DUTY EPP VI

“An. S Nursing Care With a Medical Diagnosis Of Appendicitis at Muhammadiyah

Hospital Palembang”

Compiled by :

1. Anjelia Novriani 21118059

2. Dewi Ernanti 21118063

Supervisor : Joko Tri Wahyudi S.Kep.,Ns.,M.kep

NURSING STUDY PROGRAM FACULTY OF HEALTH SCIENCES

MUHAMMADIYAH INSTITUTE OF HEALTH AND TECHNOLOGY
PALEMBANG

SCHOOL YEAR 2021

 CHAPTER I

DISEASE BACKGROUND (APPENDECITIS)

The era of information technology and globalization currently brings many changes in
people's lives, including changes in lifestyle, especially in diet (Stang in Novita, 2017). Shifts
in consumption patterns in society are influenced by developments in the amount and type of
food. People who are busy working or doing activities every day cause them not to have
much time to cook their own food. This causes many people to switch to consuming fast
food. Fast food is an option because according to some people, with a fairly affordable price
and practical processing, they can enjoy delicious food (Goleman, And Others, 2019).
Excessive junk food consumption can cause various health problems, such as obesity
(overweight), diabetes (diabetes), hypertension (high blood pressure), atherosclerosis
(hardening of the arteries), coronary heart disease, appendicitis (appendicitis), stroke, cancer.
and others (Ariska & Ali, 2019).

Appendicitis is a disease of concern because the incidence of appendicitis is high in

every country. The risk of developing appendicitis can be lifelong and requires surgery.
Appendicitis can be found at any age, only in children less than one year is rarely reported.
The highest incidence is in the 20-30 year age group, after which it decreases. The incidence
of men and women is generally comparable, except at the age of 20-30 years the incidence of
men is higher (Sjamsuhidajat & de Jong, 2010).

Appendicitis that is not treated promptly will cause complications. One of the most
dangerous complications is perforation. Perforation occurs 24 hours after the onset of pain.
Symptoms include fever with a temperature of 37.7 ° C or higher, and continuous abdominal
pain or tenderness (RAdwan, 2013) .3 The World Health Organization (WHO) states that the
incidence of appendicitis in the world in 2012 reached 7% of the total population. world
(Ambarwati, 2017). In Asia the incidence of appendicitis in 2013 was 4.8% of the total
population. Meanwhile, from the results of the Household Health Survey (SKRT) in
Indonesia in 2013, the number of people with appendicitis in Indonesia reached 591,819
people and increased in 2014 by 596,132 people (Soewito, 2017). Based on data according to
the Ministry of Health, the number of clients suffering from appendicitis is around 26% of the
total population in East Kalimantan (Anas, Kadrianti, E., 2013). The impact of appendicitis
on basic human needs includes basic fluid needs, because patients experience high fever so
that fluid fulfillment is reduced. The basic need for nutrition is reduced because the client
with appendicitis experiences nausea, vomiting, and has no appetite. The need for a patient's
comfort experiences pain in the abdomen because of the inflammation experienced and
personal hygiene is disturbed because the patient experiences weakness. The need for
security, sufferers experience anxiety because of the disease they suffer and if not treated, the
mortality rate is quite high due to peritonitis and shock when the infected worms are
destroyed (Elizabeth J. Corwin, 2011).
 CHAPTER II

THEORETICAL CONCEPTS

A. Definition Appendicitis
Appendicitis is inflammation of the appendix vermiformis and is the most common
cause of acute abdominal pain. This disease affects all ages, both men and women,
but more often affects men aged 10 to 30 years and is the most common cause of
acute inflammation in the lower right quadrant and is the most common cause for
emergency abdominal surgery (Smeltzer & Bare, 2013 ).
Appendicitis is a condition where the infection occurs in the tuft of the worm. In mild
cases it can heal without treatment, but many cases require a laparotomy with the
removal of the infected tufts of worms (Anonymous, 2007 in Docstoc, 2010)

B. Etiology Appendicitis
Acute appendicitis is a bacterial infection. Various things play a role as the trigger
factor. Clogged appendix lumen is a factor proposed as a triggering factor in addition
to hyperplasia of lymph tissue, fecalit, appendix tumors, and ascaris worms can also
cause blockage. Another cause that is thought to cause appendicitis11 is erosion of the
appendix mucosa due to parasites such as E. histolytica (Jong, 2010).
Epidemiological research shows the role of eating habits of low-fiber foods and the
effect of constipation on the onset of appendicitis. Constipation will increase
intrasecal pressure, which results in functional obstruction of the appendix and
increased growth of bacteria from the common colonic flora. All of this will facilitate
the emergence of acute appendicitis (Jong, 2010)

C. Signd ans symptoms

Complaints of appendicitis usually begin with pain in the umbilicus or periumbilicus
accompanied by vomiting. Within 2-12 hours the pain will move to the right lower
quadrant, which will persist and be aggravated when walking. There are also
complaints of anorexia, malaise, and fever that are not too high. There is usually
constipation as well, but sometimes diarrhea, nausea and vomiting occur. At the onset
of the disease no abdominal complaints were persistent. However, within a few hours
 the lower abdominal pain will be progressive, and a careful examination will reveal a
point with maximum pain. Light percussion in the right lower quadrant can help
locate pain. Loose pain and spasms usually also appear (Mansjoer, 2011).

D. Pathophyisiology Appendicitis
Appendicitis may be initiated by obstruction of the lumen caused by involved faeces
or fecalites. This explanation is consistent with the epidemiological observation that
appendicitis is associated with low dietary fiber intake (Burkitt, 2007). In the early
stages of appendicitis, mucosal inflammation occurs first. This inflammation then
proceeds to the submucosa and involves the muscular and serous (peritoneal) layers.
Fibrinopurulental fluid exudate forms on serous surfaces and continues to several
adjacent peritoneal surfaces, such as the intestine or abdominal wall, causing localized
peritonitis (Burkitt, 2007). In this stage the necrotic glandular mucosa exfoliates into
the lumen, which becomes distended with pus. Finally, the arteries that supply the
appendix become platelets and the appendix with insufficient blood supply becomes
necrosis or gangrene. Perforation will occur immediately and spread to the peritoneal
cavity. If the perforation is covered by the omentum, a local abscess will occur
(Burkitt, 2007).

