ACUTE

APPENDICITIS
BSN 4YB-3 Group 11
GROUP MEMBERS
● Añis, Angelica Joy A.
● Cañares, Mary Mae Beatrice M.
● Danganan, Krystine Claire M.
● Del Rosario, Rojeangre P.
● Fernandez, Alexander
● Noor, Hafizah N.
● Tecson, Djan Mouren
TABLE OF CONTENTS
01 03
Patient’s Profile Background of the
Study

02 04
History of Present Anatomy and Physiology
Illness
TABLE OF CONTENTS
05 07
Pathophysiology Medical Management

06 08
Laboratory and Surgical Management
Diagnostic Test
TABLE OF CONTENTS
09 11
Drug Study Discharge Planning

10
Nursing Care Plan (NCP)
PATIENT’S PROFILE
Patient A.C.T.T. Chief Complaint:
Age: 24 years old Abdominal Pain
Sex: Female
Religion: Born Again Christian
Occupation: N/A
Marital Status: Single
Address: Pasig City
Date of Arrival: February 27, 2023
 HISTORY OF PRESENT ILLNESS
On February 27, 2023, patient A.T. came in due to abdominal pain.
A day before admission, patient has onset of right lower quadrant pain
radiating to the epigastric area 5-6/10, with associated vomiting of
previously ingested food. No vaginal bleeding or discharge, no history
of contact, and no changes in bladder habits. With noted constipation
described as scanty stool compared to normal amount.

On day of consult, abdominal pain now noted at hypogastric area

8-9/10. Cramping with associated vomiting of previously ingested
food. No other associated signs and symptoms. Persistence
prompted consult.
03
BACKGROUND OF
THE STUDY
 APPENDICITIS
INFLAMMATION OF
THE APPENDIX
Appendix is a vestigial
organ (NO FUNCTION
IN HUMAN BODY)
CLINICAL PRESENTATION:
● ABDOMINAL PAIN: RLQ ( where the
appendix is located; 2/3rd from the
umbilicus (McBurney’s point)
● Nausea
● Vomiting
● Fever
● Rebound tenderness: applying
pressure on McBurney’s point, and on
removal of pressure, patient will feel
severe pain
In addition, three classical signs are often in patients
with appendicitis including:

● ROVSING’S SIGN : Referred pain to the RLQ upon palpation of the LLQ

● PSOAS SIGN: RLQ pain with right hip flexion or extension

● OBTURATOR SIGN: RLQ pain elicited with right thigh flexion and
internal rotation while in supine position
04
ANATOMY AND
PHYSIOLOGY
VERMIFORM APPENDIX
● This accessory organ is a thin worm-like
extension from the ileocecal junction located in
the intestines.

● The size of the appendix ranges from 10-20 cm,

with an average of 8-10 cm.

● Tissue associated with the lymphatic system can

be found within the mucosa of the appendix and
is thought to be a reservoir for probiotics.

● The appendix’s function as part of the immune

system decreases as an individual grows older.
05
PATHOPHYSIOLOGY
 Unhealthy Diet
(fatty foods, high residue diet)

Appendical lumen Obstruction due to

constipation (fecalith)

Distention of the appendix and spasms

Increase intraluminal and intramural pressure in the appendix

Occlusion of blood vessels, and decrease blood flow to the appendix

Ischemia and necrosis of the appendix

 Presence of Bacterial overgrowth in the obstructed appendix

Severe inflammation of the appendix

Appendix Perforates or ruptures

Abscess formation and peritonitis occurs

GENERAL SIGNS AND SYMPTOMS: SIGNS OF RUPTURED APPENDIX:

Anorexia (42kg) Abdominal pain (RLQ): 8/10
Nausea and Vomiting McBurney’s Sign (pain during palpation)
Dizziness Blumberg’s sign (rebound tenderness)
Scanty stool Guarding behavior
Fever
06
LABORATORY AND
DIAGNOSTIC TEST
 CBC
Known as complete blood test is a blood test that look at overall health and find wide range
range of conditions.

