Appendectomy is the surgical removal of the appendix. An inflamed appendix (appendicitis) may be removed using a laparoscopic approach with a 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.
Table of Contents
- Nursing Care Plans and Management
- Recommended Resources
- See also
Nursing Care Plans and Management
Nursing care planning and management for patients who underwent appendectomy include: preventing complications, promoting comfort, and providing information.
Nursing Problem Priorities
The following are the nursing priorities for patients with appendectomy:
- Manage postoperative pain effectively.
- Monitor and prevent complications, such as infection or abscess formation.
- Administer appropriate antibiotics perioperatively.
- Promote wound healing and prevent surgical site infections.
- Educate patients on postoperative care and signs of potential complications.
Assess for the following subjective and objective data:
- Reports of pain
- Facial grimacing, muscle guarding; distraction behaviors
- Expressive behavior (restlessness, moaning, crying, vigilance, irritability, sighing)
- Autonomic responses
Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with appendectomy based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.
Goals and expected outcomes may include:
- The client will report pain is relieved/controlled.
- The client will appear relaxed, and able to sleep/rest appropriately.
- The client will demonstrate the use of relaxation skills and diversional activities, as indicated, for individual situations.
Nursing Interventions and Actions
Therapeutic interventions and nursing actions for patients who undergo appendectomy may include:
1. Providing Acute Pain Relief
After an appendectomy, patients experience acute pain due to the surgical incision and manipulation of the abdominal tissues, as well as postoperative inflammation and stretching of the abdominal wall muscles.
Assess pain, noting location, characteristics, and severity (0–10 scale). Investigate and report changes in pain as appropriate.
Useful in monitoring the effectiveness of the medication, and the progression of healing. Changes in characteristics of pain may indicate developing abscess or peritonitis, requiring prompt medical evaluation and intervention.
Watch closely for possible surgical complications.
Continuing pain and fever may signal an abscess.
Provide accurate, honest information to patients and SO.
Being informed about the progress of the situation provides emotional support, helping to decrease anxiety
Keep at rest in a semi-Fowler’s position.
To lessen the pain. Gravity localizes inflammatory exudate into the lower abdomen or pelvis, relieving abdominal tension, which is accentuated by the supine position.
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.
Place an ice bag on the abdomen periodically during the 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.
Administer analgesics as indicated.
Relief of pain facilitates cooperation with other therapeutic interventions (ambulation, pulmonary toilet).
2. Managing Risk for Hypovolemia
A patient who underwent appendectomy may experience hypovolemia due to factors such as decreased oral intake, increased fluid losses from vomiting, diarrhea, wound drainage, and diuresis from pain medication, leading to dehydration and decreased blood volume.
Monitor BP and pulse.
Variations help identify fluctuating intravascular volumes
Inspect mucous membranes; assess skin turgor and capillary refill.
Indicators of the adequacy of peripheral circulation and cellular hydration.
Auscultate and document bowel sounds. Note passing of flatus, and bowel movement.
Indicators of return of peristalsis, readiness to begin oral intake. Note: This may not occur in the hospital if the patient has had a laparoscopic procedure and has been discharged in less than 24 hr.
Provide clear liquids in small amounts when oral intake is resumed, and progress diet as tolerated.
Reduces the risk of gastric irritation and vomiting to minimize fluid loss.
Give frequent mouth care with special attention to the 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 the immediate postoperative phase to decompress the bowel, promote intestinal rest, and 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, and 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.
3. Promoting Infection Control and Management
Inspect incision and dressings. Note characteristics of drainage from the wound (if inserted), and the presence of erythema.
Provides for early detection of developing infectious processes and monitors resolution of preexisting peritonitis.
Monitor vital signs. Note onset of fever, chills, diaphoresis, changes in mentation, and reports of increasing abdominal pain.
Suggestive of the presence of infection or developing sepsis, abscess, or peritonitis.
Obtain drainage specimens if indicated.
Gram stain, culture, and sensitivity testing are useful in identifying causative organisms and choice of therapy.
Administer antibiotics as appropriate.
Antibiotics given before appendectomy are primarily for prophylaxis of wound infection and are not continued postoperatively. Therapeutic antibiotics are administered if the appendix is ruptured or abscessed or peritonitis has developed.
Prepare and assist with incision and drainage (I&D) if indicated.
May be necessary to drain the contents of a localized abscess.
Watch closely for possible surgical complications.
Continuing pain and fever may signal an abscess.
4. Initiating Patient Education and Health Teachings
Identify symptoms requiring medical evaluation (increasing pain; edema or erythema of wound; the presence of drainage, fever).
Prompt intervention reduces the risk of serious complications (delayed wound healing, peritonitis).
Review postoperative activity restrictions (heavy lifting, exercise, sex, sports, driving).
Provides information for the patient to plan for return to usual routines without untoward incidents.
Encourage progressive activities as tolerated with periodic rest periods.
Prevents fatigue, promotes healing and a feeling of well-being, and facilitates the resumption of normal activities.
Discuss care of the incision, including dressing changes, and bathing restrictions, and return to the physician for suture and staple removal.
Understanding promotes cooperation with the therapeutic regimen, enhancing the healing and recovery process.
Encourage the patient to cough, breathe deeply, and turn frequently.
To prevent pulmonary complication
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
More nursing care plans related to gastrointestinal disorders:
- Bowel Incontinence (Fecal Incontinence)
- Diarrhea Nursing Care Plan and Management
- Cholecystitis and Cholelithiasis
- Gastroesophageal Reflux Disease (GERD)
- Ileostomy & Colostomy
- Inflammatory Bowel Disease (IBD)
- Liver Cirrhosis
- Nausea & Vomiting
- Peptic Ulcer Disease
- Subtotal Gastrectomy