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ANGELES UNIVERSITY FOUNDATION College of Nursing

Appendectomy (A Case Study)

Submitted by: Mistal, Mona Liza David, Audrey Cordero, Jelica Joy Torres , Robinson BSN 3-II Group 42

Submitted to: Ms. Jazper Herrera, RN Clinical Instructor

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TABLE OF CONTENTS: I. INTRODUCTION……………………………………………………………………….3 a. Current trends about the disease condition………………………………..4 b. Reasons for choosing such case for presentation………………………..5 II. NURSING ASSESSMENT……………………………………………………..…….6 a. Personal History…………………………………………………………...…6 b. Pertinent Family Health-Illness History………………………………….…7 c. History of Past Illness…………………………………………………….….8 d. History of Present Illness………………………………………………..…..8 e. Physical Examination……………………………………………… ………..9

f. Diagnostic and Laboratory Procedures……………………………..……12
III. ANATOMY and PHYSIOLOGY(with visual aids)…………………………….…...14 IV. THE PATIENT’S ILLNESS…………………………………………………….…….18 a. Synthesis of the disease……………………………………………...….…..18 a1. Definition of the disease……………...……………………….……18 b2. Predisposing / Precipitating factors…………………………...….18 c3. Signs and symptoms with rationale………………………… ……19 d4. Health promotion and preventive Aspects of the Disease ..…..20 V. THE PATIENT AND HIS CARE………………………………………………………21

a. Medical Management……………………………………….………

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a. IVF’s, BT, NGT feeding, Nebulization, TPN, Oxygen therapy, ...21 b. Drugs……………………………………………………………....….23 c. Diet……………………………………………………………….……25 d. Activity / Exercise………………………………………….….……..26 b. Surgical Management (actual SOPIERs)…………………………….……27
c. Nursing Mangement…………………………………………………….….…28 a. Nursing Care Plan……………………………………………….……28 b. Actual SOAPIES …………………………………………………..…29 VI. CLIENTS DAILY PROGRESS IN THE HOSPITAL…………………………...…..31 a. Client’s daily Progress Chart………………………….………………….….31 b. Discharge Planning……………………………………………………….….31

a. General Condition of Client upon Discharge…….……………...31 b. METHOD…………………………………………...……………….31

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VII. CONCLUSION and RECOMMENDATIONS…………………………….….……32

I. Introduction
The appendix is a closed-ended, narrow tube 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 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. Appendicitis is inflammation of the appendix. It is thought that appendicitis begins when the opening from the appendix into the cecum becomes blocked. The blockage may be due to a build-up of thick mucus within the appendix or to stool that enters the appendix from the cecum. The mucus or stool hardens, becomes rock-like, and blocks the opening. This rock is called a fecalith (literally, a rock of stool). At other times, the lymphatic tissue in the appendix may swell and block the appendix. Bacteria which normally are found within the appendix then begin to invade (infect) the wall of the appendix. The body responds to the invasion by mounting an attack on the bacteria, an attack called inflammation. (An alternative theory for the cause of appendicitis is an initial rupture of the appendix followed by spread of bacteria outside the appendix.. The cause of such a rupture is unclear, but it may relate to changes that occur in the lymphatic tissue that line the wall of the appendix.) If the inflammation and infection spread through the wall of the appendix, the appendix can rupture. After rupture, infection can spread throughout the abdomen; however, it usually is confined to a small area surrounding the appendix (forming a periappendiceal abscess). The treatment for appendicitis is antibiotics and surgical removal of the
appendix (appendectomy). Appendectomy is the removal by surgery of the appendix, the small worm-like appendage of the colon (the large bowel). An appendectomy is performed because of probable appendicitis.

Acute appendicitis is the most common cause in the USA of an attack of severe, acute abdominal pain that requires abdominal operation.

