Guide — Gastrointestinal
Appendicitis & Peritonitis Nursing Care
Appendicitis is the most common abdominal surgical emergency — and its most dangerous moment is the one that feels like relief. When the inflamed appendix ruptures, the pain eases briefly, then the abdomen turns rigid as peritonitis sets in. Knowing what NOT to do (no heat, no laxatives) matters as much as recognizing it.
9 min read · Gastrointestinal
Educational use only. Surgical timing, analgesia, and antibiotic orders are individualized — follow the surgical team’s orders and your facility’s protocols. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Overview
Appendicitis is inflammation of the appendix, usually from obstruction (a fecalith, lymphoid swelling) that traps bacteria, raises pressure, and compromises blood flow — risking gangrene and perforation. It is most common in adolescents and young adults and is the classic cause of the “acute abdomen.”
Peritonitis is inflammation of the peritoneum — the membrane lining the abdominal cavity — most often from a ruptured organ spilling bacteria or GI contents (a perforated appendix, diverticulum, or ulcer). It is a surgical emergency that can progress to sepsis and septic shock. Appendicitis is the bridge: untreated, it ruptures into peritonitis.
Key Concepts
The migrating pain and McBurney’s point
Classic appendicitis pain begins periumbilically/vaguely, then localizes to the right lower quadrant at McBurney’s point (about one-third the way from the anterior iliac spine to the umbilicus), with anorexia, nausea, low-grade fever, and a positive rebound tenderness (Blumberg’s sign).
The provocative signs
Rovsing’s sign (pressing the LLQ causes RLQ pain), psoas sign (RLQ pain on right hip extension), and obturator sign (pain on internal rotation of the flexed right hip) all point to peritoneal irritation in the RLQ. Patients often lie still with the right knee drawn up; movement and coughing hurt.
The most dangerous sign: sudden relief
Sudden cessation of pain often means the appendix has ruptured — the pressure is released — and is quickly followed by diffuse pain, a rigid board-like abdomen, rebound, high fever, and tachycardia as peritonitis develops. Relief here is an emergency, not improvement.
What NOT to do
No heat to the abdomen (vasodilation can hasten rupture), no laxatives or enemas (increased motility/pressure can rupture it), and keep the patient NPO pending surgery. Treatment is appendectomy (usually laparoscopic) plus antibiotics; a ruptured appendix may need open surgery, drains, and a longer antibiotic course.
Assessment Findings
Track the pain’s migration and localization to McBurney’s point, elicit rebound and the provocative signs, and note guarding, anorexia, nausea, and low-grade fever with an elevated WBC. The decisive nursing observation is any change in pattern: sudden relief then rigidity, rising fever and heart rate, and a hard, distended, silent abdomen signal rupture and peritonitis. In peritonitis, expect diffuse severe pain, board-like rigidity, absent bowel sounds (ileus), fever, tachycardia, and signs of progressing sepsis/hypovolemia from fluid shifting into the inflamed cavity. Reassess vitals and the abdomen frequently while awaiting the OR.
Nursing Priorities
Stabilize and prepare for surgery
NPO, IV fluids, IV antibiotics as ordered, pain and antiemetic control, and surgical consent/prep. Position of comfort — often semi-Fowler’s with knees flexed — reduces tension on the abdomen. Reinforce no heat, no laxatives, no enemas.
Treat peritonitis aggressively
If peritonitis develops: aggressive IV fluid resuscitation, broad-spectrum antibiotics, NG decompression for ileus, semi-Fowler’s to localize/pool drainage in the pelvis, and rapid surgical source control. Monitor closely for septic shock and organ dysfunction.
Post-appendectomy care
Uncomplicated laparoscopic recovery is quick: early ambulation, advancing diet, incision care, and pain control. For a ruptured/perforated appendix, expect drains, a longer antibiotic course, semi-Fowler’s positioning to promote drainage, and vigilant monitoring for abscess and ongoing infection (persistent fever, increasing pain, purulent drainage).
Pulmonary and wound vigilance
Incentive spirometry and early mobility (an abdominal incision discourages deep breaths), wound assessment for infection or dehiscence, and bowel-function return. Report fever, redness, or drainage promptly.
Therapeutic Communication Considerations
Appendicitis often strikes the young and otherwise healthy, and the speed of the diagnosis-to-OR pathway can frighten patients and parents. Explain the urgency plainly — why surgery sooner prevents rupture, why food and pain medicine may be limited beforehand. If rupture has occurred, prepare the family honestly for a longer, more complicated course without alarming language. For adolescents, address embarrassment around the exam and the abdominal/groin signs with privacy and matter-of-fact professionalism.
Patient & Family Education
Pre-op, reinforce why nothing by mouth and no heat/laxatives, and to report sudden pain relief immediately. Post-op teaching covers incision care and hand hygiene, the activity and lifting restrictions per surgeon, diet progression, and the infection warning signs that warrant a call — fever, increasing or new abdominal pain, redness, swelling, or drainage at the incision, and persistent vomiting. For ruptured cases, explain the drain, the longer antibiotics, and the abscess signs to watch for after discharge. Most patients return to full activity within a few weeks.
NCLEX Pearls
- ✦Pain migrates from periumbilical to RLQ at McBurney’s point, with rebound (Blumberg’s), Rovsing’s, psoas, and obturator signs.
- ✦SUDDEN pain relief = rupture — expect rigid abdomen, high fever, and peritonitis to follow. It’s an emergency, not improvement.
- ✦NO heat, NO laxatives, NO enemas, keep NPO — any of those can precipitate rupture.
- ✦Peritonitis = board-like rigid abdomen, absent bowel sounds, fever, tachycardia → risk of septic shock; position semi-Fowler’s.
- ✦Ruptured appendix → drains, longer antibiotics, watch for abscess (persistent fever, increasing pain).
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American College of Gastroenterology (ACG) / AGA · ASPEN (nutrition support). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →