Nanda Books

Appendicitis Preoperative Care

1. Preoperative preparation in the treatment room

1. Observation

Within 8-12 hours after onset of complaints, signs and symptoms of appendicitis are often unclear. In this state close observation is necessary. Patients were asked to complete bed rest and fasting. Laxatives should not be given when suspected appendicitis or other forms of peritonitis. Abdominal and rectal examination and blood tests (leukocyte count and type) repeated periodically. X-ray of the abdomen and thorax erect performed to look for other possible complications. In most cases, the diagnosis is established denagn localized pain in the lower right area within 12 hours after onset of complaints.

2. Intubation if necessary

3. Antibiotics

4. Shave the area of ​​operation

Shaving the area of ​​operation is intended to prevent infection in surgery because the area is not shaved hair can be a hiding place for germs and also interfere / hinder the process of healing and wound care. Nevertheless there are certain conditions that do not require shearing before oprasi, for example in wound incision in the patient's arm.



2. Radiological examination and laboratory

1. Radiological examinations, such as: Photo thoracic, abdominal, bone photo (fracture area), USG (ultrasonography), CT scan (computerized tomography scan), MRI (Magnetic Resonance Imaging), BNO-IVP, Renogram, Cystoscopy, Mammography, CIL (Colon in the Loop), EKG / ECG (Electrocardiography), ECHO, EEG (Electroencephalography), etc..

2. Laboratory examinations, such as the examination of blood: hemoglobin, leukocyte count, lymphocyte count, erythrocyte sedimentation rate, platelet count, total protein (albumin and globulin), electrolytes (potassium, sodium, and chloride), clotting time, bleeding time, urea, creatinine, BUN , etc.. Can also be done on bone marrow examination if the disease associated with blood disorders.

Examination of Blood Sugar Levels
Examination of Blood Sugar Levels conducted to determine whether the patient's role in blood sugar levels normal range or not. Blood Sugar Testing is usually done by fasting 10 hours (fasting at 10 pm, and blood drawn at 8 am) and also examined Blood Sugar Levels 2 hour PP (post-prandial).


3. Mental and psychological preparation

Mental preparation is important in the process of preparation for the surgery, because of mental patients who are not ready or unstable can affect his physical condition.

Surgery is a potential or actual threat to a person of integrity who could evoke physiological and psychological stress reactions (Barbara C. Long)

Examples of physiological changes that arise due to anxiety / fear, among others:

1. Patients with a history of hypertension when experiencing anxiety before surgery can lead to patients difficult to sleep and blood pressure will be increased so that the operation can be canceled.
2. Female patients who are anxious about the operation to menstruate earlier than usual, so that the operation had to be postponed. Everyone has a different view in the face of the operating experience that will give a different response, but the real fear and anxiety experienced by each person is always in the face of surgery.

Various reasons can cause fear / anxiety patients face surgery include:

• Fear of pain after surgery
• Fear of physical changes, be ugly and not functioning normally (body image)
• Fear of malignancy (when the diagnosis is established is uncertain)
• Fear / anxiety experienced by people dama conditions that havethe same disease.
• Fear / horror facing the operating room, surgical equipment and personnel.
• Scared to death while sedated / unconscious again.
• Fear of the operation fails.

Fear and anxiety that may be experienced by patients can be detected by the physical changes such as:

• Increased pulse rate and respiration
• Hand movements uncontrolled
• Palms were moist
• Restless
• Asks the same question over and over again
• Difficulty sleeping
• Frequent urination.

Nurses need to assess the coping mechanisms used by the patient in the face of stress. Besides, the nurse should assess the things that could be used to assist patients in dealing with fear and anxiety, such as the nearest person, the level of the patient's progress, the supporting factors / support system.

To reduce and cope with anxiety patients, nurses can ask anything related to the preparation of the operation, such as:

• Experience previous operation
• Understanding the patient about the purpose / reason for surgery
• Knowledge of patients about physical preparation and support operations.
• Knowledge of the patient about the situation / condition of the operating room and operating room personnel.
• Knowledge of the patient about the procedure (pre, intra, post surgery)
• Knowledge of exercises to do before surgery and should
• After running operations, such as deep breathing exercises, effective cough, ROM, etc..

Inadequate mental preparation can affect the decision making of patients and their families. So it is not uncommon that patients refuse surgery previously approved and patients usually go home without surgery and a few days later came back to the hospital After feel ready and this has, to delay the operation should have been done a few days / weeks ago. Therefore, the patient's mental preparation becomes important to be noticed and supported by the family / significant other patients.

Mental preparation can be done with the help of family and caregivers. The presence and involvement of the family is very supportive patient mental preparation. Families only need to accompany the patient prior to surgery, providing patients with the prayers and support words reassuring patients and confirm the patient's decision to undergo surgery.

The role of nurses in providing mental support can be done in various ways:

1. Helping patients to know about the actions experienced by patients before surgery, to provide information to patients about the time of surgery, the things that will be experienced by the patient during the operation, showing where operating rooms, etc.. By knowing the various information during the operation it is expected that patients becoming better prepared for the operation, though there are families who do not want the patient to know about various matters related to the operation that will be experienced by the patient.

2. Giving an explanation before any operations preparatory action in accordance with the level of development. Use clear and simple language. For example: if the patient must be fasting, the nurse will explain when to start fasting and until when, useful for what, and if the blood is taken, the patient should be given an explanation of the purpose of blood tests done, etc.. Expected by providing complete information, the anxiety experienced by patients will be lowered and mentally prepare patients well.

3. Provide opportunities for patients and their families to inquire about any procedures. And provide opportunities for patients and families to pray together before patient transfer to the operating room.

4. Correcting saah understanding about surgery and other things because of misconceptions will cause anxiety in patients.

5. Collaboration with physicians associated with the provision of pre-medication drugs, such as valium and diazepam tablets before bed to decrease patient anxiety and sleep so that patients can rest needs are met.