Appendicitis and Peritonitis on the NCLEX
McBurney's point, rebound tenderness, why no heat or enemas, rupture signs.
The classic surgical abdomen. The trap answers all do the same thing: they rupture the appendix.
Recognizing appendicitis
Pain starts vague and periumbilical, then migrates to the right lower quadrant at McBurney's point (between the umbilicus and the right iliac crest). Rebound tenderness (pain on release of pressure), guarding, low-grade fever, nausea, anorexia, elevated WBCs. Anorexia is nearly universal; a hungry patient argues against appendicitis.
What the nurse never does
No heat on the abdomen: heat increases blood flow and inflammation and can precipitate rupture. No enemas or laxatives: stimulating peristalsis against an inflamed appendix can burst it. Also: NPO (surgery is coming), no repeated deep palpation, and be cautious with analgesia timing per provider so the exam is not masked before diagnosis. Ice packs and position of comfort are allowed.
Rupture and peritonitis
Sudden relief of pain is not recovery. It is rupture: the pressure vents into the peritoneum. What follows is peritonitis: rigid, boardlike abdomen, diffuse pain, distention, high fever, tachycardia, absent bowel sounds, shallow breathing to splint the belly. This is a surgical emergency with sepsis risk.
Treatment and post-op care
Appendicitis: appendectomy, usually laparoscopic, plus IV antibiotics. Peritonitis: NG tube for decompression, aggressive IV fluids, broad antibiotics, surgery to clear the contamination, often with drains. Position post-rupture patients in semi-Fowler's: it localizes drainage in the pelvis and eases breathing. Monitor for sepsis: falling BP, rising pulse, fever, dropping urine output.
Frequently asked
Patient with RLQ pain asks for a heating pad. Why refuse?
Heat raises inflammation and rupture risk. Offer an ice pack and positioning instead.
The pain suddenly stopped an hour ago and now the abdomen is rigid. What happened?
The appendix likely ruptured and peritonitis is developing. Notify the provider immediately; this is an emergency.
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