CASE

PRESENTATION
Acute Appendicitis
CHAPTER I
Introduction
 The appendix is a closed-ended narrow tube up to
several inches in length approximately about 10 cm. (4in)
long. The anatomical name of appendix is Vemiform
appendix which is a finger-like appendage that is attached
to the cecum (the first part of the large intestine) just below
the ileocecal valve. The wall of this organ contains
lymphatic tissue that is part of the immune system for
making antibodies.
Appendicitis literally means – the inflammation of
appendix. One of the common acute inflammatory
disorders in lower gastrointestinal tract. It is said to be that
7% of the population were affected and it affects males
more than female. It occurs more in teenagers than adults
and most commonly between the ages of 10-30 years
 Once this kind of inflammatory disorder
develops, it is usually requires immediate medical
attention and surgery is a must to remove the organ to
prevent bursting a perforating can cause death.
Unfortunately, there is no alternative treatment for this.
Appendicitis is mainly manifested by abdominal
pain; specifically the aching pain begins around the
navel and often shifts to lower right abdomen. This
symptom is usually accompanied by nausea and
vomiting, loss of appetite, low grade fever and
sometimes constipation and diarrhea is associated.
 If the pain becomes sharper over several hours,
sharp pain RLQ of abdomen occurs if it will press and
then quickly released ( rebound tenderness test ) and if
coughing, walking, laughing on other jarring movements
is accompanied by pain, it is in need to site medical
attention to diagnosed and conclude acute appendicitis is
present and appendectomy
( surgical removal of vermiform appendix ) is requires
immediately.
Normally, people believed that you can have
appendicitis if you walk, jump or do jarring things after
eating. But it is not actually the main reason or cause of
appendicitis. It is said to be that blockage or obstruction
in their proximal lumen can cause acute appendicitis.
 The opening from appendix into the cecum
becomes blocked due to the built up of thick mucus
within the appendix or stool that enters the appendix
coming from cecum. The mucus or stool hardens and
becomes rock, like and blocks the opening ( fecalith- a
rock of stool). After the blockage, bacteria in the
appendix begin to invade its wall to inflame the
appendix. That’s why, it is necessary to undergo
appendectomy to prevent bursting or rupture of
appendix. Ruptured appendix followed by spread of
bacteria outside the appendix resulting to different
complications or even death. The cause of such a rupture
is unclear, but it may relate to changes that occur in the
lymphatic tissue, for example, inflammation, that line the
wall of the appendix.
 Appendicitis may diagnosed through physical
examination such as rebound tenderness, pain test
which is done by processing the RLQ of abdomen and
quickly releases it, testing the McBurneys point ( pain
elicited in the RLQ when firm pressure is applied) and
the Rovsing's sign done by pressing, on the LLQ
deeply and evenly for 5 sec were frequently used.
Laboratory test, done to diagnose Appendicitis
are CBC, Urinalysis, Abdominal X-ray, Ultrasound or
even Ct-scan.
We have chosen this case because we want to
obtain further information for us to know the real
causes and reasons why someone acquire this kind of
disorder.
CHAPTER II
Objectives
GENERAL OBJECTIVES
 We aim to acquire knowledge, skills,
and attitude for us to be able to use the
nursing process as a framework of care of
our patient. In acquiring the role of health
care providers, we aim to render proper
therapeutic management to our client’s
faster and full recovery.
SPECIFIC OBJECTIVES
 1.
Skills
To conduct a comprehensive assessment of
patient who had appendicitis and undergone
appendectomy.
To practice and enhance improvement a good
communication skills through interviews.
To develop a critical thinking and analytical
skills through frequent brainstorming
sessions.
 2. Knowledge
 
 To gain adequate knowledge regarding the
patient status.
 To develop awareness on the existing needs of a
person with appendicitis and understand the
significance of each and to know its impact to
the overall health status of the individuals.
 To broaden the scope, of knowledge regarding
the nursing process.
 3. Attitude

To establish rapport with each team members.

