Appendicitis | Nursing Diagnosis, Care Plan, and More

According to a 2021 study, abdominal pain is the most common gastrointestinal symptom that brings patients to ambulatory clinics in the U.S. It's critical that nurses understand this condition's complexity to assess it thoroughly. Although abdominal pain can indicate a less critical condition like indigestion or constipation, it can signal something more serious—like an inflamed appendix. 

Appendicitis, which involves acute inflammation of the appendix, affects roughly 8.6% of men and 6.7% of women globally. Thus, healthcare professionals, like nurses and doctors, need to recognize and treat appendicitis appropriately by creating tailored care plans for each patient. 

This guide will assist you in developing a nursing diagnosis, care plan, and other relevant information for patients with appendicitis.

Diagnosis of Appendicitis

Appendicitis is a serious medical condition characterized by inflammation of the appendix – a narrow, finger-like pouch near the colon. Without immediate surgical removal of the appendix, it can rupture and lead to severe complications like an abscess or peritonitis.

Nurses must understand the condition's pathophysiology to perform a though nursing assessment. Several symptoms of appendicitis must be identified to assist the provider in making an accurate diagnosis. These symptoms include:

• Periumbilical pain that travels to the lower-right quadrant of the abdomen
• Severe pain in the right lower quadrant of the abdomen upon palpation (known as McBurney's point)
• Fever 
• Malaise
• Constipation or diarrhea
• Abdominal bloating
• Urinary frequency or urgency 
• Nausea and vomiting
• Fecaliths - hardening of feces in varying sizes seen on X-ray 
• Feelings of urgency and frequency of the need to urinate
• Flatulence
• Loss of appetite 

As symptoms progress, patients may experience the following:

• Distention in the abdomen
• Rigid abdomen 
• Increased pain with movement or coughing 
• Pain exacerbated by palpitation 
• Abdominal rebound

When a patient presents to an acute care setting with abdominal pain, it is critical to diagnose appendicitis quickly to ensure patient safety. Delay in diagnosis can increase the risk of appendix rupture, which occurs in about 2% of cases within 36 hours and rises by 5% every 12 hours if symptoms are left untreated. 

In cases where a diagnosis is inconclusive based on physical examination and symptoms, a healthcare provider may order imaging tests to identify signs of inflammation of the appendix or fecaliths that could indicate appendicitis.

Assessment

In almost all cases, appendicitis requires prompt medical attention and surgical intervention. A thorough nursing assessment is critical in identifying signs of appendicitis and getting prompt treatment when a patient presents with abdominal pain.

A nursing assessment should include the following:

Physical Exam and History: Perform a thorough head-to-toe assessment and obtain a history from the patient about their symptoms. The nursing assessment should include assessing for the following:

• Loss of appetite
• Nausea/vomiting
• Characteristics of the abdominal pain, including signs of abdominal distention, rebound tenderness, periumbilical pain, and McBurney's point pain
• Fever
• Chills
• Constipation or diarrhea
• Difficulty passing gas
• Reports of generalized malaise
• Reports of urinary urgency or frequency
• Risk factors such as age between 10 and 30 and a family history of appendicitis

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Determine Vital Abnormalities: Check for common vital abnormalities associated with appendicitis, such as tachycardia, diaphoresis, and fever. Listen for unusual bowel sounds.

Assess Pain: Determine the location of the patient's pain, note its significant characteristics, determine its severity, and track it over time. Increasing pain may suggest appendicitis and the need for surgery.

Conduct Blood Test and Urinalysis: Look for an elevated white blood cell count and any other abnormal lab values. Labs can also be used to rule out the presence of kidney stones or a urinary tract infection. However, it's important to note that pyuria, hematuria, and proteinuria are common in appendicitis.

