What special care should be taken for children, the elderly, and pregnant women after appendicitis surgery?

Author: Sun Meng, deputy chief nurse, Beijing Friendship Hospital, Capital Medical University

Reviewer: Shi Wenzai, attending physician at Peking University International Hospital

Appendicitis is one of the common surgical emergencies and can occur in people of all ages, such as infants, teenagers, middle-aged people, the elderly, pregnant women, etc.

The treatment of appendicitis mainly includes surgery and drug therapy. Surgical resection is the most commonly used method for treating appendicitis, especially laparoscopic surgery, which has the characteristics of quick recovery, less trauma, and more beautiful appearance compared to traditional open surgery.

Today we will talk about the special considerations for postoperative care of appendicitis in special populations.

1. What special attention should be paid to the postoperative care of children with appendicitis?

Appendicitis in children can occur at any age, but is more common in children aged 5-12 years. It is more difficult to differentiate appendicitis in children than in adults. Children cannot accurately express their medical history and do not cooperate with the examination, which makes the diagnosis of appendicitis in children more complicated. Also, due to the incomplete development of children's nervous system and poor body regulation ability, the younger the child, the more atypical the symptoms, which can easily lead to missed diagnosis and misdiagnosis.

Figure 1 Original copyright image, no permission to reprint

Children with appendicitis often do not seek medical attention or treatment in time due to their atypical symptoms. In addition, the disease progresses rapidly, making appendicitis perforated more likely to occur. Therefore, we should pay more attention to the symptoms of the child, give him more care, let him express his discomfort, and try to achieve early detection, early diagnosis, and early treatment.

After the operation, according to the child's characteristics, you can use methods to distract the child's attention from the pain of the wound, give more praise and encouragement, so that the child can cooperate better with the treatment.

After the intestinal function is restored after surgery, the patient should gradually resume normal diet, and can increase the intake of foods rich in dietary fiber such as fresh fruits and vegetables. Encourage children to get up and move around early to reduce the occurrence of abdominal distension and intestinal adhesion after surgery. If the child is very young and cannot get out of bed to move around, parents can help him move around, such as helping him move his limbs in bed, turning him over, and gently massaging his abdomen, which can also promote the recovery of intestinal function.

Being active and lively is the nature of children. At this time, you should pay attention to not doing strenuous activities such as running and jumping in the early stage. At the same time, before the wound heals, be careful not to scratch the scab of the wound with your hands to avoid delayed healing of the wound.

2. What special attention should be paid to the postoperative care of appendicitis in the elderly?

For the elderly, due to varying degrees of organ function decline and reduced response ability, appendicitis symptoms are often atypical. In the early stages of the disease, fever, vomiting, abdominal distension, and diarrhea are the main manifestations. The abdominal pain is mild, and there is rarely any metastatic right lower abdominal pain. Because the symptoms and signs are not very typical, the emergency department has a high misdiagnosis rate and many postoperative complications. Therefore, when the elderly have abdominal pain or other abdominal discomfort, do not ignore it and seek medical attention as soon as possible.

Elderly people often have underlying diseases such as cardiovascular and cerebrovascular diseases, diabetes, hypertension, and chronic bronchitis. Therefore, after surgery, we should pay attention to changes in blood sugar and vital signs and take good care of the underlying diseases. Elderly people's gastrointestinal function recovers slowly, so they should move slowly after surgery and do what they can to prevent accidents such as falls.

In addition, effective coughing and expectoration should be maintained. Elderly people who stay in bed for a long time are not easy to cough up phlegm, which will lead to complications such as atelectasis. Therefore, it is necessary to encourage them to cough up phlegm and teach them how to cough up phlegm. For example, let them take a deep breath, hold their breath for a few seconds, and then cough, or family members can help them cough up phlegm, curl their hands into an arch and use the strength of their wrists to tap the back of the elderly. The strength of the tapping should be moderate and should be determined according to the tolerance of the elderly. The speed should be 40-50 times per minute, avoiding the spine, tapping from bottom to top, from outside to inside, to promote the loosening of phlegm and facilitate coughing out.

Figure 2 Original copyright image, no permission to reprint

3. What special attention should be paid to the postoperative care of pregnant women with appendicitis?

Acute appendicitis is a common surgical complication during pregnancy, which can occur at any stage of pregnancy, but is more common in the first 6 months of pregnancy. Due to the anatomical and physiological characteristics of the appendix during pregnancy, the abdominal pain symptoms are atypical and the abdominal signs are not obvious, which makes diagnosis difficult to some extent.

Appendicitis during pregnancy is quite special. When the inflammation spreads to the uterus, it stimulates uterine contraction, making miscarriage and premature birth more likely to occur. If appendicitis perforation, high fever, toxemia, etc. occur, it may threaten the safety of mother and child.

Appendicitis during pregnancy progresses rapidly, so early diagnosis and surgery are extremely important. After surgery, more attention should be paid to uterine contractions and vaginal bleeding, and wound pain and uterine contraction pain should be differentiated. Try to avoid using analgesics for wound pain. If the pain is unbearable, be sure to choose analgesics that have no side effects on the fetus or pregnant woman.

In addition, more attention should be paid to the psychological state of pregnant women, because they will worry about the safety of the fetus, whether the surgery will affect the fetus, and may experience psychological problems such as anxiety and depression.

To ensure the safety of the fetus, pay attention to monitoring the fetal heart rate and fetal movement after the operation, and give low-flow oxygen when necessary to prevent fetal distress or suffocation. According to the doctor's advice, you can give some fetal preservation drugs appropriately. If there are signs of threatened abortion, delay getting out of bed and try to rest in bed.