To strengthen cooperation and unity among
members of the group.
To develop a warm environment between the
student and the patient for a better working
relationship towards improvement of health.
CHAPTER
III
Theoretical framework
LYDIA HALL
Introduced the model on nursing, focusing on the
nations that centers around three components of care,
core, cure. Care represents nurturance and is exclusive to
nursing care is essential human need, necessary for the
health and survival of all individuals. Core involves the
therapeutic use of it self and emphasizes the use of
reflection. And cure focuses on nursing related to the
physicians order.
As health provider it is our responsibility to
perform certain nursing intervention as care, core, and
cure health teaching to secure our client the optimum
level of health we needed.
 CHAPTER
IV
Nursing history
PATIENT'S PROFILE
 Name: Agent X44
 Age: 15 y/o

 Birthday: February 3, 1994

 Address: Quezon City

 Religion: Roman Catholic

 Status: Child

 Occupation: Student

 Admitting Diagnosis: Acute Appendicitis

 Final Diagnosis: Acute Appendicitis

 Attending Physician: Dr. Lim

 Time and date of admission: 10:35 AM; September 14,

2009
Chief Complaint: Severe abdominal RLQ
pain accompanied by nausea and
vomiting.
HISTORY OF PRESENT ILLNESS
 2 days PTA, patient was in usual state of good health but after
having his dinner, he felt severe pain at his abdomen which
started at the area around his peri-umbilical area shifted to the
right lower quadrant region and accompanied by nausea and
vomiting.
  1 day PTA, patient continuously had abdominal pain on the
epigastric area and is concentrated on the RLQ. Still
accompanied by nausea and vomiting.
 Few hours PTA, patient still experienced severe abdominal
pain. He was immediately rushed to the hospital and was
admitted at the surgery ward at 11:35 PM, he was diagnose
with acute appendicitis. He underwent an emergency
appendectomy the next day, September 14 2009. His operation
begun at 8:50 AM and ended at 9:25AM.
HISTORY OF PAST ILLNESS

 According to Agent X44 he never had severe

illnesses before other than a simple fever, cough and
colds. He said that he got hospitalized for the first time.
He declared to have complete primary vaccinations /
immunizations taken in the past.
FAMILIAL HISTORY
Family has a history of hypertension
and diabetes mellitus on the both mother
and father side.
CHAPTER V
13 areas of Physical
Assessment
1. SOCIAL STATUS
 Agent X44 is a 15 years old son of Mr. &Mrs. X42 and
X43. He is a high school student of TIP and lives at Quezon
City. He was born in February 3, 1994 and a Roman Catholic.
He is a happy & playful child. He likes to go everywhere with
his friends to play basketball with them. He was said to be the
eldest of his 2 brothers and sister.
 Agent X44 is an adolescent which is according to
Erickson’s Theory of Psychosocial Development. During this
stage new interpersonal dimension emerges which is identity
vs. role confusion. To achieve right identity adolescents must
bring together everything they have learned about themselves
because if not they will left them role confusion which gives
them negative identity.
2. MENTAL STATUS
 Agent X44 is currently a senior high school
student.
 During day 1 of Assessment the patient is very
weak because of post operation (Appendectomy). Day 2,
conscious and coherent, he was slightly shy to answers
some of our question that’s why her mother helps him to
answer questions. But he still remembered what
happened before his hospitalization.
 He speaks and understands English and Tagalog.
Day 3, he is conscious and responsive. He is oriented to
time, date and person.
3. EMOTIONAL STATUS
 During day 1 and day 2, while assessing the pt. He was
obviously not comfortable with his hospitalization aside
from that he was complaining about his abdominal pain.
Day 3 he answered the questions being asked to him by
verbal and non-verbal language. He maintains eye
contact while he was responding.
4. SENSORY PERCEPTION