Imaging: Imaging may reveal abdominal inflammation and fecaliths, both signs of appendicitis. Common imaging used to diagnose appendicitis include:

• X-rays to rule out other reasons for the abdominal pain
• Ultrasound to evaluate the right lower quadrant pain
• Barium enema to evaluate changes or abnormalities of the colon
• CT scan or MRI (depending on the patient's other conditions) to inspect the size and other characteristics of the appendix

At-Risk Populations

Appendicitis can affect people of all ages, but some populations and subgroups are more susceptible to the condition than others. Consider the list of at-risk populations below when conducting your nursing assessment:

1. Pediatric patients as young as ten and young adults patients up to 30
2. Patients with cystic fibrosis
3. Patients with periumbilical injuries
4. Patients with pre-existing inflammatory bowel disease and digestive tract infections
5. Post-op patients with surgical incisions near the appendix

Although this list represents the most at-risk populations, anyone can experience appendicitis, so each patient presenting with acute or chronic onset of abdominal pain should be assessed thoroughly.

Treatments

There are various medical treatments available for appendicitis, including:

Appendectomy: This is the surgical removal of the appendix and is the most common course of treatment. There are two types of appendectomies:

• Open appendectomy (Laparotomy): This is an open surgery where the surgeon creates an incision of 5-10 centimeters to remove the appendix and clean the area.
• Laparoscopic appendectomy: This minimally invasive surgery uses several small incisions on the abdomen and a video camera to remove the appendix.

Abscess Drainage: If the appendix ruptures, the doctor may need to drain the abdomen before surgery. This procedure typically takes two weeks and involves antibiotic therapy.

Complications

Appendicitis carries a primary risk of rupture, with 2% of patients experiencing it within 36 hours if symptoms are left untreated. The risk of rupture significantly increases after that, making it necessary for the patient to receive an appendectomy as soon as possible. 

The most common complications of appendicitis are:

• Perforation of the appendix
• Peritonitis
• Abdominal Abscess
• Death

While not having an appendectomy will cause complications, it's critical to note that the surgery does come with minor risks. The most common complications of appendectomy include:

• Wound infection
• Bleeding
• Peritonitis, if the appendix ruptures during surgery
• Injury to other abdominal organs
• Ileus

Nurse's Role Caring for Appendicitis

Whether the nurse encounters a patient with appendicitis in an urgent care setting, emergency department, or medical surgical nursing unit, they are crucial to the patient's care. They play a vital role in ensuring patient comfort and safety while maintaining treatment efficacy across all phases of the condition.

In the diagnosis process, nurses provide assessments, help diagnose the condition, and provide relief from pain. During treatment, they manage and treat complications and co-occurring disorders while delivering post-operative care. 

Nurses also work to minimize the risk of complications from appendicitis and appendectomy by carefully managing care plans.

Nursing Protocols for Appendicitis

The care provided by nurses to patients with appendicitis is crucial. During the preoperative phase, nurses are responsible for ensuring that patients maintain NPO status, receive fluids to address dehydration, and monitor them for any changes in pain or signs of rupture of the appendix.

They also help to position the patient comfortably in a right-side-lying position and monitor bowel sounds. Additionally, nurses may administer pain medications and non-pharmacologic pain interventions such as relaxation, positioning, and meditation modalities. Antibiotics may be prescribed and administered orally or through an IV to address the infection.

After the appendectomy, nurses continue to monitor the patient's condition closely. They regularly check the patient's temperature to detect any signs of rupture or infection, access and clean the abdominal incision, manage the patient's diet, and monitor the color, amount, and other characteristics of drainage at the surgical site.

Nursing Care Plans Related to Appendicitis

It's crucial to create nursing care plans that guide the care of the nursing team. It's important to note that the below list is not all-encompassing. Care plans must be individualized to each patient's unique needs.

Here are some of the most common nursing care plans with nursing interventions for patients with appendicitis.

Acute Pain Care Plan

Acute pain is a common symptom experienced by patients with appendicitis. This pain typically originates in the periumbilical area and then spreads to the lower-right quadrant of the abdomen. 

Potentially Related to: 

• Bloating 
• Inflammation
• Infection
• Ruptured appendix

Evidenced By:

• Complaints of abdominal pain 
• Non-verbal demonstration of pain such, as movement, crying, or moaning
• Diaphoresis
• Abdominal rebound pain

Desired Outcomes:

• The patient will report no pain upon discharge.
• The patient will display nonverbal signs of comfort.
• The patient will verbalize understanding of their prescribed treatments and pharmacologic regimens to control pain.

Acute Pain Assessment 

Follow these steps to complete an assessment for acute pain. 

