{
  "name": "Appendectomy",
  "slug": "appendectomy",
  "url": "https://nursingplex.com/care-plans/appendectomy",
  "category": "Surgery & Perioperative",
  "summary": "Post-appendix removal care with focus on pain, peritonitis signs and early ambulation.",
  "nursing_diagnoses": [
    "Acute pain",
    "Risk for infection",
    "Deficient fluid volume"
  ],
  "overview": [
    "An appendectomy is the surgical removal of the vermiform appendix, most commonly performed emergently for acute appendicitis to prevent progression to perforation, peritonitis and sepsis. The procedure may be done laparoscopically, which is now the preferred approach in uncomplicated cases, or through an open incision when the appendix has already ruptured or when laparoscopic access is not feasible.",
    "Preoperative nursing care centers on rapid recognition of appendicitis — periumbilical pain migrating to the right lower quadrant, rebound tenderness, low-grade fever and anorexia — and on avoiding actions that could worsen an inflamed appendix, such as administering laxatives or applying heat to the abdomen, both of which risk perforation. Once perforation is suspected, the timeline compresses further, since peritonitis and septic shock can develop quickly.",
    "Postoperative care differs depending on whether the appendix was removed intact or after rupture. Uncomplicated laparoscopic appendectomy often allows rapid recovery and same-day or next-day discharge, while a ruptured appendix with peritonitis requires extended antibiotic therapy, wound and drain care, and vigilant monitoring for intra-abdominal abscess or sepsis."
  ],
  "key_facts": [
    {
      "label": "Classic pain pattern",
      "text": "Pain begins periumbilically and migrates to McBurney's point in the right lower quadrant."
    },
    {
      "label": "Never do",
      "text": "Do not apply heat to the abdomen or give laxatives/enemas if appendicitis is suspected — both can precipitate perforation."
    },
    {
      "label": "Sudden pain relief warning",
      "text": "A sudden decrease in pain before surgery may indicate perforation, not improvement, and should be reported immediately."
    },
    {
      "label": "Rebound tenderness",
      "text": "Pain that is worse when pressure is released than when applied (Blumberg's sign) suggests peritoneal irritation."
    },
    {
      "label": "Postoperative course",
      "text": "Uncomplicated laparoscopic cases recover quickly; a ruptured appendix requires extended IV antibiotics and monitoring for abscess."
    }
  ],
  "nursing_priorities": [
    "Recognize appendicitis symptoms promptly and avoid interventions that could cause perforation.",
    "Monitor for signs of perforation and developing peritonitis preoperatively.",
    "Manage acute pain safely without masking a worsening surgical abdomen.",
    "Provide thorough preoperative preparation for emergency surgery.",
    "Monitor postoperatively for bleeding, infection and return of bowel function.",
    "Detect and manage complications such as abscess or peritonitis after a ruptured appendix.",
    "Prepare the patient for a safe, timely discharge with clear wound care instructions."
  ],
  "assessment": {
    "subjective": [
      "Abdominal pain that began near the umbilicus and moved to the right lower quadrant",
      "Loss of appetite (anorexia), often an early and consistent symptom",
      "Nausea, occasional vomiting",
      "Pain that worsens with movement, coughing or walking",
      "Low-grade fever or feeling generally unwell",
      "Sudden report of pain relief, which may indicate perforation rather than resolution"
    ],
    "objective": [
      "Tenderness at McBurney's point in the right lower quadrant",
      "Rebound tenderness and guarding on abdominal palpation",
      "Low-grade fever, higher fever suggesting possible perforation",
      "Elevated white blood cell count",
      "Positive psoas or obturator sign on examination",
      "Abdominal rigidity, distention or absent bowel sounds with peritonitis",
      "Tachycardia and hypotension with progression toward septic shock"
    ],
    "related_factors": [
      "Obstruction of the appendiceal lumen by fecalith, lymphoid hyperplasia or, rarely, tumor",
      "Bacterial overgrowth and inflammation within the obstructed appendix",
      "Increased intraluminal pressure compromising blood supply, leading to ischemia and potential perforation",
      "Delayed diagnosis or treatment allowing progression to rupture and peritonitis",
      "Surgical incision as a portal for postoperative infection"
    ]
  },
  "goals": [
    "The client will have appendicitis recognized and treated before perforation occurs when possible.",
    "The client will report acceptable pain control before and after surgery.",
    "The client will maintain stable vital signs without signs of peritonitis or sepsis.",
    "The client will demonstrate return of normal bowel sounds and function postoperatively.",
    "The client will exhibit a clean, healing surgical incision without infection.",
    "The client will verbalize understanding of postoperative activity limits and wound care before discharge."