TEST 12PM RESULT INTERPRETATION 2AM RESULT REFERENCE INTERPRETATION

Hemoglobin 11.1 g/dL LOW Low oxygen supply in 12.2 g/dL NORMAL FEMALE: 12-16 Enough oxygen supply
RBC in RBC

Hematocrit 36.3% LOW Low RBC 35.3% NORMAL FEMALE: 37-47 Normal RBC
concentration due to concentration
infection

RBC Count 4.51 NORMAL Normal amount of 4.48 LOW FEMALE: 4.0-5.5 Low amount of RBCs
RBC

WBC Count 11.4 HIGH High amount of 13.6 HIGH 5-10 High amount of WBCs
WBCs

Neutrophil 0.82 NORMAL 87 HIGH 0.50-0.70

Lymphocyte 0.09 NORMAL 9 LOW 0.25-0.40
Monocyte 0.08 NORMAL 3 NORMAL 0.03-0.10
Eosinophil 0.01 NORMAL 1 NORMAL 0.00-0.04
Basophil 0.00 NORMAL 0 NORMAL 0.00-0.01
 CBC
TEST 12PM RESULT INTERPRETATION 2AM RESULT REFERENCE INTERPRETATION

Platelet 270 NORMAL Normal amount of 272 NORMAL 150-450 Normal amount of
count platelet platelet

MCH 24.6 pg LOW 27.1 pg LOW 27.0-33.2

MCV 80.5 fL NORMAL 78.8 fL LOW 80-96

MCHC 30.6% LOW 34.4 NORMAL 33.4-35.5

RDW 11.7% NORMAL - - 11.6-14.6

RDW-CV - - 12.2 NORMAL 11.60-14.60

RDW-SD 38.5 LOW 39.0-46.0
CBC
PROTHROMBIN TIME AND PARTIAL PROTHROMBIN TIME

TEST RESULT REFERENCE CONTROL

Protime 14.8 10-16 seconds 14.3

% Activity 81 %

INR 1.36

APTT 31.1 24-39 seconds 34.0

Gynecological Ultrasound
- It is a test that uses sound
waves that allows to show
and create image of the the
female pelvic organs.

Interpretation:
● Normal-sized retroverted
uterus
● Thick endometrium
● Normal Ovaries
● No adnexal mass seen at the
time of the scan.
 Urinalysis
PHYSICAL EXAMINATION RESULT

Color Yellow

Transparency Slightly hazy

Specific Gravity 1.020

pH 5.0

MICROSCOPIC EXAMINATION RESULT

Pus cells 3-5 /HPF

RBC 0-2 /HPF

Epithelial cells FEW

Mucus threads RARE

Bacteria RARE

Amorphous material RARE

 Urinalysis
CHEMICAL EXAMINATION RESULT

Albumin TRACE

Sugar NEGATIVE

Ketones NEGATIVE

Bilirubin NEGATIVE

Urobilinogen NEGATIVE

Nitrite NEGATIVE

Leukocyte esterase NEGATIVE

Blood NEGATIVE
07
MEDICAL
MANAGEMENT
 Pharmacologic Therapy

For pain - Paracetamol tramadol and ketorolac . indicated for the

symptomatic treatment of moderate to severe pain

Antibiotic - cephalosporin. It works by killing bacteria or

preventing their growth

Dietary Management

whole grains, fruits, and green leafy

vegetables
08
SURGICAL
MANAGEMENT
Appendectomy
An appendectomy is a surgical procedure to remove the appendix.

Exploratory laparotomy
A surgical procedure which involves a large incision in the abdomen to
facilitate a procedure.