E. Classification of Appendicitis
The classification of appendicitis is divided into two, namely, acute appendicitis and
chronic appendicitis (Sjamsuhidajat & de Jong, 2010):
a. Acute Appendisitis
Acute appendicitis often presents with characteristic symptoms that are based on
sudden inflammation of the umbilicus which gives local signs, with or without
local stimulation of the peritonieum. Symptoms of acute appendicitis are vague
and dull pain which is visceral pain in the epigastric area around the umbilicus.
These complaints are often accompanied by nausea and sometimes vomiting.
Generally decreased appetite. Within a few hours the pain will move to the point
of McBurney. Here the pain is felt sharper and more clearly located so that it is a
local somatic pain.
b. Choronic Appendisitis
The diagnosis of chronic appendicitis can only be confirmed if there is: a history
of lower right abdominal pain for more than 2 weeks, chronic inflammation of the
 appendix macroscopically and microscopically. Microscopic criteria for chronic
appendicitis are complete fibrosis of the appendix wall, partial or total obstruction
of the lumen of the appendix, the presence of old mucosal scarring and ulcers, and
the presence of chronic inflammatory cells. The incidence of chronic appendicitis
is 1-5%.

F. Clinical manifestations
a. Right lower quadrant pain and usually mild fever
b. Nauseous vomit
c. Anorexia, malaise
d. Localized loose pain at the point of Mc. Burney
e. Muscle spasm
f. Constipation, diarrhea

G. Complications
Complications occur due to delays in handling appendicitis. The types of
complications according to (Sulekale, 2016) are :
a. Abscess
Abscess is an inflammation of the appendix that contains pus. There is a soft mass
in the right lower quadrant or pelvic area. This mass initially takes the form of
phlegmon and develops into a cavity containing pus. This occurs when
gangrenous appendicitis or microperforation is covered by the omentum.
Appendectomy surgery for appendix abscess conditions can be done early (early
appendectomy) or delayed (interval appendectomy). Early appendectomy is an
appendectomy that is performed immediately or a few days after the client arrives
at the hospital. Meanwhile, interval appendectomy is an appendectomy that is
performed after initial conservative therapy, in the form of intravenous antibiotics
for several weeks.
b. Perforation
Perforation is the rupture of the appendix that contains pus so that bacteria spreads
into the abdominal cavity. Perforation rarely occurs in the first 12 hours since the
onset of illness, but increases sharply after 24 hours. Perforation can be seen
preoperatively in 70% of cases with clinical features that occur more than 36
hours after illness, heat more than 38.5 ° C, appear toxic, tenderness throughout
 the stomach, and especially Polymorphonuclear leukocytosis (PMN). Perforation
either in the form of free perforation or microperforation can cause peritonitis.
Perforations require immediate medical attention to limit further movement or
leakage of gastric contents into the abdominal cavity. To treat peritonitis, surgery
can be performed to repair the perforation, remove the source of infection, or in
some cases remove part of the affected organ.
c. Peritonitis
Peritonitis is inflammation of the peritoneum. If the infection is widespread over
the peritoneal surface it can lead to generalized peritonitis. Peristaltic activity is
reduced until paralytic ileus develops, intestinal stretching, and loss of electrolytes
resulting in dehydration, shock, circulatory disorders, and oliguria. Peritonitis is
accompanied by increasing abdominal pain, vomiting, abdominal pain, fever and
leukocytosis. Patients with peritonitis will be advised to stay in the hospital

H. Supporting investigation
1. Laboratory
A leukocyte count above 10,000 is found in more than 90% of children with acute
appendicitis. The number of leukocytes in people with appendicitis ranges from
12,000 - 18,000 / mm3. An increase in the percentage of the number of
neutrophils (shift to the left) with the normal number of leukocytes supports the
clinical diagnosis of appendicitis. Normal leukocyte counts are rarely found in
patients with appendicitis.
2. Urinalysis Examination
Helps to differentiate appendicitis from pyelonephritis or kidney stones.
However, mild hematuria and pyuria can occur when inflammation of the
appendix occurs near the ureter.
3. Abdomen Ultrasound (USG)
Is often used as one of the tests to support the diagnosis in most patients with
symptoms of appendicitis. Several studies have shown that the sensitivity of
ultrasound is more than 85% and the specificity is more than 90%. The
ultrasound image which is the diagnostic criterion for appendicitis acuta is an
appendix with an anteroposterior diameter of 7 mm or more, an appendicolith is
obtained, the presence of periappendix fluid or mass. False positives can occur
due to secondary infection of the appendix as a result of salphingitis or
 inflammatory bowel disease. False negatives can also arise because of the
retrocaecal location of the appendix or the air-filled intestinal cavity that blocks
the appendix.CT-Scan
4. CT scan
Is a test that can be used to diagnose acute appendicitis if the diagnosis is not
clear. The sensitivity and specificity are approximately 95-98%. Patients who are
obese, have unclear clinical presentation, and suspect an abscess, CT scan may be
used as a diagnostic test option. The diagnosis of appendicitis by CT-scan is
made if the appendix is dilated more than 5-7 mm in diameter. The walls of the
infected appendix will become small

I. Management
Nursing
a. Perform client TTV observations.
b. Place the patient in the semi-fowler position.
c. The patient is said to be good if within 12 hours there is no disturbance, as long
as the patient is fasted. When surgery

