4 Appendectomy Nursing Care Plans

July 13, 2013

Appendectomy is the surgical removal of the appendix. 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.

Nursing Care Plans

Nursing care planning and management for patients who underwent appendectomy includes: preventing complications, promoting comfort, and providing information.

Here are four (4) nursing care plans (NCP) for patients who underwent appendectomy:

Acute Pain

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

May be related to

Distension of intestinal tissues by inflammation
Presence of surgical incision

Possibly evidenced by

Reports of pain
Facial grimacing, muscle guarding; distraction behaviors
Expressive behavior (restlessness, moaning, crying, vigilance, irritability, sighing)
Autonomic responses

Desired Outcomes

Report pain is relieved/controlled.
Appear relaxed, able to sleep/rest appropriately.
Demonstrate use of relaxation skills and diversional activities, as indicates, for individual situation.

Nursing Interventions	Rationale
Assess pain, noting location, characteristics, severity (0–10 scale). Investigate and report changes in pain as appropriate.	Useful in monitoring effectiveness of medication, progression of healing. Changes in characteristics of pain may indicate developing abscess or peritonitis, requiring prompt medical evaluation and intervention.
Provide accurate, honest information to patient and SO.	Being informed about progress of situation provides emotional support, helping to decrease anxiety
Keep at rest in semi-Fowler’s position.	To lessen the pain. Gravity localizes inflammatory exudate into lower abdomen or pelvis, relieving abdominal tension, which is accentuated by supine position.
Encourage early ambulation.	Promotes normalization of organ function (stimulates peristalsis and passing of flatus, reducing abdominal discomfort).
Provide diversional activities	Refocuses attention, promotes relaxation, and may enhance coping abilities.
Keep NPO and maintain NG suction initially.	Decreases discomfort of early intestinal peristalsis, gastric irritation and vomiting.
Administer analgesics as indicated.	Relief of pain facilitates cooperation with other therapeutic interventions (ambulation, pulmonary toilet).
Place ice bag on abdomen periodically during initial 24–48 hr, as appropriate.	Soothes and relieves pain through desensitization of nerve endings. Note: Do not use heat, because it may cause tissue congestion.
Never apply heat to the right lower abdomen.	This may cause the appendix to rupture.
Watch closely for possible surgical complications.	Continuing pain and fever may signal an abscess.