Primary Postoperative Nursing Diagnosis

Risk for infection related to the surgical incision

OUTCOMES. Immune status; Knowledge: Infection control; Risk control; Risk detection; Tissue integrity: Skin; Nutritional status

INTERVENTIONS. Infection control; Infection protection; Medication prescribing; Surveillance; Wound care; Nutritional management; Fluid/electrolyte management


SURGICAL. An appendectomy (surgical removal of the appendix) is the preferred method of management for acute appendicitis if the inflammation is localized. An open appendectomy is completed with a transverse right lower quadrant incision, usually at the McBurney point. A laparoscopic appendectomy may be used in females of childbearing age, those in whom the diagnosis is in question, and for obese patients. If the appendix has ruptured and there is evidence of peritonitis or an abscess, conservative treatment consisting of antibiotics and intravenous (IV) fluids is given 6 to 8 hours prior to an appendectomy. Generally, an appendectomy is performed within 24 to 48 hours after the onset of symptoms under either general or spinal anesthesia. Preoperative management includes IV hydration, antipyretics, antibiotics, and, after definitive diagnosis, analgesics.

POSTOPERATIVE. Postoperatively, patient recovery from an appendectomy is usually uncomplicated, with hospital discharge in 24 to 48 hours (sometimes sooner depending on the technique). The development of peritonitis complicates recovery, and hospitalization may extend 5 to 7 days. The physician generally orders oral fluids and diet as tolerated within 24 to 48 hours after surgery.

Prescribed pain medications are given by the intravenous or intramuscular routes until the patient can take them orally. Antibiotics may continue postoperatively as a prophylactic measure. Ambulation is started the day of surgery or the first postoperative day.



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