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The clinical practice protocol that was developed from a critical review of the literature (see accompanying figure) was applied to 206 patients with a presumptive diagnosis of appendicitis who presented to a Texas county hospital during 1999. and other complications during the hospital stay. Rare cases of neonatal and prenatal appendicitis havebeenreported. The rate of infections depends on the degree of contamination during surgery and reaches nearly one third of cases when the appendix is perforated or gangrenous. Outcomes in this cohort of patients were compared with those in 232 patients treated for the same condition at the hospital during the previous year. Up to 18 percent of patients have postoperative infectious complications ranging in significance from wound infection to intra-abdominal abscess. and the number of wound infections dropped from 14 to four. Helmer and colleagues studied the effect of an evidence-based clinical practice guideline in reducing infectious complications of appendectomy. No patients were excluded from the study. The number of patients with intra-abdominal abscesses dropped from 12 to five after introduction of the protocol. Eight patients (4 percent) who were treated according to the protocol had postoperative surgical infections. A.The incidence of acute appendicitis is around 7% of the population in the United States and in European countries.7:1. Data were gathered on demographic and surgical features. Appendicitis can effect any at any age. evidence of infection. Appendicitis occurs more frequently in men than in women. with highest incidence occurring during the second and third decades of life. The improvement was particularly significant in patients presenting with a perforated or 4 . In Asian and African countries. Current Trends about Appendicitis Care protocols reduce appendectomy complications . use of antibiotics.Tips from Other Journals Appendectomy is the fourth most common abdominal surgery performed in the United States. comorbidities. compared with 20 patients (9 percent) in the comparison group. the incidence is probably lower because of the dietary habits of the inhabitants of these geographic areas. with a male-to-female ratio of 1.

Most importantly. B. we want to further enhance our knowledge about the disease such as to ensure appropriate evaluation of the etiology. it is not only the knowledge that was enhanced but also our skills as health care practitioners. In these patients. With that scenario. The authors conclude that use of an evidence-based clinical practice guideline can significantly reduce surgically related infections following appendectomy and is particularly effective in patients with perforation or gangrene of the appendix. the total number of infections dropped from 16 (33 percent) to five (13 percent). Reasons for choosing such case One of the formidable part in doing a case study is choosing what case is to present. II. We had this unanimous decision of choosing Girl Agnes’ case. We had established the “trust” we yearn from them and that makes it easy for us to ask certain questions we need for our case and interact with them properly. Nursing Assessment 5 . to have an experience in handling and providing humanitarian health services to a patient who has it and provide any intervention or treatment indicated based on the specific etiology and the course it follows in that specific patient.gangrenous appendix. the term Appendicitis is not accustomed to us that much. reassess and address the course the illness takes in its progression. Another thing is because we find them kind and humorous that is why our previous interaction with them is smooth and conventional. With that thought alone. first and foremost because with our initial contact we already established hormonious relationship with the patient and her significant others. Also.

Magalang Papanga. last February 28. Currently. 1939. She was born on January 3. Since he has this kind of lifestyle. Sometimes she takes care of her grandchildren at home. Pertinent Family Health-Illness History Ba Family 6 . B.A. where some are married. She also cooks food for them and clean the house. Personal History Princess Lulu M. She is married with eight children. she is just staying at home and she is dependent to his children for support. and because of his age. female. Ba 65 years old. currently residing at 176 Dolores. 2006 she manifested symptoms of appendicitis which was the reason why she was rushed to ONA. A typical Filipina and presently a part of the Roman Catholic.

Jewel o o o Mother Alcoholic Died of Tuberculosis o o o Palace Father Alcoholic Died of a ruptured appendicitis Prince Stephen o husband Princess Lulu o o Patient Dignosed with appendicitis Bu -37 -Married -working La -32 -single -Construction worker Ba -28 -married -housewife Jel -27 -married construction worker Tah -15 -single -not going to school Mah -17 -single -college student Ad -22 -single -vendor Bon -24 -married -vendor Living Condition House: 7 .

they rushed him to the ONA. History of Past Illness She has always been healthy ever since he was a kid and he was never been brought to the hospital. with no signs of hypertension. C. Dizon assessed her and diagnosed it as acute appendicitis because of (+) muscle guarding. she was chilling and felt nauseated and vomited several times. Their source of water is the pump. The patient was also assessed for Psoas sign and Obturator sign and was found out that the patient was in 8 . colds and cough. Diabetes Mellitus or even Tuberculosis. she was still experiencing the same but the pain is worsen. accompanied by fever. At 11 pm of the same night. (+)direct and rebound tenderness on the right lower quadrant. Economic Status: Princess Lulu is not working. fish.They live in a bungalow type of house. She had normal Blood pressure. They seldom bring members of the family to doctors or to the hospital for consultation or treatment of any disease. concrete and some of the married members of the family resides Food: Their food is always a usual Filipino dish consisting of rice. she is dependent on his children for support. Dr. 2006. 7 in the evening when she started to feel some pain in the abdominal area. Aside from fever. History of present Illness It was February 28. Beliefs: The BA Family believes in “herbolarios” and “hilots” and directly seek advices from them if any sickness occurred. told us that 150-200 pesos a day is enough for them to satisfy the day. Her daughter. D. Early in the Morning. meat and vegetables. nothing hinders him from doing his daily activities.