 4.a. Vision
There is no presence of discharges and no lesions
around his eyes. He can recognize different colors.
Pupils are equally reacted to light and accommodations,
test is done using penlight. He can recognize person in
far distance space. He can read without difficulty in large
letters and small letters.
 4.b. Gustatory
A day after operation patient has low appetite. All
he ate were tasted bitter according his mother. During
assessment, 2 days after his operation patient’s diet is
clear liquids only. Day 3, can now recognized different
taste. It was done by giving patient food such as candy
and soup. His buccal cavity and gums is clean, red in
color and not swollen. His teeth are clean though there is
some tooth decay noted
 4.c.Auditory
There is no discharge and odor around his ears.
Ears are symmetrically on each other. Patient shows
no signs of difficulty in hearing and heard the tic
sounds of wristwatch when placed close to his ears.
 4.d. Olfactory
A day after operation, patient can’t
distinguish different smell according to his
mother. Upon assessing his olfaction, he can
now distinguish different smell. Assessment
done by spraying cologne, lending patient some
fruits to smell. No discharges and secretions
noted.
 4.e.
Tactile
Patient is able to identify smooth from
rough, hard from soft. He is sensitive to
cold and warmth and response to slightly
painful stimuli. No signs of numbing.
 5.
MOTOR ABILITY
The patient still lying on his bed. He
can move but limited only because once
he move he feels pain in the operated site.
 6.BODY TEMPERATURE
During assessment he was afebrile with 37°
C. Temperature was taken at right axilla for 5
minutes using thermometer (normal range 36.5 °
C – 37.5 ° C). His temperature was stable until
our last assessment.
 7. RESPIRATORY STATUS
During the assessment patients RR is
18cpm. His breathing pattern is rhythmic &
shallow. No presence of adventitious sounds. No
difficulty of breathing noted. His respiration was
clear when auscultation done to his back using
stethoscope.
 8.CIRCULATORY STATUS
His BP is 110/70 mm/Hg, taken on right
brachial artery. His pulse rate was 76 bpm
taken on his right radial artery. Capillary
refill time (CRT) was also assessed on his
right thumb of 2 seconds.
 9.NUTRITIONAL STATUS
Patient infused with D5LR 1 liter
regulated at 31-32 gtts/min for 8 hrs. IV line
is infusing well without any signs of redness
on insertion site. Day 1,NPO; Day 2, clear
liquids and day 3 soft diet. He weighs 58kgs
and in 5’7 in tall. His BMI is 20.78 normal
(20-25 normal weight).
 10.ELIMINATION STATUS
10.a. Urine
Upon assessment the patient. already
voided but with assistance. Color of urine
is golden yellow, urine output 35cc per
hour in day 1 based on his record. Day 2,
he was voided 270cc based on record
6am-2pm shifts.
10.b. Stool
During assessment, patient has
already defecates once after
operation. He defecates normal
consistency and little amount only
because on his diet.
11. REPRODUCTIVE STATUS
The patient had been circumcised
when he was 11 y/o (done by the
surgeon).
12.
STATE OF PHYSICAL REST &
COMFORT
Before confinement patient sleeping
hours is usually from 10pm to 6am. After
operation, patient was not yet comfortable
because of his complaint – pain in
operated site. Difficulty of falling asleep
noted especially in strong stimuli and in
every nurses rotation.
 13.STATES OF SKIN & APPENDAGES
During assessment the patient has soft and
smooth skin. His lips are slightly dry. Fingernails
are clean and cut short. Has short hair with some
dandruff presence but no lesions sited.
Patient has some scars on his lower
extremities because of his ADL such as playing
etc. Has mole on his lower cheeks, no
malignancy sign.
 CHAPTER VI
Anatomy and Physiology
GASTROINTESTINAL
TRACT
 The structures that make up the digestive system:

The digestive system consists of a long muscular tube beginning at

the lips and mouth and ending at the anus and includes the pharynx,
esophagus, stomach and the small and large intestines. Certain large
accessory glands located outside the digestive tube, including salivary
glands, liver, gallbladder, and pancreas. Each of which secretes its special
digestive juice into the digestive tube.
The digestive function of the upper portion of the tract, food is
received into the mouth, where the tongue functions is to mix it with
saliva from the salivary glands to keep the mass pressed between the
teeth for chewing. In the process of swallowing, the tongue pushes the
food back into the throat, initiating a wave of muscular contraction that
propels the mixture to the stomach. The pharynx and the esophagus are
muscular tubes that convey the chewed food from the mouth to the
stomach.
For us to know and understand
better the process of this
system. Let’s follow this
course after eating
hamburger…
After taking a bite of your hamburger and your teeth
chew it up. The saliva (mucous membrane of the mouth)
secreted by your salivary glands moistens the food and
begin to digest the starch in the bread.  The soft mass of
chewed food (bolus) in your mouth to be swallows and
travels down your ESOPHAGUS. The ESOPHAGUS is a
muscular tube about 22-30 cm long that passes through
the middle of your chest, through your diaphragm, and
attaches to your STOMACH.  Your PYLORIC
SPHINCTER – a specialized ring of muscle that
surrounds the orifice between the stomach and duodenum
that relaxes, to let the food into your stomach, and then
tightens to keep food from going back up the esophagus. 
Your stomach makes hydrochloric acid and enzymes which
break down the protein - in this case, the beef patty. If the
sphincter isn't working just right, one gets the acidic
stomach contents refluxing back into the esophagus.  This
is Gastro-Esophageal Reflux Disease, or GERD.  This is
also known as heartburn. The stomach is very muscular and
also acts to grind up the food by squeezing and relaxing.

The stomach is connected to the SMALL INTESTINE, and

another sphincter opens to let the food through.  The small
intestine is another hollow tube.  If fully stretched out, it
would measure between 15 and 34 feet.  It's divided into
three sections.  The three sections, in order, are: the
DUODENUM, the JEJUNUM, and the ILEUM.
Our chewed-up hamburger now enters the
DUODENUM.  The LIVER makes bile, which is green
and helps the digestion of fats. Bile is stored in the
GALL BLADDER, and conveniently squirted into the
DUODENUM when food enters. PANCREATIC juice
also enters the duodenum. The PANCREAS makes
strong enzymes which help break down the fats,
carbohydrates, and proteins in the mayonnaise, bread,
and beef patty, respectively. The pancreatic juice also
contains bicarbonate, which neutralizes the strong
hydrochloric acid the stomach has contributed to the
mixture.
The tail end of the DUODENUM, the
JEJUNUM and the ILEUM absorb the nutrients
from the broken down food. They also
reabsorb water from the food mixture, and
from all the saliva and other secretions that
were used to break down the food.  The small
intestine also contains helpful bacteria which
aid the digestion of certain vitamins. It may
take 2-4 hours for food to pass from one end
of the small intestine to the LARGE
INTESTINES.
The large intestine neither receives nor secretes
digestive juices into its interior. By the time chyme
reaches the large intestine, digestion is complete,
and only some water, salts, and vitamins remain to
be absorbed. A considerable amount of fluid moves
into the intestinal contents as they pass through the
stomach and small intestine. Much of water is
reabsorbing through the walls of the large intestine.
The remaining becomes solid waste, known as feces
and moved along by peristaltic waves to the
RECTUM, where it is eliminated from the body
through the anal canal.
 The major areas of the large intestine are:
Cecum – wherein the appendix is attached.
Colon – distinguish into three areas:
Ascending colon

Transverse colon

Descending colon

Rectum – begin at the end of the descending

colon and terminates in the narrow canal.
 The APPENDIX is a closed-ended, narrow tube up
to several inches in length that attaches to the cecum the
first part of the colon like a worm. The anatomical name
for the appendix, vermiform appendix, means worm-
like appendage. The inner lining of the appendix
produces a small amount of mucus that flows through
the open center of the appendix and into the cecum. The
wall of the appendix contains lymphatic tissue that is
part of the immune system for making antibodies. Like
the rest of the colon, the wall of the appendix also
contains a layer of muscle, but the muscle is poorly
developed.
 The large intestine which is the storage tank for our human
waste. During transit through the colon, the waste continues to
have more liquid and vitamins removed. When this function does
not occur regularly, or normally, waste can block the appendix,
and become lodged so that it is not sent along for removal
naturally. In these cases, an infection will result. The immune
system will fight the infection causing the appendix to become
swollen and inflamed. The resulting infection can cause the
appendix to swell until bursting. A ruptured appendix can spread
infection products throughout the body and with it solid waste
from the colon. The combination of infection and waste inside
the human body can cause death in otherwise healthy
individuals. The occurrences of acute appendicitis in America
can be regarded as common, though most cases are recognized
and treated prior to a life-threatening result.
 Physiology of appendix:

