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 planning and management for patients who underwent appendectomy includes: preventing complications, promoting comfort, and providing information.
Risk for Deficient Fluid Volume
Risk for Deficient Fluid Volume: At risk for decreased intravascular, interstitial, and intracellular fluid.
Risk factors may include
- Preoperative vomiting, postoperative restrictions (e.g., NPO)
- Hypermetabolic state (e.g., fever, healing process)
- Inflammation of peritoneum with sequestration of fluid
- Hydration (NOC)
- Maintain adequate fluid balance as evidenced by moist mucous membranes, good skin turgor, stable vital signs, and individually adequate urinary output.
|Monitor BP and pulse.||Variations help identify fluctuating intravascular volumes|
|Inspect mucous membranes; assess skin turgor and capillary refill.||Indicators of adequacy of peripheral circulation and cellular hydration.|
|Monitor I&O; note urine color and concentration, specific gravity.||Decreasing output of concentrated urine with increasing specific gravity suggests dehydration and need for increased fluids.|
|Auscultate and document bowel sounds. Note passing of flatus, bowel movement.||Indicators of return of peristalsis, readiness to begin oral intake. Note: This may not occur in the hospital if patient has had a laparoscopic procedure and been discharged in less than 24 hr.|
|Provide clear liquids in small amounts when oral intake is resumed, and progress diet as tolerated.||Reduces risk of gastric irritation and vomiting to minimize fluid loss.|
|Give frequent mouth care with special attention to protection of the lips.||Dehydration results in drying and painful cracking of the lips and mouth.|
|Maintain gastric and intestinal suction, as indicated.||An NG tube may be inserted preoperatively and maintained in immediate postoperative phase to decompress the bowel, promote intestinal rest, prevent vomiting.|
|Administer IV fluids and electrolytes.||The peritoneum reacts to irritation and infection by producing large amounts of intestinal fluid, possibly reducing the circulating blood volume, resulting in dehydration and relative electrolyte imbalances.|
|Never administer cathartics or enemas.||Cathartics and enemas may rupture the appendix.|
|Give the patient nothing by mouth, and administer analgesics judiciously.||This may mask symptoms.|
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Gastrointestinal Care Plans
Care plans covering the disorders of the gastrointestinal and digestive system:
- Appendectomy | 4 Care Plans
- Cholecystectomy | 12 Care Plans
- Cholecystitis and Cholelithiasis | 4 Care Plans
- Gastroenteritis | 4 Care Plans
- Hemorrhoids | 3 Care Plans
- Hepatitis | 7 Care Plans
- Ileostomy & Colostomy | 10 Care Plans
- Inflammatory Bowel Disease | 7 Care Plans
- Intussusception | 3 Care Plans
- Liver Cirrhosis | 8 Care Plans
- Pancreatitis | 8+ Care Plans
- Peritonitis | 6 Care Plans
- Peptic Ulcer Disease | 5 Care Plans
- Subtotal Gastrectomy | 2 Care Plans