss of
appetite. on V/S His T°C was (38°C).
On physical examination, John exhibited tenderness at McBurney’s
point, along with guarding and rebound tenderness. A positive
Rovsing’s sign was also noted, indicating peritoneal irritation.
Discussing Questions
Ø tell the finding based on Case senario
Ø what is your mgt? is surgical or/& medical mgt, what are the indication?
Ø what is the prioperative assessment expected from you?
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Summery
EWhat is Appendicitis?
EInflammation of the appendix due to blockage or infection.
ECauses
EBlockage (fecal matter, infection, tumors)
EBacterial overgrowth
ESymptoms
EAbdominal pain (starts near the belly button, moves to lower right) Nausea,
vomiting, fever, loss of appetite
EDiagnosis
EPhysical exam (McBurney’s point tenderness)
EBlood tests (high WBC count)
EImaging (ultrasound, CT scan)
EMgt-appendectomy
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QUIz
ARE YOU READY fOR THE QUIz ?
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Questions
1) What is appendicitis?
2) What are the common cause of acute appendicitis?
3) Write the pathophyilogy of acute appendicitis?
4) Write the mgt of appendicitis?
5) What is your role for a patient who undergo appendectomy?
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REFFERENCE
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5. UpToDate 2025
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