CASE SCENARIO (Appendicitis)

A 28-year-old man named Oliver Francisco, single, Roman Catholic currently resided at
Paranaque City. Admitted on February 15, 2022 under the service of Doctor Kevin
Gloria, with a chief complaint of right lower quadrant pain (+) Mc Burney’s point. Still
with episodes of high body temperature (fever) same thing with blood pressure, heart
rate. No reported nausea and vomiting. Observed with guarding pain at the affected
side. Initial Diagnosis: Appendicitis

End of shift endorsement you are the incoming nurse, receive the following
endorsement

 Monitor vital signs every 4 hours

 Monitor output every shift, maintained on NPO as diet
 For emergency Appendectomy supposedly at 6am but, with instruction to
administer all pre- anesthetic medication (Per call of anesthesiologist and
surgeon due to on going Low Transverse Cesarean Section at Operating
Room at the moment, and exigency of hospital personnel)
 Emergency clearance granted by Anesthesiologist and Internal Medicine:
“Low Risk for Contemplated Emergency Procedure/ Appendectomy”
 Ongoing D5LR 1L to run for 8 hours, please use large bore needle gauge
18 regulated and infusing well, endorsed as full. To follow care off
Anesthesiologist once endorsed at Operating Room
 All laboratory in: CBC, Serum Na, K, Cl, Urinalysis, RAT (-) in and relayed
 Chest x-ray, to secure official result
 RTPCR- COVID 19 test still for with request sent at laboratory department
 Therapeutics:
a. Cefuroxime 1,500mg TIV 1 hour prior to operation
b. Omeprazole 40mg TIV 1 hour prior to operation
c. Metoclopramide 10mg/ ampule TIV 1 hour prior to operation
d. Paracetamol 300 mg/ ampule TIV every 4 hours for fever (Temp 37.8
degree Celsius)
 Kindly secure all consent for procedure, anesthesiology consent and pre-
operative checklist
 Surgeon and Anesthesiologist will update regarding for admission of this
patient at Operating room/ Trans- In. 9am estimated time to transfer the
patient at OR

Prepared by: John Kevin A. Eli, RN

UCP 2021-2022
Disclaimer: The name, age and all laboratory results are for educational purposes only.
History
Second child among the 3 children of the family. Worked at their own known pizza
parlor. No known history of allergies to seafoods and medications. Have familial history
of hypertension at the father side. Lung, Diabetes mellitus not declared as family history
of the patient and watcher. Known well balanced diet intake this patient, loves to eat
seed containing fruits and vegetables. Prior on the hospitalization, patient felt anorexic
like and felt nauseated but no vomitus. Patient felt abdominal pain, rigid like. Then he
felt warm to touch, fever of 38 degree Celsius. Paracetamol 500 mg per tablet per orem
every 4 hours and TSB rendered by his wife declared as management. Still with
episodes of pain, radiated at right lower quadrant pain. The reason to seek consultation
at Emergency Department last February 15, 2022 at 1am in the morning bringing this
information to the nurses on duty. Vital Signs take and recorded as follows: BP-
130/90mmHg, Heart rate- 102bpm, Respiration- 20cpm, Temperature 38 degree
Celsius, Oxygen saturation of 98 percent in room temperature. Still with guarding pain
especially on the right lower abdominal area.
Upon assessment of the nurse, (+) pain on the right abdominal area, when the left side
abdominal area was deeply palpated, (+) left lateral position with right hip flexion (+)
localized pain at right abdominal area. Nurse referred to Surgery on duty and it was to
consider Acute Appendicitis. The surgeon gave the patient and relative regarding on
this disease. Laboratories done and relayed to the above surgeon. He is planning for
Emergency Appendectomy. The surgeon ordered to refer at Internal Medicine and
Anesthesiology on duty, both of them gave this patient clearance “Low Risk for
Intermediate Emergency Procedure” with medications as ordered. The surgeon again
explained to patient and relative regarding the disease pattern and plan of procedure.
Well explained and the patient itself signed waiver of consent for procedure to do this
emergency procedure. Due to emergency cases at Operating room, this patient was
admitted to ward first while waiting the call to do this operation.

Prepared by: John Kevin A. Eli, RN

UCP 2021-2022
Disclaimer: The name, age and all laboratory results are for educational purposes only.
Laboratories

Prepared by: John Kevin A. Eli, RN

UCP 2021-2022
Disclaimer: The name, age and all laboratory results are for educational purposes only.
Prepared by: John Kevin A. Eli, RN
UCP 2021-2022
Disclaimer: The name, age and all laboratory results are for educational purposes only.
Prepared by: John Kevin A. Eli, RN
UCP 2021-2022
Disclaimer: The name, age and all laboratory results are for educational purposes only.
 Vital Signs Monitoring
Date/ Time Blood Heart Respiratory Temperature Oxygen
Pressure Rate Rate Saturation
February 130/80mmHg 109 bpm 20 cpm 38 degrees 95%
15, 2022 Celsius
4am
February 130/70 105bpm 21 cpm 37.9 degree 96%
15, 2022 mmHg Celsius
8am

LEARNING ACTIVITIES:
I. Nursing Process Application
1. Do the TPR sheet plotting (Apply corresponding guidelines, directions
regarding on this matter)
2. Do a clinical scientific drug study on the given medications administered to
the patient
3. Do a scientific laboratory study
4. Do a scientific 1 actual Nursing Care plan (it’s up to you whether your
focus plan was on Emergency Department Assessment, or Ward
Admission, or pre- operative plan to the patient)
II. Ethic- Moral Consideration
1. What is Consent for Procedures? How it is important to the Medical
Profession for every procedure that we will cater to our patients? (You
can adopt article or supported data from internet sources. Just to make
sure you included your reference URL)
III. Surgical Management
1. Research an article about the Appendectomy. The background of this
procedure, anesthesia agents possible use. And discuss nurse’s role
before, during and postoperative management. (You can adopt article or
supported data from internet sources. Just to make sure you included
your reference URL)

Prepared by: John Kevin A. Eli, RN

UCP 2021-2022
Disclaimer: The name, age and all laboratory results are for educational purposes only.