1. Assess the Pain: Begin by assessing the pain in the abdomen. Ask the patient to rate the pain on the 0/10 scale and obtain a thorough history of onset, duration, and characteristics of the pain.
2. Assess Non-Verbal Signs: Look for non-verbal signs of pain such as moaning, grimacing, or guarding. Patients may also appear to be in more discomfort with moving.
3. Palpate the Abdomen: The patient will report tenderness and pain when you palpate the abdomen. During the assessment, they may report rebound tenderness upon removing pressure to the right lower quadrant of the abdomen. The abdomen may appear rigid and distended upon observation.

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Acute Pain Interventions

The most common intervention for acute pain are:

1. Administration of Analgesics: Pain medication, such as opioids or acetaminophen, may help control pain. NSAIDs can help reduce inflammation and mitigate pain.
2. Make the Patient Comfortable: Many patients find lying on their right side or in a semi-fowler position increases comfort. To mitigate pain, offer other non-pharmacologic comfort interventions, such as warm blankets or ice packs. 
3. Offer Distractions: Many patients experience anxiety with severe pain. Offer distractions, such as meditation, relaxation techniques, and a quiet and dimly lit room to ease any anxieties and increase comfort.
4. Maintain NPO: Prevent the patient from eating or drinking to reduce discomfort and risk during surgery. 
5. Instruct on Discharge Medications: Some patients may require pain medication at discharge. Ensure the patient understands the risks and instructions associated with the drugs including when to take it, how to taper off the drug, and signs of complications that should be reported to their physician.

Risk for Infection Care Plan

Infection is a common complication of appendicitis. It can also happen after surgical intervention and may present as a wound infection. As a result, one of the most crucial responsibilities of nursing staff is to assess for any signs of infection.

Use the following care plan to help prevent infections in your appendicitis patients:

Potentially Related to: 

• Appendix rupture 
• Post-operative infections in surgical incisions
• Abscess formation 

Evidenced By:

While tenderness, fever, and inflammation indicate the presence of infection, this care plan is designed to prevent infection and minimize its associated risk.

Desired Outcomes:

• The patient's vital signs and white blood count are within normal range.
• The surgical incision is free of signs of infection, such as drainage, redness, and warmth.
• The patient verbalizes understanding of post-hospital antibiotic regimen.

Risk for Infection Assessment 

Follow the steps to assess for risk of infection:

1. Evaluate Lab Work: Begin by checking for high WBC and CRP levels, which are common in appendicitis patients. If the appendix has ruptured, levels will increase.
2. Request Imaging: You can request a CT scan and other imaging modalities to determine if the patient has appendicitis. An ultrasound may also be performed to determine free-flowing abdominal fluid in the event of a rupture.
3. Check Vital Signs: Signs of an infection may include tachycardia, fever, and hypotension. If infection is left untreated, it can spread throughout the body, causing sepsis.

Risk for Infection Interventions

The following interventions are best for preventing infection:

1. Handwashing: Handwashing is the best preventive measure against infection in healthcare. Wash hands carefully whenever handling the patient or performing tasks.
2. Administer Antibiotics: The patient may receive antibiotics orally or prophylactically before surgery. You may also treat rupture with IV antibiotics.
3. Perform Decolonization: Perform decolonization by carefully washing the skin with antiseptic soap, such as chlorhexidine, and removing any body hair. This procedure helps to decrease the risk of infection. 
4. Instruct on Surgical Care: Before the patient is discharged home, they'll need thorough instructions on wound care, including how to clean the skin and when to change the dressing. You must also educate on the signs of infection to watch for and when to report any abnormalities to the physician.

Risk for Deficient Fluid Volume Care Plan

Use the following care plan to address the risk of deficient fluid volume in patients with appendicitis. This condition can cause a lack of appetite and dehydration in patients.

Potentially Related to: 

• Loss of appetite 
• NPO status 
• Diarrhea and vomiting 
• NPO status 
• Fever
• Healing process
• Inflammation in the abdomen with the build-up of fluid

Evidenced By: 

Although patients may exhibit traditional signs of dehydration, including fatigue and discoloration of urine, this plan aims to prevent the risk of dehydration before symptoms develop.

