Gastrointestinal System Disorders Q 118

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A nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis. The client is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment, the nurse notes that the abdomen is distended and the bowel sounds are diminished. Which of the following is the most appropriate nursing intervention?

  

    A. Administer dilaudid.

    B. Notify the physician.

    C. Call and ask the operating room team to perform the surgery as soon as possible.

    D. Reposition the client and apply a heating pad in a warm setting to the client’s abdomen.

    

    

Correct Answer: B. Notify the physician

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Based on the signs and symptoms presented in the question, the nurse should suspect peritonitis and should notify the physician. If left untreated, appendicitis can lead to abscess formation with the development of an enterocutaneous fistula. Diffuse peritonitis and sepsis can also develop, which may progress to significant morbidity and possible death.

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Option A: Administering pain medication is not an appropriate intervention. While in the emergency department, the patient must be kept NPO and hydrated intravenously with crystalloid. Antibiotics should be administered intravenously as per the surgeon. The responsibility for the consent falls on the surgeon.

Option C: Scheduling surgical time is not within the scope of nursing practice, although the physician probably would perform the surgery earlier than the pre-scheduled time. The gold-standard treatment for acute appendicitis is to perform an appendectomy. Laparoscopic appendectomy is preferred over the open approach. Most uncomplicated appendectomies are performed laparoscopically.

Option D: Heat should never be applied to the abdomen of a client with suspected appendicitis. Complications of appendicitis and appendectomy include surgical site infections, intra-abdominal abscess formation (3% to 4% in open appendectomy and 9% to 24% in laparoscopic appendectomy), prolonged ileus, enterocutaneous fistula, and small bowel obstruction.

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