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20 Cards in this Set

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The most common acute inflammatory bowel problems are?
appendicitis
peritonitis
gastroenteritis
What is appendicitis?
right lower quadrant...
acute inflammation of the vermiform appendix - the blind pouch attached to cecum of colon that is usually located in the right iliac region, just below the ileocecal valve

peak age 20 to 30
men and women equally
if in elderly, usually due
to perforation
How does appendicitis occur?
lumen obstructed...inflammation leads to infection due to bacteria invading wall...blocks lumen..mucosa continues to secrete fluid until pressure within lumen exceeds venous pressure....blood flow restricted...more swelling...further impedes flow
What can set in within 24 to 36 hours and is due to hypoxia and perforation?
gangrene...and if it occurs slowly, adjacent organs may wall off area, causing localized abscess
If the infectious process of appendicitis occurs rapidly, what else might develop?
peritonitis
What might cause appendicitis?
calculi composed of fecal
material, calcium phosphate
rich mucus, and inorganic
salts
tumors
viral infections
worms
ucleration of mucosa
if elderly, usually due to
perforation due to delay
in diagnosis because
pain and tenderness not
that apparent
The most common symptom is?
abdominal pain resulting from contractions of appendix or distention of its lumen
The initial symptom is pain in the?
epigastric or periumbilical area..may not be localized and can exist anywhere in abdomen or flanks...described as mild or cramping
What symptoms follow pain in the abdomen at least 50 to 60% of the time?
nausea and vomiting
Where does pain shift after being in the epigastric area?
right lower quadrant or McBurney's point

if different, then usually because appendix is in a slightly different location
What might suggest that the appendicitis is caused by perforation?
abdominal pain that increases with cough or movement and is relieved by flexion of right hip or knees

anorexia
What might the patient's temperature read?
normal or slightly elevated at 99 to 100.5F...if higher, than might be peritonitis...as temp rises, pulse rate rises
Don't confuse appendicitis with gastroenteritis. Appendicitis is _________ _______, then ________ Gastroenteritis is ________,
then _______ ________
abdominal pain, then n & v

n & v, then abdominal pain
WBC count may be up 10,000 to 18,000, but lab findings don't establish the diagnosis. Greater than 20,000 may indicate a _______
appendix. If prolonged symptoms, then _______ ______
or ____ ______ may be diagnostic.
perforated
barium enema
CT scan
What is the nonsurgical management of appendicitis?
keep NPO for possible surgery
IV fluids
keep patient in semi-Fowlers
position if possible to
keep drainage in lower
abdomen
schedule surgery and give
opioid analgesics
DON'T give laxatives or
enemas...may perforate
appendix
Surgical management includes?
laparoscopy
laparotomy
There's not much preop teaching because?
client is in pain and it's usually an emergency
The operative procedure is done by?
removing appendix through an incision about 3 inches long in RLQ...usually via laparoscopy
What is postop care for appendectomy?
assess drain if one inserted
NG tube may have been placed
opioid analgesics may have
been prescribed
patient may be discharge
same day as surgery
return to usual activities
within 1 to 2 weeks
if open surgery, then resume
activities in 2 to 4 wks
peritonitis case may require
week-long hospitalization
Why might an NG tube be inserted in a peritonitis case?
to decompress stomach and prevent abdominal distention