Gastrointestinal System Disorders Q 37

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When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?

  

    A. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.

    B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

    C. The appendix may develop gangrene and rupture, especially in a middle-aged client.

    D. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

    

    

Correct Answer: B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.

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A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion.

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Option A: Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. The pathophysiology of appendicitis likely stems from obstruction of the appendiceal orifice. This results in inflammation, localized ischemia, perforation, and the development of a contained abscess or frank perforation with resultant peritonitis.

Option C: Geriatric, not middle-aged, clients are especially susceptible to appendix rupture. Appendicitis occurs most often between the ages of 5 and 45 with a mean age of 28. The incidence is approximately 233/100,000 people. Males have a slightly higher predisposition of developing acute appendicitis compared to females, with a lifetime incidence of 8.6% for men and 6.7 % for women.

Option D: When an obstruction is the cause of appendicitis, it leads to an increase in intraluminal and intramural pressure, resulting in small vessel occlusion and lymphatic stasis. Once obstructed, the appendix fills with mucus and becomes distended, and as lymphatic and vascular compromise advances, the wall of the appendix becomes ischemic and necrotic.

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