J. Nursing Care Concept

Assessment
a. Client identity
Usually the client's identity consists of name, age, gender, status, religion,
occupation, education, address, the person in charge also consists of the name, age
of the person in charge, hub, family, and occupation.
b. Reason for entry
Usually when the client is hospitalized he complains of abdominal pain in the
lower right quadrant, usually accompanied by little or no vomiting and bowel
movements, sometimes experiencing diarrhea and constipation.
c. Medical history
a) Current medical history
Usually the complaints felt by clients are during post op surgery, feeling
pain at the surgical incision, also usually feeling tired and unable to move
or immobilize themselves.
b) Past medical history
 Usually clients have a habit of eating low-fiber foods, they can also eat
spicy things.
d. Family medical history
Usually there is no effect on hereditary diseases such as hypertension, hepatitis,
diabetes mellitus, tuberculosis, and asthma.
e. Physical examination
Usually normal client awareness is composmetis, E: 4 V: 5 M: 6. The client's vital
signs are usually not normal because the client's body feels pain starting from
usually high blood pressure, tachycardia pulse and usually shortness of breath
when the client feels pain.
f. Head
On the client's head, there is usually no problem if the disease is appenditis,
maybe there is someone in the eye that gets the client's eyes like panda eyes
because the client cannot sleep with pain.
g. Neck
In the neck, there are usually no problems for clients who suffer from apedicitis.
h. Thorac
In the lung, the client usually does not have a problem or disturbance in the
normal sound of the lungs. When the percussion sounds, the sound is usually the
second sonor of the lung fields and when in auscultation the sound is vesicular. In
the client's heart there is also no problem with regular client heart sounds when in
auscultation, regular client heart sounds (lup dup), third heart sounds due to blood
oscillation between the orta and the vesticular. Blood injection final heart sound
(S4). The third and fourth heart sounds are caused by vestricular filling, after the
isovolumetric phase and atrial contraction are absent when additional sounds such
as murmurs (rumbling, rustling) are present (Lehrel 1994).
i. Abdomen
In the abdomen usually pain in the lower right region or at the point of Mc
Bruney. When doing an inspection. Usually there is no specific picture in the
stomach. Bloating is often seen in clients with complicated perforations. A lower
right abdominal lump may be seen in a periapedicular mass or abscess. On
palpation, usually the right lower abdomen will show an increased pain response.
Pain on palpation is limited to the right iliac region, may be accompanied by pain
relief. Muscle contraction indicates stimulation of periotenium parietale. On
 pressing the lower left abdomen, you will feel pain in the lower right abdomen
which is called a rofsing sign. In restroxecal or retroileal appendicitis, deep
palpation is needed to find pain. (Sjamsuhidayat 2005)

K. Nursing Diagnosis According to NANDA

Based on assessment data, nursing diagnoses that usually appear in clients with
appendicitis are:
1. Acute pain associated with physical injury agents (eg, abscess, amputation, burns,
cuts, heavy lifting, trauma, surgical procedures, excessive exercise) Domain: 12
Comfort, Class: 1 physical comfort, Page: 469 NANDA
2. Delayed post-surgical recovery associated with mobility impairment
(1998,2006,2013; LOE 2.1) Domain: 11 Safety / protection, Class: 2 Physical
injury, Pages: 429
3. Nutritional imbalance: less than body requirements associated with the inability to
digest food. (1975,2000) Domain: 2 Nutrition, Class: 1 Feeding, Pages: 177
4. Sleep disruption associated with immobilization. (1980, 1998, 2006, LOE 2.1)
Domain: 4 Activities / Rest, Class: 1 Sleeping / resting, Pages: 229
5. Infection Risk (1986, 2010, 2013; LOE 2.1) Domain: 11 Security / Protection,
Class: 1 Infection, Pages: 405
 CHAPTER III

NURSING CARE

Nursing Care An. S With a Medical Diagnosis Of Appendicitis at Muhammadiyah

Hospital Palembang

Case 3

A 19 year old man came to Muhammadiyah Palembang Hospital with complaints of

abdominal pain in the lower right quadrant with a pain scale of 7 out of 3 days before
entering the hospital. The pain will increase when he walks. The patient was constipated for 3
days. Currently, the patient's diet is irregular and rarely consumes fibrous foods. From the
results of the assessment, the patient experienced symptoms of anorexia and rovsing. The
patient complains that his body feels hot. The general condition of the patient really looks
sick, feverish. The patient's medical diagnosis was appendicitis. The results of the
examination were obtained BP: 130 / 80mmHg, RR: 20x / minute, P: 90x / minute, T: 38.5 C
and Leukocytes: 13,000

Entry date : 01 January 2021

Assessment date : 01 January 2021

Nu. RM : 17.21 XX

Medical diagnosis : Appendicitis

I. Client Identity
Name : An. S
Age : 19 years old
Gender : Male
 Address : Jl. Raya Ranau Desa Rantau Panjang, Kec. Buay Rawan
Phone number :-
Status : Student
Religion : Islam
Ethnic : Javanese
Profession : Student
Length of work :-
RM number : 17.21 XX
Date of entry : 01 January 2021
Assessment date : 01 January 2021
Source of information : Family
Closest family : Mother and Father
Medical diagnosis : Appendicis

II. Medical history

A. Current health status
1. Main complained
An.S complained abdominal pain in the lower right quadrant with a pain scale
of 7 out of 3 days before entering the hospital. The pain will increase when he
walks.
2. Factor Predisposisi
An.S say he was constipated for 3 days.
3. Factor presipitasi
An.S say he was constipated for 3 days. Currently, the patient's diet is
irregular and rarely consumes fibrous foods.

