Republic of the Philippines

University of Southern Mindanao

COLLEGE OF HEALTH SCIENCES
Kabacan, Cotabato

ACUTE APPENDICITIS

A Case Study Presented to the Faculty of

University of Southern Mindanao
College of Health Sciences

In Partial Fulfillment for the Requirements in

NURSING CARE MANAGEMENT 112
Care of Clients with Problems in Oxygenation, Fluid & Electrolytes, Infectious,
Inflammatory & Immunologic Response, Cellular Aberrations (Acute & Chronic)

Abdula, Malija L.
Abpi, Jouharah Pampay A.
Abubaker, Rania P.
Abusama, Ashna M.
Alap, Hasmin K.
Alucilja, Rose Rayzhel E.
Andiano, Erika Leianne N.
Ayob, Aminah C.
Bado, Mina K.
Cabaluna, Lovely Grace B.
Caro, Millen Anjaneth A.
Carugda, Trixia Ann Claire B.
Contreras, Laida May O.
Dalgan, Moslih A.
Dela Cuesta, Miliza Mae J.
Dicay, Zamzamin D.
Diez, Dawn Ilish Nicole L.
Dimalen, Abdulhaq K.

November 2021
TABLE OF CONTENTS

1
 PAGE
TITLE PAGE 1

TABLE OF CONTENTS 2

ACKNOWLEDGEMENTS 4

CHAPTER PAGE

I INTRODUCTION 5

Rationale 6

II OBJECTIVES OF THE STUDY 8

III PATIENT’S DATA 10

IV FAMILY BACKGROUND/HEALTH HISTORY 11

V DEFINITION OF COMPLETE DIAGNOSIS 12

VI PHYSICAL ASSESSMENT 14

VII ANATOMY AND PHYSIOLOGY 17

VIII ETIOLOGY AND SYMPTOMATOLOGY 25

IX PATHOPHYSIOLOGY 31

X DOCTOR’S ORDERS 33

XI DIAGNOSTIC EXAMS 38

XII DRUG STUDY 49

XIII SURGICAL PROCEDURE 71

XIV NURSING THEORIES 74

XV NURSING CARE PLAN 77

XVI HEALTH TEACHINGS AND RECOMMENDATIONS 90

XVII DISCHARGE PLAN 92

XVIII PROGNOSIS 93

2
REFERENCES 97

ACKNOWLEDGEMENTS

3
 The Third Year Bachelor of Science in Nursing Section B Group One would like
to extend their deepest appreciation and most heartfelt gratitude to the following people
whose collective effort helped furnish and largely contributed to the completion of this
study.

To our clinical instructor, CHRISTINE MAE D. MARAGGUN, RN, RM whose

expertise and brilliance, along with unending patience in answering queries, has helped
shape this case presentation. Her guidance and encouragement also greatly inspired
the researchers in finishing the presentation. Without her counsel, the student nurses
would have had a hard time dealing with the whole study.

To the student nurse’s parents and guardians, who gave their never-ending
support and understood the demand this study needs to be able to finish in such a short
time; for being encouraging in these trying times where everyone is doing their best to
learn despite hindrances brought by the current health situation.

Above all, to the Almighty God and Allah for His abundant blessings showered
upon us, for blessing us with spiritual guidance for the whole duration of carrying out
this presentation, and for the graces sent to us as we worked hard in completing this
study.

4
 CHAPTER I

INTRODUCTION

Acute appendicitis is a sudden and severe inflammation and swelling of the

appendix, which is a narrow finger-shaped tube that connects to the large intestine on
the lower right side of your abdomen and projects from your colon. This happens when
something blocks the inside of the appendix. The appendix is located in the lower right
side of the abdomen (Sissons, 2021). This causes abdominal pain, which can appear
suddenly and worsen within hours. In most people, however, pain starts around the
navel and then moves. Appendicitis pain typically worsens as the inflammation worsens,
eventually becoming severe. (Smink, 2021)

Appendicitis is the most common acute surgical condition of the abdomen.

Approximately 7 percent of the population will have appendicitis in their lifetime, with the
peak incidence occurring between the ages of 10 and 30 years. This may be due to a
viral, bacterial, or parasitic infection in the digestive tract, which can enlarge the tissue
of the appendix wall, stools causing a blockage in the tube between the large intestine
and the appendix, tumors, inflammatory bowel disease, injury or trauma to the
abdomen.

Without treatment, the appendix can rupture or burst within 48–72 hours of a
person first experiencing symptoms of acute appendicitis. A ruptured or burst appendix
can lead to a serious infection called peritonitis, which can be life threatening without
prompt treatment. According to Johns Hopkins, as the swelling increases, the blood
supply to the appendix reduces and stops. Without enough blood, the appendix may
start to die, or it could tear or burst.

Acute appendicitis should be suspected in any patient who presents with a high
intensity of perceived abdominal pain of at least 7-12 hours duration, with migration to
the right lower quadrant, and followed by vomiting. Although symptoms alone have a
low discriminating power, the diagnosis of acute appendicitis becomes more certain

5
when the physical examination findings include right lower quadrant tenderness,
guarding, rebound tenderness and other signs of peritoneal irritation. (Bongala, 2018)

Although anyone can develop appendicitis, most often it occurs in people

between the ages of 10 and 30. Standard treatment includes the surgical removal of the
appendix. Appendicitis occurs most commonly between the ages of 10 and 20 years
and it has a male-to-female ratio of 4:1. The lifetime risk is 8.6% for males and 6.7% for
females in the United States. Appendectomies have become less common as
diagnostic modalities, medical management, and surgical practices have improved. In
Western countries, the incidence of both perforated and nonperforated appendicitis has
leveled off. When compared to Western countries, the incidence of appendicitis is
higher in some newly industrialized Asian, Latin American, and Middle Eastern
countries. (Ferris, 2019)

The age-standardized death rate for appendicitis decreased by 46% from 1990 to
2013, according to the Global Burden of Disease Study. Mitigating mortality for
appendicitis is dependent on robust healthcare systems that are designed to quickly
diagnose and treat acute presentations. Newly industrialized countries with a high —
and rising — incidence of appendicitis must prepare their clinical infrastructure to
diagnose and treat the condition quickly, or risk unnecessary morbidity and mortality.
Furthermore, because the impact of appendicitis is unknown in many developing
regions, population-based incidence studies are required.

Most people will make a full recovery from appendicitis and can live normal,
healthy lives without their appendix.

Rationale

The Third Year Bachelor of Science in Nursing Section B Group 1 taking up

Nursing Care Management 112 was given the case of Acute Appendicitis.

A 17-year-old female patient was admitted to Kabacan Medical Specialist, Inc. on

6
February 6, 2021 due to an Abdominal Pain in the Right Lower Quadrant. The admitting
diagnosis was Tlc Acute Appendicitis but was confirmed that it was a case of Acute
Appendicitis. The student nurses aim to exhibit understanding regarding the disease, its
risk factors and complications and its preventable measures. The case also gives us a
chance to deeply understand how the aforementioned disease can affect the patients,
knowing that there are multiple cases of people acquiring this disease in the Philippines.
The subject matter is highly affiliated to the current course subject taken and the student
nurses would like to apply all the things that they have learned through their lectures for
the benefit of the patient and also to improve both their knowledge and skills.

7
 CHAPTER II

OBJECTIVES OF THE STUDY

This chapter discusses the case study's general and specific objectives. This
serves as a guide for the entire course of the study in terms of gathering needed data
and providing direction in intervention planning. Following that, both the client and the
nurse will feel a sense of accomplishment (Kozier, Erb, Berman, & Snyder, 2008).

General Objectives

The purpose of this research is to examine and improve the patient's current
health status. Furthermore, the student nurses envision this study as a tool for
extracting information from the data collected and facilitating comprehensive
understanding.

Specific Objectives

This study specifically aims to:

- build rapport and efficient communication with the patient and patient’s family,

- collect data about the patient and significant other that is relevant to the study,
track patient’s medical history,

- ensure the progress of the patient's health through the patient's medical history
with the participation of the patient, significant others, and health care provider,

- disclose the complete definition of patient’s diagnosis,

- illustrate the disease process of acute appendicitis,

- demonstrate a deep understanding of the causes of acute appendicitis,

- review the diagnostic examinations performed, as well as their implications and

the responsibilities that fall under the scope of the nurse service,

8
- identify and classify patient needs prioritization,

- identify the drugs prescribed and administered, and to elucidate each drug's
classification, indication, mechanism of action, contraindication, side and
adverse effects, and nursing responsibilities in drug administration,

- generate a nursing care plan based on the level of prioritization of the assessed
needs.

- select acknowledged nursing theories relevant to this case analysis,

- formulate a discharge plan,

- outline probable prognosis, and

- evaluate the implications of the findings for nursing practice, education, and
research

9
 CHAPTER III

PATIENT’S DATA

Name Patient X

Address Katidtuan, Kabacan, North Cotabato

Sex Female

Age 17 years old, 10 months, 16 days

Birth Date March 21, 2003

Civil Status Single

Religion Catholic

Nationality Filipino

Educ. Attainment N/A

N/A
Occupation

CLINICAL /ADMITTING DATA:

Type of Room Room O

Date and Time of Admission February 06, 2021, 02:45 PM

Right Lower Quadrant Abdominal
Chief Complaint
Pain
Vital Signs upon Admission

Blood Pressure Rate 90/70 mmHg

Cardiac Rate 93 bpm

Respiratory Rate 21 cpm

Temperature 36.9 ºc

Brief Clinical History No Significant Illnesses

10
 Admitting Diagnosis Tlc Acute Appendicitis

Final Diagnosis Acute Appendicitis

Hospital Admitted Kabacan Medical Specialist, Inc.

Surgical Procedure Performed Appendectomy, February 6, 2021

Date and Time of Discharge February 9, 2021, 04:25 pm

Key Informant/s Father of Patient X

CHAPTER IV

FAMILY BACKGROUND/HEALTH HISTORY

The female patient who is 17 years old describes a pain on her right lower
quadrant. She experienced the pain at the mentioned site 24 hours ago and the severity
of pain increased 12 hours prior to admission. The pain is associated with anorexia and
had an episode of vomiting after eating breakfast.

The said patient has no significant illnesses on her medical history as well as no
significant information on her OB/GYN history. No relevant family background
information that concerns the present illness of the patient.

