SESSION 6:

APPENDICITIS
DIVERTICULAR DISEASES

P1W1 - NUR 149/150

Learning Outcomes:
At the end of the module, students will be able to:
1. Describe Appendicitis and recognize different Diverticular
Diseases, and identify risk factors and causes
2. Discuss the pathophysiologic responses to
alterations/problems in Appendicitis and Diverticular
Diseases
3. Assess the clientʼs oneʼs health status/competence.
4. Formulate with the client a plan of care to address needs
/problems and based on priority
Learning Outcomes:
At the end of the module, students will be able to:

5. Apply the nursing process as a framework for care of the

patient with Appendicitis and Diverticular Diseases
6. Identify strategies aimed at preventing and treating
Appendicitis and Diverticular Diseases (Health teaching)
7. Evaluate with the client the health status/competence and
/or expected outcomes of the nurse –client working
relationship.
Anatomy
Where is your appendix located?
A. Inferior end of the cecum
B. Anterior end of the cecum
C. Behind the cecum
Where is your
appendix located?
A. Inferior end of the
cecum

Located at the
posteromedial wall of the
cecum
Anatomy
True or False:

Appendix is an immunologic organ

Anatomy
True
Appendix is an immunologic organ
- Secretes immunoglobulin A
Anatomy

What is the function of appendix?

Anatomy

What is the function of appendix?

- Secretes immunoglobulin A
- Reservoir to recolonize colon
with healthy bacteria
Which best describes Appendicitis?
A. Inflammation of the appendix
B. Caused by obstruction of the appendiceal
lumen
C. Its prime symptom is periumbilical or
diffuse pain
D. Most common cause is ingestion of seeds
Appendicitis
Inflammation of appendix
caused by obstruction of
the appendiceal lumen

Most common acute

surgical abdomen
(risk is higher in males)
Enumerate the possible
causes of Appendicitis.
 Enumerate the possible causes of Appendicitis.

● Fecalith - most common cause

● Obstruction of the lumen
● Hypertrophy of the lymphoid tissue
● Vegetable and fruit seeds
● Intestinal worms (ascariasis)
Who are at risk for developing
Appendicitis?
 Who are at risk for developing
Appendicitis?

● Occurs between the ages of 10 and 30 years

● Higher incidence in males
● Has familial predisposition
Pathophysiology
Pathophysiology
Risk Factors: 10 -30 yo, Male, with family
history, infection by ascariasis, constipation

Appendix becomes kinked Lymphoid hyperplasia

or occluded by fecalith, 2 inflammation or
foreign bodies, tumors infection
 Proximal obstruction of
appendiceal lumen

Produces a closed-loop
obstruction with continuing
normal secretion of appendix

Vague
Distention of appendiceal lumen periumbilical
pain
 Increased distention, Nausea and
vomiting
Rapid multiplication of bacteria Visceral pain
increases

Increase appendiceal lumen

pressure

Engorgement and vascular

congestion
 Inflammatory process now
Leukocytosis Shift in pain to
>18,000 cells/mm3 involves serosa of the appendix the right lower
Increased CRP and parietal peritoneum quadrant
Pt moves slowly,
prefer to lie
supine

Impairment of blood supply

Compromised mucosal integrity

Urinalysis Further bacterial invasion

 Tenderness at infarcts/ischemia develops in
McBurney’s point
Guarding at right the antimesenteric border
iliac fossa
+ Rovsing sign
+Psoas sign
+Obturator sign

CT scan / Appendicitis Diarrhea

Constipation
Ultrasound
Pregnancy test

Gangrene /
Perforation
Let’s Review

What is the main etiologic

factor of Appendicitis?
Let’s Review

What is the main etiologic

factor of Appendicitis?
Obstruction of the lumen due to fecaliths or
hypertrophy of lymphoid tissue
Let’s Review

Where is McBurney’s point

located?
Let’s Review

Where is McBurney’s point

located?
The point over the right side of the abdomen
that is one-third of the distance from the
anterior superior iliac spine to the umbilicus
(navel).
Let’s Review

What is Rovsing sign?

