Appendicitis is an infection or inflammation of the appendix, a pinky-sized, tube-like structure part of the large intestine. The appendix is located in the right lower section of the abdomen in most children. Show
The appendix is a pinky-sized, tube-like structure located in the right lower section of the abdomen. What causes appendicitis in a child?Appendicitis is the result of a blockage of the appendix caused by hard mucus or stool, or swelling caused by a virus. The blockage causes the appendix to swell and become inflamed. If the swelling and infection are left untreated, the appendix can burst (perforate), causing the contents of the appendix to be released into the abdomen, spreading the infection.
When infected, the appendix becomes swollen and inflamed (pictured on the left). Sometimes, this is caused by a blockage with mucous or hard stool (pictured on the right). Appendicitis is the most common cause of emergency abdominal surgery in children. Though it can happen at any age, appendicitis occurs more frequently in school-aged children, and rarely occurs under the age of 1. Appendicitis symptomsThe signs and symptoms of appendicitis can vary from child to child. The most common symptoms of appendicitis in children are:
Testing and diagnosisAppendicitis is diagnosed with a thorough health history and physical examination. Your child may need to have an imaging study completed, such as an ultrasound, MRI or CT scan, to see the appendix. Your child may also have laboratory studies completed, such as a complete blood count (CBC), to determine the extent of the infection. Appendicitis treatmentsAppendectomy in ChildrenAn appendectomy is the surgical removal of the appendix. It can be performed as a laparoscopic procedure or as an open surgery through a small incision. Immediately following diagnosis, patients with appendicitis will receive antibiotics to treat the infection. Ultimately, the treatment for appendicitis is a surgery to remove the appendix, called an appendectomy. Your child’s surgeon will help determine the best treatment for your child. When to call the doctor after surgeryPlease call us if your child has any of the following after appendicitis surgery:
Appendicitis is considered an emergent condition, requiring immediate attention. If you think that your child may have appendicitis, please have them evaluated at the Emergency Department. Pain assessment in infants and children is also challenging due to the subjectivity and multidimensional nature of pain. The dependence on others to assess pain, limited language, comprehension and perception of pain expressed contextually. In some children it can be difficult to distinguish between pain, anxiety and distress. Assessment and documenting pain is needed in order to improve management of pain. When assessing a child’s level of pain careful consideration needs to be given to their:
Pain measurement quantifies pain intensity and enables the nurse to determine the efficacy of interventions aimed at reducing pain. A pain assessment should be conducted during a patient’s admission. (link to Nursing Assessment nursing clinical guideline) Points to consider:
When to assess pain?
Pain Assessment ToolsTools used for pain assessment at RCH have been selected on their validity, reliability and usability and are recognized by pain specialists to be clinically effective in assessing acute pain. All share a common numeric and recorded as values 0-10 and documented on the clinical observation chart as the 5th vital sign. Three ways of measuring pain:
Pain Assessment Tools used at RCHThere are three main tools used for the neonate, infant and child 3-18 years these tools reflect a combination of self-report and behavioural assessment. 1. FLACC - The acronym FLACC stands for Face,Legs, Activity, Cry and Consolability. Behavioural
How to use FLACCEach category (Face, Legs etc) is scored on a 0-2 scale, which results in a total pain score between 0 and 10. The person assessing the child should observe them briefly and then score each category according to the description supplied.  2. Wong-Baker faces pain scale 3-18yo How to use? 3. Visual Analogue scale 8-years and older Self report How to use? Ask the child using numbers from 0 = no pain through to 10 being the worst pain Physiological indicators
Physiological indicators in isolation cannot be used as a measurement for pain. A tool that incorporates physical, behavioural and self report is preferred when possible. Key considerations
Special ConsiderationsMulti language Wong Baker and Numeric tools are available if needed https://www.briggshealthcare.com/Wong-Baker-Faces-Pain-Rating-Scale-8-Languages Modified PAT Tool is used in the Neonatal Intensive Care Unit http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal_Pain_Assessment/ Comfort B is used for Ventilated paediatric patients assessing both pain and sedation http://www.rch.org.au/picu_intranet/guidelines/Nursing_management_of_the_patient_with_invasive_mechanical_ventilation_in_PICU/ Companion DocumentsFurther information on pain management principles and assessing pain in children can be found here: LinksEducation
Evidence TableThe evidence table for this guideline can be viewed by clicking here. Please remember to read the disclaimer. The development of this nursing guideline was coordinated by Sueann Penrose, CNC, Children's Pain Management Service, and approved by the Nursing Clinical Effectiveness Committee. Updated August 2022. Which action would a nurse take with a patient who is scheduled for an appendectomy and is crying?Which action would be appropriate for a nurse to take with a patient who is scheduled for an appendectomy and is crying? Validate the inference by asking the patient about the crying behavior. Family members bring an unconscious patient to the emergency department.
Which technique best encourage a patient to tell his or her full story?Using open-ended questions encourages the patient to tell his or her story and actively describe his or her health status.
Which actions does the nurse take during the working phase of a patient interview?During the working phase, you will gather data and identify and practice problem-solving skills and coping skills with your patient.
Which patient information is usually included in the biographical information that may be collected by the admitting office staff?The client's birth date, Social Security number, medical record number, or similar identifying data may be included in the biographic data section.
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