  ],
  "interventions": [
    {
      "title": "1. Preoperative assessment and safety",
      "points": [
        "Assess and document the pain pattern, location and any migration carefully, since the classic progression strongly supports the diagnosis.",
        "Avoid administering laxatives, enemas or applying heat to the abdomen, all of which can increase the risk of appendiceal rupture.",
        "Monitor for a sudden decrease in pain, which paradoxically may indicate perforation as pressure is released rather than true improvement, and report it immediately.",
        "Keep the patient NPO in anticipation of emergency surgery.",
        "Monitor vital signs and white blood cell trends for evidence of worsening infection or developing peritonitis."
      ]
    },
    {
      "title": "2. Pain management",
      "points": [
        "Administer prescribed analgesics for comfort while continuing to reassess the abdominal exam, since adequate pain control does not preclude close monitoring for deterioration.",
        "Position the patient in a comfortable position, often with the right hip and knee flexed, to reduce tension on the abdominal wall.",
        "Provide antiemetics as ordered for associated nausea, which also contributes to discomfort.",
        "Reassess pain regularly using a consistent scale to track trends over time."
      ]
    },
    {
      "title": "3. Postoperative monitoring",
      "points": [
        "Monitor vital signs, incision site and dressing for bleeding or drainage per facility protocol.",
        "Assess bowel sounds and monitor for the return of flatus or bowel movement, indicating resolving postoperative ileus.",
        "Encourage early ambulation as tolerated to promote circulation, reduce ileus and prevent respiratory complications.",
        "Monitor temperature and white blood cell counts, especially after a ruptured appendix, watching for signs of intra-abdominal abscess.",
        "Manage any surgical drains carefully, documenting output characteristics and volume."
      ]
    },
    {
      "title": "4. Preventing and detecting complications",
      "points": [
        "Assess for signs of peritonitis — rigid, board-like abdomen, high fever, tachycardia and hypotension — which require immediate escalation.",
        "Administer prescribed IV antibiotics on schedule, especially for a ruptured or perforated appendix requiring extended coverage.",
        "Monitor for wound infection, including redness, warmth, swelling or purulent drainage at the incision site.",
        "Watch for signs of paralytic ileus or bowel obstruction, such as persistent nausea, absent bowel sounds and abdominal distention."
      ]
    },
    {
      "title": "5. Discharge preparation",
      "points": [
        "Teach proper incision care, including keeping the site clean and dry and recognizing signs of infection.",
        "Review activity restrictions, typically avoiding heavy lifting and strenuous activity for several weeks, particularly after open surgery.",
        "Reinforce the full course of any prescribed oral antibiotics if ordered at discharge.",
        "Provide clear instructions on when to seek follow-up care versus emergency evaluation."
      ]
    }
  ],
  "patient_teaching": [
    "Avoid heavy lifting and strenuous exercise for the period recommended by your surgeon to allow proper healing.",
    "Keep the incision clean and dry, and watch for redness, warmth, swelling or drainage that could indicate infection.",
    "Take any prescribed antibiotics for the full course, even if you feel better before finishing them.",
    "Report fever, worsening abdominal pain, persistent vomiting or inability to pass gas or stool promptly.",
    "Gradually resume normal activity and diet as tolerated, starting with light foods before returning to a regular diet.",
    "Attend your follow-up appointment so the surgeon can assess healing and remove sutures or staples if needed.",
    "Know that with a ruptured appendix, recovery may take longer and may include a more extended course of antibiotics — follow all instructions closely."
  ]
}