Appendicitis Nursing Diagnosis & Care Plan

Appendicitis is the inflammation of the appendix, a small pouch attached to the large intestine in the right lower quadrant of the abdomen. The appendix has shown to have benefits in infants but the function in adults is largely unknown. Research suggests the appendix may help regulate intestinal bacteria.  

If the appendix becomes blocked it will become inflamed and swollen leading to pain, nausea, vomiting, diarrhea, and fever. If not treated promptly, the appendix can burst which is a medical emergency requiring an appendectomy. 

The Nursing Process  

Nurses may treat patients with appendicitis in several phases of their condition from arriving at the emergency department with sudden pain, to caring for them post-operatively, to reviewing their discharge instructions with them once they return home. Nurses must understand how to treat the symptoms and prevent infection and complications that can result from appendicitis. 

Nursing Care Plans Related to Appendicitis 

Acute Pain Care Plan 

Acute pain is an expected finding in appendicitis. Pain may start in the umbilical area and then shift to the right lower quadrant, becoming severe quickly. 

Nursing Diagnosis: Acute Pain

Related to: 

  • Inflammation 
  • Bloating/gas 
  • Ruptured appendix 
  • Infectious process 

As evidenced by: 

  • Complaints of sudden abdominal pain 
  • Guarding of the abdominal area 
  • Restlessness, moaning, crying 
  • Diaphoresis 

Expected Outcomes: 

  • Patient will report a pain score of 0/10 by discharge 
  • Patient will display signs of comfort as evidenced by resting with eyes closed and vital signs within normal limits 
  • Patient will verbalize an understanding of their prescribed pharmacologic regimen to control pain  

Acute Pain Assessment

1. Assess location and characteristics of pain.
Appendicitis pain occurs in the right lower quadrant of the abdomen. The patient will likely complain of sharp pain that started suddenly.

2. Palpate the abdomen.
The patient will likely have tenderness when the abdomen is palpated. Rebound tenderness may occur which is when pain is felt upon removal of pressure to the abdomen rather than application. The abdomen may also appear rigid.

3. Assess nonverbal signs of pain.
The patient will often guard against the pain and may be in the fetal position with their knees drawn up. They will likely grimace or moan when the area over the inflamed appendix is palpated.

Acute Pain Interventions

1. Administer analgesics.
Appendicitis is very painful and patients should be given opioids, Acetaminophen, and NSAIDs to control inflammation.

2. Offer distraction.
Until pain relief occurs or surgery takes place the patient may need distractive measures to refocus their attention and promote relaxation.

3. Keep NPO.
Instruct the patient that not eating or drinking is important to prevent further gastric irritation and vomiting and as a safety measure in preparation for potential surgery.

4. Instruct on medications at discharge.
Some cases of uncomplicated appendicitis may not require surgery. Patients may continue a course of antibiotics and pain relief at discharge. Ensure the patient understands to complete the entire course of antibiotics and to contact their provider if symptoms worsen or do not improve.


Risk For Infection Care Plan 

Appendicitis can become life-threatening if the appendix ruptures causing peritonitis and the leaking of pus into the abdomen. 

Nursing Diagnosis: Risk for Infection

Related to: 

  • Appendix rupture 
  • Abscess formation 
  • Surgical incision infection following appendectomy 

Note: A risk for diagnosis is not evidenced by signs and symptoms as the problem has not occurred. Nursing interventions are directed at prevention. 

Expected Outcomes: 

  • Patient will remain free of infection as evidenced by vital signs and white blood count within expected limits 
  • Patient will display appropriate healing of surgical incision as evidenced by an absence of redness, warmth, or drainage 

Risk For Infection Assessment

1. Monitor lab work.
An elevated WBC and CRP levels are usual findings with appendicitis. In the instance of perforation, these values will be even more elevated.

2. Obtain imaging.
A CT scan is the most common imaging test used to evaluate and diagnose appendicitis. If the appendix has ruptured, this will show as free abdominal fluid on ultrasound and the perforation may be visualized.