sensitivity to light EARS a. eyelids: skin intact. thick hair. evenly distributed. smooth texture. no discoloration. eyebrows: symmetrically aligned equal movement. general: mobile. pinna recoils after it is folded. black in color HEAD AND FACE a. dry. face: palpabral fissures equal size EYES a. smooth border h. skull: rounded. scalp: no evidence of flaking or dandruff b. pupils: black in color. no tenderness. dry skin. absence of edema. involuntary blinks e. promp return of pink or usual color HAIR a. 2006 BP=110 / 90 T= 37. round. smooth g. E. poor turgor NAILS a. Physical Examination March 01. absence of nodules or masses c.firm. + PERRLA. conjunctiva: shiny.2º C SKIN a . no infection RR= 20 bmp PR=84 bpm 9 .pain during the assessment hence he was admitted right away and had an emergency appendectomy. long with dirt. hair evenly distributed c. vision: able to read newsprint. General: converse curvature. smooth skull contour. no discharge. when pinched skin springs back to previous state. eyelashes: equally distributed curled slightly outward d. equal size. sclera: whitish with capillaries f. general: symmetrically aligned b.General: dark brown in color.

ability to pursue lips b. skin intact. full symmetrical chest expansion b. no swelling NECK a. Olfactory– have the sense of smell 10 . muscles: equal in size. external: symmetric and straight. no deformities Cranial Nerves I. general: equal size on both sides of the body. able to roll the tongue upward and side to side d.thyroid gland: not visible CHEST a.lymph nodes: not palpable d. chest wall intact. MUSCULOSKELETAL a. internal: presence of hair MOUTH AND OROPHARYNX a. tongue: no lesions. equal strength b. absence of DOB CARDIOVASCULAR a. dry. with thin whitish coating. not tender. external: symmetric. head centered. normal beating pattern ABDOMINAL a. air moves freely as the client breaths b. lips: uniform pink color. presence discharge NOSE a.b. external ear canal: presence of hair follicles. with indirect tenderness. general: with direct and rebound tenderness on the right lower quadrant. palates and uvula: light pink. positioned in the middle of soft palate e. no tremors. lungs: normal breath sounds. spinal column is straight. no contractures. discoloration of enamel c. tonsils: pink. teeth: missing teeth due to cavities. normally firm. movement: coordinated smooth movements without discomfort c . heart: absence of heart sounds. no tenderness.

Vagus– (+) gag reflex XI. can swallow X. Vestibulocochlear– normal voice tones audible. Optic – normal visual acuity III. VI.Facial – normal muscle strength of facial expressions VIII. Diagnostic and Laboratory Procedures 11 . Abducens– positive papillary reflex and eye convergence test VII. Oculomotor– positive papillary reflex and eye convergence test IV Trochlear– positive papillary reflex and eye convergence test V. IX. Glossopharyngeal– (+) gag reflex. able to hear ticking on the both ears.II. Accessory– normal muscle strength XII. Trigeminal – can sense the sensation of pain. temperature and normal muscle strength. touch. Hypoglossal – normal tongue movements F.

Gravity: 1. If there is infection.003-1. glucose. clear Sugar: ( . Gravity: 1.to determine urine composition such as blood.030 Pus cells: +10 HPF RBC: 0-3 HPF O: 03-01-06 Urinalysis R: 03-01-06 Analysis & interpretati on of result The microscopic analysis shows normal levels. Diagnosis/ Lab procedure Date ordered Date result in Indication or purpose result Normal value Analysis & interpretati on of the result 12 . Nursing Responsibilities: • • • • • • Explain the procedure and the purpose to the client. tell the patient that the test will be repeated to monitor any development. it can alter the result Ask the client what are the medication that he/she had taken.030 Pus cells: 0-1 HPF RBC: 1-2 HPF normal value Yellow. protein result Yellow.) Ph: acidic Sp. Explain to the client the importance of the procedure Explain to the client that urine sample is needed Ask the client if he/she had eaten.Diagnosis/ Lab procedure Date ordered Date result Indication or purpose . clear Sugar: ( .) Ph: acidic Sp.

