this ppt will explain the problem of Acute Appendicitis in Children, its etiology, pathophysiology, clinical manifestation, diagnostic evaluation, therapeutic management and nursing consideration.

1. ACUTE APPENDICITIS
MS. ANNA BROWN
SHRI VENKATESHWARA UNIVERSITY
Gajraula. UP

2. Introduction
• Definition- Appendicitis,
inflammation of the vermiform,
appendix is the most common
condition, requiring abdominal
surgery during childhood.
• Although, uncommon in children
younger than two years of age, It is
associated with the increase of
complication and mortality, in this
age-grou.
• Primarily, an acute condition,
appendicitis, rapidly progress to
perforation and peritonitis, if it is
remain undiagnosed.
• It is significant paediatric problem
because early diagnosis is frequently
delayed as the result of the child’s
inability to verbalize symptoms; also
the clinical sign may be mistaken for
other illness.

3. Etiology.
• Exact cause of appendicitis is poorly understood, but it is always a
result of obstruction of lumen, usually, by a fecalith (hard faecal
material ).
• Sometimes a fold of the peritoneum causes the appendix to adhere
to the cecum, resulting in an obstructive kink.
• Other causes include.
• Lymphoid hyperplasia
• Fibrous stenosis from an earlier inflammation.
• Tumour
• Parasites and microorganisms are potential etiological agent.
• Dietary habits may play a role, children with high fibre diet have
lower incidence of appendicitis. Then those whose fibre intake is
low. Fibre increases the bulk and softness of the stool-a factor that
minimize the chances of obstruction and promote evacuation.

4. Clinical manifestation
• Right Lower quadrant
abdominal pain
• fever.
• Rigid abdomen,
• decrease or absent bowel
sounds
• vomiting.
• Constipation or diarrhea may
be present.
• Anorexia
• Tachycardia
• Rapid shallow breathing.
• Pallor
• Lethargy
• Irritability
• Stooped posture.

5. Diagnostic Evaluation
• History and physical examination.
• The total WBC and the percentage of neutrophils are usually
elevated. The WBC is seldom higher than 15,000 to 20,000 per mm3.
• Radiographic studies of the abdomen may reveal possible
contributing causes of appendicitis such as facalith or foreign body.
• The Cardinal feature is initially generalized (usually periumbilical);
however, it is usually descends to the lower right quadrant.
• The most intense site of the may be McBurney point, Located at a
point midway between the anterior superior iliac crest and the
umbilicus.
• Rebound tenderness is not reliable sign, and is extremely painful to
the child
• Referred pain, elicited by light percussion around the perimeter of the
abdominal, Indicate the presence of peritoneal irritation, such as
riding over bumps in an automobile or gurney aggravates the pain.
• In addition to pain, probably most significant clinical manifestations
are a change in behaviours
• anorexia and vomiting
• fever , varying from 37.5 to 38.5o C(99.5 to 101.5o F)
McBurney Point

6. Therapeutic Management
• The definitive treatment of appendicitis
before perforation is surgical removal of
appendix (appendectomy).
• However, fluid and electrolyte imbalance need
to be corrected before surgery since the child
is likely to be dehydrated as a result of marked
anorexia.
• Recovery is rapid, and if no complication
occur, the child is dischareged with 2-3 days.

7. Therapeutic management conti……
• Ruptured Appendix-
• management of the child diagnosed with peritonitis
caused by a ruptured appendix often begin
preoperatively with:
 IV administration of fluid and electrolytes
 systemic antibiotics
 Naso-gastric suction
• Post-operative management- Include
 IV fluid
 continued administration of antibiotics
 Nasogastric suction for abdominal decompression until
intestinal activity returns.
 The child with peritonitis is given antibiotics including
Ampicillin, Gentamicin and clindamycin for 7-10 days.

8. • In some instance, the wound is closed falling irrigation of peritoneal
cavity.
• Many surgeons, however leave the wound open (delayed closure)
to prevent wound infection.
• A Penrose drain may be used to permit transperitoneal drainage.
• When delayed closure is used, wound irrigation and wet-to-dry
dressings are a routine part of post-operative care.
• Prognosis-
• Complication occurs infrequently after a simple, appendectomy,
and recovery is usually rapid and complete.
• The mortality rate from perforating appendicitis has improved from
nearly certain death of one century ago to 1% or less at present.
• Complication, however, do occur they are:
 Wound infection
 Intraabdominal abscess
 The key to reducing complication from appendicitis is the early
recognition of the illness.