11
 CHAPTER V

DEFINITION OF COMPLETE DIAGNOSIS

Appendicitis can occur at any age, but it is most common in people in

their teens and twenties. Appendicitis is most common in children during
their tween or teen years. However, appendicitis can occur in children as
young as elementary school.
Cleveland Clinic, Appendicitis: 
Symptoms, Tests, Treatment & Prevention, 2020

The most of appendicitis cases occur in people between the ages of

10 and 30. A family history of appendicitis may increase your risk,
particularly if you are a man.

John Hopkins Medicine, Appendicitis, 2021

Appendicitis primarily affects children and teenagers aged 5 to 20. It

is uncommon in infants.

Ryan J. Brogan, Appendicitis (for Parents), 2018

Acute appendicitis is a rapidly progressing inflammation of the

appendix, a small part of the large intestine. The appendix is a pouch-like
structure located in the lower right quadrant of the abdomen, near the
junction of the small and large intestines.

William C, Lloyd III, Acute Appendicitis, 2021

Appendicitis is most likely caused by a blockage in the lining of the

appendix, which leads to infection. The bacteria multiply quickly, inflaming,
swelling, and filling the appendix with pus.

12
 Appendicitis causes pain in your lower right abdomen. In most
people, however, pain begins around the navel and progresses.
Appendicitis pain usually worsens as the inflammation worsens and
eventually becomes severe.

Mayo Clinic, Appendicitis - Symptoms and causes, 2021

Appendicitis usually starts with a dull, cramping, or aching pain in the

abdomen. As the appendix becomes swollen and inflamed, it irritates the
peritoneum, the lining of the abdominal wall. A ruptured appendix is a
potentially fatal condition. Rupture occurs rarely within the first 24 hours of
symptoms, but the risk of rupture increases dramatically after 48 hours. 

Tyler Walker and Ann Pietrangelo, Emergency Signs and Symptoms of

Appendicitis, 2019
Appendicitis is considered a medical emergency because an
inflamed appendix can rupture and cause serious harm. Because of the
high risk of rupture, appendicitis is usually treated with immediate surgery.

Dignity Health, Emergency Appendectomy in Arizona, 2021 

In some patients, the appendix can rupture, resulting in an abscess,

or pus collection. If this is the case, your doctor may advise you to have a
percutaneous abscess drainage procedure in addition to an appendectomy
to remove the fluid from your body.

American College of Radiology, Appendicitis, 2020

Appendicitis, if left untreated, can cause your appendix to burst. A

ruptured appendix could cause complications. Peritonitis, for example, is a
serious infection that can spread throughout your abdomen. Another
possible complication is an appendiceal abscess, which is an abscess of the
appendix.

National Institute of Diabetes and Digestive and Kidney Diseases,

13
 Definition & Facts for Appendicitis, 2021
CHAPTER VI

PHYSICAL ASSESSMENT

This chapter deals with the head to toe assessment of the patient performed on
February 6, 2021 at around 2:45 pm. This is done systematically using the techniques
of inspection, palpation, percussion and auscultation with the use of materials such as
thermometer, stethoscope and also the senses.

General Physical Assessment

Patient X is a 17 years old female. She is conscious, coherent and awake. The
patient has a right lower quadrant abdominal pain. Patient was received awake,
responsive and coherent. The patient was certainly oriented to time, place, persons.
Patient has a mesomorphic type of body-built weight 54 kilograms and stands
5’4’’ tall. She was able to deal with her emotions appropriately as the interview went on.
Wearing a cotton T-shirt and jogging pants, the patient looked neat and tidy.

Vital Signs:

Blood Pressure: 90/70 mmHg RR: 21 cpm

Pulse Rate: 93 bpm TEMP: 36.9⁰c

Skin/Skin Appendages

Patient’s skin was warm to touch with a fair complexion; fingernails were trimmed and
tidy. Hair was distributed evenly, no clubbing of fingernails noted.

Head and Hair

Head was normocephalic and had a smooth skull contour. Hair was smooth, and was
evenly distributed. The hair was black in color. The scalp was clean. No swelling or
tenderness noted upon palpation.

14
Eyes

Both eyes were symmetrical. Eyelashes equally distributed, curled slightly outward.
Pupil size is 3mm in diameter for both eyes. Reaction to light was brisk. There was a
uniform reaction to accommodation. The pupil was black in color with pinkish
conjunctiva. Lids closed symmetrically, skin intact, no discharges and no discoloration.
Blinking reflex was functional. No ulceration or lesions noted on the area.

Ears

Both ears were symmetrical; the auricle aligned with the outer canthus of the eye. The
color of the outer ear was homogenous with that of the skin color. The external was
firm, and non-tender. No discharges, tenderness, masses, or swelling were noted upon
inspection and palpation.

Nose

The external was symmetrical. Nasal flaring-noted, air felt when exhaled. Nasal mucosa
was intact and pinkish in color and was free of purulent discharges.

Mouth and Throat

The lips were dry and pale-looking. The gums were pinkish in color. Her teeth were still
intact, 32 pearly white and shiny. Uvula was in the middle. Mucosa was pinkish. Tonsils
were uninflamed. No further abnormalities noted.

Neck

The neck was symmetrical and was proportionate to head and shoulder. The thyroids
were smooth as palpated. She was able to turn her head in an upward, sideward and
downward position with movement. The carotid artery had a mild pulsation. No sign of
lesion or tenderness noted.

15
Five Senses

Sense of Sight

Patient can read normally. She can follow a hand movement within a 3-4 feet distance.
She can recognize people and things.

Sense of Taste

Patient can identify all the different types of taste sweet, sour, bitter and salty food.

Sense of Smell

Patient has good smelling ability; she can distinguish different odors such as fragrance
or perfume and aroma of beverages that she drinks.

Sense of Hearing

She can recognize sounds and can hear clearly; she responds to conversation normally.
She becomes alert when someone opens the door, she can hear the distance
particularly when someone enters the room.

Sense of Touch

The patient responds when someone touches her, and she can distinguish soft from
rough texture and can identify hot from cold water.

16
 CHAPTER VII

ANATOMY AND PHYSIOLOGY

This chapter deals with the discussion of the body system related to the case

being studied. This step fosters a thorough comprehension of the subject through

anatomy and physiology, which serves as a basis for knowledge as well as safe and

successful medical practice (McHanwell, 2020).

Figure 1. Gastrointestinal System

The GI tract is a pathway 7 to 7.9 meters (23 to 26 feet) in length that extends
from the mouth to the esophagus, stomach, small and large intestines, and rectum, to
the terminal structure, the anus.

17
The Mouth

The mouth plays a role in digestion. Digestion begins when food enters the mouth, teeth

break down food and the muscular tongue pushes food back toward the pharynx, or

throat. Three salivary glands-the sublingual gland, the submandibular gland, and the

parotid gland-secrete enzymes that partially digest food into a soft, moist, round lump.

Muscles in the pharynx swallow the food, pushing it into the esophagus. The epiglottis

prevents food from entering the trachea, or windpipe during swallowing.

18
The Esophagus

The esophagus is a muscular tube that acts as a passageway of food through the

stomach. Food is swallowed and goes down the esophagus after it has been chewed

and combined with saliva in the mouth. The esophagus contains a stratified squamous

epithelial lining that protects it from trauma, and the submucosa secretes mucus from

mucous glands that helps food travel down the esophagus. Food is driven into the

stomach by waves of peristalsis, which are surrounded by layers of muscle, which are

voluntary in the top third and involuntary in the bottom third.

19
The Stomach

The stomach is a j-shaped organ having two openings (esophageal and duodenal) and

four regions (cardia, fundus, body, and pylorus). Each region serves a specific purpose:

the fundus gathers digestive gases, the body secretes pepsinogen and hydrochloric

acid, and the pylorus secretes mucus, gastrin, and pepsinogen.

The stomach has five major functions;

• Temporary food storage

• Control the rate at which food enters the duodenum

• Acid secretion and antibacterial action

• Fluidisation of stomach contents

• Preliminary digestion with pepsin, lipases etc.

20
The Small Intestine

The small intestine is where the majority of chemical and mechanical digestion takes

place, as well as nearly all of the absorption of beneficial nutrients. The absorptive

mucosal type lines the whole small intestine, with slight variations for each segment.

The smooth muscle wall of the intestine has two layers, and rhythmical contractions

force digestion products through the intestine (peristalsis). The small intestine is divided

into three sections:

The Duodenum. Around the head of the pancreas, the duodenum creates a 'C' shape.

Its major job is to neutralize the acidic stomach contents (known as 'chyme') and start

digestion; Brunner's glands in the submucosa generate an alkaline mucus that

neutralizes the chyme and protects the duodenum's surface.

The Jejunum and The Ilium. The jejunum and the ileum are the greatly coiled parts of

the small intestine, and together are about 4-6 meters long; the junction between the

two sections is not well-defined. The mucosa of these sections is highly folded (the folds

are called plicae), increasing the surface area available for absorption dramatically.

21
The Pancreas

Structurally, the pancreas has four sections; head, neck, body and tail; the tail stretches

back to just in front of the spleen. The pancreas is mostly made up of exocrine glands

that produce enzymes to help in food digestion in the small intestine. Lipases,

peptidases, and amylases are the most often generated enzymes for fats, proteins, and

carbohydrates, respectively. These are released into the duodenum through the

duodenal ampulla, which is also where the liver's bile empties. Exocrine secretion of the

pancreas

is regulated by hormones, and the same hormone that promotes secretion

(cholecystokinin) also promotes bile discharge from the gall bladder. Bile acts as an

emulsifier, making fats water soluble and providing a large surface area for pancreatic

enzymes to work on.

22
The Large Intestine

Almost all of the nutritionally important products have been eliminated by the time

digestive products reach the large intestine. Water is removed from the remainder by

the large intestine, which then passes semi-solid feces into the rectum, where they are

evacuated from the body through the anus. The mucosa is divided into straight tubular

glands, which are made up of water-absorbent cells and mucus-secreting goblet cells

that help with feces movement. Areas of lymphoid tissue can also be seen in the ileum

(called Peyer's patches), and they provide local immunological protection of possible

weak points in the body's defenses. As the gut is teeming with bacteria, reinforcement

of the standard surface defenses seems only sensible.

