Page 974 - Saunders Comprehensive Review For NCLEX-RN

3. Administer mineral and vitamin supplements,
including iron, folic acid, and fat-soluble vitamins A,
D, E, and K.
4. Teach the child and parents about a gluten-free diet
and about reading food labels carefully for hidden
sources of gluten (Box 33-1).
5. Instruct the parents in measures to prevent celiac
crisis.
6. Inform the parents about the Celiac Sprue Association.
IX. Appendicitis
A. Description
1. Inflammation of the appendix
2. When the appendix becomes inflamed or infected,
perforation may occur within a matter of hours,
leading to peritonitis, sepsis, septic shock, and
potentially death.
3. Treatment is surgical removal of the appendix before
perforation occurs.
B. Assessment
1. Pain in periumbilical area that descends to the right
lower quadrant

2. Abdominal pain that is most intense at

McBurney’s point
3. Referred pain indicating the presence of peritoneal
irritation
4. Rebound tenderness and abdominal rigidity
5. Elevated white blood cell count
6. Side-lying position with abdominal guarding (legs
flexed) to relieve pain
7. Difficulty walking and pain in the right hip
8. Low-grade fever
9. Anorexia, nausea, and vomiting after pain develops
10. Diarrhea

C. Peritonitis

1. Description: Results from a perforated appendix
2. Assessment
a. Increased fever
b. Progressive abdominal distention
c. Tachycardia and tachypnea
d. Pallor
e. Chills
f. Restlessness and irritability

An indication of a perforated appendix is

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