B. Current health status

Subjective Data: Patient reported abdominal pain in right lower quadrant with
pain scale 7 out of 3 days before admission to hospital. The pain will increase
when he walks. The patient said he was constipated for 3 days. Currently, the
patient's diet is irregular and rarely consumes fibrous foods. The patient complains
that his body feels hot.
Objective Data: From the results of the assessment, the patient experienced
symptoms of anorexia and rovsing. The general condition of the patient really
 looks sick, feverish. The patient's medical diagnosis was appendicitis. The results
of the examination were obtained BP: 130 / 80mmHg, RR: 20x / minute, P: 90x /
minute, T: 38.5 C and Leukocytes: 13,000
Nursing Problems:
1. Acute pain
2. Hyperthermia
3. Constipation
C. Previous medical history
1. Disease that has been experienced
a. Accident : An. S say never got an accident
b. Operation (type and time) : An. S say never doing operation
c. Disease (chronic and acute) : An.S said he had no history chronic and
acute disease
d. Last admission to the hospital : Mrs.H said last entry hospital 5 years
ago

2. Allergies (drugs, food, bandages, etc.)

Mr. S says there is no allergy to drugs or food

3. Habit

Type Frequency Amount Duration

A Smoke Never Never Never
B Coffee A little 1 glass a day 2 years until
now
C Alcohol Never Never Never

4. Medicines Used
Type Duration Dose
Paracetamol 4 years 500mg
Bodrex 6 years 500mg
D. Family history
The client said the family does not have a history of any disease
Genogram :

Information :

: Men :C : Client
: Female

: Men died : Female died

E. Case Handling Notes

The client came to the Muhammadiyah Palembang Hospital with complaints of
abdominal pain in the lower right quadrant with a pain scale of 7 out of 3 days
before entering the hospital. The pain will increase when he walks. The patient
was constipated for 3 days. Currently, the patient's diet is irregular and rarely
consumes fibrous foods. From the results of the assessment, the patient
experienced symptoms of anorexia and rovsing. The patient complains that his
body feels hot. The general condition of the patient really looks sick, feverish. The
patient's medical diagnosis was appendicitis. Examination results obtained BP:
130 / 80mmHg, RR: 20x / minute, P: 90x / minute, T: 38.5 C and Leukocytes:
13,000
III. Nursing assessment
1. Improved health
Ds : An. S said he did not know about the cause of his illness
Do : An. S looked confused when asked about his illness
Nursing Problems: Knowledge Deficiency
2. Nutrition
Ds : the client said that currently the patient's diet is irregular and rarely consumes
fibrous foods.
Do : From the results of the assessment, the patient experienced symptoms of
anorexia and rovsing.
Health Problems: Nutritional Deficits
3. Elimination
Ds : The client said he had constipation for 3 days, the client said he drank 330ml
today,
Do : The client looks weak and looks like he is holding his stomach
Health Problems: Constipation
4. Activity/rest

Ds : the client said when his stomach hurt and the client said fever could not be
managed

Self care abilities 0 1 2 3 4

Eat/drink 

Bath 

Toilet 

Get dressed 

Mobility in bed 

Move 

Ambulation/ROM 
 NNote:
0 = independent, 1 = assistive device, 2 = assisted by other people, 3 = assisted by
other people and tools, 4 = depending on the total
Nursing Problems: No Nursing Problems
5. Perception / Cognitive
Ds : The client said he was sure he would get well soon
Do : Moderate General Condition. It appears that the five cognitive functions of
the patient are not impaired.
Nursing Problems: No Nursing Problems
6. Self-perception
Ds : The client said that he had a perception that the appendicitis he was
experiencing was due to not having a clean lifestyle and often spicy
Do : Do: The client appears calm and confident that he will recover
Nursing Problems: No Nursing Problems
7. The Role of Relationships
Ds : The client said he was Javanese. The client says he adheres to Islam, the
client says everyday uses the Palembang language and culture, the client says
there are no problems with social relationships with family or neighbors
Do : Clients appear cooperative when spoken to
Nursing Problems: No Nursing Problems
8. Seksualitas
DS : The client said he was not married and had never had sexual relations
Nursing Problems: No Nursing Problems
9. Tolerance/stress coping
Ds : The client looks calm, and sure he will recover
Do: Composmentis awareness level
Nursing Problems: No Nursing Problems
10. Principles of life
Ds : The client said he followed Palembang culture. The client said that religious
activities that can be done when sick are only prayer. The client says that he
believes that the illness he is experiencing is a trial from God and tries to get well,
Do: The client seems excited when talking about his recovery
Nursing Problems: No Nursing Problems
11. Safety/protection
 Ds : The patient complains that his body feels hot.
Do: The general condition of the patient really looks sick, feverish. Examination
results obtained BP: 130 / 80mmHg, RR: 20x / minute, P: 90x / minute, T: 38.5 C
and Leukocytes: 13,000
Health Problems: Hyperthermia
12. Convenience
Ds : The client complained of abdominal pain in the lower right quadrant with a
pain scale of 7 out of 3 days before admission to the hospital. The pain will
increase when he walks.
Do: The patient looks weak
Health Problems: Acute Pain