47 L/L RBC: M: 4.4 x 10/L White blood cell is above the normal range.54 L/L F: 0. White blood cell is above the normal range.47 L/L RBC: M: 4.37-0.41 RBC: 5.3 x 10/L F: 4. Leukocytosi s indicates appendicitis.4 Hct: 0. 13 .54 L/L F: 0. Diagnosis/ Lab procedure Date ordered Date result in Indication or purpose result Normal value Analysis & interpretati on of the result A decrease in hemoglobin indicates anemia.4 x 10/L Nursing Responsibilities: • Explain the procedure and the purpose to the patient. there is systemic infection.37-0.10 x 10/L Hct: M: 0.25 Hgb: M: 140-180 gm/L F: 120-160 gm/L WBC: 5.6 Hct: 0. Leukocytosi s indicates appendicitis.5-6.45 RBC: 5.50 WBC: 14.25 Hgb: M: 140-180 gm/L F: 120-160 gm/L WBC: 5.10 x 10/L Hct: M: 0.2-5. O: 03-01-06 Hematologic test R: 03-01-06 -to indicate anemia and polycythemi a Hgb: 139 WBC: 12.O: 03-01-06 Hematologic test R: 03-01-06 -to indicate anemia and polycythemi a Hgb: 1.40-0.5-6.40-0.2-5.3 x 10/L F: 4. there is systemic infection.

commonly called the throat. except the hard palate. It is about 25 cms. below by the floor of the mouth including the tongue and behind by the faucial isthmus. Anatomy and Physiology In a normal human female. above by the hard and soft palate. includes tongue. III. salivary glands and mucosa) The mouth is the first of the digestive tract. Ask the patient if he/she had eaten food because it can alter the result.• • • • Explain to the patient that it requires blood sample and it can cause pain and discomfort due to the needle puncture. Ask for the religion and culture of the patient. It is lined by stratified squamous non-cornified epithelium. the GI tract is approximately 25 feet or 7 and a half meters long and consists of the following components  Mouth (Oral cavity/ Bucal Cavity. It is where the digestive tract and the respiratory tract cross. It is the opening through which takes in food. It is bound infront by the lips. gingival and filiform papillae of tongue which are cornified. lined with moist stratified squamous epithelium that extends from the pharynx to the stomach. The human pharynx is bent at a sharper angle. teeth. Long and lies anterior to the vertebrae and posterior to the trachea within the 14 .  Pharynx The pharynx is the part of the digestive system which connects the mouth with esophagus. Ask the patient if he/she had taken some drugs because it can alter the result.  Esophagus (Gullet/ Oesophagus) The esophagus is a muscular tube.

 Duodenum Duodenum is a hollow jointed tube that connects the stomach to the jejunum. many medical terms related to the stomach part in “gastro” or “gastric”. it is the shortest. It is an alimentary canal used to strore and digest food. It is about 6 meters long and consists of 3 parts: duodenum. the stomach is a large multichambered organ that hosts symbiotic bacteria which produced enzymes required for the digestion of cellulose from plant matter. It passes through the diaphragm and ends at the stomach.  Bowel/Intestine  Small Intestine Small intestine is the portion of the alimentary tract between the stomach and the large intestines whose main function is for absorption. It’s primary function is as a storage and mixing chamber for ingested food.mediastinum. It transports food from the pharynx to the stomach. jejunum and ileum. Latin names for the stomach include Ventriculus and Gasti. the widest and most fixed part of the small intestine and is largely retro-peritoneal closely attached to the dorsal wall. being regurgitated and rechewed at least once in the process. In humans the stomach is a highly acidic environment (maintained by the hydrochloric acid secretion) wit peptidase digestive enzymes. The partially digestive plant matter passes through each of the stomach’s chambers in sequence. In ruminants.  Jejunum 15 .  Stomach The stomach is an enlarged segment of the digestive tract in the left superior part of the abdomen. It is lined with simple columnar epithelium.