Desired Outcomes:

• The patient will demonstrate a fluid balance within normal limits, including stable vital signs, adequate urine output, and signs of normal skin hydration, such as moist mucus membranes and normal skin turgor throughout treatment.
• The patient is free of vomiting or diarrhea upon discharge.

Risk for Deficient Fluid Volume Assessment 

Use the following steps to assess the risk of deficient fluid volume:

1. Assess Skin Turgor and Mucous Membranes: Dry membranes and abnormal skin turgor may indicate dehydration.
2. Check Lab Values: Dehydration can manifest as an electrolyte imbalance, so check labs frequently and track them over time to assess for trends.
3. Monitor Fluid Intake to Urinary Output: Compare fluid intake and urinary output each shift. Look for other urinary signs of dehydration, such as dark or concentrated urine with increased specific gravity.
4. Assess intestinal activity by auscultating bowel sounds: Ensure bowel sounds are active before beginning oral intake.

Risk for Deficient Fluid Volume Interventions

Deploy the following interventions for deficient fluid intake:

1. Administer IV Fluids with electrolytes as prescribed: IV fluids are the best way to replace lost fluids. Additionally, if the patient is pre-op with NPO status, they won't be able to drink water.
2. Offer clear liquids as prescribed post-op and advance diet as tolerated: Once bowel sounds are active, clear liquids should be offered, and the diet should be advanced as tolerated to achieve and maintain normal fluid balance.
3. Administer Antiemetics: Because vomiting is a common side effect of appendicitis, you can treat it with antiemetics to prevent nausea and promote fluid retention.
4. Provide oral care: Mucus membranes dry quickly if the patient is unable to take fluids orally. Apply a moisturizer to the lips and offer mouth swabs to keep the oral cavity moist.

Knowledge Deficit Care Plan

Most patients won't fully understand the surgical and medical interventions necessary to treat appendicitis. Use the following care plan to address the potential knowledge deficiencies.

This plan aims to educate patients on the signs and symptoms of appendicitis, post-operative care, and other relevant information related to their condition.

Potentially Related to: 

• Lack of exposure to a friend or family member who has had appendicitis in the past
• Misinformation or misinterpretation of information
• Unfamiliarity with informational resources
• Inability to understand the information presented

Evidenced By:

• Verbalization of concerns
• Questions and requests for information
• Suspicion of the treatment plan
• Statements of misconception 
• Inaccurate follow-through of instructions

Desired Outcomes:

• The patient will participate in the treatment regimen according to the instructions.
• The patent will verbalize understanding and ask any questions they have before discharge.
• The patient will self-advocate throughout the process.
• The patient will verbalize when to contact the physician or other care provider with ongoing questions after discharge.

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Knowledge Deficient Assessment 

Follow these steps to conduct an assessment of possible knowledge deficiency:

1. Inquire: Ask the patient to explain their degree of familiarity with the condition and request any information needed.
2. Assess Non-Verbal Cues: Determine the presence of confusion by assessing body language and facial expressions.

Knowledge Deficit Interventions

Conduct the following interventions to address knowledge deficiency:

1. Explain Procedures: Take the time to explain each treatment step to the patient.
2. Review Post-Operative Instructions: Ensure patients understand their pharmacological regimen and post-op instructions.
3. Encourage Questions: Encourage the patient to ask for clarification when confused. 
4. Use the Teach-Back Method: Use the teach-back method by asking the patient to answer a few questions about the information you provide them about their condition. This ensures they comprehend the information you teach them about appendicitis, appendectomy, medications, and other prescribed treatments.

Anxiety Related to Surgical Procedure Care Plan

Many patients experience anxiety related to impending surgical procedures for acute appendicitis. With the following care plan, you can mitigate the patient's concern and, in doing so, minimize the risk potential.

Potentially Related to: 

• Impending surgical procedure 
• Deficient knowledge 
• Fear of hospitalization, healthcare providers, or other aspects of the visit
• Pain

Evidenced By: 

• Rapid heart rate, tachycardia 
• Excessive sweating 
• Verbalization of fear 
• Crying or non-verbal expressions of fear

Desired Outcomes:

• The patient will freely discuss fears and concerns throughout the process.
• The patient will display regular vital signs.
• The patient will experience no anxiety by discharge.