Some researcher says that appendix has no known

physiologic function. The removal of it appears no changes in
the digestive system. But recent study released that one of the
function of the appendix is storing and protection (act as a
safe house) of good bacteria that aids the digestion of food.
The intestinal bacteria are harmless as long as they remain in
the large intestine; in fact, they are useful in synthesizing
vitamins K. Bacterial activity in the large intestine also
contributes to the production of intestinal gas or flatus
(blowing), which cause flatulence. The cells in the intestinal
glands of the large intestine secrete large amount of alkaline
mucus, which helps neutralize acids produced by intestinal
bacteria and also lubricates the lumen for the easy passage of
feces.  
CHAPTER
VII
Pathophysiology
 Risk Factor

Luminal Obstruction

Increase Mucosal Secretion

Increase intraluminal pressure

Exceeds capillary perfusion pressure Epithelial mucosal secretions

accumulate

Venous and lymphatic drainage Arterial stasis and tissue

are obstructed infarction

Intraluminal hypertension Appendical distention

STAGNATION exceeding the appendix
capacity of 0.1-0.3 ml
Venous out flow Visceral afferent fibers are stimulated enters the
Loss of epithelial integrity obstruction 10th thoracic vertebral level

Ischemia Referred Epigastric pain Periumbilical pain

Vascular constriction and susceptibility to bowel

flora invasion Inflamation of serosa &
adjacent structure

Thrombosis of appendicular artery and

vein Triggers somatic pain fibers innervating
PERITONEA structures

Luminal bacteria multiply

Radiating pain in the periumbilical area to the
RLQ
Perforation and spillage of infected appendical
contents in PERITONEUM

Gangrene occur APPENDICITIS

 Appendicitis is caused by obstruction of appendiceal lumen. The
causes of obstruction include lymphoid hyperplasia, secondary to
irritable bowel disease (IBD) or infection, fecal stasisand fecaliths
(common to elderly patient), parasites, foreign bodies (rare).
Lymphoid hyperplasia of the appendix may be related to crohns
disease, mononucleosis, amoebiasis, GI and respiratory
infections. Fecaliths are solid bodies within the appendix that
form after the precipitation of calcium salts, undigested fiber in a
matrix of dehydrated fecal materials. When the lumen is
obstructed there will be an increase mucosal secretion that may
cause increase in intraluminal pressure. When the intraluminal
pressure increase either the pressure exceeds capillary perfusion
or epithelial mucosal secretion will accumulates. If the pressure
exceeds the venous and lymphatic drainage are obstructed.
Stagnation occurs when the appendix reach its capacity (0.1-
0.3ml). At the same time venous outflow is obstructed.
 As a consequence, at the appendiceal wall Ischemia begins
(inadequate flow of blood to a part of the body) resulting to
loss of epithelial integrity allowing vascular constriction and
susceptibility to bowel flora invasion. Thrombosis of
appendicular artery and vein then luminal bacterial multiplies
formation of pus. Within few hours this localized condition
may worsen because leading to perforation & spillage of
appendical contents in Peritoneum and gangrene occurs.
While if the epithelial mucosal secretions accumulate arterial
stasis and tissue infarction occurs that will result to
Intraluminal hypertention and appendiceal distention. Visceral
afferent fibers are stimulated and enter the 10th thoracic
vertebral level. Pain is typically felt in the epigastric and
periumbilical area it is generally vague and poorly localized.
Inflamation of serosa & adjacent structures occurs which
triggers somatic pain fibers innervating PERITONEAL
structures which typically casing pain to the right lower
quadrant (RLQ).
CHAPTER VII
NURSING
MANAGEMENT