9. Nursing Management
• Assessment-
1. Severity of pain
2. Degree of change in behaviour
3. The younger, nonverbal child will assume a rigid,
motionless, side-lying posture with knees flexed
on the abdomen.
4. Decrease range of motion of the right hip.
5. Older children may exhibit all of these behavior
while complaing of abdominal pain. They can
always can indicate the pain location.

10. Nursing care plan
Nursing diagnosis- Pain related to inflammation, inflamed
appendix.
Patient goal-Will experience no pain or reduction of pain to
level acceptable to child.
Nursing intervention.
• Pain assessment.
• Allow position to comfort usually with like flexed because it
may vary among children.
• Provide a small pillow for splinting of abdomen.
• Administer analgesic to provide pain relief.
Expected outcome- child rest, quietly reports and or exhibit
no evidence of discomfort.

11. Nursing diagnosis- High risk for fluid volume deficit
related to decrease intake and losses secondary to loss
of appetite, vomiting
Patient goal- will receive fluid for adequate hydration.
• Nursing intervention/rationals.
• Maintain NPO to minimize losses, through vomiting
and minimize abdominal distension.
• Maintain Integrity of infusion site for intravenous fluid
and electrolytes.
• Administer IV fluid and electrolytes as prescribed
monitor intake and output to assess hydration.
Expected outcomes-
• Child receives sufficient fluids to replace losses.
• Child exhibit, sign of adequate hydration.

12. Nursing diagnosis - High risk for infection related to possibility of rupture.
Patient goal- Will experience minimize risk of infection.
Nursing intervention/rationals-
• Closely monitor Vital sign, especially for increased heart rate and temperature and
Rapid shallow breathing to detect ruptured. Appendix.
• Observe for the signs of peritonitis eg.
 Sudden relief of pain sometimes at times of perforation.
 Followed by increase
 diffuse pain and rigid guarding of the abdomen
 abdominal distension
 Gloating
 belching. (From accumulation of air)
 Pallor
 chills
 a little irritablity
 for appropriate treatment to be initiated.
• Avoid administrating, laxative or enema. Since these measure is stimulate bowel
motility and increase risk of perforation.
• Monitor WBC as indicator of infection.
Expected outcome.
• Child remains free of symptoms of peritonitis
• Sign of peritonitis are recognized early.

13. Post-operative care
RUPTURED APPENDIX.
Nursing diagnosis- High risk for a spread of infection related
to presence of infective organism in abdomen.
Patient goal- Will experience minimize risk of spread of
infection,
Nursing Intervention /rational.
• Provide wound care and dressing changes as prescribed to
prevent infection.
• Monitor Vital sign and WBC to assess presence of infection.
• Administer, antibiotics as prescribed.
Expected outcome.
• Child demonstrates resolution of peritonitis as evidenced
by lack of fever clean wounds normal WBC.

14. Nursing diagnosis- High risk for injury related to absence of
bowel motility.
Patient goal- It will experience abdominal distension vomiting.
Nursing intervention/Rational.
• Maintain NPO in early post-operative period to prevent
abdominal distension and vomiting.
• Maintain nasogastric tube decompression until bowel
motility return.
• Assess abdomen for distension tenderness presence of
bowel sound to assess presence of peritonitis.
• Monitor passage of flatus in a stool as indicator of bowel
motility.
Expected outcome.
• Child does not exhibit sign of discomfort abdomen and
remains soft and not distended.
• Child does not vomit.

15. Nursing diagnosis. Altered family, process related
to illness and hospitalization of child.
Patient / Parent goal- Will receive adequate
support.
Nursing intervention/Rationales.
• Encourage expression of feeling and concerned to
enhance coping
• Encourage child to discuss hospital admission and
treatment in order to clarify misconception.
Expected outcome-
• Child and Family Express feeling and concerns.
• Child and family demonstrate understanding of
hospitalization and treatment.