Let’s Review

What is Rovsing sign?

pain in the right lower quadrant when the left

lower quadrant is palpated
How do you illicit Obturator sign
and Psoas sign?
How do you illicit Obturator sign
and Psoas sign?
Obturator Sign Psoas sign
Pain on passive internal rotation of Pain on passive extension of the
the hip when the right knee is right thigh. It is present when the
flexed. inflamed appendix is retrocecal and
overlying the right psoas muscle.
Diagnostic Tests
CBC Leukocytosis >18,000 cellls/mm3

CRP Increased - strong indicator of appendicitis

especially for complicated appendicitis
Urinalysis & To r/o urinary tract infection and ectopic
Pregnancy test pregnancy
CT scan or Used to confirm diagnosis
ultrasound
What is the treatment of
Appendicitis?
What is the treatment of
Appendicitis?

Appendectomy
(Open or Laparotomy)
Nursing Diagnosis
1. Acute pain related to obstructed appendix
2. Risk for fluid volume deficit related to preoperative vomiting
and postoperative status (NPO)
3. Risk for infection related to ruptured appendix
Acute pain related obstructed appendix

Assessment Goal Nursing Intervention

Subjective Data: To reduce - Place patient in high fowler's

pain position
Verbalization of pain - Educate on the use of incentive
with pain scale spirometer and encouraged to
use it at least every 2 hours
Objective Data: while awake
- Administer opioids as per
Facial grimace doctor’s order
Increases HR
Risk for deficient fluid volume related to preoperative
vomiting and postoperative restrictions
Assessment Goal Nursing Intervention

Subjective Data: To replace - Infuse IV fluids as per

fluid loss doctor’s order
Nausea and - Auscultate for bowel
promote sounds and ask the patient
Objective Data: adequate for passing of flatus
renal - Monitor urine output
Vomiting function
NPO status
ACTIVITY TIME: NCP MAKING
GROUP ACTIVITY:

1. Group yourself into five (5).

2. Each member of the group must participate in the activity.
3. Everyone in the group will do brainstorming.
4. Fill in the missing data with the nursing diagnosis provided.
5. I will draw lots and choose 1 group, to present their NCP to the
class.
Risk for infection related to ruptured appendix

Assessment Goal Nursing Intervention

Subjective Data:

Objective Data:
MEDICAL SURGICAL Nursing NSG Diagnosis Nursing
MNGT MNGT Assessment Interventions

IV FLUIDS Appendectomy Assess the level of Acute pain related to IV infusion.

pain. obstructed appendix.

Antibiotic therapy Laparotomy and Assess relevant Risk for deficient fluid Antibiotic
laparoscopy laboratory findings. volume related to therapy
preoperative
vomiting, Positioning
postoperative
restrictions.

Drainage Assess patient’s vital Risk for infection Oral fluids

signs in preparation for related to ruptured
surgery. appendix.
Diverticular Disease
What is Diverticular Disease?
What is Diverticular Disease?
Diverticular disease (diverticulosis and
diverticulitis) is a group of conditions associated
with diverticula (bulging pouches) in the colon.
Diverticulosis is the presence of multiple
pouches in the colon and is often asymptomatic.
 Differentiate a True
diverticula vs a Pseudo -
diverticula
Differentiate a True diverticula vs a
Pseudo - diverticula

True Diverticula Pseudo - diverticula

Herniations of all layers of Only involve the mucosa
the GI wall (mucosa, and submucosa
muscularis propria,
adventitia)
 What is the difference
between Diverticulosis and
DIverticulitis?
 What is the difference between
Diverticulosis and Diverticulitis?
Diverticulosis Diverticulitis

Presence of multiple Inflammation of one or

diverticula without more diverticula and is a
inflammation or common reason for
symptoms elective colectomy
Who are at risk for developing
Diverticular Disease?
Who are at risk for developing
Diverticular Disease?
● Low intake of dietary fiber
● Diet high in red meat, fat, refined
sugar
● Slow colonic transit
● Obesity
● History of cigarette smoking
● Regular use of NSAIDs
● Positive family history
Instructions:
1. Group yourself into 5, 10 members each
2. Brainstorm about the pathophysiology of
Diverticulosis (assignment)
3. Decide on who will present in front of the class
4. Group to present will be determined by draw
lots
Diagnostic Tests
Colonoscopy Visualization of the extent of diverticular dse

