Table of contents

....................................................................1

Introduction……………………………………………………………………………….2

Objectives………………………………………………………………………………….3

Patient Profile…………………………………………………………………………….4

Physical Assessment…………………………………………………………..………5-
6

Anatomy and Physiology…………………………………………………………….7

Pathophysiology………………………………………………………………………….8
-9

Laboratory………………………………………………………………………………….
9

Medical Surgical
Intervention……………………………………………………….10-11

Gordon’s Pattern of functioning………………………………………………….12-

13

Drug
study……………………………………………………………………………………14

Nursing Care Plan…………………………………………………………………………

15-16

Discharge
Planning…………………………………………………………………………17

Reference……………………………………………………………………………………
18

1
Introduction:

About Appendicitis
The appendix is a small finger-like organ that's attached to the large intestine in the lower right side of the
abdomen. The inside of the appendix forms a cul-de-sac that usually opens into the large intestine. When
that opening gets blocked, the appendix swells and can easily get infected by bacteria.

Appendicitis is a condition characterized by inflammation of the appendix. It is a medical emergency. All

cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is
high, mainly because of peritonitis and shock. Reginald Fitz first described acute and chronic appendicitis in
1886, and it has been recognized as one of the most common causes of severe acute abdominal pain
worldwide. A correctly diagnosed non-acute form of appendicitis is known as "rumbling appendicitis".

2
Objectives:

General

After four weeks of Related Learning Experience, I will be able to acquire the knowledge, skills and
attitude regarding appendicitis.

 This study will help us to learn more about appendicitis

 To learn how to give quality nursing care to patients who are suffering from the disease itself.
 It will also give us knowledge on what we can teach to the patients and their relatives on how to
prevent in acquiring the disease.

Specific

 Within the days of case study, I will be able to construct a pathophysiology connecting the
conditions of Dengue Fever.
 To be able to make two (2) appropriate NCP’s for my patient.
 To be able to deeply understand what is appendicitis.
 To be able to know the signs and symptoms of the complication.
 To be able to render quality nursing care to the patient with appendicitis.

3
PATIENTS PROFILE

NAME : MB
Age : 10/yrs
Sex: Male
Physician : Dr. Arcellana/zaen
Room : 533d
Chief complaint: abdominal pain
Diagnosis : Acute appendicitis

Past Medical History

(+)skin asthma

History f present illness:

A few hours prior to admission, the patient experienced severe amount of epigastric pain
Associated with 3x vomiting,(+) low grade fever.
At around 4pm ,increased pain in RLQ, patient was brought to the nearest hospital, then
transferred to the institution

4
 Physical Assessment
Assessment Technique Findings Normal Findings Analysis

General Appearance and Mental Status

Built Inspection Thin Proportionate to Normal

height
Posture Inspection Bent Posture Erect Posture normal
Signs of distress Inspection No distress No distress noted Normal
noted
Signs of health Inspection Healthy Healthy Normal
appearance appearance

Attitude Inspection Cooperative Cooperative Normal

Affect Inspection Appropriate to Appropriate to Normal

situation situation
Speech Inspection Understandable Understandable Normal

Hair
Evenness Inspection Evenly Evenly distributed Normal
distributed
Thickness Inspection, Thick hair Thick hair Normal
Texture Inspection, Silky, resilient Silky, resilient hair Normal
hair
Presence of Inspection, No infection or No infection or Normal
infection or infestation infestation
infestation
Amount of body Inspection Few Variable Normal
hair

Nails
Fingernail plate Inspection Convex Convex curvature Normal
shape curvature
Fingernail and Palpation Smooth texture Smooth texture Normal
toenail texture
Tissues Inspection Intact Intact epidermis Normal
surrounding nail epidermis

Nail Hygiene Inspection Dirty, long Clean, trimmed Poor nail hygiene
nails nails
5
 Skin

abdomen Inspection No laceration, With suture in There is deviation on normal

equal skin color the right lower skin contour because of the
quadrant; dry and laceration made for the
intact operation