IV. Review Of System dan assessment and physical examination

1. Respiration system
Ds : The client said there were no complaints related to breathing, either tightness
or blockage.
Do: The nose looks clean, there are no polyps, normal function.
Nursing Problems: No Nursing Problems
2. Cardiovasculer system
Ds : The client said it was not tight
Do :
Inspection : ictus cordis was not visible
Palpation : ictus cordis is palpable at ics 5
Percussion : right heart border: sternum, left : 3 fingers right , top : from
ICS 3, down to ICS 5
Auscultation : 1 lub 2 dub heart sound was heard, no additional heart sound
was heard
Nursing Problems: No Nursing Problems
3. Neural system
Ds : The client said there was no complaint and never felt anything strange in his
nerves
Do:
Physiological Reflexes : Patella (+), Triceps (+), Biceps (+)
Pathological Reflex : Not assessed
 Nursing Problems: No Nursing Problems
4. Urinary system
Ds : The client said that he was constipated and the urine was cloudy yellow
Do:
Inspection: No urinary Vesica enlargement
Palpation: No tenderness in Urinary Vesica
Nursing Problems: No Nursing problems
5. Digestive system
Ds : The client said that he was constipated and not eating fibrous food, no
appetite due to nausea and vomiting
Do:
Inspection: Bloated abdomen
Palpation: No tenderness in the abdomen
Percussion: Timpani
Auscultation: Bowel sounds: 10x / minute
Nursing Problems: Constipation
6. Muscoloskeletal system
Ds : The client said there were no complaints regarding the joints or muscles
Do:
Inspection: No fracture
Palpation: No tenderness
Nursing Problems: No problem Nursing
7. Integumentary system
Ds : The client said there was no complaint
Do:
Inspection: No scar, olive skin color
Palpation: The skin feels warm
Nursing Problems: No Nursing problems
8. Endocrine system
Ds : The client said there were no problems related to the endocrine system
Do:
Inspection: There were no signs of endocrine system abnormality
Palpation: No signs of endocrine system abnormalities
Nursing Problems: No Nursing problems
9. Sensory system
a. Vision
Ds : he client said normal vision, can still see without the help of glasses
DS:
Inspection: Symmetrical, ananemic conjunctiva, anicteric scelera
Palpation : No tenderness
Nursing Problems: No Nursing problems
b. Hearing
Ds : The client said the hearing was clear, he did not have a hearing loss
Do:
Inspection: Symmetrical, clean
Palpation: There is no tenderness in the ear lobe
Nursing Problems: No Nursing problems
c. Smell
Ds : The client says there is no disturbance related to smell and can distinguish
odors
Do:
Inspection: Clean, no polyps
Palpation : No pain
Nursing Problems: No Nursing problems
10. Psicososial system
a. Client's Perception of the Disease: The client says that the illness will
definitely be cured.
Nursing Problems: No Nursing problems
b. The reaction during the interaction good interaction, when asked to talk, the
client looks cooperative
Nursing Problems: No Nursing Problems
c. Emotional Status
The client appears calm when spoken to
Nursing Problems: No Nursing Problems
V. Supporting investigation

Supporting investigation Check up result

Laboratorium Leuokosit : 12.000

Hemoglobin : 13 g/dl
Hematologi Lengkap
Rontgen Nothing
EKG Nothing
USG Appendicitis Acute

VI. Therapy

How to
The name of Drug Contra
No Dose administer Indication
therapy class Indication
drugs
1 Paracetamol 3x1 Oral Antipiretik Fever,pain Hipersensitif
tab

500m
g
2 Domperidon 3x1 Oral Antiemeti nausea, Pregnant
tab k vomiting, women
20mg indigestion
3 Ringer laktat 500cc IV to restore Hypernatemi
nutrient and a, kidney
Gtt
electrolyte disorders,
20x/m
balance liver cell
damage,
lactic
acidosis
 DATA ANALYSIS

Client’s initials : An. S Gender: Men

Age : 19 years old Room : Internal disease

NO DATA ETIOLOGY PROBLEM

1 Ds : Physiological injury Acute pain
agents (inflammatory
P: The pain will increase
when he walks. appendicitis)

Q: The client complained of

Nerve Respone to
stomach pain
Inflammation
R: The client complained of
abdominal pain in the lower
Systemic Response
right quadrant

S: With a pain scale of 7 Acute Pain

Q: From 3 days before

entering the hospital.

Do: The patient looks weak.

The patient's medical
diagnosis was appendicitis.
Examination results
obtained:

TD: 130 / 80mmHg,

RR: 20x / minute,

P: 90x / minute,

T: 38.5 C and

Leukocytes: 13,000

2 Ds: The patient complains Disease process Hyperthermia

that his body feels hot.
(appendicitis)
 Do: The general condition
of the patient really looks
sick, feverish. Examination Systemic Respon
results obtained T: 38.5 C
Increased body
temperature
3 Ds: The patient said he was Lack of fiber intake Constipation
constipated for 3 days.
Currently, the patient's diet
is irregular and rarely
consumes fibrous foods.
Constipation
Do: From the results of the
assessment, the patient
experienced symptoms of
Nausea and Vomting
anorexia and rovsing.

LIST OF NURSING PROBLEMS :

1. Acute pain
2. Hipertermi
3. Constipation

PRIORITY NURSING PROBLEM :

1. Acute pain
2. Hipertermi
3. Constipation

DIAGNOSIS NURSING (PES)

1. Acute pain bd physiological injury agents (inflammatory appendicitis)

2. Hyperthermia bd Disease Process (appendicitis)
3. Constipation bd less fiber intake
 NURSING INTERVENTION

NO DIAGNOSIS NURSING PLANS RATIONAL

Objectives and outcome criteria Intervention
1 Acute pain bd After nursing action for 2 x 24 hours, it is Pain manajment: a. Observation
physiological injury
expected that the pain level will decrease 1. To find out the
agent (inflammatory
a. Observation location,
appendicitis) is and it can decrease with the Criteria
characteristics,
characterized by: 1. Identify the location, characteristics,
Results: duration,
duration, frequency, quality,
frequency,
DS: intensity of pain
quality, intensity
No Criteria Early Purpose 2. Identify non-verbal pain responses
of pain
P: The pain will increase 3. Identify factors aggravating and
1 Complaints of 2 4 2. To determine the
when he walks. relieving pain
pain response
pain 4. Identify the effect of pain on quality
3. To find out the
Q: The client complained of life
2 Grimace 3 5 factors that
of stomach pain 5. Monitor success of complementary
aggravate and
decreased therapy relieve pain
R: The client complained
3 Not being 3 5 4. Knowing the
of abdominal pain in the b. Teraupetik
lower right quadrant protective 1. Provide non-pharmacolgic success of
techniques to reduce pain (eg
4 Reported pain 2 4 complementary
S: With a pain scale of 7 acupressure, massage therapy, warm
control / cold compresses) therapies
Q: From 3 days before 2. Environmental controls that may
entering the hospital. 5 The ability to 3 5 aggravate pain (eg room b. Teraupetik
1. To reduce the
recognize the temperature, lighting and noise
pain felt by the
Do: 3. Education
cause of pain client
4. Explain the causes and triggers of
2. To provide a
The patient looks weak. 6 ability to use 3 5 pain
5. Collaboration sense of comfort
 The patient's medical non- 6. Analgesic administration and reduce pain
diagnosis was
pharmacological collaboration c. Education
appendicitis.
Examination results techniques c. Education So that clients
obtained: explain the causes and triggers of pain
understand and know
d. Collaboration
Indikator scale : the causes and
TD : 130 / 80mmHg,
Analgesic administration collaboration
triggers of pain
RR : 20x / minute,  1 = Very disturbed
d. Collaboration
P : 90x / minute,  2 = Disturbed a lot
Reducing Client Pain
 3 = Quite annoyed
T : 38.5 C and
 4 = Slightly disturbed
Leukocytes: 13,000  5 = Not disturbed