23
The Appendix

The appendix is a small, vermiform (i.e., wormlike) appendage about 8 to 10 cm (3 to 4

inches) long that is attached to the cecum just below the ileocecal valve. The inner

lining of the appendix produces a small amount of mucus that flows through the open

center of the appendix into the cecum. The wall of the appendix contains lymphatic

tissues 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 muscles are

poorly developed. The appendix fills with byproducts of digestion and empties regularly

into the cecum. Because it empties inefficiently and its lumen is small, the appendix is

prone to obstruction and is particularly vulnerable to infection (i.e., appendicitis).

24
 CHAPTER VIII

ETIOLOGY AND SYMPTOMATOLOGY

Table 1. Predisposing Factors

PREDISPOSING RATIONALE PRESENT/

FACTORS
ABSENT

Age Being young is more susceptible to acute Present

appendicitis. Appendicitis is known to be an
illness that affects people in their younger age,
with only 5-9% of instances occurring in the
elderly (Hardin, 1999).

Genetic History of appendicitis in a first-degree relative Present

is associated with a relative risk for Appendicitis.
According to Basta et al. (1990), the chance of
appendicitis was 10 times more in a child with at
least one relative with a reported
appendectomy, compared e

with that in a child with no affected relatives.

Gender Male had a higher risk of having perforated Absent

appendicitis than female.

Table 2. Precipitating Factors

25
PRECIPITATING RATIONALE PRESENT/
FACTORS
ABSENT

Diet Populations that consume diets low in fiber and Present

high in refined carbohydrates are at an
increased risk for appendicitis, possibly
because high fiber increases stool transit times,
reduces fecal viscosity, and inhibits fecalith
formation. It may also decrease the potential for
appendiceal lumen obstruction.

Socioeconomic Higher incidence rates are seen in economically Present

Status disadvantaged populations. Socioeconomic
advantages are strongly associated with lower
incidence of acute appendicitis (Flum, 2020).

Luminal The cause of appendicitis is unknown but is Present

Obstruction probably multifactorial; luminal obstruction, and
dietary and familial factors have been
suggested. Obstruction such as a hard piece of
stool getting trapped in the appendix could lead
to appendicitis.

Infection Possibly stomach infection that has traveled to Absent

the site of infection could lead to appendicitis.

26
Table 3. Signs and Symptoms

SIGNS/ RATIONALE JUSTIFICATION PRESENT/

SYMPTOM ABSENT
S

27
 RLQ Pain As the appendix Upon admission of Patient Present
becomes inflamed, it X, her chief complaint is
will irritate the lining of pain on the right lower
Abdominal wall. This quadrant of her abdomen
causes localized, sharp 24 hours ago.
pain in the right lower
part of the abdomen
Pain beginning in the
periumbilical region and
migrating to the lower
quadrant occurs in only
50 percent of patients
with appendicitis (Liu,
C.D. et al. 1997)

Nausea and Nausea and vomiting Upon taking the patient’s Present
Vomiting are symptoms that are history, she stated that she
commonly associated had 1 episode of vomiting
with acute appendicitis. after eating breakfast.

Anorexia Anorexia is an important Patient X that her

and prevalent symptom abdominal pain was
in acute appendicitis. If associated with anorexia
a patient has abdominal 24 hours ago.
pain but he or she does
not have anorexia, the
diagnosis of appendicitis
becomes doubtful.

28
Rovsing’s A positive Rovsing’s sign Upon physical Present
sign is characterized by right examination, the patient
lower abdominal pain tests positive to Rovsing’s
upon palpation of the left sign.
side of the
lower abdomen,
maybe because of the
pressure from the
maneuver generates
elevated tension in the
abdomen or could be a
result of the inflamed
appendix rubbing against
the right iliac fossa.

Psoas sign A positive Psoas sign Patient X is having positive Present

suggests that an Psoas sign upon
inflamed appendix is assessment.
located along the course
of the right psoas
muscle.

Rebound Rebound tenderness is The patient had direct and Present

tenderness often indicative of rebound tenderness upon
general peritonitis, physical assessment.
appendicitis could lead
to peritonitis which
presents with rebound
tenderness upon
palpation.

29
CHAPTER IX

30
 PATHOPHYSIOLOGY

The purpose of this chapter is to trace the disturbed physiological mechanism

linked with the patient condition. The flowcharts make understanding the course of

disease processes simple (McCanse, 2018)

APPENDICITIS

Precipitating factors:
Predisposing factors:
• Low fiber diet
• Age
• Constipation
• Gender
• Genetics • Infections
• Socioeconomic
status

Occlusion of appendix (fecalith, lymph nodes, tumor,

helminths or indigestible substances (seeds) etc.)

Decreased drainage of mucosal secretions

Increased ILP inappendix

Vasocongestion

Decreased blood supply in appendix

Decreased oxygen supply in

appendix

31
Necrosis begins; bacteria invasion
32
 Death Sepsis Peritonitis Walling off of omentum

CHAPTER X

DOCTOR’S ORDER

This chapter deals with the standard and uniform instruction of physicians
attending the patient with a certain disease and its relevance in the process of health
restoration. Lack of understanding doctor’s task may bring negative consequences on
patients’ safety (Abdulwahid et. al., 2018)
TIME & DOCTOR’S ORDER RATIONALE REMARKS
DATE

2/6/21 < Please admit under service of To be able to provide DONE

physician the patient with the
2:45 H specific care needed

< NPO DONE

< TPN q 4° and record TPN is ordered for DONE
patient who,
for whatever
reason cannot
obtain
adequate nutrition
through their digestive
track
< Lab:

CBC To evaluate blood DONE

component and
clothing factor
Urinalysis Urinalysis may DONE
demonstrate changes
such as mild pyuria,
proteinuria and
hematuria, but the
test serves more to
exclude urinary tract

33
TIME & DOCTOR’S ORDER RATIONALE REMARKS
DATE

causes of abdominal
pain than to diagnose
appendicitis.

To assess the current

or past presence of
Covid 19 Rapid Antigen test SARS-CoV-2. DONE

DONE
< Start venoclysis D5LR TL at 30
gtts/min
< Cefuroxime 750g q 8° IVTT ANST/ DONE
HOLD Used to treat certain
infections caused by
bacteria such as
bronchitis, gonorrhea,
Lyme diseases and
infection of the skin,
ears, sinuses and
throat.

< Schedule for appendectomy DONE

Appendectomy is the
surgical removal of
the appendix
< Secure consent/ appeal DONE
The patient may have
the freedom to make
decisions
< Inform assisting physician for order DONE
To create
received
collaborative
treatment among the
client and health care
provider.
< Sultamicillin (Gravitam) 1.5 gm q DONE
Sultamicillin used to
8° ANST
prevent and treat a
number of bacterial
infections
< For HCG To evaluate DONE
components of the

34
 TIME & DOCTOR’S ORDER RATIONALE REMARKS
DATE

blood particularly
platelet count.

02/6/21 < To OR please DONE

3pm

2/6/21 POST OP

5:00 p. - TO RM

- NPO Doctors would DONE

prescribe NPO in the
nighttime to prevent
aspiration pneumonia
especially those who
will undergo a general
anesthesia.

DONE
- Monitor VS q 15 mins & 2° then q
4°

- IVF with D5LR, I h at 20 gtts/h DONE

- Sultamicillin 1.5 gms q 8 hrs IVTT DONE
Has been shown to
be clinically effective
in non-comparative
trials in patients with
infections of the
respiratory tract, ears,
nose and throat
urinary tract, skin and
soft tissues

- Ketorolac 30 mg q 8 hrs IVTT DONE

Used for the short-
term treatment of
moderate to severe
pain
- Refer To secure that DONE
patients are seeing
the correct providers

35
TIME & DOCTOR’S ORDER RATIONALE REMARKS
DATE

for the correct

problems

2/7/21 < IVF to follow: D5LR TL @ 20 DONE

gtts/min
7am
2/7/21 < Encourage patient to ambulate Instruct the patient to DONE
sit on the side of the
7:30 am bed first, prior to
ambulation

2/7/21 < May have soft diet To relieve mild DONE

12:22 pm intestinal or stomach
discomfort

2/7/21 < IVF TF D5LR TL @ 20 gtts/min used for electrolyte DONE

replenishment and
9:20 pm caloric supply

2/8/21 < IVF to follow; D5LR TL @ 20gtts/ used for electrolyte DONE
min replenishment and
1pm
caloric supply

2/8/21 < to consume IV medication Replace water sugar DONE

and salt
6:10 pm
< May have DAT (diet as tolerated) The patient should be DONE
careful on the food
she eats.
< May remove Foley catheter It is important to DONE
remove catheter to
prevent infection and
other complications.

02/09/21 < May Go Home

< Home medication

• Levofloxacin 500mg tab OD x Used to treat a variety

5days of bacterial infection.

36
• Celecoxib 200mg cap, 1 Celecoxib is a
cap BID PRN NSAID used to treat
painful rheumatic
conditions. It eases
the pain and
reduces
• Advice daily bath and open inflammation
dressing
To protect the
wound from infection
with microorganisms
• Follow up after 1week with further trauma
02/10/21 2pm
To check for health
problem that may
occur after treatment
ends

37
 CHAPTER XI
DIAGNOSTIC EXAMINATION

This chapter contains the approach through which healthcare provider used to gather all clinical information of the
patient for the purpose of clinical decision Patient management is strongly correlated with diagnostic test findings
(Lecouvet, 2020).

HEMATOLOGY Hematology tests include tests on the blood, blood proteins and blood-producing organs. These tests can
evaluate a variety of blood conditions including infection, anemia, inflammation, hemophilia, blood-clotting disorders,
leukemia and the body's response to chemotherapy treatments.