Extremities
Arms Inspection No ecchymosis Right metacarpal Right arm has limited
noted. Full and connected to the IV movement due to the IV
equal pulses. line. connection

Legs Inspection No Absence of Normal

deformities, deformities and good
good ROM, no ROM. Absence of
edema and edema and
ecchymosis ecchymosis

6
ANATOMYAND PHYSIOLOGY OF APPENDIX
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.

7
Pathophysiology

Non modifiable: Modifiable

*gender(male) *lifestyle
*age(10-30) *food preferrence

Episodes of Constipation Low Fiber Diet

↓ ↓
↓
Occlusion of Appendix by Fecalith
↓
Decreased flow/drainage of mucosal secretions
↓
Increased ILP in the appendix
↓
Vasocongestion
↓
Decreased blood supply in the appendix
↓
Decreased O2 supply in the appendix
↓
Appendix starts to be necrotic; Bacteria invade the appendix
↓
Disruption of Cell Membrane of Appendix
↓
Start of Inflammatory Process
↓
↓ ↓ ↓
Release of Chemical Mediators Activation of the Vomiting Neutrophils to area
Center in the Medulla
↓ ↓
---> Histamine, Prostaglandin, Stimulation of Vagus Suppression of Pus Formation
Leukotrienes, Bradykinin Nerve Sympathetic (phagocytized bacteria
↓ GI Function and dead cells)

Swelling of Appendix Risk for Infection

(if appendix ruptures)
---> Prostaglandin, Bradykinin Nausea & Vomiting Anorexia
↓
Pain in the RLQ of Abdomen Risk for Deficient Risk for Imbalanced Nutrition
↓ Fluid Volume less than body requirements
Acute Pain
---> Interleukin-1
↓
Increased WBC

Inflammation of Appendix (Appendicitis) <

↓
Appendectomy

8
 ↓
Tissue Trauma

↓
Open Wound Disruption of Cell Membrane Norciceptors on the
↓ ↓ ↓ Dermis
Impaired Tissue Risk for Start of Inflammatory ↓
Integrity Infection Process Send Impulse to CNS

Release of Prostaglandin/ Pain on Surgical

Bradykinin Site

Activity Intolerance

Laboratory findings

INVESTIGATION RESULTS UNIT REFERENCE Analysis

RANGE

FULL BLOOD
COUNT
Red Cell Count 4.79 x10^12/L ( 4.5 - 6.0 ) normal
Haemoglobin 132 low mg/dL (120-150 )

Hematocrit 0.38low % ( 0.40-0.48 ) a blood loss that is more

acute, such as a hemorrhage
MCV 79.5low fL ( 80-96 ) Indicates a blood loss that is
more acute, such as a
hemorrhage
MCH 27.60 Pg ( 27-33 ) normal

MCHC 34.60 g/dL ( 32 - 36 ) normal

RDW 13.2high % ( 4.0 - 11.0 )

--
Platelet count 235 x10^9/L ( 150 - 400 ) normal

White cell count* 21.2high x10^9/L ( 5.0-10.0 ) Shows an infection

9
Medical surgical management:

APPENDECTOMY
During an appendectomy, an incision two to three inches in length is made through the skin and the layers of
the abdominal wall over the area of the appendix. The surgeon enters the abdomen and looks for the
appendix which usually is in the right lower abdomen. After examining the area around the appendix to be
certain that no additional problem is present, the appendix is removed. This is done by freeing the appendix
from its mesenteric attachment to the abdomen and colon, cutting the appendix from the colon, and sewing
over the hole in the colon. If an abscess is present, the pus can be drained with drains that pass from the
abscess and out through the skin. The abdominal incision then is closed.

Newer techniques for removing the appendix involve the use of the laparoscope. The laparoscope is a thin
telescope attached to a video camera that allows the surgeon to inspect the inside of the abdomen through a
small puncture wound (instead of a larger incision). If appendicitis is found, the appendix can be removed
with special instruments that can be passed into the abdomen, just like the laparoscope, through small
puncture wounds. The benefits of the laparoscopic technique include less post-operative pain (since much of
the post-surgery pain comes from incisions) and a speedier return to normal activities. An additional
advantage of laparoscopy is that it allows the surgeon to look inside the abdomen to make a clear diagnosis
in cases in which the diagnosis of appendicitis is in doubt.