3. Assess vital signs.
Signs of worsening infection and sepsis include fever, tachycardia, and hypotension.

Risk For Infection Interventions

1. Administer antibiotics.
Antibiotics are a first-line treatment option for appendicitis. Antibiotics may be given prophylactically prior to surgery. Peritonitis or abscess formation will be treated with IV antibiotics.

2. Perform decolonization.
Before surgery, the nurse will decolonize the patient of bacteria by removing body hair and washing with chlorhexidine or another antiseptic soap. This decreases the risk of infection during surgery.

3. Instruct on surgical site care.
After surgery, the nurse will instruct on how to care for surgical incisions such as when to change the dressings and how to clean the area as well as educating on signs and symptoms of infection and when to notify the provider.

4. Handwashing.
Handwashing is the #1 way to prevent infection. Nurses and healthcare staff should always perform hand hygiene before touching the patient or performing tasks. The patient should also be instructed to wash their hands frequently, especially before and after touching their surgical site.


Risk For Deficient Fluid Volume Care Plan 

Symptoms of appendicitis can place the patient at risk for dehydration. 

Nursing Diagnosis: Deficient Fluid Volume

Related to: 

  • Vomiting 
  • Diarrhea 
  • Loss of appetite 
  • NPO status 

Note: A risk for diagnosis is not evidenced by signs and symptoms as the problem has not occurred. Nursing interventions are directed at prevention. 

Expected Outcomes: 

  • Patient will maintain an adequate fluid balance as evidenced by stable vital signs and adequate urine output 
  • Patient will report an absence of vomiting or diarrhea by discharge 

Risk For Deficient Fluid Volume Assessment

1. Assess skin turgor and mucous membranes.
Severe dehydration manifests as poor skin turgor and dry mucous membranes.

2. Monitor I&O.
Monitor the patient’s IV intake to their urine output. A urinary catheter can make monitoring more accurate.

3. Monitor lab values.
Dehydration is likely to be corrected quickly and without last concerns. The nurse can monitor electrolyte levels and replace as needed.

Risk For Deficient Fluid Volume Interventions

1. Administer IV fluids.
Replacing fluids lost through vomiting or diarrhea will be an initial intervention. The patient may also be prescribed NPO status and will not be able to take in oral fluids.

2. Administer antiemetics.
Nausea and vomiting are common symptoms of appendicitis and also contribute to pain and discomfort along with fluid loss. An antiemetic can prevent further nausea and vomiting.

3. Progress diet as prescribed.
After surgery or once symptoms are controlled, the patient will likely start on a liquid diet and then advance as tolerated to bland foods and then a normal diet. Once cleared to consume liquids, the patient should drink plenty of fluids.


References and Sources

  1. Appendicitis. (n.d.). Johns Hopkins Medicine. Retrieved March 15, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/appendicitis
  2. Appendicitis – Diagnosis and treatment. (2021, August 7). Mayo Clinic. Retrieved March 15, 2022, from https://www.mayoclinic.org/diseases-conditions/appendicitis/diagnosis-treatment/drc-20369549
  3. Bradley, A. C., Hutson, M. S., & Kyle, J. A. (2019, December 17). Acute Appendicitis in Adults. US Pharmacist. Retrieved March 15, 2022, from https://www.uspharmacist.com/article/acute-appendicitis-in-adults
  4. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
  5. Girard-Madoux MJH, Gomez de Agüero M, Ganal-Vonarburg SC, Mooser C, Belz GT, Macpherson AJ, Vivier E. The immunological functions of the Appendix: An example of redundancy? Semin Immunol. 2018 Apr;36:31-44. doi: 10.1016/j.smim.2018.02.005. Epub 2018 Mar 2. PMID: 29503124.
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Maegan Wagner, BSN, RN, CCM

Maegan Wagner is registered nurse with over 10 years of healthcare experience. She earned her BSN at Western Governors University. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public.