where the colon turns inferiorly. long called the APPENDIX. Attached to the cecum is a tube about 9 cms. rectum and anal canal. colon.5 meters long and makes up 2/5 of the total length of the small intestine. past ileocal junction. It is a sac that extends inferiorly about 6 cms. 16 . Colon  The colon is about 1. where it turns left  Transverse Colon The transverse colon extends from the right colic flexure to the left colic flexure near the spleen. It is about 3. Cecum and Appendix  Cecum is the proximal end of the large intestine and is where the large and the small intestine meet at the ileocal junction.Jejunum is about 2.  Large Intestine The large intestine extends from the ileocal junction up to the anal opening in the peritoneum. It is located in the right lower quadrant of the abdomen near the iliac fossa. It is about 5-6 feet long. It is subdivided into: cecum and appendix.8 meters long and consists of four parts:  Ascending colon  Transverse colon  Descending colon and sigmoid colon Ascending Colon  The ascending colon extends superiorly from the cecum to the right colic flexure near the liver.5 meters long and it makes up 3/5 of the small intestine.5-1.  Ileum The ileum joins with the cecum at ileocal junction.

 Anal Canal The anal canal represents the terminal portion of the large intestines and it is about 2-3 cms. Descending Colon and Sigmoid Colon The descending colon extends from the left colic flexure to the pelvis. where it becomes the SIGMOID COLON. long 17 . The sigmoid colon forms an S-shaped tube that extends medically and the inferiorly into the pelvic cavity and ends at the rectum.  Rectum The rectum is a straight muscular tube that begins at the termination of the sigmoid colon and ends at the anal canal.

Palpation of the abdomen causes pain in the right quadrant. held momentarily. However.5 to 1 cm. Abscess formation generally occurs and danger of rupture is omnipresent. The average adult appendix is 9-10 cm in length with a diameter of 0. This "rebound tenderness" suggests inflammation has spread to the peritoneum. the pain may disappear for a short period and the patient may feel suddenly better.Predisposing / Precipitating Factors Predisposing Factors: • Classic history of appendicitis 18 . Synthesis of the Disease a1. The appendix can also become kinked. There is no specific cause of appendicitis. the appendix can lie medial. the appendiceal artery. If the appendix ruptures.2. Appendix occurs most commonly on children. once peritonitis sets in. and then rapidly released. Its blood supply. Definition of the Disease Appendicitis is the inflammation of the vermiform appendix. lateral. At this time the abdomen may become rigid and extremely tender. which is attached to the cecum and lies in the right lower quadrant. Appendicitis is characterized by a sharp abdominal pain that may be localized at McBurney’s point (half way between the umbilicus and right iliac crest). Pressing the abdomen at McBurney's point causes tenderness in a patient with appendicitis. the patient may experience a momentary increase in pain. although inflammation can occur spontaneously from an infection or from fecal waste that have been trapped in the lumen of the appendix. When the abdomen is pressed. the pain returns and the patient becomes progressively more ill. This small finger shaped tube branches of the large intestine. a. adolescents and young adults but individuals of any age may have appendicitis. is a terminal branch of the ileocolic artery which transverses the length of the appendix.IV. obstructing the circulation. The Patient’s Illnesses A. anterior or posterior to the cecum. it is behind the bowel or mesentery or in the pelvis.

6 times more common in males than in females Age: the peak incidence is in the second and third decades with 80 % of cases occurring in persons younger than 45 years of age but individuals of any age may have appendicitis. Other symptoms of appendicitis may include: · Nausea or vomiting. Sign and Symptoms Appendicitis often starts with mild pain near the navel. · Abdominal swelling. The pain gradually moves to the right lower part of the abdomen. parasites or bacteria Diet deficient in fiber Precipitating Factors: a. and is more intense when the person moves.• • Sex: Appendicitis is 1.3 to 1. When this occurs. Lymphoid Follicular Hyperplasia Infections by viruses.3. • • • • Anatomical Variations in the position of the appendix. Chronic appendicitis is rare. · Constipation. It worsens with time. If the infection continues. This improvement is followed by more intense but similar pain. the appendix may rupture. there is often relief of the pain for a short while. · Elevated temperature. · Increased pulse rate. It causes a milder pain in the right lower abdomen that may come and go. · Loss of appetite. 19 .

. Health promotion and Preventive Aspects of the Disease A-void too much activity(eating then working or playing right away) P-eople of any age are susceptible.d. I-increase peristalsis to prevent constipation X-ray. male are more prone P-revent obstruction of the lumen E-xercise N-otify physician if any signs and symptoms occur D-iet should be high in fiber. so to. ultrasound and other lab test should be take into consideration to avoid rupture of the appendix 20 .3.

