A Case Presentation of:

BSN-119 Group 73
 The agent-host-environment model is primarily used
to predict illness rather than to promote wellness,
although identification of risk factors that result from
the interactions of the agent, host, and environment
helps in promoting and maintaining health. Because
each of agent-host-environment factors constantly
interact with others, health is an ever changing state.
Health is seen in when all three elements are in
balance, while illness is seen in one when one, two, or
three elements are not in balance.
(Fundamentals of Nursing by Kozier 2004)
 Appendicitis is an inflammation of the inner lining of the vermiform
appendix that spreads to its other parts. It may occur for several reasons, such
as an infection of the appendix, but the primary cause in most cases is the
obstruction of the appendiceal lumen. Appendicitis is a common and urgent
surgical illness with generous overlap with other clinical syndromes, and
significant morbidity, which increases with diagnostic delay. No single sign,
symptom, or diagnostic test accurately confirms the diagnosis of appendiceal
inflammation in all cases.

Obstruction of the appendiceal lumen is the primary cause of

appendicitis. An anatomic blind pouch, obstruction of the appendiceal
lumen leads to distension of the appendix due to accumulated intraluminal
fluid. Ineffective lymphatic and venous drainage allows bacterial invasion of the
appendiceal wall and, in advanced cases, perforation and spillage of pus into
the peritoneal cavity.

Left untreated, appendicitis has the potential for severe

complications, including perforation or sepsis, and may even cause death.
(emedicine.medscape.com
LeBlond RF, DeGowin RL, Brown DD. DeGowin's Diagnostic Examination. 8th ed. McGraw-
Hill; 2004:1040.)
 We chose this certain topic for further study under the concept of
Endocrine System & Metabolism. By this, we would be able to gain knowledge
about its etiology and other certain revelations regarding the disease and its
underlying factors. Particularly, statistics report that 1 of 5 cases of appendicitis is
misdiagnosed; however, a normal appendix is found in 15-40% of patients who
have an emergency appendectomy.

We hereby gathered selected data from our patient and also facts from
certain references that would contribute and support the case.
A. Hypothesis

Acute Appendicitis due to fecalith obstruction of the

appendiceal lumen which could lead to bacterial
overgrowth and an increase in intraluminal pressure and
sets off an inflammatory process that can lead to infection,
thrombosis, necrosis, perforation, and peritonitis.

In our study of the patient’s condition, we have perceived

that the predisposing factors which contributed to the
occurrence of Acute Appendicitis are the Host and the
Agent. There had been no any environmental factor
involved to cause the disease, however, we cannot
disregard or detach it for it is originally a part of the
ecologic model.
The predisposing factors together with their components are
as follows:
B. Predisposing Factors

1. Host
Age: 39 years old
Sex: Male
Lifestyle (Nutrition): Low fiber diet

2. Agent
Non-living: Fecaliths
C. The Lever

Agent

Host
E
We have chosen the lever ecologic model because it is
used to show the relationship between the host, agent, and
environment. It is also used to determine if there is an
imbalance among the three pre-disposing factors or there is
one that contributes more than the other, which may lead
to an occurrence of the disease.

Since the patient is male & at the age of 39, age is one
factor because Appendicitis could occur in all ages and
regarding the gender, there is higher incidence in men than
in women. Due to his nutritional lifestyle which is low fiber
diet, it could also cause Appendicitis because high fiber diet
is truly recommended to prevent such disease. And the
fecalith, as the agent, initiated the disease process through
obstruction in the appendecial lumen that caused pain in
the right lower quadrant of his abdomen, the client went to
the hospital immediately.
D. Analysis
Appendicitis is the inflammation of the vermiform appendix, usually acute, that if undiagnosed leads rapidly to
perforation and peritonitis. The inflammation is caused by an obstruction such as a hard mass of feces or a foreign
body in the lumen of the appendix, fibrous disease of the bowel wall, an adhesion, or parasitic infestation. The
most common symptom is constant pain in midabdomen. Extreme tenderness occurs over the right rectus muscle.
Appendicitis is also characterized by vomiting, a low grade fever of 99° to 102 ° F, an elevated white blood count,
rebound tenderness, a rigid abdomen, and decreased or absent bowel sounds. Treatment is appendectomy within
24 to 48 hours of the first symptom because delay usually results in rupture and peritonitis as fecal matter is
released into the peritoneal cavity.