2 Hyperthermia bd Disease Thermoregulasi a. Vital Signs Monitor a. Vital Signs Monitor

Process (appendicitis) is Monitor BP, pulse, and RR Knowing the TTV
After nursing action for 3 x 24 hours, it is
characterized by: Value
expected that there will be no increase in b. Temperature Regulation b. Temperature
Ds: The patient 1. Monitor for signs of Regulation
temperature with the following criteria:
complains that his body hyperthermia and hypothermia 1. To know the
feels hot. 2. Monitor skin temperature increase and
No Criteria Early Purpose Fever Treatment decrease in body
Do: The general 3. Give a warm compress to the temperature in
1 Feel 3 5 forehead and groin and axillary extremes
condition of the patient
really looks sick, goosebumps area 2. Knowing the
feverish. Examination 4. Collaboration with doctors in client's
when it’s drug administration (antipyretics temperature and
results obtained T: 38.5
C cold and antibiotics) vital signs within
5. Collaboration in intravenous normal ranges

3 Constipation bd lack of
fiber intake is
characterized by:
Ds: The patient said he
was constipated for 3
days. Currently, the
patient's diet is irregular
and rarely consumes
fibrous foods.
2 Hot sweats 3 5 fluid administration c. Fever Treatment
6. Cover the patient to prevent loss 1. To lower the
3 Shivering 3 5 psien's body
of body warmth
when cold 7. Encourage increased intake of temperature
fluids and nutrients 2. Giving antiperatik
4 Increased 2 4 can lower body
skin temperature while
giving antibiotics
temperature can reduce the
5 Dehidration 3 5 risk of spreading
bacteria
3. To increase the
Indikator scale : volume of fluid in
the patient's body
 1 = Very disturbed and prevent shock
4. To prevent loss of
 2 = Disturbed a lot body warmth
5. To help reduce
 3 = Quite annoyed
hyperthermia
 4 = Slightly disturbed
5 = Not disturbed
After nursing action for 3 x 24 hours, the Constipasion/ impaction management : 1. In order to find out
the cause of
client is expected to achieve bowel
constipation
1. Monitor for signs and symptoms of
elimination, with the following criteria: 2. Knowing the
constipation
development of the
2. Bowel movement monitor including
therapeutic effect
No Criteria Early Purpose frequency, consistency, shape, volume
3. To find out changes
and color as appropriate
1 Elimination 2 4 in bowel sounds
3. Bowel sound monitor
4. To overcome
pattern 4. Consultation with a doctor about drug
constipation
administration
5. So that clients
Do: From the results of 2 Heavy form 2 4 5. Describe the etiology of the problem understand the action
6. Identify contributing factors (eg, of care
the assessment, the of stool
medications, bed rest and diet) that 6. To find out the
patient experienced 3 Bowel 2 4 contribute to constipation. appropriate action
7. Encourage increased fluid intake 7. So that the patient's
symptoms of anorexia sounds fluid needs are met
and rovsing.
Indikator scale :

 1 = Very disturbed
 2 = Disturbed a lot
 3 = Quite annoyed
 4 = Slightly disturbed
5 = Not disturbed
 NURSING IMPLEMENTATION

Client’s initials : An. S Gender: Men

Age : 19 years old Room : Internal disease

Gender : Men No RM : 12.21 XX

NO DIAGNOSIS Day, date and time IMPLEMENTATION Day, EVALUATION Prf

date
and
time
1 Acute pain bd 01 Jan 2021 Manajmen Nyeri : 03 Subjective:
physiological injury Jan
1. The client said he understood the causes
08.00 am a. Observation
agents (inflammatory 2021 and signs of pain
1. dentify the location, 2. Patient says Pain is reduced The patient
appendicitis)
characteristics, knows the scale, intensity and frequency
08. 00
duration, frequency, of pain
quality, intensity of am
pain. (P: The pain Objective:
will increase when 1. The patient is able to control pain
he walks. Q: The 2. The patient looks healthier
client complains of Goal achieved
abdominal pain. R:
The client complains
 of abdominal pain in No Criteria Early Purpose The
the lower right
last
quadrant. S: With a
pain scale of 7. Q: 1 Complaints of 2 4 4
From 3 days before
pain
admission to the
hospital) 2 Grimace 3 5 5
2. Identifying the
Location of Pain. decreased
(Client said Lower 3 Not being 3 5 5
right quadrant
abdominal pain) protective
3. Identify factors 4 Reported pain 2 4 4
aggravating and
relieving pain. control
(Client says the pain 5 The ability to 3 5 5
will increase when
walking) recognize the
4. Identify the effect of cause of pain
pain on quality of
life. (The client said 6 Ability to use 3 5 5
that if the pain arose, non
the client could not
rest and was very parmacological
anxious) techniques
5. Monitor success of
complementary
therapy Indikator scale :
b. Teraupetik
1. Provides non  1 = Very disturbed
pharmacological
 2 = Disturbed a lot
techniques to reduce
 pain. (Providing  3 = Quite annoyed
acupressure and
massage techniques  4 = Slightly disturbed
to reduce pain in  5 = Not disturbed
clients, cooperative
clients)
2. Controlling the A : goal is achieved, the patient’s acute pain
environment that can problem is resolved
aggravate pain.
(Adjust room
temperature and air
circulation,
cooperative patient)
c. Edukation
Explain the causes
and triggers of pain.
(The client said he
understood and
understood the
trigger for the pain)
is willing)
d. Collaboration
collaboration in
giving analgesics
(then patient says
they are willing)