Anxiety Related to Surgical Procedure Assessment 

Follow the steps below to assess stress related to surgical procedures:

1. Request Verbal Confirmation: Ask the patient to share their fears with you and rate their anxiety on a 0-10 scale.
2. Observe Non-Verbal Signals: Pay attention to the patient's speech patterns and other physiological symptoms of anxiety, such as fidgeting or crying.
3. Conduct Head-to-Assessment: Note any physical signs of anxiety, such as heart palpitations or high blood pressure.
4. Assess Vital Signs: Determine the presence of tachycardia or tachypnea in patients with anxiety.
5. Conduct a Thorough Medical History: Ask the patient about underlying mental health conditions, such as anxiety or depression.

Anxiety Related to Surgical Procedure Interventions

Offer the following interventions to prevent stress related to surgical procedures:

1. Acknowledge the Presence of Anxiety: Begin by addressing and validating the patient's feelings.
2. Administer Medication as Appropriate: You may be able to administer anti-anxiety medication to help the patient manage their anxiety if prescribed.
3. Provide Active Listening and Distractions: Depending on the patient's needs, provide active listening and distract them throughout the procedure.
4. Offer Soothing Coping Mechanisms: Help patients manage anxiety by guiding them through healthy coping mechanisms such as mindfulness and visualization.
5. Allow Family or Friends to Stay with the Patient if Possible: Having a solid support system can help the patient feel safe. Allow loved ones to stay with the patient as much as possible.
6. Request Consults from Mental Healthcare Providers as Needed: If the patient's anxiety isn't reduced by other modalities, consider requesting a consult from a mental healthcare provider who can order treatments as necessary.

Risk for Constipation Care Plan

Patients diagnosed with appendicitis are at a greater risk of experiencing constipation. Use the following care plan to prevent constipation and mitigate the risks linked to infrequent bowel movements.

Potentially Related to: 

• Insufficient fluid intake 
• Irregular eating patterns 
• Abdominal sensitivity 
• Medications like NSAIDs and antibiotics 
• Reduced postoperative intestinal motility

Evidenced By:

Although constipation presents as few bowel movements and hard, dry stools, this care plan aims to prevent constipation before it occurs. 

Desired Outcomes:

• The patient will have regular bowel movements by discharge.
• The patient will understand the treatment plan and post-operative care for constipation symptoms.

Risk for Constipation Assessment 

To assess the risk of constipation, follow the steps below:

1. Assess Abdominal Pain: Although the patient is likely in pain, you can ask for the location, duration, and severity of pain to determine if it is due to constipation.
2. Ask About Bowel Habits: Ask the patient about their bowel movements, including frequency, consistency, and effort to pass stool.
3. Assess Stool Characteristics: If the patient has a bowel movement, be sure to assess the color, consistency, and amount of stool and document it in the chart.

Risk for Constipation Interventions

The following interventions help reduce the symptoms of constipation:

1. Treat Pain and Discomfort: Treat the patient's pain with pain medication if necessary. However, remember that many pain medications can further cause constipation, so assess the risk of constipation before administering pain medications.
2. Administer Stool Softeners: Provide laxatives or softeners to help the patient pass stools.
3. Increase Hydration: Use IV hydration or ask the patient to drink more water if appropriate.
4. Prescribe High-Fiber Diet: Once the patient is cleared, you can prescribe a high-fiber diet to aid constipation.
5. Increase Activity: Have the patient sit up in a chair or take a walk once able to aid in intestinal motility.

Activity Intolerance Care plan

Activity intolerance could arise from fatigue, pain, or anxiety associated with appendicitis treatment. To treat activity intolerance, consider the following care plan.

Potentially Related to:

• Abdominal pain
• Constipation 
• Dehydration
• Post-op fatigue
• General malaise

Evidenced By:

• Expressed desire to remain immobile
• Reports of weakness or fatigue
• Altered physiological response to movement
• Inability to perform specific movements 
• Changes in vital signs with movement

Desired Outcomes:

• The patient will return to regular activities as normal following discharge.
• The patient will display improvement in movement intolerance by discharge.
• The patient will take one walk per shift around the unit while hospitalized without signs of pain or discomfort.

