Award Date


Degree Type

Doctoral Project

Degree Name

Doctor of Nursing (ND)



First Committee Member

Mary Bondmass

Second Committee Member

Rhone D'Errico

Third Committee Member

Betty Burston

Number of Pages



Acute appendicitis (AA) is the most common cause of acute abdominal pain requiring surgery in pediatric, adult, and pregnant patients. Several etiologies are believed to trigger luminal obstruction, which causes mucus and bacteria proliferation, resulting in inflammation and wall tension with subsequent necrosis and rupture of the appendix. Most AA patients present with the primary complaint of abdominal pain, which Murphy first described the characteristic diagnostic sequence seen in approximately 50% of patients as colicky centralized abdominal pain with subsequent vomiting with the migration of pain to the right lower quadrant (RLQ), specifically, the right iliac fossa. The typical AA patient will complain of colicky, periumbilical pain, which has progressively worsened over the past 24 hours that has become persistently sharp in the RLQ. Diagnostic imaging is essential in diagnosing AA, and it is critical for medical providers to quickly and accurately diagnose AA to reduce perforated appendix and negative appendectomy rates. Yet, there is not a universally accepted, widely utilized diagnostic imaging protocol for suspected AA patients. Ultrasonography (USG) and computerized axial tomography (CAT) scans are used most in diagnosing AA in all ages. Current evidence-based practice (EBP) literature shows that USG should be the first-line imaging modality followed by CAT scan as the second line in diagnosing AA in children and adults, to reduce ionizing radiation and cost burdens. The purpose of this Doctor of Nursing Practice (DNP) project was to develop, implement, and evaluate an educational intervention and an evidence-based USG-first algorithm for medical providers who treat patients with suspected AA. Pre- and post-test assessment questions were used to evaluate the implementation of knowledge and the AA clinical practice change over a six-to-eight-week period. Descriptive statistics were used to analyze demographic data, tabulating frequencies, and percentages. Pre- and post-assessment scores were analyzed via a paired t-test for matched samples. This project’s results displayed a statistically significant change in provider knowledge and may have improved clinical practice and patient outcomes. This project’s USG-first imaging algorithm for diagnosing acute appendicitis can likely be sustained in clinical nursing practice.


Appendectomy; Computerized Axial Tomography; Diagnostic Imaging Modality; Ultrasound


Medical Sciences | Medicine and Health Sciences | Nursing

File Format


File Size

862 KB

Degree Grantor

University of Nevada, Las Vegas




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