10
If the appendix is not ruptured (perforated) at the time of surgery, the patient generally is sent home from the
hospital after surgery in one or two days. Patients whose appendix has perforated are sicker than patients
without perforation, and their hospital stay often is prolonged (four to seven days), particularly if peritonitis
has occurred. Intravenous antibiotics are given in the hospital to fight infection and assist in resolving any
abscess.

Occasionally, the surgeon may find a normal-appearing appendix and no other cause for the patient's
problem. In this situation, the surgeon may remove the appendix. The reasoning in these cases is that it is
better to remove a normal-appearing appendix than to miss and not treat appropriately an early or mild case
of appendicitis

11
Gordon’s Pattern of functioning

Patterns of Before hospitalization During hospitalization Analysis

functioning
Health perception The patient did not The patient abides The patient’s family
undergo self with the doctor’s believe that consulting
medication, they orders the doctor
immediately consult immediately can
to the MD lessen the danger
during illness
Metabolic Pattern The patient eats a The patient is on There is change in the
variety of foods a day general liquid diet metabolic pattern
2-3 times a day since patient has
restriction to diet
Elimination Pattern The patient has no The patient has no The patient
difficulty or pain in bathroom privileges complained
urinating or after the surgery restlessness while on
defecating using the which made him catheter
bathroom urinate through folly
catheter
Activity and Exercise The patient was able The patient is on bed The patient feel bored
to play basketball and is not able to during hospitalization
with his friends inside ambulate; until after
the patient’s house the operation
Cognitive and The patient is The patient is Even though the
Perception conversant and conversant and patient is hospitalized
cooperative, the cooperative; he he still has a
patient is currently always state that he functional cognitive
enrolled as a Grade 5 will miss much in function which is not
student their class related to his
condition
Sleep-rest pattern The patient has no The patient is The patient has more
difficulty in sleeping subjected to bed rest time to rest but
and is able to sleep 8 and sleep pattern is interrupted due o
hours a day with his interrupted due to treatments to be done
family in a room. He treatment and medical
wake up early for procedures
school
Self-perception Patient is active and is Patient is now shy The patient may have
active with friends because of his felt a lower self-worth
condition and he still because of his
needs to urinate in a condition
12
 bed pan
Role-relationship The patient is the Though hospitalized No significant change
pattern eldest among the the patient was able to is observed, even
siblings and is maintain family though hospitalized
obedient to his parents bonding through family members still
family visits strengthen bond
through visits
Sexuality The patient plays The patient does not The patient’s activities
basketball with his play with his friends was appropriate for
friends with the same anymore because of his gender before and
gender and watches hospitalization he during hospitalization
“anime movies” only draws on his he uses his time to
color book most of the draw so he will not
time get bored in the
hospital
Stress and Coping The patient tries to eat The patient sleep Patient had a different
or play with friends when in pain or approach in coping
when subjected to stressors are present with stress when he
stress was hospitalized
Vales and Beliefs The patient is able to The patient and his During hospitalization
go to mass every family does not the patient did not
Sunday with his perform any ritual or perform any religion
family religion bound related activity
activity in he hospital because of the
limitations brought by
the illness

13
Drugstudy
Generic Brand Classifi Dosage Indication Mechanism Adverse Contra Nursing
Name Name cations of action Reaction Indication implication
>Ketorolac Korteg NSAID 15 mg Relief for Inhibits Stimulat Assess
or s IV mild pain Coax-2 ion, pain after
to severe drowsin administrat
pain. ess, ion.
nausea,
vomitin
g,

>nalbuphine > 25mg Relief for Assess

IV mild pain pain after
to severe administrat
pain. ion.