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Activity Intolerance Assessment 

Use the following steps to conduct an activity intolerance assessment:

1. Consult the Patient: Ask the patient to report any instances of activity intolerance.
2. Monitor Vital Signs: Take the patient's resting pulse, blood pressure, and respiratory data. Monitor throughout and after movement or activity.
3. Determine Level of Activity Intolerance: Track the patient's progress across different activities, determine the level of intolerance, and ask the patient to investigate the perceived causes.
4. Assess Hydration and Nutritional Status: Determine the patient's hydration levels to rule out dehydration. 

Activity Intolerance Interventions

Follow these steps to provide interventions for activity intolerance:

1. Establish Goals of Activity with the Patient: Work with the patient to set activity goals each shift.
2. Increase Fluid Intake: Provide IV fluids or urge the patient to drink water if applicable.
3. Provide Emotional Support: Encourage the patient as they attempt movement or activity. 
4. Gradually Increase Activity: Set realistic but progressively larger activity goals.
5. Provide Support: Offer support such as a bedside commode or assistance with ADLs until the patient can safely perform activities alone.

Impaired Skin Integrity Care Plan

In the course of or after treatment for appendicitis, the patient might encounter skin damage caused by surgical incision or excessive fluid accumulation in the abdomen. Follow this care plan to tackle impaired skin integrity.

Potentially Related to: 

• Appendix perforation 
• Surgical incision
• Fluid excess in the abdomen 
• Inflammation 

Evidenced By:

• Tissue damage 
• Surgical incision
• Changes in the appearance of the affected area

Desired Outcomes:

• The patient will maintain intact tissue integrity following discharge.
• The patient will understand post-op care for the surgical incision. 
• The patient will experience reduced pain or no pain by discharge.

Impaired Skin Integrity Assessment 

To conduct a deficient skin integrity assessment, follow the steps below:

1. Perform a Skin Assessment: Perform regular skin checks to determine changes in skin integrity over time. If the patient isn't as active as usual, be sure to check for signs of skin breakdown and assess the surgical site.
2. Assess the Affected Area: Check the surgical site at least every shift and more frequently according to protocols or if the patient has an increase in pain, drainage, or other concerning signs. Assess the length of the incision and ensure the edges are well-approximated. Look for redness, swelling, and drainage. Document the skin assessment per the hospital protocol.
3. Monitor Metrics such as WBCs, albumin, prealbumin, and total protein to determine complications in healing. You can also monitor body temperature for signs of infection.

Impaired Skin Interventions

To improve impaired skin integrity, the following steps can be taken:

1. Change dressings frequently and as per the recommended protocol.
2. Educate the patient on proper wound care and post-operative care, including when and how to change the dressing and what types of changes to report to the physician.
3. Administer fluids to help with a speedy recovery.
4. Monitor the patient's intake to ensure they are eating a healthy diet to promote healing.
5. Teach the patient to turn and reposition at least every two hours. If they are unable to do this on their own, provide assistance.
6. Assist the patient to get out of bed to promote circulation and healing.

More Appendicitis Diagnoses 

The following diagnoses may also co-occur with appendicitis:

• Anorexia 
• Fecaliths 
• Fever
• Lethargy and fatigue 
• Resistance to treatment 
• Agitation 

Appendicitis NCLEX Test Questions

If you plan to take the NCLEX test anytime soon, you might need sample test questions related to appendicitis. Consider the following.

Which of the following complications of appendicitis might happen if the patient doesn't seek treatment within 24-36 hours of symptom onset?

1. Constipation
2. Perforation
3. Peritonitis
4. Seizure

A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the nurse would expect to find rebound tenderness at which location.

1. Left lower quadrant 
2. Left upper quadrant
3. Right upper quadrant
4. Right lower quadrant

A patient presents with a suspected appendicitis. What clinical manifestations do you expect the patient to have?

1. High fever
2. Rebound tenderness
3. Nausea and vomiting
4. Pain relieved by lying on either side

Additional Readings and Resources

Looking for more information about caring for patients with appendicitis? Check out the allnurses resources below:

For further information on appendicitis, refer to the following resources:

• Appendicitis Guide
• Ruptured Appendix Guide

For additional information on care plans and the NCLEX exam, consult:

• An NCLEX Study Guide
• A Guide to Care Plans