THE PATIENT AND HIS CARE 1. Medical management A.V. IVF’s 21 .

contains dextrose dehydrated alcohol 40ml.NaCl 2. Client’s Initial Reaction to the Treatment >Check Tubing the IV for presence of air >Check Integrity of the Infusion >Monitor IV flow rate >Adjust rate of Client’s of flow fluids response to appropriate the to need of Treatment patient as prescribed D5LRS is Indication/s administered Or and given to patient to Purpose/s give the necessary nutrients to replace any lost fluids since the Provides patient is in principal ions NPO. perfor med.28g. it was given to the patient to prevent dehydration and contains plasma volume. medications 50g. of acute looses of extraxcellular fluid volume in surgery. 22 .Indication/s Medical Manageme nt/ Treatment Date ordere d. in patients He responded that are well to the dehydrated treatment.0 osmolar mEq/L of dextrose is Calcium. Client has a guarding behavior but was cooperative with the treatment procedure. Used to and volume depleted. He responded well to the treatment. It is of normal also used as plasma is a main line almost the to administer same Antibiotics proportions as with normal and plasma. D5LRS will increase the solute concentration of plasma. Mg acetate 0. draining water out of the cells into the extracellular General compartment Description to restore osmotic equilibrium. 4 mEq/L of Hypotonic Potassium. potassium acetate 1. It rapidly metabolized. since 3. D5LRS contains 130 mEq/L Sodium. Replacement IV. this solution exerts higher osmotic pressure than of the blood plasma./min #1 O: 03-01-06 C: 03-01-06 O:03-02-06 C:03-02-06 O:03-02-06 C:03-03-06 O:03-03-06 Date C:03-04-06 ordere d. No signs of abnormalities observed or felt by the patient.1g Client has a guarding replace behavior but was deficits in the cooperative extracellular with the treatment compartment procedure. perfor O:03-04-06 med. it solution 109 maybe mEq/L isoChloride. has 120 Normosol M calories. C:03-05-06 change d O:03-05-06 C:03-05-06 #2 #3 #4 Medical Managem ent/ Treatmen #5 t #6 D5NM 1Lx 35 gtts/min #4 O: 01-31-06 C: 01-31-06 Slightly hypertonic solution. fructose 150g.34g. change d General Description Or Purpose/s Client’s Initial Reaction to the Treatment Client’s response to the Treatment D5LRS 1L x 8° @ 3031 gtts.

identify first the pationt  Explain the procedure  Prepare the equipment  Wash hands  Check the fluid to be infused  Use the smallest gauge needle possible  Drip the tubing before connecting to the needle once being infused  Adjust the IVF as indicated  Report any pain. IV q 4° Paracetamol . Drugs Name of the Drugs Generic Name Brand Name Date Ordered Date Taken Date Changed 03-01-06 03-01-06 03-06-06 Route and Indication/ Frequency of Purposes administration Specifi Foods taken Client’s response to medication NPO 1 amp. no side effects observed Cefuroxime 03-02-06 03-02-06 03-04-06 750mg IV q 8° -Antiinfective -2nd generation cephalospor ins -inhibits bacterial cell wall synthesis rendering cell wall osmotically unstable.non narcotic analgesics decreases fever The patient took the drugs properly. infection reduced. no side effects observed The patient took the drugs properly. infection reduced. infufusion or dislocation felt by the patient B.Nursing Responsibilities  Before administering the IV. leading to cell death by binding to cell wall membrane NPO 23 .

thought o irritate colonic intramural plexus. stimulant Soft diet diphenylmethane -acts directly on the intestine by increasing motor activity.Metronidazole 03-02-06 03-03-06 03-06-06 500mg IV q8° ANST(-) >Ambecide NPO >Anti-infective >kills susceptible amoeba. RTC centrally acting > Patient had no manifestations of any side effects Plasil 03-02-06 03-02-06 03-03-06 5mg/ml q 8° x >anti-emetic 4 doses NPO Patient had no manifestation regarding any side effects Famotidine 03-02-06 03-02-06 03-03-06 20 mg IV q 12º Histamine H2 NPO x 3 doses antagonist Patient had no manifestation regarding any side effects Patient had no manifestation regarding any side effects Kortezor 03-02-06 03-02-06 03-03-06 30 mg IV q 8º x Pain reliever 4 doses NPO Captopril Dulcolax 03-03-06 03-03-06 03-03-06 03-05-06 03-05-06 03-05-06 25mg SL Supp 2 suppl rectum NPOClear liquid -laxative. trichomonas and bacteria NPOClear liquid Patient had no manifestations of any side effects Tramadol 03-02-06 03-03-06 03-06-06 100mg IV q 6º >Analgesic. increases ater in the colon Patient had no manifestation regarding any side effects 24 .