Table 5. Hematology

EXAM NORMAL RATIONALE PATIENT REMARKS CLINICAL

VALUES RESULTS SIGNIFICANCE
02/06/21
WBC Count 5.00 – Used as part of a 8.5 Normal Normal WBC
10.00x10/L full complete count indicate
blood count to: that the body
screen for a wide isn’t fighting the
range of disease infection the way
and conditions, it should be.
helps diagnose
an infection or
inflammatory
process or other

38
 diseases that
affect the number
of WBC.
Segmenters 0.50 – 0.70 They function to 0.68 Normal Normal
kill invaders of the Segmenters
body indicate free from
infections and
serious
conditions.
Band Form 0.02 -0.05 The most
commonly
produce white
blood cells that
are essential for
fighting diseases.
That is why the
body produces
them in excess to
decrease risk of
infections
developing.
Monocyte 0.03 -0.05 A type of white 0.05 Normal Normal monocyte
blood cell that count indicates
fight certain that the immune
infections and system is free
help other white from infections.
blood cells
remove dead or
damage tissues,
destroy cancer
cells, and
regulate

39
 immunity against
foreign
substances.
Lymphocyte 0.23 -0.35 Responsible in 0.24 Normal Normal
determining the lymphocytes no
specificity of the indication of
immune infection.
response to
infectious
microorganisms
and foreign
substances.
Eosinophils Major effectors 0.03
cells in the
immune system.
They have a
beneficial role in
host defense
against
nematodes and
other parasitic
infections and
are active
participants in
many immune
responses.
Basophils 0.00 -0.01 Necessary for
the immune
system’s natural
response to
invaders, such as
infectious germs.

40
 When a
potentially
harmful allergen
enters the body,
the immune
system responds
by trying to
isolate and
eliminate the
allergen.
MCHC 320.00 -345.00 Checks the
g/L average amount
of hemoglobin in
the group of red
blood cells. High
MCHC is
diagnosed as
part of blood test
known as
complete blood
count (CBC).
MCH 27.00 -34.00 pg It’s the average
amount in each
of the red blood
cells of a protein
called
hemoglobin,
which carries
oxygen around
the body.
MCV 83.00 -92.00 fl It is an important

41
 number listed on
a complete blood
count that can
help diagnose
different types of
anemia as well
as other health
conditions. The
MVC is the value
that describes
the average size
of red blood cells
in blood sample.
Hemoglobin 120.00 -140.00 It is done to 114 LOW Lower
g/L check for low or hemoglobin
high levels of red indicate that the
blood cells. It can body does not
be done as part have enough iron
of routine check the body and
up to screen for can’t make
problems and or enough
because a child hemoglobin.
isn’t feeling well.
When the level of
red blood cell is
low, it is called
anemia.
Hematocrit It is often used to 0.35
check for
anemia. The test
may be used to

42
 screen for,
diagnose, or
monitor a
number of
conditions and
diseases that
affect red blood
cells.
RBC Count It is typically 3.00-5.00X10
ordered as part
of a complete
blood count and
may be used as
part of a health
check up to
screen for a
variety of
conditions. The
test may also be
used to help
diagnose and/or
monitor a
number of
diseases that
affect the
production or
lifespan of red
blood cells.
Platelet Count Used to assist in 150.00-
the diagnosis of 350.00X10g/L
bleeding

43
 disorders and to
monitor patients
who are being
treated for any
diseases. It is a
test that
determines the
number of
platelets in the
sample of blood
that helps stop
the bleeding
when there is n
in jury in the
blood vessel or
tissue.
ESR It can help to 0.00-
determine if you 20.00mm/hr
have a condition
that causes
inflammation
associated with
conditions such
as infections,
cancers and
autoimmune
diseases. An ESR
may also be used
to monitor an
existing condition.
Clotting Time It is an important 5.00-8.00 mins
test because it

44
 checks to see if
five different
blood clotting
factors are
present. It is
made longer by
blood-thinning
medicine, such
as warfarin
which is a low
level of blood
clotting factors.
Blood Group It is done so you
can safely
donate your
blood or receive
a blood
transfusion. It is
also done to see
if you have
substance called
Rh factor on the
surface of the red
blood cells. A
small number of
antigens and
antibodies are
responsible for
the ABO blood
types.
BSMP Measure the

45
 sugar (glucose)
level, electrolyte
and fluid
balance, and
kidney function.
A high may
indicate acute or
chronic kidney
failure, diabetes
or dehydration.

URINALYSIS Urinalysis is a test of the urine which is used to detect and manage a wide range of disorders, such as
urinary tract infection, kidney disease and diabetes. It involves checking and analyzing the appearance, concentration and
content of urine.

Table 6. Urinalysis

EXAM NORMAL RATIONALE PATIENT REMARKS CLINICAL

VALUES RESULTS SIGNIFICANCE
Pus Cells 10-25 Test for pus cells
it is to determine
if there is site of
infection location.
RBC 0-2 Test to measure
the number of
red blood cells in
urine sample.
Epithelial cells FEW Test to signify the

46
 present of
epithelial cells in
the urine.
Renal cells Test to find or rule
out potential
kidney
impairment or
disease.
Mucus Threads FEW Test for the
indication of
urinary tract
infection.
Yeast Cells Test to signify if
there’s
pyelonephritis or
cystitis.
Bacteria Test for detecting
germs in urine
found and
identified with this
test (UTI).
Amorphous Test for detecting
Urates the presence of
amorphous urate
crystals in the
urine that
indicate the
probable nature
of the stone.
Amorphous Test to measure
phosphate the amount of

47
 phosphate in the
urine.
Uric Acid Crystals Test for detecting
level of uric acid
in the urine.
Calcium Oxalate Test to signify if
you have a high
level of the
chemical oxalate
in the urine.
Triple Test in measuring
Phosphates the amount of
phosphate in the
urine and if it
indicates urinary
tract infection.

Ammonium biuret Test measure of

protein in normal
urine without
interference from
drugs or
pigments.
Hyaline Test that indicate
a decreased or
sluggish urine
flow.

48
 CHAPTER XII
DRUG STUDY

This chapter deals with the drugs prescribed by the attending physician. This includes the classification, indication,
mechanism of action, contraindication, adverse reactions and the responsibilities entrust to the nurses. According to
McCuistionet. al. (2020), it is highly necessary in the acquisition and application of reasoning skills in the clinical practice
thereby promoting safe drug administration.

Ampicillin Sodium + Sulbactam. A Drug Study

NAME CLASSIFICATION INDICATION MECHAN CONTRAINDIC SIDE ADVERSE NURSING
ISM OF ATION EFFECTS EFFECTS RESPONSIBILITIES
ACTION
Generic Therapeutic class: Intraabdomina • Contraindicat Allergic CV: • Ask the patient
Name: Antibiotics l, gynecologic, ed in patients Thrombophlebi about allergic
Inhibits reaction,
Ampicillin and skin hypersensitiv tis reactions to
sodium + Pharmacologic cell-wall e to drug or suprainfecti GI: Diarrhea penicillin before
structure
Sulbacta class: other Hematologic, giving the drug.
infections synthesis ons,
m sodium penicillin, in Agranulocytosi • Watch for signs
Aminopenicillins caused by during those with diarrhea, s, leukopenia, and symptoms of
Brand beta-lactamase susceptible sensitivity to thrombocytope hypersensitivity,
Name: inhibitors bacterial nausea,
strains. multiple nia, such as
Unasyn multiplicati allergens, and vomiting, erythematous
on thrombocytope
in those with nic purpura. maculopapular
Dosage: erythemato
mononucleosi Skin: Pain at rash, urticarial,
5.5 s us and anaphylaxis.
injection site,
grams because of • Monitor for CDAD,
rashes in thrombophlebit
high risk of is, rash, which can be
Route: maculopapul glandular fatal. Antibiotics
IVTT urticarial.

49
Frequen ar rash. fever and Other: may need to be
cy: q 8 • Contraindicat Hypersensitivit stopped and other
chronic
hours ed in patients y reactions. treatment begun.
with a history lymphatic • Tell the patient to
of leukemia. report all adverse
cholestatic reactions,
jaundice or including rash,
hepatic fever, or chills. A
dysfunction rash is the most
associated common allergic
with reaction.
ampicillin- • Warn patient that
sulbactam I.M. injection may
injection. cause pain at the
• Use injection site.
cautiously in
patients with
other drug
allergies
(especially to
cephalosporin
s) because of
possible
cross-
sensitivity and
in those with
renal
impairment.

Bupivacaine Hydrochloride. A Drug Study

50
 NAME CLASSIFICA INDICATION MECHANISM CONTRAIN SIDE ADVERSE NURSING
TION OF ACTION DICATION EFFECTS EFFECTS RESPONSIBILITIES
Generic Pharmacologi Prolonged local Bupivacaine is Myasthenia Hypotension, Body as a • Monitor for signs
Name: c class: anesthesia by Whole: of inadvertent
a prescription gravis, bradycardia,
Bupivacai regional nerve Hypersensitivit intravascular
ne Local block, epidural medication hypovolemi cardiac arrest, y [cutaneous injection, which
Hydrochl Anesthetics block, spinal lesions, can produce a
used as a local a, complete CNS effects
anesthesia urticaria, transient
oride
anesthetic heart block, include sneezing, "epinephrine
diaphoresis, response"
Brand (numbing intravenous agitation,
Name: respiratory syncope, (increased heart
medicine). regional depression, hyperthermia, rate or systolic BP
Marcaine,
convulsion, angioneurotic or both,
Sensor Bupivacaine anesthesia
edema circumoral pallor,
Caine and
blocks the (Bier’s (including palpitations,
myocardial
nerve impulses laryngeal nervousness)
Dosage: Block), depression
that send pain edema), within 45 seconds
5 may be more
signals to your 0.75% for anaphylaxis, in the unsedated
ampules severe and
brain. epidural anaphylactoid patient and an
use in more reaction]. increase by 20
5mg/ml
obstetrics. resistant to be CNS: bpm or more in
Route: treated. Nervousness, heart rate for at
Intrathec unusual least 15 seconds
al anxiety, in sedated patient.
Injection excitement, • Vasoconstrictor-
dizziness, containing
Frequen drowsiness, solution should be
cy: tremors, administered
convulsions, cautiously, if at all,
STAT unconsciousne to areas with end
ss, respiratory arteries (e.g.,
arrest. digits, penis) or to
Special areas that have a

51
Senses: compromised
Pupillary blood supply;
constriction; ischemia and
blurred or gangrene can
double result. Inspect
vision; areas for
tinnitus. evidence of
GI: Nausea, reduced perfusion
vomiting. because of
Other: vasospasm: pale,
Inflammation cold, sensitive
or sepsis at skin.
• Note: Systemic
injection site,
reactions (toxicity)
chills, pupillary
are more apt to
constriction. occur in children
or older adults
and may develop
rapidly or be
delayed for as
long as 30 min
after
administration.
• Monitor for
toxicity: CNS
stimulation
(unusual anxiety,
excitement,
restlessness)
usually occurs
first, followed by
CNS depression
(drowsiness,

52
 unconsciousness,
respiratory arrest).
However,
because
stimulation is apt
to be transient or
absent,
drowsiness may
be the first sign in
some patients
(especially
children and older
adults).

