I. Pathophysiology—Events occur so rapidly that process
takes about 1 to 3 days.
a. Appendix becomes blocked by feces, a foreign object, or
b. Obstruction, along with continued secretion of mucus,
causes the wall of the appendix to become distended.
c. Blood supply to the wall of the appendix is reduced, causing
ischemia and accumulation of toxins.
d. Wall of the appendix starts to break down, and normal bacteria
found in the gut attacks the decaying appendix.
e. Leads to necrosis and perforation of the appendix.
II. Staging—Usually has three stages (Santacroce & Ochoa,
a. Edematous stage
i. Individual may experience spon-taneous recovery from
inflammation at this stage or it may progress.
ii. Peritoneal fold attaching the appendix to the ileum
(mesoappendix) often becomes inflamed.
b. Purulent stage
i. Spontaneous remission rarely occurs.
ii. Can progress to perforation and rupture
iii. Peritonitis possible
c. Gangrenous stage
i. Spontaneous regression never occurs.
ii. Peritonitis present
a. Obstruction of appendix lumen causes it to become vulnerable
to invasion of bacteria normally found in the gut.
b. Peak incidence in individuals in their late teens and early
20s; occurs more commonly in men than in women.
IV. Procedures—Inflamed appendix may be surgically removed
using an open incision or using a laparoscopic approach with
a. Presence of multiple adhesions, retroperitoneal positioning
of the appendix, or the likelihood of rupture necessitates an
open or traditional procedure.
b. Laparoscopic procedure results in significantly less postoperative
pain, lower wound infection rate, and faster return
to normal activities.
a. Morbidity: Approximately 250,000 cases are reported
annually in the United States.
b. Mortality: In 2002, 480 deaths occurred related to diseases
of the appendix in the United States (National Vital
Statistics and Records [NVSR], 2005).
Although many of the interventions included here are appropriate
for the short-stay client, this plan of care addresses the
traditional appendectomy care provided on a surgical unit,
after being diagnosed in the emergency department (ED).
Psychosocial aspects of care
1. Prevent complications.
2. Promote comfort.
3. Provide information about surgical procedure, prognosis,
treatment needs, and potential complications.
1. Complications prevented or minimized.
2. Pain alleviated or controlled.
3. Surgical procedure, prognosis, therapeutic regimen, and
possible complications understood.
4. Plan in place to meet needs after discharge.