It is non. if decreasing. Made up of clear It is mainly used liquid foods which for post operative leave no residue in patients.and infections. stiffness. onset. and charcteristic of symptoms  Assess for history of drug addiction. notify the physician  Caution patient to report bleeding. Clear Liquid Diet 03-03-06 03-03-06 03-03-06 Restriction of solid Upon admission nor liquid foods by to provide more mouth accurate observation in the condition of the client and for pre and post operative patient to prevent aspiration of the food taken in as an effect of the anesthesia. bruising or fatigue  Monitor patient bowel and consistency of stool  Evaluate for therapeutic response: release of pain. allergy to any medicine  Monitor vital signs  Obtain CBC and necessary cultures before administering  Encourage increased fluid intake  Document C. swelling  Document indications for therapy. Diet Types Of Diet NPO Date ordered Date started Date changed 03-01-06 03-01-06 03-03-06 General Description Indications Purpose or Specific Foods taken Client’s response to the treatment She exhibited some loss of appetite.Nursing Responsibilities:  Assess patient from allergic reaction (ANST)  Assess the patient for any sign and symptoms  Identify Urine output. patients the GIT. to Water Pineapple juice Jelly ace she first seemed to have a loss of appetite with the ordered diet. non.location. but then gradually 25 .with acute illness stimulating.

stressful activities. was able to oxygen and avoid any energy demand. date changed Date ordered 03. Soft Diet 03-04-06 03-04-06 03-06-06 and relieve thirst.  Continuous monitoring of the client’s diet should be observed d.  The nurse should make sure that the patient adheres to the ordered diet.  The ordered diet should be monitored. non-irritating. It is done between 1-2 feeding intervals. 26 . to reduce colonic fecal matter. the foods has been some GIT modified. is restricted from any stressful activities To decrease Pt. took in the foods that were ordered by the physician.gas forming.01 -06 Date started 03-01-06 Date General description Indication purpose or Client’s response to the activity or exercise Bed rest Pt. following surgery liquefied foods. Nursing Responsibilities:  The benefits as well as the disadvantages should be explained well to the client. liberal diet. It is a diet disturbances or modified in chewing consistency to have problems and new roughage. It is similar to the It is used for regular diet except patients with that the texture of acute infections. Activity/Exercise Type of Date exercise ordered. date started. semi-solid foods and those which are easily digested. Soup Lugaw Crackers Mammon Pineapple juice water The patient manifested an improved appetite. This could offer an entirely adequate.

No enemas. The incision usually heals with no drainage. The appendix is removed through a small incision over McBurney’s point or through a right paramedical incision. maintain good body alignment and carry out active ROM exercises. heating or laxatives should be used before surgery because they could stimulate peristalsis and cause a rupture of the appendix. performed ADLs. Attempts are made to remove the inflamed appendix before it ruptures and preoperative care is directed toward resting the colon. Drains are used when an abscess is discovered when the appendix has rupture and sometimes when the appendix was edematous and ready to rupture and was surrounded by clear fluid. Surgical Management a. was able movements and performed her strengthen the ADLs like walking muscles. Brief Description A surgical procedure called an appendectomy is necessary before the appendix ruptures. To be able limit Pt. Nursing responsibilities: • Check for the doctors order • Explain the purpose of the exercise to the client • Instruct client to maintain the exercise ordered by the physician • Assist the patient in moving and walking • Provide comfort measures to avoid injury of the patient B.changed 03-03-06 Ambulation (walking) Date ordered 03-04-06 Date started 03-04-06 Pt. 27 .