Interventions
Preoperatively:
1. Maintain NPO status.
2. Administer IV fluids and electrolytes as prescribed to prevent dehydration and
correct electrolyte imbalances.
3. Monitor for changes in the level of pain.
4. Monitor for signs of a ruptured appendix and peritonitis.
5. Avoid the use of pain medications so as not to mask pain changes associated with
perforation.
 6. Administer antibiotics as prescribed.
7. Monitor bowel sounds
8. Position in a right side-lying or low to semi-Fowler’s position to promote comfort.
9. Apply ice packs to the abdomen for 20 to 30 minutes every hour if prescribed.
10. Avoid the application of heat to the abdomen.
11. Avoid laxatives or enemas.

Postoperatively:
1. Monitor vital signs, particularly temperature.
2. Maintain NPO status until bowel function has returned, advancing the diet gradually as
tolerated and as prescribed when bowel sounds return.
3. Assess the incision for signs of infection such as redness, swelling, drainage, and pain.
4. Monitor drainage from the drain, which may be inserted if perforation occurred.
5. Position the client in a right side lying or low to semi-Fowler’s position with the legs slightly
flexed to facilitate drainage.
6. Change the dressing as prescribed, and record the type and amount of drainage.
7. Perform wound irrigations if prescribed.
8. Administer antibiotics and analgesics as prescribed.
09
DRUG
STUDY
 CIPROFLOXACIN

MECHANISM OF ADVERSE NURSING

DRUG INDICATION CONTRAINDICATION
ACTION EFFECTS CONSIDERATIONS

GENERIC NAME: Pharmacodynamics: Treatment of infection Hypersensitivity to Superinfection such as ● This may be given
Ciprofloxacin This drug enters the caused by a wide ciprofloxacin and other enterococcal and with food to
bacterial cell via spectrum of quinolones. fungal, dizziness, and minimize
BRAND NAME: passive diffusion Gram-negative temporary loss of gastrointestinal
Ciprobay through channels in the bacteria including e. Caution against renal vision. upset.
cell membrane and Coli and urinary tract impairment. ● Give at least 2
CLASSIFICATION: interfere with the DNA infections. hours before or 6
Fluoroquinolone enzymes that are hours after
(antibiotic) necessary for bacterial antacids, calcium,
growth and iron, and
DOSAGE & reproduction. zinc-containing
FREQUENCY: 500 products.
mg tablet BID for 7 ● Establish baseline
days Pharmacokinetics: assessment for
This drug is absorbed history of
ROUTE: from the hypersensitivity to
Oral gastrointestinal tract, the drug and
metabolized in the liver, quinolones.
and excreted through ● Assess for renal
the urine and feces. impairment.
● Advise patient not
to drive or operate
heavy machinery.
 METRONIDAZOLE

MECHANISM OF ADVERSE NURSING

DRUG INDICATION CONTRAINDICATION
ACTION EFFECTS CONSIDERATIONS

GENERIC NAME: Pharmacodynamics: This drug is used for Hypersensitivity to Headache, dizziness, ● Monitor hepatic
Metronidazole This drug inhibits DNA preoperative and metronidazole and other anorexia, nausea, function before and
synthesis by causing a post-operative antiprotozoals. vomiting, dry mouth, periodically during
BRAND NAME: loss of helical DNA prophylaxis against metallic taste, treatment.
Dazomet structure through infections for patients Caution against severe diarrhea, and ● Provide small,
diffusion of specific with perforated liver dysfunction and darkening of the urine. frequent, nutritious
CLASSIFICATION: anaerobes which appendicitis and end-stage renal disease. meals if the patient
Antibacterial causes cell death. undergoing colorectal experiences
surgery. gastrointestinal
DOSAGE & upset.
FREQUENCY: 500 Pharmacokinetics: ● Advise the patient
mg tablet every 8 This drug is to take the drug
hours for 5 days well-absorbed from the with food.
gastrointestinal tract,
ROUTE: metabolized in the liver,
Oral and excreted mostly
through the urine and
feces.
 KETESSE