Diagnostic Tests
 COMPLETE BLOOD COUNT

RESULT NORMAL POSSIBLE

VALUES SIGNIFICANCE

Hemoglobin 121g/l M:140-180g/l Anemia, Hemorrhage

F:120-160g/l leukemia

Hematocrit 0.36 M:0.40-0.54 Anemia, Hemorrhage

F:0.37-47 leukemia

WBC 16-6x10g/l 5-10x10g/l Bacterial infection,

Leukemia, severe
sepsis

Neutrophils 0.85 0.35-0.65 Bacterial infection,

tumor inflammation,
stress, drug reaction

lymphocytes 0.22 0.20-0.40 Normal

Monocytes 0.05 0.020.05 Normal

 Impression:
The white blood cell count in the blood usually becomes elevated with infection. In early appendicitis,
before infection sets in, it can be normal, but most often there is at least a mild elevation even early.
Unfortunately, appendicitis is not the only condition that causes elevated white blood cell counts.
Almost any infection or inflammation can cause this count to be abnormally high. Therefore, an
elevated white blood cell count alone cannot be used as a sign of appendicitis.
 URINALYSIS

Test Result Normal

values MICROSCOPIC Results
Color Yellow Amber WBC 0-1/hpf
Transparency Slightly turbid 0-1/hpf
RBC
pH 6.1 4.8-8.0 Epithelial Cells Few
Specific 1.025 1.015-1.025 Moderate
Mucus Threads
Gravity
Protein negative negative Bacteria few

Glucose negative negative

Impression:
Urinalysis is a microscopic examination of the urine that
detects red blood cells, white blood cells and bacteria in the urine.
Urinalysis usually is abnormal when there is inflammation or stones in the
kidneys or bladder. The urinalysis also may be abnormal with appendicitis
because the appendix lies near the ureter and bladder. If the inflammation
of appendicitis is great enough, it can spread to the ureter and bladder
leading to an abnormal urinalysis. Most patients with appendicitis,
however, have a normal urinalysis.
DRUG STUDY
 Dug name:
Diphenhydramine 1 ampule TIV PRN for pruritis
 Brand name:
Benadryl
 Classification:
Antihistamine
 Indications:
Symptomatic relief of allergic symptoms caused by histamine release including
nasal allergies and allergic dermatosis; adjunct to epinephrine in the treatment of
anaphylaxis; night time sleep aid; prevention of treatment of motion sickness. Topically
for relief of pain and itching.
 Contraindications:
Hypersensitivity to diphehydramine or any component of the formulation; active
asthma; neonates or premature infants.
 Adverse reaction:
Anorexia, constipation, dry mucous membrane, epigastric distress, vomiting,
itchiness.
 Route
IV
 Frequency
PRN
 Dosage
1 amp
NURSING CONSIDERATION

 Monitor effectiveness of therapy and

adverse reaction.
 Take as prescribe; avoid excessive dosage
 Monitor patient’s response and arrange for
adjustment of dosage to lowest possible
effective dose.
 Drug name:
Paracetamol 300mg TIV q 4hrs for fever 38C above
 Brand name:
Aeknil
 Classification:
 Analgesic
 Indications:
Paracetamol has good analgesic and antipyretic properties. It is suitable for the treatment of pain of
all kinds (such as postoperative pain post traumatic pain).
 Contraindications:
Paracetamol should not be used in hypersensitivity to the preparation and in severe liver diseases.
 Adverse reaction:
In rare cases hypersensitivity reactions, predominantly skin allergy (itching and rash), may appear
long-term treatment with high doses may cause a toxic hepatitis with following initial symptoms: nausea,
vomiting, sweating, and discomfort.
 Route
IV
 Dosage
300mg
 Frequency
q4 for Temp. above 38ºC
 Nursing consideration:
Do not exceed recommended dose; do not take for longer than 10 days
 Drug name:
Nalbuphine 5 mg TIV PRN for severe pain
 Brand name:
Nubain
 Indications:
Moderate to severe pain
 Contraindications:
Contraindicated in patients hypersensitive to drug.
 Adverse reaction:
Biliary tract spasms, constipation, cramps, dyspnea, nausea and
vomiting.
 Route
IV
 Dosage
5mg
 Frequency
PRN for severe pain
 Nursing consideration:
Reassess patients level of pain at least 15 and 30 minutes after parenteral
administration.
Constipation is often severe with maintenance therapy. Make sure stool
softener or other laxative is ordered.
 Drug name:
Cefuroxime 750mg TIV q 8º
 Brand name:

Cefuroxine sodium (Zinacef)

 Indications:

Lower respiratory infections caused by bacteria Pneumonia, Aureus, E-coli

 Contraindications:

Contraindicated with allergy to cephalosporins/penicillin.

 Adverse reaction:

Headache, insomnia, fatigue, rashes, pruritus, dyspepsia

 Route

IV
 Dosage

750 mg
 Frequency

q 8º
 Nursing consideration:

Be aware that patient may be at increase risk for GI bleeding, monitor

accordingly.
Establish safety measures if CNS/ visual disturbances occur.
NCP
 Assessment Nursing Diagnoses Planning Intervention Rationale Evaluation

Subjective Acute pain due Within 1 hour Independent: The goal

Cues: to post of nursing 1.Assess 1.Serves as
was met
“ masakit yung operation intervention location, baseline data.
parting (appendectomy) character, after 1 hour
the patient
inoperahan sa onset/duration, of nursing
akin” as will able to frequency,
verbalize
intervention
verbalized by quality, severity 2.Pain is
decrease in the patient
the patient. of pain. subjective
Objective: pain from 2. Accept experience and pain level
~ A mild pain pain scale of patient’s cannot be felt decrease
felt in the right 7 to level 2. description of by others. from pain
lower quadrant pain.
of the abdomen. 3. Observe non- 3. Provide
scale of 7 to
~ Pain scale of verbal cues. comparison of pain scale of
7 (from pain subjective data. 2. The
scale of 0-10) is 4. Monitor 4. Usually patient falls
the highest. vital signs. altered in acute
~ Facial mask pain; to monitor
asleep after
of pain. progress of intervention
~ Guarding condition. done.
behavior.
~ Discomfort in 5. Provide quiet 5. Provide
movement. environment. relaxation
technique.
6.Provide comfort 6. Provide
measures such as back pharmacological
rub, change in position management.
and use of heat and
cold.
7.Encourage deep 7. Aids in better tissue
breathing exercise. oxygenations thus
reduce pain.
8.Diverts perception
8. Encourage of pain.
diversional activities
such as watching tv,
listening to music.
9. Encourage adequate 9. To prevent fatigue.
rests periods.

Dependent: 1.Control and relieves

1.Administer pain pain.
medication as Indication:
prescribed. Relief of moderate to
Generic name: severe pain. Pre-
Nalbuphine HCL operative analgesia, as
Brand name: a supplement to
Nubain balanced anesthesia
 Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation

Subjective Sleep pattern After 4 hours 1. Establish 1. For the After doing the
Cues: rapport with patient to feel at nursing
disturbance of nursing the patient. ease and
“Pagising- related to intervention comfortable, interventions,
gising ako thus facilitating the patient now
pain due to the patient
pagtulog gawa client-nurse understand all
ng opera ko” as post must able to interaction. the techniques
verbalized by operation. learn some 2. Ask the patient 2. To have an
of sleeping
what is the idea on what
the patient. techniques of reason why he and how to start pattern and can
Objective: effective can’t sleep. the health able to sleep
~ Dark circles sleeping 3. Health teaching teaching. comfortable.Da
to the patient. 3. For the
under eyes. pattern, as y 3 the patient
 Explain patient to
~ irritable evidenced by necessity of understand the verbalized
disturbances purpose of viral “sige,
for signs that naiintindihan
monitoring causes him to ko po, tatry ko
vital signs and be awake and
or other care why vital signs po”
 Provide quiet have to be
environment done.
and comfort 4. For the client
measures (eg. to help him
Back rub, more
washing comfortable/rel
hands/face, ax on his bed.
cleaning) in
preparation
for sleep.
 Assessment Nursing Diagnosis Planning Intervention Rationale Evaluation
Subjective: Within 1 hour Independent: After 1 hour of
Deficient 1.Provide active 1.Promotes self of
“bakit ako of nursing nursing
knowledge role for client in control over
nagkaroon ng intervention, learning process. situation and is intervention
appendicitis?” related to the patient will means for the patient can
As verbalized lack of have sufficient determining that, now
by the patient. knowledge that client is understand the
exposure assimilating /
about nature of
Objective
and appendicitis.
using new
disorder.
information.
Always asks unfamiliarit 2.Providean
questions. y of environment that 2.Helps to retain
in conducive to information what
information learn has been
resources. discussed.
3.Provide written
information/guidel 3.Reinforces
ines and self learning process,
learning modules allows client to
for client to refer proceed at over
to us for recovery. pace.
Assessment Nursing Planning Intervention Rationale Evaluation
Diagnosis
4. Discuss 4.To prevent
information overload.
relevant only to
the situation.

5. Provide 5.May assist

information with
about additional further
learning learning/pr
resources omote
learning at
own pace
Chapter IX
Evaluation
 Medications
Patient was given a dose of antibiotic intravenously
during the surgery and the antibiotic is continued until the
day after surgery. Take home medicines are cefalexin 500 mg
TID for 5 days and mefenamic acid 500 mg q6 for 3 days.
 
 Exercise
Patient should be encouraged to leave bed and increase
ambulation gradually. Activity restrictions will depend on
the severity of the appendicitis. Driving exercise and lifting
heavy objects will be limited for a few weeks to allow for
incisional healing. Light exercise is advisable such as
walking but not too far.
 
 Treatment
Light activity at home is encouraged after surgery;
patient is advised to avoid strenuous activity like lifting
heavy objects and activity that requires energy.

 Heath teaching
>eat food rich in ascorbic acid to boost immune system
of the body.
>remind the family member to note for fever.
>educate the client to maintain a clean environment.
>instruct the patient to have rest and take the prescribed
medicine and comply with it.
 Out-patient
Patient should be seen about one to two weeks
after discharge. The wound should be examined for
evidence of inflammation and the patient should be
checked for fever.

 Diet
To allow the digestive tract to rest after surgery,
patient will not be given anything to eat or drink for
the first 24 hours after an appendectomy. After that,
patient gradually be given small amounts of water,
then clear liquids and then solid foods, until finally
the patient is able to handle required diet.
 Prognosis
Appendicitis is usually treated successfully
by appendectomy. Unless there are
complications, the patient should recover without
further problems. The mortality rate in cases
without complications is less than 0.1%. When
an appendix has ruptured or a severe infection
has developed, the likelihood is higher for
complications with slower recovery or death
from disease. After different interventions done
by nurses and doctors to the client, the patient
will spend few days in the hospital until the
different symptoms of the said illness is cured.
 Acknowledgement
We group A1 as a Nursing group would like to show our deepest
heartfelt gratitude for those people who help us to make this case study a
successful one.
To God almighty who gave us enough strength, inspiration and
empowerment for daily lives so we could perform properly and act
accordingly.
To our beloved parents and family for whom we dedicate this case
study and especially for their moral support understanding as well as for
their financial support. To our beloved WCC faculty and staff especially to
Mr. Ramilo “yogo” Paralejas Clinical Instructor in NCM 121 RLE who
devoted his time in supervising us in our exposure in the Hospital and for
his patience in correcting our work to make it better.
To our chosen patient agent X44 and her family who welcomed us
whole hearted open and shared their stories and being cooperative to
answer our queries. For allowing us to gather some information so that our
case made possible. 
To our group for sharing laughers, the rapport that we had established
and the understanding and helping arms and hands of everyone. We have
learned lot of things that we will treasured it on journey and as we strive
forward registered Nurses.