Celecoxib. A Drug Study

53
 NAME CLASSIFICA INDICATION MECHANISM CONTRAINDI SIDE EFFECTS ADVERSE NURSING
TION OF ACTION CATION EFFECTS RESPONSIBILITIES
For elderly  gas or CNS: • Watch for signs
Therapeutic patients and Thought to Serious skin bloating headache, and symptoms
Generic
class: those reactions sore throat dizziness, of overt and
Name: inhibit
NSAIDs weighing less (Stevens-  cold insomnia. occult bleeding
Celecoxib
Pharmacologi than 50 kg, prostaglandin Johnson symptoms CV: HTN, and rash.
c class: start at lowest syndrome,  constipation peripheral • Drug can cause
Brand Cyclooxygena dosage. synthesis, fluid retention;
toxic  dizziness edema.
Name: se-2 For patients monitor patient
impeding epidermal dysgeusia EENT:
Celebrex inhibitors with Child- with HTN,
cyclooxygena necrolysis)  unexplained pharyngitis
Pugh class B can occur. , rhinitis, edema, or HF.
weight gain
hepatic se-2, to Discontinue sinusitis. Patient teaching
Dosage: impairment,  shortness of
drug at the GI: • Tell patient to
200 mg reduce produce breath or
first sign of abdominal report history of
dosage by inflammatory, difficulty
pain, allergic
Route: about 50%. analgesic, and rash. breathing
reactions of
 swelling of diarrhea,
Oral Do not use it antipyretic sulfonamides,
the dyspepsia,
Route in patients effects. flatulence, aspirin, or other
with severe abdomen, NSAIDs before
 feet, ankles, GI
Frequen renal or reflux, therapy.
severe or lower • Instruct patient
cy: PRN legs nausea.
for pain hepatic Metabolic: to promptly
impairment. diarrhea report signs of
nausea hyperchlor
For patients emia GI bleeding,
who are poor  excessive such as blood
Musculos
metabolizers tiredness in vomit, urine
keletal:
of CYP2C9,  unusual or stool; or
start bleeding back pain. black, tarry
treatment at  or bruising Respirato stools.
half the itching lack ry: • Instruct patient
lowest to take drug
of energy dyspnea,
recommende with food if
loss of URI.

54
d dose. appetite Skin: stomach upset
 pain in the erythe occurs.
upper ma • Tell a
 right part of multifor patient who has
the me, trouble
exfoliati swallowing a
 stomach
ve capsule whole
yellowing of dermati
the skin or that the
tis, contents of the
eyes flu-like Steven
 symptoms capsule may be
s
taken with
 blisters Johnso
n applesauce.
fever rash
syndro • Tell the
hives
me, patient that that
swelling of
toxic drug may harm
the face,
epider the liver. Advise
throat,
mal patients to stop
tongue, lips,
necroly therapy and
eyes, or sis, notify
hands rash. prescriber
 hoarseness Other: • immediat
difficulty acciden ely if
 swallowing tal
experiencing
or breathing injury.
signs and
pale skin
symptoms of
 fast • hepatoto
heartbeat xicity, including
 cloudy, nausea,
discolored fatigue,
 , or lethargy,
 bloody urine itching,

55
 back pain yellowing of
 difficult or skin or eyes,
painful right upper
urination • quadrant
 frequent tenderness,
urination, and flu like
especially at syndrome.
night • Inform
that it may take
several days
before
consistent pain
relief occurs.
• Advise patient
that using OTC
NSAIDs with
celecoxib may
increase the
risk of GI
toxicity.

56
 D5LR. A Drug Study
NAME CLASSIFICATION INDICATION MECHANISM CONTRAIN SIDE ADVERSE NURSING
OF ACTION DICATION EFFECTS EFFECTS RESPONSIBILITIES
Generic Pharmacologic Supply of The Itching, Allergic • Do not administer
Name: class: nutrition and Hypertonic hives, reactions or the solution
Hypersensitiv
D5LR water at times Solutions has swelling of anaphylactoid unless it is clear
(Lactated ity the face, symptoms and the container
Alkalinizing Agents of diseases better
Ringer’s and loss of to any of the puffy eyes, such as is undamaged.
and 5% effective
blood, components. coughing, localized or • Monitor changes
Dextrose osmolarity in sneezing, generalized in fluid balances,
intoxication comparison
Injection) sore urticaria and electrolyte
and diuresis.
with body throat, pruritus; concentrations
Dosage: fluids. difficulty periorbital, and acid base
5 bottles This allows breathing, facial, and/or balance regularly.
fever, and laryngeal • Monitor fluid
1L the fluid to
injection edema, intake and output
pull itself into coughing, and weight
site
Route: IV the vascular sneezing, carefully.
reaction
osmosis that (infection, and/or • Do not give
Frequen
results in an swelling, difficulty with concentrated
cy: breathing solutions via IM or
increase in redness).
30gtts/mi have been subcutaneously.
n then the vascular
• Check vital signs
20gtts/mi volume. It reported
frequently and
then raises during
n report for
the administration
abnormal
of Lactated
intravascular changes.
Ringer's and
osmotic • Monitor glucose
5% Dextrose
pressure and Injection. level carefully.
delivers fluid, • Be extra cautious
electrolytes in the
administration of
and calories

57
 for energy. parenteral fluids.
• In cases of
adverse reactions
happening,
discontinue the
infusion and
evaluate the
patient.
• Make sure to
discard unused
portions properly
to avoid
contamination.
• Observe aseptic
technique when
changing the IV
fluid.
• Always be ready
to give assistance
to the patient if
needed.
• Closely monitor
the patient and
take note of
findings.

Diazepam. A Drug Study

58
 NAME CLASSIFICATION INDICATION MECHANIS CONTRAINDI SIDE ADVERSE NURSING
M OF CATION EFFECTS EFFECTS RESPONSIBILITIES
ACTION
Generic Therapeutic class: Short-term A ● Patient ● drowsin CNS: ● Periodically
Name: Anxiolytics treatment of benzodiaze hypersen ess drowsiness, monitor LFTs,
Diazepa severe anxiety pine that sitive to dysarthria, CBC, and renal
disorders & potentiates drugs. ● tirednes slurred function in
m
Pharmacologic insomnia; the effects ● Use s or speech, patients receiving
Brand class: sedative & of GABA, cautiousl tremor, repeated or
fatigue
Benzodiazepines premedicate: depresses y in transient prolonged
Name:
management the debilitate ● muscle amnesia, therapy.
Diastat, Controlled of status CNS, and d patients fatigue, ● Monitor HR, BP,
AcuDial, epilepticus & suppresses and in weakne and mental status
substance ataxia,
Diazepa febrile the spread patients ss headache, changes. Patient
m schedule: IV convulsions, of seizure with insomnia, at an increase for
Intesol, in the control activity. hepatic ● inability paradoxical falls.
Valium of or renal to anxiety, Patient Teaching
muscle spasm impairme hallucinations, ● Caution patient or
as in tetanus: nt, control
Do minor caregiver of
sag management depressio muscle changes in patient taking an
e: of n, history EEG opioid with
movem
4 alcohol of patterns, pain, benzodiazepine,
am withdrawal substanc ent vertigo, CNS depressant,
ps/ symptoms. e abuse, s confusion, or alcohol to seek
10 impaired (ataxia) depression. immediate
mg/ml gag CV: CV medical attention
reflex, or ● headac collapse, for dizziness,
Route: chronic he light-headedness,
used by open extreme
angle ● tremor sleepiness, slow
anesthes
glaucoma and difficult
iologist ● dizzines
and in breathing, or
those at s unresponsiveness

59
 risk for ● Warn the patient
falls. to report all
● Some adverse reactions
injectable and avoid
forms
may
contain
propylen
e glycol;
large
amounts
are
potentially
toxic and
have been
associated
with
hyperosmo ● dry
larity, lactic mouth
acidosis, or

Ketorolac. A Drug Study

NAME CLASSIFICATION INDICATION MECHA CONTRAINDICA SIDE ADVERSE NURSING

60
 NISM TION EFFECTS EFFECTS RESPONSIBILITIES
OF
ACTION
Generic Therapeutic Short-term May  Hypersens - Headache CNS: • Correct hypovolemia
Name: class: managemen inhibit itive to - Drowsiness headache, before giving drug.
Ketorola Nonsteroidal anti- t of prostagl drug - Indigestion dizziness, • Contraindication for
c inflammatory moderate andin  Peri- Stomach or drowsiness epidural or intrathecal
drug severe acute synthesi operative abdominal , sedation. administration
Brand (NSAIDs) pain and s to pain in pain CV: because of alcohol
Name: inflammation produce patients - Nausea arrhythmia content.
Toradol . anti- requiring - Diarrhea s, • Watch for and
Pharmacologic inflamm CABG - Dizziness edema, immediately evaluate
class: atory, surgery. - Itching HTN, signs and symptoms
Nonsteroidal anti- analges  Patient - Swelling of heart attack (chest
Dosage: palpitations
inflammatory drug ic, and currently (edema) pain, shortness of
6 GI:
(NSAIDs) antipyre receiving - Increased breath or trouble of
amps/30 dyspepsia,
tic. aspirin, blood urea breathing) or stroke
mg/ ml GI pain,
probeneci nitrogen (BUN) (weakness on one
nausea,
d, or other - Constipation part or side of the
Route: constipatio
NSAIDs - Purpura body, slurred speech)
Intraven n, diarrhea,
because of - Increased • Carefully observe
ous flatulence,
cumulative serum patients with
peptic
risks of creatinine coagulopathies and
ulceration,
Frequen inducing - Drowsiness those taking
stomatitis,
cy: q8h serious - High blood anticoagulants.
vomiting,
NSAID- pressure • May increase risk of
GI
related (hypertension) serious thrombotic
hemorrhag
adverse events, MI, or stroke,
e.
reactions. which can be fatal.
GU: renal
 Increase • May mask signs and
failure
risk of symptoms of
Hematolo
heart infection because of
gic:
their antipyretic and