MECHANISM OF ADVERSE NURSING

DRUG INDICATION CONTRAINDICATION
ACTION EFFECTS CONSIDERATIONS

GENERIC NAME: Pharmacodynamics: Treatment of pain with This drug is Peptic ulcers, ● This may be given
Dexketoprofen This drug inhibits the mild to moderate contraindicated to perforation or with food to
cyclooxygenase intensity. patients with history of gastrointestinal minimize
BRAND NAME: pathway which also allergy to any NSAID, bleeding. Other gastrointestinal
Ketesse reduces prostaglandin cerebrovascular accident, adverse effects upset.
synthesis and produces myocardial infarction, encountered are ● Provide small,
CLASSIFICATION: anti-inflammatory and coronary artery bypass commonly frequent meals
Non-steroidal analgesic effects. graft, uncontrolled gastrointestinal in ● Ensure that patient
Anti-inflammatory hypertension, and nature such as is well hydrated
Drugs congestive heart failure. nausea, dyspepsia, during therapy.
Pharmacokinetics: constipation, or
DOSAGE & This drug is absorbed Caution against renal and diarrhea.
FREQUENCY: 25 from the liver impairment.
mg tablet every 8 gastrointestinal tract,
hours as needed for metabolized in the liver,
pain and excreted through
the urine.
ROUTE:
Oral
 HYOSCINE N-BUTYLBROMIDE

MECHANISM OF ADVERSE NURSING

DRUG INDICATION CONTRAINDICATION
ACTION EFFECTS CONSIDERATIONS

GENERIC NAME: Pharmacodynamics: This drug is indicated Hypersensitivity to Tachyarrhythmias, ● Advise the patient
Hyoscine This drug blocks the for gastrointestinal hyoscine N-butylbromide, hypotension, to avoid consuming
N-Butylbromide action of acetylcholine and genitourinary myasthenia gravis, increased intra-ocular alcohol.
in the smooth muscles spasm. narrow-angle glaucoma, pressure, drowsiness, ● Avoid driving and
BRAND NAME: of the gastrointestinal, tachycardia, and confusional states, and operating
Buscopan biliary, and urinary megacolon. epileptic seizures. machinery after
tracts which exhibits administration.
CLASSIFICATION: spasmolytic actions on Caution against renal and ● Raise side rails as
Antimuscarinic smooth muscles. liver impairment. a precaution.

DOSAGE & Pharmacokinetics:

FREQUENCY: 10 This drug is readily
mg tablet every 8 absorbed from the
hours for pain gastrointestinal tract,
metabolized in the liver,
ROUTE: and excreted mainly
Oral through the urine.
 MECHANISM OF ADVERSE NURSING
DRUG INDICATION CONTRAINDICATION
ACTION EFFECTS CONSIDERATIONS

Generic Name: Pharmacodynamics: Symptomatic Hypersensitivity to Young adults Assess for

Metoclopramide Blocks dopamine/ treatment of metoclopramide. (18–30 yrs) dehydration (poor
serotonin receptors in diabetic receiving large skin turgor, dry
Brand Name: chemoreceptor trigger gastroparesis, Concurrent use of doses (2 mg/kg) mucous
Reglan zone of the CNS. prevent/treat medications during membranes,
Enhances acetylcholine nausea/vomiting likely to produce chemotherapy and longitudinal furrows
Classification: response in upper GI with extrapyramidal reactions. usually are limited to in tongue).
Antiemetic tract, causing increased chemotherapy or akathisia
motility and accelerated after surgery. Situations in which GI (involuntary limb Assess for nausea,
Dosage and gastric emptying without motility may be movement, facial vomiting, abdominal
frequency: stimulating gastric, dangerous (e.g., GI grimacing, motor distention, bowel
10 mg biliary, or pancreatic hemorrhage, GI restlessness) sounds.
secretions; increases perforation/obstruction),
Route: lower esophageal history of seizure Avoid tasks that
IV sphincter tone. disorder, require alertness,
pheochromocytoma motor skills until
Pharmacokinetics: response to drug is
Well absorbed from GI established.
tract. Metabolized in
liver. Protein binding: Report involuntary
30%. Primarily excreted eye, facial, limb
in urine movement

