Removing the appendix is the gold standard treatment for appendicitis. An appendectomy is surgical removal of the appendix.
Antibiotics are often given preoperatively to help prevent infection before and after the surgery. Antibiotic treatment kills bacteria and stronger and longer courses of antibiotics are required if peritonitis occurs. Uncomplicated appendicitis may be treated with antibiotics alone in cases of nonperforated appendicitis, if surgery is contraindicated or if the patient wishes to avoid it for other reasons. However, appendectomy is still widely used and encouraged.
IV fluids are given to maintain fluid and electrolyte balance. Additionally, patients should be kept on NPO status as the stomach should be empty prior to surgery.
The use of enemas or laxatives are dangerous as the resulting peristalsis may cause perforation of the appendix.
Placing the patient in semi-Fowler’s, especially if there is an infection, is an important intervention. Semi-Fowler’s is a position where the patient is supine with the head of the bed at a 30-45 degree angle with the knees straight or slightly bent. This allows for the infection to localize in the peritoneum and not ascend to the lungs, heart, etc. This position is preferred, as high-Fowler's may not be tolerated by patients.
An NG tube is placed until GI motility returns. Be sure to assess bowel sounds.
The diet is advanced as tolerated.
Pain management is an important intervention not only to keep the patient comfortable, but to promote early ambulation, which decreases the risk of developing complications and aids in recovery time. Analgesics are commonly used to manage pain.
Ambulation should begin the day of surgery or the first postoperative day. Encouragement of early ambulation decreases the risk of possible postoperative complications and aids in recovery time.
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