61
 attack or decreased anti-inflammatory
stroke in platelet actions.
patients adhesion, Patient teaching
with or prolonged • Advise the patient to
without bleeding seek medical attention
heart time, immediately for chest
disease or purpura. pain, shortness of
risk factors Skin: breath or trouble of
for heart diaphoresis breathing, weakness
disease. , pruritus, in one part of the
 Risk rush. body, or slurred
appears speech.
greater at • Advise patient to
higher maintain adequate
doses fluid intake
• Tell the patient to
promptly report edema
and weight gain.
Other: pain at
injection site

Nalbuphine Hydrochloride. A Drug Study

NAME CLASSIFICA INDICATION MECHANIS CONTRAINDICA SIDE ADVERSE NURSING
TION M OF TION EFFECTS RESPONSIBILITIES

62
 ACTION EFFECTS
Generic Therapeutic Relief of Nalbuphine is Respiratory Nausea, Sedation, • Reassess patient’s
Name: class: Opioid moderate to an agonist at depression, acute vomiting, drowsiness, level of pain at
Nalbuphi Analgesics severe pain. kappa opioid alcoholism, head constipatio sweating, least 15 and 30
ne receptors and injuries, increased n, nausea, dry minutes after
Perioperative
Hydrochl an antagonist intracranial drowsiness mouth & parenteral
oride analgesia, at mu opioid , confusion, dizziness
Pharmacologi pressure, administration.
e c class: premedication receptors. bronchial asthma, respiratory • Nalbuphine acts
Opioid agonist- n. heart failure. depression, as an opioid
Brand secondary to cough antagonist and
antagonist Supplement to
Name: chronic lung suppressio may cause
balance n
Nubain disease, withdrawal
anesthesia. monoamine syndrome.
Dosag oxidase inhibitors. • Monitor circulatory
e: 6 and
amps/1 respiratory status,
0 bladder and bowel
ml function. if
respirations are
Route: shallow or rate is
used by below 12
anesthesi breaths/minute,
ologist withhold dose and
notify prescriber.

Levofloxacin. A Drug Study

NAME CLASSIFICA INDICATION MECHANIS CONTRAINDI SIDE ADVERSE NURSING
TION M OF CATION EFFECTS RESPONSIBILITIES
63
 ACTION EFFECTS
Generic Therapeutic Inhibits Drug is • headache CNS: • Drug may
Name: class: bacterial associated • hunger, encephalopat cause an
Levofloxa Antibiotics DNA gyrase with increased irritability hy, seizures, abnormal ECG.
Use in
cin and prevents risk of • numbness dizziness, • Most
patients with
DNA tendinitis and • tingling headache, Anti-bacterials
acute bacterial
Brand Pharmacologi replication, tendon • burning insomnia; can cause
sinusitis, acute
Name: c class: transcription, rupture, pain headache pseudomembra
bacterial
Levaquin Fluoroquinolon repair, and especially in confusion (ophthalmic). nous colitis. If
exacerbation •
recombinatio patients older CV: edema, diarrhea occurs,
es of bronchitis, • agitation
n in than age 60, chest pain. notify the
and • paranoia
Dosage: susceptible in patients EENT: foreign prescriber; drug
uncomplicated bacteria. taking • problems body or
500 mg may be
UTI isn’t corticosteroids with burning stopped.
recommended , and in those memory or sensation in
Route: • Monitor
because of risk with heart, concentrati eye, eye pain,
Oral glucose level
of serious kidney, or on vision loss,
Route and results of
adverse effect. lung • hives photophobia renal function
Use in these transplants. • difficult (ophthalmic). tests, LFTs,
Frequen patients only breathing GI: and blood
cy: 5 when • swelling in pseudomembr counts.
days they have no your face anous Patient teaching
other or throat
(Duration colitis, • Tell the patient
treatment • fever
) abdominal to take drug as
options. • sore throat pain, prescribed,
• burning in constipation, even
your eyes diarrhea, if signs and
• skin pain dyspepsia, symptoms
• red or nausea, disappear.
purple skin vomiting. • Advise patient
rash that GU: vaginitis. to take drug
spreads Hematologic: with plenty of
and causes fluids and to

64
blistering lymphopenia, space
and peeling eosinophilia, antacids,
hemolytic sucralfate, and
products
anemia.
containing iron
Metabolic: or zinc.
hypoglycemia • Tell the patient
Musculoskel to take oral
etal: back solution 1 hour
pain, tendon before or 2
rupture. hours after
Respiratory: eating.
allergic • Warn patient to
pneumonitis, avoid
dyspnea. hazardous
Skin: tasks until
erythema adverse effects
multiforme, of drug are
Stevens unknown.
Johnson • Advise patient
syndrome, to avoid
photosensitivit excessive
y, pruritus, sunlight
rash, injection exposure.
site reaction. • Instruct patient
Other: to stop drug
and notify
anaphylaxis, prescriber if
multisystem rash or other
organ failure, signs or
hypersensitivit symptoms of
y reactions. hypersensitivity
develop.

65
 • Instruct patient
to notify
prescriber of all
adverse
reactions,
including loose
stools or
diarrhea.
• Instruct patient
not to use
contact lenses
during
treatment for
bacterial
conjunctivitis.

Cefuroxime. A Drug Study

NAME CLASSIFIC INDICATION MECHANISM CONTRAINDICATI SIDE ADVERSE NURSING
ATION OF ACTION ON EFFECTS EFFECTS RESPONSIBILITIE

66
 S
Generic Treatment of Inhibits cell- • Contraindica • rash CV:  Monitor
Name: ted in • hives phlebitis, patient for
Therapeutic resp tract wall synthesis,
Cefuroxi patients • itching; thrombophleb signs and
me class: infections, promoting hypersensiti red, itis. symptoms of
sodium Antibiotics ear, nose & ve to drug or GI: diarrhea, superinfectio
osmotic swolle
throat infection other n pseudomemb n and
Brand including otitis instability; cephalospori , ranous diarrhea
Pharmacolo ns.
Name: media, blister colitis, and treat
gic class: usually
Zinacef sinusitis, • Use ed, or nausea, them
Second- bactericidal.
tonsillitis, cautiously in peelin anorexia, appropriatel
generation vomiting. y. Drug may
pharyngitis, patients g skin
cephalospori with or Hematologic increase
Dosage: acute & hypersensiti
ns without : hemolytic INR and
750mg chronic ve to
penicillin fever anemia, risk of
bronchitis, • wheezi thrombocytop bleeding.
Route: bronchiectasis because of
ng enia, Monitor
Intraveno w/ infection, the transient
• tightne patient.
us bacterial possibility of neutropenia,
ss in  Have your
pneumonia, cross- eosinophilia.
the blood work
Frequen lung abscess sensitivity Skin:
chest checked if
cy: q8h & post-op with other maculopapul
or you are on
pulmonary beta lactam ar and
throat cefuroxime
infection; UTI antibiotics. erythematous
trouble injection for a
• Accor rashes,
including breathi long time.
ding to urticaria,
pyelonephritis, ng, Talk with
clinical pain,
cystitis & swallo induration, your doctor.
asymptomatic practice
wing, sterile  Severe and
bacteriuria; guidelines,
or abscesses, sometimes
skin & skin cefotaxime
talking temperature deadly
structure or
unusu elevation, allergic side
infections ceftriaxone tissue
al effects have
should be
67
including used to treat • h sloughing at rarely
cellulitis, childhood oarse I.M. happened
erysipelas, bacterial ness; injection with drugs
peritonitis meningitis or site. like this one.
& and swellin Other:  This
traumatic pneumococc g of anaphylaxis medicine
infection; al and the , may affect
septicemia; meningococ mouth, hypersensitiv certain lab
meningitis; cal face, ity reactions, tests. Tell all
gonorrhea meningitis lips, serum of your health
(uncomplicate caused by • tongue sickness. care
d& penicillin , or providers and
complicated resistant throat. lab workers
gonorrhea) strains and • Seizur that you take
especially for Hemophilus e cefuroxime
the patient in influenzae • Any injection
whom type b unexpl  Patient
penicillin meningitis. ained teaching
treatment is Use bruisin  Instruct
not cautiously in g or patient to
recommended patients with bleedi notify the
d; bone & joint a history of ng prescriber
infections. colitis and in about rash,
Pre-op those with loose stools,
prophylaxis renal diarrhea, or
which reduces insufficiency. evidence of
the incidence superinfectio
of certain n.
 Advice
patient
receiving

68
 drug I.V.
insertion site.

Sultamillicin. A Drug Study

NAME CLASSIFICA INDICATION MECHANISM CONTRAIN SIDE ADVERSE NURSING

69
 TION OF ACTION DICATION EFFECTS EFFECTS RESPONSIBILITI
ES
Generic Therapeutic Treatment of upper Prevents Hypersensit Diarrhea, Serious • Assess
Name: class: and lower bacterial cell ive to nausea, anaphylactoid patients from
Sultamicil Penicillin respiratory tract & wall synthesis penicillin vomiting reactions. beginning and
lin gynecological by binding to 1 rashes, Diarrhea or loose throughout
infections. or more of the itching, bowel, nausea, therapy.
Brand Pharmacologi Prophylaxis to penicillin- blood vomiting, • Obtain
Name: c class: reduce the risk of binding dyscrasias, epigastric specimens for
Silgram Beta-Lactam infections proteins super distress & culture and
following resulting in infections, abdominal cramps; sensitivity
antibiotics inhibition of the dizziness,
surgery or anemia, before therapy.
cesarean. final difficulty in thrombocytopenia, First dose may
Dosage: transpeptidatio breathing eosinophilia & be given
1.5 mg n step of leukemia; transient before
peptidoglycan elevations of receiving
synthesis in ALT(SGPT) & results.
Route:
the bacterial AST(SGOT) • Observe
Intraveno
cell walls. transaminase patients for
us signs and
s,
symptoms of
bilirubinemia,
anaphylaxis
abnormal hepatic
function and
jaundice; rash,
itching & and other
skin reaction.