Avoid alcohol
 MECHANISM OF ADVERSE NURSING
DRUG INDICATION CONTRAINDICATION
ACTION EFFECTS CONSIDERATIONS

Generic Name: Pharmacodynamics:
Omeprazole Inhibits
hydrogen-potassium
Brand Name: adenosine triphosphatase
Prisolec (H+/K+ ATP pump), an
enzyme on the surface of
Classification: gastric parietal cells.
Proton-pump Increases gastric pH,
inhibitors reduces gastric acid
production.
Dosage and
frequency: Pharmacokinetics:
40 mg Rapidly absorbed from GI
tract. Protein binding:
Route: 95%. Primarily distributed
IV into gastric parietal cells.
Metabolized in liver.
Primarily excreted in
urine.
Short term treatment Hypersensitivity to Pancreatitis, Evaluate for
of symptomatic omeprazole, other hepatotoxicity, therapeutic
gastroesophageal proton pump inhibitors. interstitial response (relief of
reflux disease Concomitant use with nephritis occur GI symptoms).
(GERD) poorly products containing rarely. May
responsive to other rilpivirine increase risk of Report headache,
treatment. H. C. difficile onset of black, tarry
pylori–associated infection. stools, diarrhea,
duodenal ulcer (with abdominal pain
amoxicillin and
clarithromycin). Avoid Alcohol
Long-term treatment
of pathologic Take before eating
hypersecretory
conditions, treatment
of active duodenal
ulcer or active
benign gastric ulcer
 MECHANISM OF ADVERSE NURSING
DRUG INDICATION CONTRAINDICATION
ACTION EFFECTS CONSIDERATIONS

Generic Pharmacodynamics Immediate-Rele Hypersensitivity to Seizures reported in Assess drug history

Name: Binds to mu-opioid ase: traMADol, opioids. patients’ receiving
Tramadol receptors in CNS, Management of post-op management in tramadol within Review past medical
inhibiting ascending pain moderate to patients under 18 yrs recommended history, esp.
Brand Name: pathway. Inhibits reuptake moderately following tonsillectomy dosage range. May epilepsy, seizures.
Conzip of norepinephrine, severe pain. and/or adenoidectomy; have prolonged
serotonin, inhibiting severe respiratory duration of action, Patients with history
Classification descending pain pathways Extended-Rele depression; acute cumulative effect in of drug abuse are at
Opioid thus reduce pain. ase: bronchial asthma in patients’ with increased risk for
analgesic Around-the-cloc absence of appropriate hepatic/renal misuse or abuse.
Pharmacokinetics: k management monitoring; GI obstruction impairment,
Dosage and Rapidly, almost completely of moderate to (paralytic ileus [known or serotonin syndrome Avoid alcohol, other
Frequency: absorbed after PO moderately suspected]). Concomitant (agitation, narcotics, sedatives.
50 mg administration. Protein severe pain for use with or within 14 days hallucinations,
binding: 20%. Metabolized extended following MAOI therapy tachycardia, Report severe
Route: in liver (reduced in pts period. hyperreflexia). constipation,
IV with advanced cirrhosis). difficulty breathing,
Primarily excreted in excessive sedation,
urine. seizures, muscle
weakness, tremors,
chest pain,
palpitations
 MECHANISM OF CONTRAINDICATIO ADVERSE NURSING
DRUG INDICATION
ACTION N EFFECTS CONSIDERATIONS

Generic Name: Pharmacodynamics Temporary relief of Hypersensitivity to Early Signs of Severe/recurrent

