00:00
So can appendicitis be prevented?
And then how do we treat it?
Nope. Unfortunately,
we can't prevent appendicitis.
00:08
We don't know what causes
it so we can't prevent it.
00:12
But as far as treatment goes,
first, we can do some
nursing interventions
to help patients with appendicitis
you know while they're recovering,
either before surgery or before
their antibiotics start working.
00:25
So one thing that patients
may ask for is a heat pack,
which feels good.
00:29
But we actually
don't want to use this
because there's a chance
that that could actually
cause that appendix
to rupture or perforate.
00:35
These patients will likely be NPO,
or not able to take
anything by mouth.
00:41
And so they will need to
have IV fluids administered
as their source of hydration.
00:47
And then we're going to
treat these patients pain.
00:50
So we can do that,
both with nursing interventions,
like treating them with comfort
measures and with positioning,
and then they also will likely
get medications
as well to help with that pain.
01:06
So for some reason
a patient has pain,
and that pain suddenly goes away,
that's a sign that the
appendix may have ruptured,
and this is when
surgery is indicated.
01:19
Otherwise, these patients
are treated with antibiotics.
01:23
If they're have appendicitis,
and it's caught pretty early,
and they had a nice imaging study
that shows that it looks okay
and not perforated or ruptured,
you can usually just
treat it with antibiotics
and that inflammation will go away
without any surgery involved.
01:42
So let's work through all of that
in like a little flowchart.
01:46
The medical treatment for
appendicitis includes antibiotics.
01:51
We usually start with
intravenous or IV antibiotics.
01:55
Usually we give these to kids
whether or not
they're going into surgeries.
01:58
But if they're going to surgery,
they always get IV antibiotics
just to kind of start
reducing that inflammation.
02:05
If there's no perforation
seen during an operation
or on the scan then no more
antibiotics are needed.
02:14
If for some reason when they go in
and look during surgery,
if that appendix is gangrenous
like it looks infected,
and parts of it are gangrenous
usually means that like
it's getting kind of rotten almost
then the antibiotics
will be continued
after that appendix is removed,
because this infection is
usually starting to spread
at that point
beyond the appendix.
02:41
If a patient is doing well,
either if they got that dose
of IV antibiotics,
they didn't need surgery,
they can actually go home
on oral antibiotics,
or after surgery and they got
a few doses of IV antibiotics
and things were looking better,
they can also go home and finish
a course with oral antibiotics.
03:03
And then lastly,
we want to make sure
that they're able to eat and drink
normally after the surgery
or after they've given those
first few doses of antibiotics.
03:15
Additionally, like with anything,
we want these patients
to start to move around,
which always helps with
the healing process.
03:23
Let's put everything together
now in the clinical judgment model.
03:28
And we'll look at
layers two and three
to form our hypotheses.
03:35
And we'll start by recognizing those
cues are the signs and symptoms.
03:41
Let's review the signs and
symptoms of appendicitis.
03:47
The first is where the pain starts
around the umbilicus
or the belly button.
03:53
It moves to the
right lower quadrant,
and then it spreads
out or is diffused
throughout the whole abdomen.
04:00
The next symptom
that usually happens
is that patients become
listless or irritable.
04:07
So their mental status changes a bit
just because they don't feel well.
04:11
Their appetite has decreased
because they don't want to eat
when their abdomen hurts.
04:17
They develop nausea and
vomiting, and then the fever.
04:21
And remember,
these symptoms are all the same
but in a different order
than if the patient had
viral gastroenteritis.
04:29
And that would be
starting with the fever,
and the nausea and vomiting,
and working backwards.
04:34
So now let's analyze all those
cues or signs and symptoms.
04:38
So we have all the
signs and symptoms,
we think the patient
probably has appendicitis,
but let's actually find out for sure
that they have it.
04:44
So we'll draw the blood labs,
the serum electrolytes
and complete blood count.
04:49
And then we'll start
with trying to image it
with the abdominal ultrasound.
04:54
Then we'll either move
to the CAT scan or MRI.
04:58
If we didn't see the appendix
on the ultrasound, and then lastly,
they'll try to look
at it in surgery.
05:05
The surgeons will,
if we're still not sure.
05:09
Now, let's prioritize
our hypotheses.
05:12
We think our patient
has appendicitis.
05:15
And now we need to take action.
05:18
Our action plan involves by
treating the appendicitis.
05:22
So we're going to do those treatment
plans that we talked about.
05:27
So we're going to avoid
heat on the area
to reduce the chance
of appendix rupture.
05:32
We are going to give those
patients IV fluids as ordered
because they're likely not
going to be eating or drinking,
especially if they
need to have surgery.
05:40
And then we're going to
treat their pain both with
nursing interventions and
with pain medications.
05:48
The patient also may be
treated with surgery,
especially if we have that sudden
decrease in their pain level,
which is a sign of
appendix rupture.
05:58
And then they're all
going to get antibiotics
usually have at least one dose
of IV antibiotics, if not more.
06:05
And then they'll finish
with oral antibiotics
to completely treat
the appendicitis.
06:11
So let's evaluate our
outcomes of those actions.
06:15
And these include an improvement
in the patient's abdominal pain.
06:20
We want their energy level
to be back to normal
and improvement in their
nausea and vomiting.
06:25
We want to make sure that
that fever has gone away,
which is always a good sign that
the infection has gone away.
06:33
And then lastly,
we want to make sure
that they're able to
eat and drink normally.
06:39
So that was our
clinical judgment model.
06:41
And that was our lecture on
a pediatric appendicitis.
06:44
Thank you for listening,
and we'll see you next time.