70
 CHAPTER XIII

SURGICAL PROCEDURE

A. DESCRIPTION

- Appendectomy is a surgical procedure done to remove the appendix when it is

infected or inflamed. The condition appropriate for this surgery are for those
patients who has appendicitis.

- Appendicitis is the inflammation of the appendix and has clinical manifestation

that includes abdominal pain in their lower right region of their abdomen where
the placement of the appendix should be. Other common symptoms include loss
of appetite gradually causing the patient to experience nausea and vomiting,
hyperthermia and visual evidence of flushed face.

- The process of appendectomy starts by creating an incision, about two to three

inches in length. An oblique incision is usually used for an open appendectomy
type of procedure. The incision is made through the skin and the layers of the
abdominal wall over the appendix. The surgeon enters the abdomen and looks
for the appendix which is usually in the right lower abdomen. The surgeon
examines the area to see if there are any other additional problems around the
appendix. If there are no present problem seen, then the appendix is removed.
The appendix is cut, freeing it from its mesenteric attachment to the abdomen
and colon. The hole in the colon is then sewed and the surgical site is closed.

71
B. RATIONALE

Appendectomy is performed when a patient is diagnosed with appendicitis. The

removal of the inflamed appendix can reduce the worsening of the inflammation that
can spread throughout the abdomen.

C. NURSING RESPONSIBILITIES

● Pre-operative
1. Conduct diagnostic examinations such as White Blood Cell Count, Abdominal X-
Ray, Hematology Test, Ultrasound, Pregnancy Test, Rapid Antigen Swab Test,
CT scan and Urinalysis, as doctor’s order, and relay results after.
2. Monitor Vital Signs and observe for any abnormalities.
3. Monitor for changes in level of pain.
4. Monitor bowel sounds of patient.
5. Position patient in a right side lying or low to semi fowler to promote comfort to
the patient
6. Administer IV fluids to keep patient hydrated.
7. Apply ice packs to the abdomen every hour for 20-30 minutes, as prescribed.
8. Retrieve consent for major operation from the patient.
9. Advise patient to not eat anything 8 hours prior to the surgery to avoid
complications during the surgery.
10. Explain the procedure to patient and provide answers for when they raise a
question about the surgery to relieve anxiety and fear of the procedure.

● Post-Operative
1. Monitor VS of patient.
2. Monitor temperature to indicate possible sign of infection.
3. Assess incision for signs of infection such as redness, swelling and pain.

72
4. Keep the surgical wound clean and dry and change dressings in required times.

5. Main the patient’s NPO status until bowel function has returned,
6. Administer prescribed or tolerated diet for patient when bowel sound returns.
7. Administer medication prescribed for the patient.
8. If prescribed pain medications are not working, inform the physician.
9. If peritonitis has developed, inform the physician immediately.
10. Observe for an appendix rupture on the incision site.
11. Advise patient to prevent doing any strenuous activity after the surgery.
12. Provide comfort to patient and apply support on the abdomen when coughing,
laughing or moving by placing a pillow over the abdominal area.
13. Advise patient to have enough rest but also recommend patient to take short
walks to prevent deep vein thrombosis (DVT).

73
 CHAPTER XIV

NURSING THEORIES

HENDERSON’S “Nursing Need Theory”

Henderson views the nursing process as “really the application of the logical
approach to the solution of a problem. The steps are those of the scientific method.”
Nursing process stresses the science of nursing rather than the mixture of science and
art on which it seems effective healthcare service of any kind is based.

Henderson enumerated the 14 components that make up the basic nursing care
(fundamental needs), which are as follows:

1. Breathe normally

2. Eat and drink adequately

3. Eliminate body wastes

4. Move and maintain desirable postures

5. Sleep and rest

6. Select suitable clothes – dress and undress

7. Maintain body temperature within normal range by adjusting clothing and

modifying environment

8. Keep body clean and well-groomed and protect the integument

9. Avoid dangers in the environment and avoid injuring others

10. Communicate with others in expressing emotions, need, fears, or opinions

11. Worship according to one’s faith

12. Work in such a way that there is a sense of accomplishment

74
 13. Play or participate to various forms of recreation

14. Learn, discover, or satisfy the curiosity that leads to normal development and
health and use the available health facilities

APPLICATION

The concept of nursing conceptualized by Henderson in her definition of nursing

and the 14 components of basic nursing is uncomplicated and self-explanatory.
Therefore, it could be used as a guide for nursing practice by most nurses with the
facility.
Many ideas she presented remain relevant in the present times.

OREM’S “Self-Care Deficit Nursing Theory”

The central philosophy of the Self-Care Deficit Nursing Theory is that all
patients want to care for themselves, and they are able to recover more quickly and
holistically by performing their own self-care as much as they’re able. This theory is
particularly used in rehabilitation and primary care or other settings in which patients are
encouraged to be independent.

The major assumptions of Orem’s Self-Care Deficit Theory are as follows:

• People should be self-reliant, and responsible for their care, as well as

others in their family who need care.
• People are distinct individuals.
• Nursing is a form of action. It is an interaction between two or more
people.
• Successfully meeting universal and development self-care requisites is
important component of primary care prevention and ill health.
• A person’s knowledge of potential health problems is needed for
promoting self-care behaviors.

75
 • Self-care and dependent-care are behaviors learned within a socio-
cultural context.

APPLICATION

One of the benefits of Dorothea Orem’s Self-Care Deficit Nursing theory is that it
can easily be applied to a variety of nursing situations and patients. The generality of its
principles and concepts make it easily adaptable to different settings, and nurses and
patients can work together to ensure that the patients receive the best care possible,
but are also able to care for themselves.

76
 CHAPTER XV

NURSING CARE PLAN

This chapter deals with the provision of directive in rendering individualized care to the patient. This includes
organization of assessed data into nursing diagnosis that will be subjected to the nurse’s plans of care, re-enactment and
reassessment. Planning out the care to be rendered facilitates active management of patient’s recovery (Rio et al., 2019)

Risk for Infection. A Nursing Care Plan

ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION/OUTCOME

DIAGNOSIS INTERVENTION
Subjective Risk for Short Term: Independent: Goal met:
Cues: Infection Within 8 hours 1. Inspect the - Early detection - Patient was free from any
“Namumula yung related to a of incision for any of signs of signs of infection.
balat ko banda site for intervention: further signs of infection can (Endorsed to ward for
doon sa sugat organism - The patient infection such as provide rapid continuity of care.)
ng surgery at invasion will be free pus, wound nursing
saka masakit secondary to from any signs drainage or intervention.
siya” as stated infection of infection. erythema.
by patient. Long Term: - To observe
Objective Cues: Within the 2. Monitor Vital abnormalities in
- Presence of patient’s Signs regularly. the vital signs
surgical wound hospital stay: such as increase
from - The patient in temperature
appendectomy will achieve a can indicate

77
procedure. timely wound fever, one of the
- Redness of healing with 3. Change signs of infection.
skin surrounding no infection wound dressing
the incision site. present on the and perform - To promote
incision wound care. wound healing
wound. and also provide
4. Encourage protection from
patient to infection.
verbalize their - To be aware of
feelings about their overall
their condition. condition and if
they feel any
5. Educate and more pain in their
brief the patient body that can
about how to indicate the
prevent infection presence of
of surgical infection.
wound - For patient to be
mindful of their
surgical wound
and to avoid
6. Observe doing things that

78
closely for can cause
possible surgical infection and also
complication. promote good
wound healing.
7. Practice and - If patient
emphasize experiences
constant and continuous pain
proper hand or fever, this may
hygiene. signal an
abscess.
8. Assess - Hand hygiene is
appendectomy one of the most
site every 24 important means
hours and during to prevent the
dressing spread of
changes; infection.
document any - Wound healing
abnormal by primary
findings. intention requires
dressing to
protect it from
contamination

79
 until the edges
seal (usually 24
hours). Wound
healing by
9. Administer secondary
prescribed intention requires
antimicrobial a dressing to
therapy within 15 maintain
minutes of adequate
schedule. hydration; the
10. Minimize dressing is not
length of stay in needed after
hospital wound edges
seal.

- Antibiotics
administered at
proper intervals
ensure
maintenance of
therapeutic level.
- To exposure

80
 nosocomial
organisms

Acute Pain. A Nursing Care Plan

ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION/OUTCO

DIAGNOSIS INTERVENTION ME
Subjective Acute Pain Within 8 hours of 1. Assess 1. Useful in After 8 hours of duty,
related to nursing pain, noting monitoring the goal was met.
Cues:
presence of interventions the location, effectiveness of
“Sumasakit po characteristics, medication,
surgical patient will:
severity (0–10 progression of
yung sugat ko”, incision
scale). Investigate healing. > as verbalized by the
as patient evidenced by and report Changes in patient, the pain was
reports of changes in pain as characteristics
verbalized > Report pain

81
Objective pain is appropriate. of pain may relieved
“Sumasakit relieved/controlled indicate
Cues:
po yung sugat . developing
> (+) pain @ ko”, as patient abscess or
verbalized peritonitis, > the patient appeared
incision site
2. Provide requiring prompt relax and was able to
> Pain scale – 6 > Appear relaxed, accurate, honest medical sleep
information to evaluation and
> Patient had a able to sleep/rest appropriately
patient and SO. intervention.
grimaced face appropriately 2. Being
informed about
3. Keep at rest progress of
> had demonstrated
in semi-Fowler’s situation
position. provides use of relaxation skills
emotional
and diversional
support, helping
to decrease activities.
anxiety
3. To lessen
4. Encourage early the pain. Gravity
ambulation. localizes
inflammatory
exudate into the
lower abdomen
or pelvis,
5. Provide relieving
diversional abdominal
activities tension, which is
accentuated by
6. Administer supine position.
analgesics as 4. Promotes
indicated. normalization of
organ function

82
 (stimulates
peristalsis and
7. Place an ice passing of
bag on the flatus, reducing
abdomen abdominal
periodically during discomfort).
the initial 24–48 5. Refocuses
hour, as attention,
appropriate. promotes
relaxation, and
may enhance
coping abilities.
8. Never apply 6. Relief of
heat to the right pain facilitates
lower abdomen. cooperation with
other
9. Watch closely therapeutic
for possible interventions
surgical (ambulation,
complications pulmonary
toilet).
7. Soothes
and relieves
pain through
desensitization
of nerve
endings.
Note: Do not
use heat,
because it may
cause tissue
congestion.
8. This may

83
 cause the
appendix to
rupture.
9. Continuing
pain and fever
may signal an
abscess.

