Editing Medical-Surgical Nursing (section)

=== Appendicitis and Bowel Obstruction ===

Appendicitis produces periumbilical pain migrating to the right lower quadrant at McBurney point, rebound tenderness, anorexia, nausea, low-grade fever, and leukocytosis. Do not apply heat, do not give enemas or laxatives, and keep the patient nothing by mouth, because these measures can precipitate rupture. Sudden relief of pain followed by worsening diffuse pain suggests perforation with peritonitis.

Small bowel obstruction presents with colicky pain, profuse vomiting, and early high-pitched then absent bowel sounds; large bowel obstruction presents with marked distention and obstipation. Care includes nothing by mouth, nasogastric decompression, intravenous fluids with electrolyte replacement, and monitoring for strangulation.