2 Hyperthermia bd 01 Jan 2021 03 Jan S: The client said there was no fever and was
good enough
disease Temperature
process(appendicitis) 13.00 – 13.30 am Regulation 2021 O: The client looks fresher and doesn't feel limp
anymore. Normal TTV, TD: 120/80, N: 95x / m,
RR: 20x / minute, T: 37 C
1. Monitor skin 08.00
temperature
Wib No Criteria Early Purpose The
(Warm Skin)
2. Monitor for signs last
of hyperthermia 1 Feel 3 5 5
and hypothermia
(R / there was a goosebumps
sign of when it’s
hyperthermia,
namely the skin cold
13.30 – 15.30 am felt warm, T: 2 Hot sweats 3 5 5
38.8ºc and there
were no signs of 3 Shivering 3 5 5
hypothermic when cold
symptoms)
4 Increased 2 4 4
Fever Treatment skin
temperature
1. Suggests
increasing fluid 5 Dehidration 3 5 5
and nutrient
intake(Cooperati
Indikator scale :
ve Client)
2. Cover the patient
to prevent loss of  1 = Very disturbed
body warmth
(Cooperative  2 = Disturbed a lot
Client)  3 = Quite annoyed
3. Apply a warm
 compress to the  4 = Slightly disturbed
forehead and
groin and axillary
area(The client is 5 = Not disturbed
cooperative and
willing to A : Hyperthermia problem An. S recolved
compress)
4. Collaborate in the
administration of
intravenous
fluids (Attached
to Ringer's
Lactate 500cc
intravenous fluid)
5. Collaborating
with doctors in
drug
administration
(antipyretics and
antibiotics)
(The drug is
taken by mouth,
the patient takes
the medicine
properly)
Paracetmol 3x1 /
r 500mg
Ceftriaxone
2x1gr / vial

Monitor vital
signs
 (TD: 120/80, N:
95x / m, RR: 20x
/ minute, T: 37
02 Jan 2021
C)
The client
08.00-10.30 am seemed better
and the heat was
dropping

3 Constipation and 02 Jan 2021 1. Monitor for signs 03 Jan Subjective: The patient says that he is not
and symptoms of constipated and today his bowel movements are
insufficient intake 2021
constipation. smooth, the shape and frequency are normal.
10.30 Am
2. Monitor bowel
movements, 10.00 Objective: The patient looks fresh, normal
including
am bowel sounds, the client has had his bowel
frequency,
consistency, movements on schedule, the client knows the
shape, volume
signs, symptoms and causes of constipation.
and color as
appropriate.
3. Monitor bowel No Criteria Early Purpose The
sounds.(bowel last
sounds)
4. Identify the 1 Elimination 2 4 4
factors that cause pattern
constipation.
5. (Patients say they 2 Heavy 2 4 4
eat less fibrous from of
food)
Collaboration of drug stool
delivery.
3 Bowel 2 4 4
(patient is willing)
sounds

Indikator scale :

 1 = Very disturbed
 2 = Disturbed a lot
 3 = Quite annoyed
 4 = Slightly disturbed

5 = Not disturbed

A : goals achieved An. S constipation

problem that’s resolved
 CHAPTER IV

DISCUSSION

Based on the nursing care that has been carried out by Nursing Client An. S with a medical
diagnosis of appendicitis in the Inpatient Room of the Muhammadiyah Hospital Palembang
on January 1, 2021, the following discussion was obtained:

1. Assessment
Based on the theory of the client An. S found the etiology and signs of symptom are
obtained, the cause of this appendicitis is a blockage of the feces / stool which over
time becomes constipated causing the Escherichia coli bacteria to have the
opportunity to multiply in the intestine and become an infection that results in
intestinal inflammation in the client's body. studied according to what is theoretical,
and also on the symptoms obtained in theoretical pain in the lower right quadrant of
the client's absentee on a scale of 7, nausea, vomiting, constipation, and seen from the
client's high leukocytes, the point is the signs and symptoms contained theoretically
according to the existing findings on managed clients. The patient's medical
diagnosis was appendicitis. The examination results obtained BP: 130 / 80mmHg,
RR: 20x / minute, P: 90x / minute, T: 38.5 C and Leukocytes: 13,000. Patients also
experience hyperthermia which is caused by the percentage of the disease.

2. Nursing diagnoses
There are 3 diagnoses made in the case review, namely:
First Diagnosis is Acute Pain bd Physiological Injury Agent (inflammatory
appendicitis) characterized by Ds: P: Pain will increase when he walks. Q: The client
complains of abdominal pain, R: The client complains of abdominal pain in the lower
right quadrant, S: With a pain scale of 7, Q: From 3 days before admission to the
hospital. Do: The patient looks weak. The patient's medical diagnosis was
appendicitis. Examination results obtained: BP: 130 / 80mmHg, RR: 20x / minute, P:
90x / minute, T: 38.5 C and Leukocytes: 13,000.
The second diagnosis is Hyperthermia bd Disease Process (appendicitis) characterized
by: Ds: The patient complains that his body feels hot. Do: The general condition of
the patient really looks sick, feverish. Examination results obtained T: 38.5 C.
 The third diagnosis is constipation bd lack of fiber intake is indicated by: Ds: The
patient says he has constipation for 3 days. Currently, the patient's diet is irregular
and rarely consumes fibrous foods. Do: From the results of the assessment, the
patient experienced symptoms of anorexia and rovsing.