Impaired Skin Integrity. A Nursing Care Plan

ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION/OUT

DIAGNOSIS INTERVENTION COME
Subjective Impaired Skin Within 8 hours 1. Keep the 1. Moisture After 8 hours of
of nursing area clean harbors nursing
Cues: Integrity
interventions: and dry. bacteria and interventions:
“Medyo related to > Patient will be pathogens. > Patient was
relieved from 2. Palpate relieved from pain
masakit at surgical
pain and itch surgical 2. To determine and itch from the
makati po yung incision from incision incision for degree and wound
> Nurse will size, shape, depth of injury > Patient
tahi ko at hindi
explain and consistency, or damage to demonstrated
rin po ako promote texture, the understanding of
understanding temperature integumentary plan to heal and
marunong kung
of plan to heal and system prevent injury.
paano linisan and prevent hydration > Patient understood
injury to the and and apply measures
ang sugat,” the
patient. determine to protect and heal
patient > Nurse will skin layer the skin, including
describe involvement 3. These findings wound care.
verbalized
measures to . will give > Endorsed patient

84
Objective protect and heal 3. Assess information on for the continuity of
the skin, characteristi the extent of
Cues: care.
including wound cs of the the impaired
> patient has a care. wound, skin integrity
including or injury. An
slightly
color, size odor may
grimaced face (length, result from the
width, presence of
> guarding of
depth), infection on
the affected drainage, the site.
and odor.
area
> surgical 4. Assess the 4. Pain is part of
patient’s the normal
incision is itchy
level of inflammatory
according to pain. process. The
extent and
patient
depth of injury
may affect
5. Monitor the pain
status of the sensations.
skin around
the wound. 5. Individualize
Monitor plan is
patient’s necessary
skincare according to
practices, the patient’s
noting the skin condition,
type of soap needs, and
or other preferences.
cleansing
agents
used, the

85
 temperature
of the water,
and
frequency of 6. The patient
skin who scratches
cleansing. the skin to
alleviate
6. Know signs extreme
of itching itching may
and open skin
scratching. lesions and
increase the
risk for
infection.

7. Keep a
sterile 7. A sterile
dressing technique
technique reduces the
during risk of infection
wound care. in impaired
skin integrity.
This involves
the use of a
sterile
procedure
8. Administer field, sterile
antibiotics gloves, sterile
as ordered. supplies and
dressing,
sterile
instruments
(Kent et al.,

86
9. Tell the 2018).
patient to 8. Although
avoid intravenous
rubbing and antibiotics may
scratching. be indicated,
Provide wound
gloves or infections may
clip the nails be managed
if well and more
necessary. efficiently with
topical agents.
10. Educate
patient 9. Rubbing and
about scratching can
proper cause further
nutrition, injury and
hydration, delay healing.
and
methods to 10. The patient
maintain needs proper
skin knowledge of
integrity. their condition
to prevent
11. Teach skin impaired skin
and wound integrity.
assessment
and ways to
monitor for
signs and 11. Early
symptoms assessment
of infection, and
complication intervention
s, and help prevent

87
 healing. the
development
12. Instruct of serious
patient, problems.
significant
others, and 12. Accurate
family in the information
proper care increases the
of the patient’s ability
wound, to manage
including therapy
handwashin independently
g, wound and reduces
cleansing, the risk for
dressing infection.
changes,
and
application
of topical
medications
).

88
 CHAPTER XVI

HEALTH TEACHING/RECOMMENDATIONS

This chapter contains the instructions provided by the health practitioners in the
phase of health restoration and recommendations formulated out of the upshot of the
whole case study. In one hand, health teachings are quite significant in managing
personal health problems (Hall, 2020) and on the other hand, recommendations pave
way for future research concepts (Kaa, 2020).

HEALTH TEACHINGS

• Following your surgeon's directions, keep the wound clean and dry for the first 72
hours. Your surgeon will tell you if you can shower after that.
• Avoid baths, swimming pools, and hot tubs until your incision is completely
healed, or you might get an infection.
• Follow any special instructions your doctor or nurse gives you.
• If there is a drainage tube, be sure to cover this area with the dressing.
• Do not use rubbing alcohol, hydrogen peroxide, or iodine, which can harm the
tissue and slow wound healing.
• Do not scrub or soak the wound.
• Air-dry the incision or pat it dry with a clean, fresh towel before reapplying the
dressing.
• Wash with cool water and soap. Clean as close to the stitches as you can. Do
not wash or rub the stitches directly.
• Call your doctor, midwife, or nurse call line now or seek immediate medical care
if:
o The wound is larger or deeper, or it looks dried out or dark.
o The drainage coming from or around the wound increases or becomes
thick, tan, green, or yellow, or smells bad (which indicates pus).
o Your temperature is 100.5°F (38°C) or higher.

89
RECOMMENDATIONS

With this study, the student nurses were able to gain knowledge and wider view and
perspective of the case.

To the patient, the patient needs to be informed of her condition. She must be well
oriented of the facts about the things that she should be alarmed. We recommend that
the patient take all of the medication that the doctor has prescribed for her. She must
also follow the doctor’s advice.

To the community, that they must be in sufficient coordination with the health care
team regarding promotion of health of their community.

To the family, we encourage that the family continue to love and support the patient in
whatever means in physical, psychological, social and spiritual

development of the patient. It could still help the patient survive when there is a strong
bond of relationship within the family.

To the health care team, they should righteously implement basic and ideal procedure
regardless of the health care facilities where they belong. They must observe and
always remember to keep in line with their duties towards the patient.

90
 CHAPTER XVII

DISCHARGE PLAN

Medication/Treatment:

● Levofloxacin 500mg tab: 1-tab OD x 5 days

● Celecoxib 200mg Cap: 1 cap BID PRN

Exercise:

● Try walking each day

● For 2 weeks avoid lifting anything that would make you strain. Avoid strenuous

activities like bicycling, jogging, aerobics exercise until the doctor says it is okay.

● Bed rest

● Promote good and proper sleep to prevent fatigue and anxiety.

Hygiene:

● Advice daily bath and open dressing

Diet:

● Normal diet such well-cooked soft cereals, mashed potatoes, rice, plain pasta

91
 CHAPTER XVIII

PROGNOSIS

This chapter deals with the notion about the phasing of patient’s recovery as
anticipated by the usual process and idiosyncrasy of the disease state. Accordingly,
prognosis relatively amends patient charted implications (Selim et. al., 2020).

Initial Prognosis
CRITERIA POOR FAIR GOOD JUSTIFICATION
Onset of illness Patient was taken to
the hospital due to pain
on the right lower of her
abdominal and had 1
✓ episode of vomiting
after eating breakfast.

Duration of Patient was already

suffering from
illness
abdominal pain
associated with
Anorexia since 24hours
ago with exacerbation
✓ of pain at 12 hours pta.

92
Precipitating factor Patient showed
signs and symptoms
of acute appendicitis
such as right lower
abdominal pain,
✓
vomiting, anorexia,
positive on Rovsing's
sign and psoas sign
test.

Age Being young is more

susceptible to acute
appendicitis.
Appendicitis is
known to be an
✓ illness that affects
people in their
younger age, with
only 5-9% of
instances occurring
in the elderly
(Hardin, 1999).

Socioeconomic A lower
Status socioeconomic
status has
significantly negative
✓
impact on the
occurrence and
treatment of
appendicitis and
appendectomy. (Lin,
KB., Chan, CL.,
Yang, NP. et al.
2015)
Attitude and The patient health
status is improving
Willingness to take ✓
with the help of
medications/complianc

93
 e to treatment family members, and
regimen the patient's
condition has
improved as a result
of the various
interventions
provided by the
health care team.

Final Prognosis
CRITERIA INDICATION SCORE
Onset of illness FAIR 1
Duration of illness FAIR 1
Precipitating factors FAIR 1
Age FAIR 1
Socioeconomic Status FAIR 1
Attitude and Willingness to GOOD 3
take medications/compliance
to treatment regimen
Indications
1 POOR
2 FAIR
3 GOOD
TOTAL Poor Fair Good GENERAL
0 5 1 PROGNOSIS
COMPUTATION 1-1.6 : POOR
1.7-2.3: FAIR
(0*1)/6 (5*1)/6 (1*1)/6
2.4-3 : GOOD
0 0.83 0.16 1 : POOR

94
Rationale for a Fair Prognosis

If patients are treated in a timely fashion, the prognosis is good. Wound infection

and intra-abdominal abscess are potential complications associated with

appendectomy. With an early operation, the chance of death from appendicitis is very

low. The person can usually leave the hospital in 1 to 3 days, and recovery is normally

quick and complete. The calculations presented above shows that Patient X has a fair

chance of recovery.

The health care team tasked for the patient is keen on making sure that Patient X

recovers from the condition with the help of the family members. The patient’s condition

also showed improvement throughout her stay and positively reacted from the given

interventions in the hospital.

95
 REFERENCES

American College of Radiology (2020). Appendicitis. Radiologyinfo.Org. Retrieved from:

https://www.radiologyinfo.org/en/info/appendicitis
Appendicitis - Symptoms and causes. (2021, August 7). Mayo Clinic.
https://www.mayoclinic.org/diseases-
conditions/appendicitis/symptomscauses/syc-20369543
Basta M., Morton E., Mulvihill JJ., Radovanovic Z., Radojicic C., et al. (1990).
Inheritance of Acute Appendicitis: Familial Aggregation and Evidence of
Polygenic Tranmission. Escholarship.
https://escholarship.org/uc/item/9zf1h82p&ved
Begum, J. (2004). Appendicitis. WebMD. Retrieved from:
https://www.webmd.com/digestive-disorders/digestive-diseases-appendicitis
Brogan, R. (2018). Appendicitis (for Parents) - Nemours KidsHealth. Kidshealth.Org.
Retrieved from: https://kidshealth.org/en/parents/appendicitis.html
Feiten, D. (2009). Appendicitis. Retrieved from:
https://www.pediatricandadolescentmedicine.net/Appendicitis-Condition
Flum, D. (2020). Geographic Association Between Incidence of Acute Appendicitis
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