CBC Elevated WBC

Urinalysis Analyzed in patients with suspected

colovesicular fistulas
CT scan Diagnostic test of choice to confirm
diverticulitis
Abdominal Demonstrate free air under the diaphragm if a
x-rays perforation has occured from the diverticulitis
Treatment of Acute, uncomplicated
● Rest
● Oral fluids - clear liquid *Hospitalization is often
diet indicated for those who are
● HIgh-fiber, low-fat diet older, immunocompromised,
● Analgesic medications taking corticosteroids, or
● Selective antibiotics unable to tolerate oral fluids
Treatment of Acute, complicated
● Withholding oral intake
● Administering IV fluids *Hospitalization is often
● Instituting nasogastric suctioning indicated for those who
if vomiting or distention occurs - are older,
to rest bowel immunocompromised,
● Broad-spectrum antibiotics taking corticosteroids, or
● Analgesics unable to tolerate oral
fluids
Surgical
Treatment
Use the mnemonic HIGH FIBER to remember key nursing
interventions for a patient with diverticular disease:
● Help your patient by assessing the problem, recording and reporting signs and
symptoms, monitoring progress, administering necessary medications, and teaching

your patient about necessary lifestyle and diet changes.

● Increase patient comfort and rest.

● Get relief and/or diminish discomfort for your patient.

● Handle patient anxiety with psychological support.

● Encourage Fluid intake.

● Instruct your patient about the disease and the benefits of a high-fiber diet and
proper nutrition.
● Be proactive in all treatment procedures, including follow-up.

● Evaluate patient progress and look for evidence of no abnormalities.

● Record and report signs and symptoms.

ACTIVITY TIME: NCP MAKING
GROUP ACTIVITY:

1. Group yourself into five (5).

2. Each member of the group must participate in the activity.
3. Everyone in the group will do brainstorming.
4. Fill in the missing data with the nursing diagnosis provided.
5. I will draw lots and choose 1 group, to present their NCP to the
class.
Nursing Care Plans for Diverticulosis and Diverticulitis

1. Acute Pain r/t bowel inflammation

2. Imbalanced Nutrition: Less than body requirements r/t loss
of appetite
3. Ineffective tissue perfusion r/t blockage of diverticula
NCP Answers on next slides..
Acute Pain r/t bowel inflammation

Assessment Goal Nursing Intervention

Subjective Data: Patient will verbalize a significant - Assess pain characteristics,

reduction of pain as evidenced by intensity and location
Reports abdominal pain/tenderness stable vital signs and absence of - Provide a clear liquid or soft
restlessness and guarding behavior. diet as indicated
- Encourage bed rest
Objective Data: - Provide nonpharmacological
pain relief such as music
Diaphoresis therapy, imagery and
Facial grimacing relaxation
Guarding behavior - Administer medications as
Positioning to ease pain needed
- Prepare patient for surgical
intervention as indicated
Imbalanced Nutrition: Less than body requirements r/t loss of
appetite, inability to absorb nutrients due to inflammatory
response
Assessment Goal Nursing Intervention

Subjective Data: Patient will maintain an - Assess the patientʼs nutritional habits
average weight and - Assess barriers to acquiring adequate
Reports poor appetite identify food choices nutrition
appropriate for - Provide parenteral nutrition as indicated
diverticulitis - Administer antiemetics and pain
Objective Data: medications as indicated
- Identify food preferences
Difficulty swallowing - Educate pt about proper nutrition
Insufficient dietary intake - Consider fiber supplements
Inadequate fluid intake
Inadequate knowledge of
nutrient requirements
Ineffective tissue perfusion r/t
blockage of diverticula

Assessment Goal Nursing Intervention

Subjective Data Patient will not experience severe - Assess pts elimination patterns
abdominal pain or swelling and bowel sounds
Reports of abdominal pain Patient will remain free from - Closely monitor signs and
gastrointestinal tissue perfusion symptoms
Objective Data complications like intestinal - Administer antibiotics,
perforation, obstruction, and analgesics and IV fluids
Abdominal tenderness peritonitis -Educate on bowel rest
Abdominal cramping -Prepare for surgery
Constipation
Decreased bowel sounds