A laparoscopic appendectomy requires only small incision and allows client to be discharged 24 hours after surgery. in which the appendix is removed through a scope maybe done. a laparoscopic appendectomy. duration. b. Nursing Responsibilities Preoperative  Assess the location. Bowel function is usually normal soon after surgery and convalescence is short. severity. onset.If no rupture has occurred. precipitating factors and alleviating measures in relation to the pain  Intravenous fluids as prescribed to maintain fluid and electrolyte balance  Instruct nothing by mouth to the patient prior to surgery  Record allergies and medications as well  Place the patient in semi fowlers or side lying position to provide comfort  Analgesics are withheld until physicians determines diagnosis Post Operative  Determine (+) flatus 28 .

Region on RLQ. Quality: Stabbing and throbbing. severely: always. Clear Liquid after Flatus  Soft Diet after  Assist patient in turning. Actual SOPIE S>Ø O> the patient manifest the following (+) guarded behavior (+) facial grimaces (+) restlessness (+) pupillary dilatation (+) narrowed focus Onset of pain: often. coughing and deep breathing to promote expansion of the lungs  Assess abdominal wound for redness. swelling and foul discharge  Provide wound care  Promote early ambulation b. Level of pain of 10/10 A> Acute pain R/T stimulation of nerve endings 29 .

P> After 2-3° of Nursing Intervention and health teaching the pt will be able to decrease pain from 10 to 6 using a scale of 10 as evidence by using of relaxation technique and diversional activities. I>  Monitored and recorded vital signs  Assessed patient condition  Performed comprehensive assessment of pain  Accepted patient perception of pain  Observed non-verbal cues  Encouraged verbalization of feeling about pain  Provided quiet and calm environment  Provided patient comfort measures  Encouraged relaxation exercise such as deep breathing  Encouraged diversional activities  Encouraged adequate rest  Discussed with SO way on how to assist patient to reduce pain E> Goal met AEB reducing of pain from 10 to 6 using a scale of 10 30 .

Client’s daily progress chart Days Nursing Problems Acute Pain Risk for deficient fluid volume Impaired skin Integrity Physical Immobility Risk for Infection Vital Signs Blood Pressure Admission / / 03-02-06 / / / / / 8am 110/80 / / 8am 100/70 03-03-06 / / / / 8am 110/60 03-04-06 / / / / 8am 110/80 03-05-06 / / / / 8am 90/60 31 .VI.CLIENT’S DAILY PROGRESS IN THE HOSPITAL a.

with few days of nursing intervention. the client’s general condition has improved: 1.9 20 82 / 37 21 84 / 37 21 89 / 36.Temperature Respiratory Rate Pulse Rate Lab Procedures Medical Managements 1.1 20 70 / / / / / / / / / / / / / / / / / / / / / / / / / / / / / B. She can ambulate with assistance 32 .Discharge Planning a. IVF’s D5LRS Drugs: Paracetamol Cefuroxime Metronidazole Tramadol Plasil Famotidine Kortezor Captopril Dulcolax Diet NPO Clear Diet Soft Diet 36. She is slowly regaining his strength 2. General Condition Of client upon Discharge Since we were not able to see the client when she was discharged from the Hospital.6 21 66 / 36.

daily wound cleaning H.rich food will increase peristalsis. it cannot be presented an experience of this shall be contented with proper prevention. So there is regular bowel movement. Anyone with these symptoms need to see a qualified physician immediately.increase fluid intake. Notify physician if any signs and symptoms occur. One should always play safe in preventing obstruction of the lumen. but it increases intensity. mild umbilical pain maybe vague at first. still everyone is susceptible. apply hot compress O. Diet should always be high in fiber to increase peristalsis and to 33 . that people of any age and sex are susceptible. So there is no fecal material that will be formed.b. Over a period of time. Not everyone with appendicitis has all the symptoms. Recommendation One should always remember the health promotion and prevention of appendicitis.take the medicines prescribed E. Just remember the acronym APPENDIX. signs and symptoms occur rapidly. which is avoiding too much activity.be back at OPD as ordered by the doctor D. METHOD M.Diet as tolerated with an increase intake of Vitamin C VII. Exercise is important. Conclusion and Recommendation Every individual of any age are prone to appendicitis though its more common with males. Faulty diet especially low in fiber is one cause of the observation therefore by eating fiber. vitamin C.exercise such as walking and proper breathing T. The pain may intensify and worsens other may have a sensation called “down ward urge” pain medication and other laxatives should not be taken in their situation.

ultrasound and other laboratory test should be taken into consideration to avoid response of the appendix. Lastly x-ray.prevent constipation. 34 .