APPENDECTOMY - APPENDECTOMY An inflamed appendix may be...

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APPENDECTOMY An inflamed appendix may be removed using a laparoscopic approach with laser. However, the presence of multiple adhesions, retroperitoneal positioning of the appendix, or the likelihood of rupture necessitates an open (traditional) procedure. Studies indicate that laparoscopic appendectomy results in significantly less postoperative pain, earlier resumption of solid foods, a shorter hospital stay, lower wound infection rate, and a faster return to normal activities than open appendectomy. CARE SETTING Although many of the interventions included here are appropriate for the short-stay patient, this plan of care addresses the traditional appendectomy care provided on a surgical unit. RELATED CONCERNS Peritonitis Psychosocial aspects of care Surgical intervention Patient Assessment Database (Preoperative) ACTIVITY/REST May report: Malaise CIRCULATION May exhibit: Tachycardia ELIMINATION May report: Constipation of recent onset Diarrhea (occasional) May exhibit: Abdominal distension, tenderness/rebound tenderness, rigidity Decreased or absent bowel sounds FOOD/FLUID May report: Anorexia Nausea/vomiting PAIN/DISCOMFORT May report: Abdominal pain around the epigastrium and umbilicus, which may have an insidious onset and become increasingly severe; pain may localize at McBurney’s point (halfway between umbilicus and crest of right ileum) and be aggravated by walking, sneezing, coughing, or deep respiration. Increasingly severe, generalized pain or the sudden cessation of severe pain (suggests perforation or infarction of the appendix). Varied reports of pain/vague symptoms (due to location of appendix [e.g., retrocecally or next to ureter] or due to onset of peritonitis) May exhibit: Guarding behavior; lying on side or back with knees flexed; increased right lower quadrant (RLQ) pain with extension of right leg/upright position Rebound tenderness on left side (suggests peritoneal inflammation) RESPIRATION May exhibit: Tachypnea; shallow respirations SAFETY May exhibit: Fever (usually low-grade)
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TEACHING/LEARNING May report: History of other conditions associated with abdominal pain, e.g., acute pyelitis, ureteral stone, acute salpingitis, regional ileitis May occur at any age Discharge plan DRG projected mean length of inpatient stay: 4.2 days/short stay: 24 hours considerations: May need brief assistance with transportation, homemaker tasks Refer to section at end of plan for postdischarge considerations. DIAGNOSTIC STUDIES WBC: Leukocytosis above 12,000/mm 3 , neutrophil count often elevated to greater than 75%. Abdominal x-rays:
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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APPENDECTOMY - APPENDECTOMY An inflamed appendix may be...

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