Paracetamol Analgesic: Activates mild to moderate pain, acetaminophen, Toxicity: pain or high/
descending serotonergic headache, fever. severe hepatic Anorexia, continuous fever
Brand Name: inhibitory pathways in impairment or severe nausea, may indicate serious
Biogesic CNS. Antipyretic: Inhibits active liver disease diaphoresis, illness.
hypothalamic heat fatigue within
Classification: regulating center. Results first 12–24 hrs.
Analgesic and in antipyresis. Produces
Antipyretic analgesic effect. Later Signs of
Toxicity:
Dosage and Pharmacokinetics Vomiting, right
Frequency: Rapidly, completely upper quadrant
60 mg / ml absorbed from GI tract; tenderness,
rectal absorption variable. elevated LFTs
Protein binding: within 48–72 hrs
20%–50%. Widely after ingestion.
distributed to most body
tissues. Metabolized in
liver. Excreted in urine.
 MECHANISM OF ADVERSE NURSING
DRUG INDICATION CONTRAINDICATION
ACTION EFFECTS CONSIDERATIONS

Generic Pharmacodynamics: Used for the Hypersensitivity to GI tract: Provide small

Name: treatment of cephalosporins or Nausea and frequent meals to
Cefoxitin Cefoxitin is a cephamycin serious bacterial penicillins. Use with vomiting, diarrhea, alleviate discomfort
antibiotic often grouped infections, such caution with hepatic and anorexia, abdominal
Brand Name: with the as urinary tract renal impairment. pain, and flatulence Provide fluids
Mefoxin second-generation infection, blood Caution in pregnant or
cephalosporins. It is active infection, bone lactating patients Dizziness, lethargy, Monitor for signs of
Classification against a broad range of and joint and paresthesia superinfection to
: gram-negative bacteria infection, and arrange for
Cephalosporin including anaerobes. The lower respiratory treatment if
Antibiotics bactericidal action of tract infection. superinfection
cefoxitin results from occurs
Dosage and inhibition of cell wall
Frequency: synthesis. Take safety
1 g precautions: Avoid
driving and
Route: Pharmacokinetics: hazardous tasks.
Parenteral It is well absorbed in the
GI tract.
 MECHANISM OF NURSING
DRUG INDICATION CONTRAINDICATION ADVERSE EFFECTS
ACTION CONSIDERATIONS

Generic Name: Produces analgesic, Used for pain Hypersensitivity to Peptic ulcer, gastritis, Monitor renal
Ketorolac anti-inflammatory management. ketorolac, aspirin and severe reaction function, \lft, urinary
effects, reduces other NSAIDS. (cholestasis, jaundice) output.
Brand Name: intraocular Prophylaxis before major occur rarely.
Toradol inflammation. surgery. Monitor daily pattern
Acute hypersensitivity of bowel activity,
Classification: Pharmacokinetics: reaction (fever, chills, stool consistency.
NSAID Metabolized in liver. joint pain) occurs
Primarily excreted in rarely. Monitor for bleeding.
Dosage and urine. Not removed
frequency: by hemodialysis. Avoid aspirin,
30mg/mL alcohol.

Route: Report abdominal

Parenteral - IV pain, bloody stools,
or vomiting stools.

If GI upset occurs,
take with food, milk.
 MECHANISM OF ADVERSE NURSING
DRUG INDICATION CONTRAINDICATION
ACTION EFFECTS CONSIDERATIONS

Generic Name: A progesterone Used to treat irregular Known or suspected Breakthrough Patient should be
Dydrogesterone that works by duration of cycles and progesterone dependent bleeding and monitored for visual
regulating the irregular occurrence neoplasms, undiagnosed spotting; venous disturbances,
Brand Name: healthy growth and duration of abnormal vaginal thromboembolism; migraine headache
Duphaston and normal periods caused by bleeding; any CNS effects or embolic disorders.
shedding of the progesterone contraindications (dizziness,
Classification: womb lining by deficiency. associated with estrogen. drowsiness). Advice to not drive
Steroid acting on or operate
hormones progesterone Existing or history of Rarely, increased machinery.
receptors in the serious liver disorders. risk of ovarian
Dosage and uterus. cancer. May be taken with or
frequency Lactation without food.
given:
10 mg tablet BID
for 5 days