>ranitidine >zantac >antaci 25mg For acidic Inhibits Urticaria Constipati Taken
d IV gastric secretions and on before
environme of Hcl acid pruritus meals
nt

>cefuroxim >zegen cephalo 500mg Treatment Thromb Allergy to Taken on

e sporins BID for ophlebiti cephalosp full
infection s and orins stomach
pruritus

14
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

Subjective: Acute pain Short-term >identify the scale >To have a Short-term goal:
“Sumasakit yung related to post Goal: or intensity of pain baseline scale After 1 hour of
pinag operahan operative After of pain to nursing
sa akin” As incision as 30min.-1 evaluate the interventions the
verbalized by the observed in hour of effectiveness patient was able
patient. the objective nursing of therapy to verbalize that
interventions, >encourage use of > to distract the pain is
Objective: the patient relaxation attention and relieved from
> Facial grimace will be able techniques such as reduce tension pain scale of 6
>guarding to verbalize focused breathing >to promote out of 10 to 2 out
behavior that the pain non of 10
>restlessness is relieved >provide comfort pharmacologic
>pain scale of 6 from pain measures e.g. cold al pain
out of 10;where scale of 6 out packs management. Long-term Goal:
10 is the highest of 10 to 2 out After 2-3 nursing
of 10 shift the patient
Dependent: was able to state
Long-term >Administer and practice diff.
Goal: analgesics as >to maintain non
After 2-3 prescribed by MD acceptable pharmacological
nursing shift level of pain techniques to
the patient reduce pain
will be able perception
to state and
practice diff.
non
pharmacolog
ical
techniques to
reduce pain
perception

Nursing care plan

15
ASSESSMENT DIAGNOSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

Risk for Short term >stress proper hand >>first line Short term goal:
infection goal: hygiene especially defense against After 2-3 hours
related to After 2-3 all care givers infection of nursing
broken skin hours of interventions,
(surgical nursing >instruct client to patient was able
incision) interventions, protect the integrity to verbalize
secondary to patient will of the skin >premature understanding of
appendectomy be able to >emphasize discontinuation individual
. verbalize necessity of taking of treatment causative risk
understanding antibiotics as potentiate drug factors.
of individual directed resistant
causative risk bacteria Long term goal:
factors. >recommend routine >to reduce After 2-3 nursing
pre operative body bacterial shifts the patient
Long term shower/scrubs colonization was able to
goal: >maintain sterile achieve timely
After 2-3 techniques for all wound healing;
nursing shifts invasive procedure free of purulent
the patient drainage;
will be able afebrile
to achieve
timely wound
healing; be
free of
purulent
drainage or
erythema; be
afebrile

16
DISCHARGE PLANNING
M – edication
Advise intake of appropriate vitamin supplement to increase protection mechanism of the immune system.
Continuation of cefuroxime BID for 5 days+ vitamin -c
E – xercise
There are no activities or exercises that are contraindicated for the client when the wound heals. He may
proceed with his regular activity and play. Immediately after discharge the patient should have more time to
rest to regain the normal daily living pattern
T – reatment
Ensure clients compliance to treatment regimen and go back for further follow up in the institution
H –ealth teachings
Advise to follow proper body hygiene and cleanliness on surroundings.
O – ut Patient/ Follow-up
Encourage patient to go to scheduled follow up check up in Dr. Zaen’s office in the building of capitol
medical center
D – iet
Instruct to eat foods that are rich in vitamins and minerals such as fruits, vegetables, meat and milk to help
the client get the energy he needs for his daily activities and to boost his immune system.
S - piritual belief

Encourage the client to go to church and pray. It is essential for the client to have a strong faith in order to
help him cope with the challenges he may encounter and to mold himself as a person.

17
REFERENCE

1. Brunner and Suddarth’s Textbook of Medical Surgical Nursing. Eleventh Edition

2. Priscilla lemone medical surgical nursing
.
3. Ross and Wilson Anatomy and Physiology in Health and Illness. Tenth Edition.
4. Medical Surgical Nursing Critical Thinking in client care
Third Edition
5. MIMS and MIMS Annual
6. NANDA
7. Pictures www.wikipedia.com

18