(Mosby’s Pocket Dictionary of Medicine, Nursing, & Health Professions p. 106)

E. Conclusion

We therefore conclude that our hypothesis is correct because the

patient had acute appendicitis due to fecalith obstruction to the
lumen of the vermiform appendix affected by the patient’s age,
gender, and lifestyle. It was manifested by atypical symptom of the
right lower quadrant which was the reason why the client
immediately went and reported to the hospital. It was also the
reason why the client had undergone appendectomy within 24 hours
of the first symptom because delay or when left untreated, it usually
results in rupture, peritonitis , or even death.
F. Recommendations
The best way to prevent Appendicitis is to eat plenty of raw, fresh
vegetables and fruits, whole grains and at least eight glasses
of liquid a day will provide the fiber needed to prevent constipation
and minimize the risk of the appendix becoming infected. However, if
there are symptoms of appendicitis already, there are some herbs that
have been known to help reduce the effects. These herbs include:
detoxifying and fever-reducing herbs (Flos lonicerae, Fructus
forsythiae, Herba taraxaci, Patrinia scabioseafolia, Gypsum fibrosum),
circulation-enhancing herbs (Semen persicae, Radix paeoniae
rubra, Squama manitis, Spina gleditsiae), and laxatives (Rhizoma
rhei, Mirabilitum depuratum). Belladonna and Bryonia are classic
homeopathic remedies often used for an inflamed appendix with
symptoms.
F. Recommendations (continuation)
Eat lactic acid fermented foods such as natural, unsweetened
yogurt to keep the bacterial culture in the colon healthy. Exercise
regularly to help prevent fecal matter from lodging and hardening in
the colon.
If surgery has been performed, Vitamin E supports wound healing
and Vitamin C prevents infection and supports the immune system.
Bioflavonoids work naturally with Vitamin C. These vitamins are
excellent during any infection, and Vitamin C can be taken in high
dosages if necessary. The B vitamins can be added to the regimen to
provide the body with the extra strength needed for the stress of the
surgery and illness.
(Dr. Eddy's Clinic Integrated Medicine - Web Journal )
www.dreddyclinic.com
F. Recommendations (continuation)
Treatments for Acute Appendicitis
The list of treatments mentioned in various sources for Acute
Appendicitis includes the following list. Always seek professional
medical advice about any treatment or change in treatment plans.

 Emergency hospitalization
 Appendectomy
 Laparoscopic appendectomy
 Paracetamol
 Panadol
 Ibuprofen
 Diclofenac
F. Recommendations (continuation)
 Buscopan
 Over the counter pain medications
 Treatment depends on underlying cause
 Call emergency services in case of acute pain
 Appendecectomy
 Antibiotics

(www.wrongdiagnosis. com)
F. Recommendations (continuation)

 The most important factor in your recovery after surgery is following the full course of treatment
ordered by your healthcare provider, including taking all of any prescribed antibiotics. To feel
better as soon as possible you should:
 Rest. Get plenty of sleep but avoid staying in bed for long periods of time during the day.
 Eat foods high in protein while you are healing if your provider says it is OK.
 Eat small frequent meals.
 Gradually increase your walking and activity as directed by your provider.
 Keep your sutures clean.

 Wash your hands before and after changing the dressing on your incision(s), and after disposing of
the dressing.
 Keep taking prescribed medicine until it is finished.
 Contact your provider if the following signs of wound infection appear:
› redness or warmth at the suture site
› yellow or green drainage from the wound
› fever.
F. Recommendations (continuation)

 Wash your hands before and after changing the dressing on your
incision(s), and after disposing of the dressing.
 Keep taking prescribed medicine until it is finished.
 Contact your provider if the following signs of wound infection
appear:
› redness or warmth at the suture site
› yellow or green drainage from the wound
› fever.

(www.med.umich.edu.com)