3. Intervention (Nursing Care Plan)

In preparing the nursing care plan, using a nursing plan based on the NIC-
NOCNANDA standard. In the case of a nursing plan that appears, these are:
For the First Diagnostic Intervention, namely Acute Pain bd Physiological Injury
Agent (Inflammatory Appendicitis), Pain Management Interventions are carried out:
1) Observation
- Identify the location, characteristics, duration, frequency, quality, intensity of
pain
- Identify non-verbal pain responses\
- Identify factors aggravating and relieving pain
- Identify the effect of pain on quality of life
- Monitor success of complementary therapy
2) Teraupetic
- Provide non-pharmacolgic techniques to reduce pain (eg acupressure, massage
therapy, warm / cold compresses)
- Environmental controls that may aggravate pain (eg Room temperature,
lighting and noise

3) Education
Explain the causes and triggers of pain
4) Collaboration
Analgesic administration collaboration

For the second diagnosis, namely the Second Diagnosis, namely Hyperthermia bd
Disease Process (appendicitis). Interventions :

1) Monitor Vital Signs : Monitor BP, pulse, and RR.

2) Temperature Regulation : Monitor signs of hyperthermia and hypothermia,
Monitor skin temperature.
 3) Fever Treatment: Give warm compresses to the forehead and groin and axillary
areas, collaboration with doctors in administering drugs (antipyretics and
antibiotics), Collaboration in intravenous fluids, Cover the patient to prevent loss
of body warmth, Encourage increased fluid and nutritional intake

For the third diagnosis, namely constipation bd lack of fiber intake, intervention is
carried out, namely constipation / impaction management:

1) Monitor for signs and symptoms of constipation

2) Bowel movement monitor including frequency, consistency, shape, volume and
color as appropriate
3) Bowel sound monitor
4) Consultation with a doctor about drug administration
5) Describe the etiology of the problem
6) Identify contributing factors (eg, medications, bed rest and diet) that contribute to
constipation.
7) Encourage increased fluid intake

4. Implementation
Nursing implementation is also in accordance with the nursing care plan that has been
prepared and is in accordance with Mrs. R's condition. Nursing diagnosis Acute pain
is related to physical injury agents and the implementation that has been done,
namely:
Acute pain bd physiological injury agents (inflammatory appendicitis)
1) Identify the location, characteristics, duration, frequency, quality, intensity of
pain. (P: The pain will increase when he walks. Q: The client complains of
abdominal pain. R: The client complains of abdominal pain in the lower right
quadrant. S: With a pain scale of 7. Q: From 3 days before admission to the
hospital)
2) Identifying the Location of Pain. (Client said Lower right quadrant abdominal
pain)
3) Identify factors aggravating and relieving pain. (Client says the pain will
increase when walking)
4) Identify the effect of pain on quality of life (The client says that if the pain
occurs, the client cannot rest and is very anxious)
 5) Monitor success of complementary therapy
6) Provides non pharmacological techniques to reduce pain. (Providing
acupressure and massage techniques to reduce pain in clients, cooperative
clients)
7) Controlling the environment that can aggravate pain. (Adjust room
temperature and air circulation, cooperative patient)
8) Explain the causes and triggers of pain. (The client said he understood and
understood the trigger for the pain)
9) Collaboration of Analgesics (Patients say they are willing)

Hyperthermia bd Disease Process (appendicitis)

1) Monitor skin temperature (Skin feels warm)

2) Monitor for signs of hyperthermia and hypothermia (R / there are signs of
hyperthermia, namely the skin feels warm, T: 38.8ºc and there are no signs of
hypothermic symptoms)
3) Encourage increasing fluid and nutritional intake (Cooperative Clients)
4) Cover the patient to prevent loss of body warmth (Cooperative Client)
5) Give a warm compress to the forehead and groin and axillary area (Client is
cooperative and willing to compress)
6) Collaborate in the administration of intravenous fluids (Attached to Ringer's
Lactate 500cc)
7) Collaborating with doctors in administering drugs (antipyretics and
antibiotics) (Drugs enter orally, patients take medication correctly) Paracetmol
3x1 / r 500mg, Ceftriaxone 2x1gr / vial
8) Monitor vital signs (BP: 120/80, N: 95x / m, RR: 20x / minute, T: 37 C). The
client seemed better and the heat was dropping

Constipation bd less fiber intake

1) Monitor for signs and symptoms of constipation.

2) Monitor bowel movements, including frequency, consistency, shape, volume
and color as appropriate.
3) Monitor bowel sounds. (bowel sounds)
 4) Identify the factors that cause constipation. (Patients say they eat less fibrous
food)
5) Collaboration of drug delivery. (patient is willing)

5. Evaluation
Evaluation is an intellectual action to improve the nursing process which indicates
how far the nursing diagnosis, action plan and implementation have been achieved.
Through nurse evaluation to monitor negligence that occurs during the assessment,
analysis, planning, and implementation stages of nursing actions (Nursalam, 2010).
The evaluation was carried out based on an established diagnosis, namely the first
diagnosis, namely Acute Pain and evaluated for the results of the problem. Pain was
resolved and the intervention was stopped. Diagnosis of Hyperthermia bd Disease
Process (appendicitis) fever decreases the problem of Hyperthermia is resolved and
intervention is stopped. Diagnosis of Constipation bd lack of fiber intake, the
problem is resolved and the intervention is stopped.
 CHAPTER V

CONCULUSION AND RECOMMENDATION

A. Conclusion
From the implementation of nursing care to client An. With appendicitis, it can be
concluded that appendicitis is an inflammatory disease of the appendix or appendix,
which is experiencing constipation of the fascia, causing blockage and giving the
opportunity for the Escherichia coli bacteria to multiply so that it becomes an
infection as a result of infection which will cause acute pain in the lower right side of
the abdomen. the position of the umbilicus of the worm. Therefore, nursing care is
carried out to An's client. S.

B. Suggestion
Hopefully this case report can help readers in nursing care and establishing a
diagnosis. Readers can understand related Appendixitis Theory Review from
definition to diagnosis.
 BIBLIOGRAPHY

Akhyar yayan, 2008, Apendisitis, diakses 19 April 2012 from http://www. Yayanakhyar.
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Arif Muttaqin & Kumala Sari ,2011.Gangguan Gastrointestinal(Aplikasi asuhan keperawatan

medical bedah),Jakarta:Salemba medika.

Birnbaum BA, Wilson SR, 2000, Appendicitis at the millenium, Radiology 215:337-348