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Med-Surg Exam 3 - N's part Questions with Correct Answers
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Med-Surg Exam 3 - N's part Questions with Correct Answers
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Med-Surg Exam 3 - N's part Questionswith Correct Answers
appendicitis - Answer-acute inflammation of the vermiform appendix (wormlike)
appendicitis is most common in - Answer-children and adolescents (10-30yrs), but can
occur at any age
More common in males
Familial predisposition
acute condition - Answer-a sudden condition requiring immediate treatment
Most common cause of RLQ pain, acute abdomen, and emergency abdominal surgery
in the U.S. - Answer-Appendicitis
Perforation - Answer-hole that completely penetrates a structure
Puncturing
Perforation of the appendix leads to - Answer-peritonitis
Main peritonitis signs - Answer-Temp > 101 °F or 38.3 °C
Perforation is more common in - Answer-Older adults (>30), appendix usually ruptures
and is more serious
- diagnosis is more difficult in older adults because pain & tenderness is decreased,
which delays diagnosis and treatment
Peritonitis leads to what - Answer-Sepsis- septic shock- MODS
Appendicitis is caused bg - Answer-Obstruction, leading to infection because the
bacteria invades the wall of the appendix
Clinical manifestations of appendicitis - Answer-vague periumbilical pain (visceral pain
that is dull and poorly localized) with anorexia descends to RLQ pain - pain more severe
at McBurney's point !!
Pain becomes constant if appendix ruptures !
Nausea
Low grade fever
Tachycardia due to fever, fluid loss, and pain
Muscle guarding
Patient maintains side-lying position with abdominal guarding and legs flexed
Abdominal distention/paralytic ileus/ patients condition worsens
Constipation or diarrhea
Local tenderness my be elicited at McBurney point when pressure is applied
,Rebound tenderness and abdominal rigidity !!
Positive Rovsing sign when palpating LLQ (pt will feel pain in RLQ)
paralytic ileus - Answer-complete absence of peristaltic movement that may follow
abdominal surgery or complete bowel obstruction
McBurney's point - Answer-A point on the right side of the abdomen, about two-thirds of
the distance between the umbilicus and the anterior bony prominence of the hip (iliac
crest)
- late stage of appendicitis
Signs of perforation - Answer-- Increased pain with coughing- relieved with bending of
right hip/knees
- abrupt change in BP/pulse/character of pain
- elevated WBC (leukocytosis) >20,000 with shift to the left
- perforation-peritonitis
- guarding of the abdomen
- increased temp and chills
- pallor
- progressive abdominal distention and abdominal pain
- restlessness, tachycardia, tachypnea
Diagnosing appendicitis - Answer-- Ultrasound will show an enlarged appendix -
confirms
- CT scan is most commonly used diagnostic test
- perform a pregnancy test in women of childbearing age to rule out ectopic pregnancy
(this is done before any radiologic test are performed)
- urinalysis to rule out UTI or renal calculi
- diagnostic laparoscopy- acute appendicitis (allows direct visualization of contents of
abdomen or pelvis)
Gangrene can occur in ________ hours of appendicitis - Answer-24-36
Perforation can occur in as little as ____ hours of appendicitis- risk increases after
_____ hours - Answer-24 hours; 48 hours
6-24 hours after onset of pain
WBC in acute appendicitis - Answer-10,000-20,000 with shift to the left
Normal CRP levels - Answer-<10mg/L
>10= serious infection, trauma, chroric disease
- marker for inflammation
How to know if a patient has rebound tenderness - Answer-Palpate deeply and then
quickly release pressure. If it hurts more when you release, the patient has rebound
tenderness
, What NOT to give a patient with appendicitis - Answer-NO laxatives or enemas- leads
to perforation
NO heat - can cause rupture, which leads to peritonitis
NO analgesics until cause of pain is determined
NO driving while taking opioids due to dizziness
What does it mean if pain suddenly stops in a patient with appendicitis? - Answer-The
appendix just ruptured
N/V before pain means - Answer-Gastroenteritis
N/V after pain means - Answer-Appendicitis
Nursing management for appendicitis - Answer-No heating pads, edemas, or laxatives
Maintain NPO until blood count reports received
No analgesics until cause of pain is determined
Ice bag
Watch for peritonitis
Sudden absence of pain can indicate that the appendix is ruptured
Referred pain indicates peritoneal irritation
Pain can initially be anywhere in abdomen or flank, but always progresses to RLQ
Surgical Management for appendicitis - Answer-appendectomy: 2 types
- laparoscopy: if uncomplicated (minimally invasive surgery)
- laparotomy: if rupture or peritonitis is suspected
Surgery may be delayed if patient has abscess, perforation, or peritonitis because that
has to be dealt with first
Pre-op nursing interventions for an appendectomy - Answer-Maintain NPO
Administer prescribed fluids to prevent dehydration
Monitor for changes in level of pain
Monitor for s/s of ruptured appendix and peritonitis
Position patient in right side-lying or low semi Fowler's position for comfort
Monitor bowel sounds
Apply Ice packs for 20-30 mins every hour
Administer abx
Post-op appendectomy - Answer-- NPO until return of bowel sounds/bowel function
returns
- advance diet gradually as tolerated/prescribed when bowel sound returns
- adequate pain management prior to and after surgery
- if rupture of appendix had occurred- expect a drain to be inserted/incision may be left
open to heal from inside to outside (secondary intention)
- drainage may be profuse for the first 12 hours
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