Route:
Oral
 MECHANISM OF ADVERSE NURSING
DRUG INDICATION CONTRAINDICATION
ACTION EFFECTS CONSIDERATIONS

Generic Name: Inhibits gastric acid Duodenal ulcer, Hypersensitivity to Reversible hepatitis, Obtain history of
Ranitidine secretion. gastric ulcer ranitidine. bloody dyscrasias epigastric/abdominal
Reduces gastric (benign), occur rarely. pain.
Brand Name: volume, hydrogen hypersecretory OTC: do not use if trouble
Zantac ion concentration. conditions, GERD, or pain when swallowing Smoking decreases
erosive esophagitis food, vomiting with blood, effectiveness of
Classification: Pharmacokinetics: or blood or black stool is medication.
Histamine Rapidly absorbed present.
from GI tract. Transient
Dosage and Metabolized in liver. burning/pruritus may
frequency: Primarily excreted in occur with \iv
50mg urine. Not removed administration.
by hemodialysis.
Route: Report headache.
Parenteral - IV
Avoid alcohol,
aspirin.
 MECHANISM OF ADVERSE NURSING
DRUG INDICATION CONTRAINDICATION
ACTION EFFECTS CONSIDERATIONS

Generic Name: Pharmacokinetics: It is used for Hypersensitivity to Anaphylactic Drug may cause
Parecoxib Absorption time to post-operative parecoxib, aspirin, other reactions, somnolence,
peak plasma pain or patient NSAIDs, or sulfonamides. angioedema, dizziness, or vertigo;
Brand Name: concentration: with increased risk of if affected, do not
Dynastat approx. 30 min (IV). It predisposition to History of serious allergic thrombotic events, drive or operate
enters the breast fluid retention. drug reaction. particularly with machinery.
Classification: milk. Excreted mainly prolonged use.
via urine. Pregnancy (3rd trimester) Monitor blood
Non-steroidal and lactation. Peripheral edema pressure at the start
anti-inflammatory of therapy and
and antirheumatic Back pain periodically during
products use; CBC, LFTs,
renal function.
Dosage and
frequency: Assess for weight
40mg gain, edema,
bleeding, bruising,
Route: serious skin or
Parenteral - IV hypersensitivity
reactions, and signs
of gastrointestinal
effects.

Avoid alcohol
 MECHANISM OF ADVERSE NURSING
DRUG INDICATION CONTRAINDICATION
ACTION EFFECTS CONSIDERATIONS

Generic Name: Blocks serotonin, Prevention of Hypersensitivity to Hypertensions, Assess degree of

Ondansetron both peripherally on post-op ondansentron, other Ht3 acute renal failure, nausea, vomiting.
vagal nerve nausea/vomiting antagonists. GI bleeding,
Brand Name: terminals and respiratory Provide emotional
Zofran centrally in Concomitant use of depression, coma, support.
chemoreceptor apomorphine. extrapyramidal
Classification: trigger zone. effects occur rarely. Refrain from
Selective 5-HT3 Caution: mild to moderate nausea/vomiting
receptor Pharmacokinetics: risk for QT prolongation or QT interval generally occurs
antagonist Readily absorbed ventricular arrhythmia. prolongation, shortly after drug
from GI tract. torsade de pointes administration.
Dosage and Metabolized in liver. may occur.
frequency: Primarily excreted in Avoid alcohol,
4mg urine. Unknown if barbiturates.
removed by
Route: hemodialysis. Report persistent
Parenteral - IV vomiting.

Avoid tasks that

require alertness,
motor skills until
response to drug is
established (may
cause drowsiness,
dizziness).
10
NURSING CARE
PLANS (NCP)
 NCP #1

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Acute pain related to Short term goal: Independent: Short term:
“Complain of inflammation in the
abdominal pain appendix, as After 30 minutes of 1. Keep at rest in Bed rest in After 30 minutes of
radiating to the nursing semi-Fowler’s position semi-Fowler’s nursing
evidenced by the (+)
epigastric area” as intervention, the position will lessen intervention, the
verbalized by the Blumberg sign, a pain patient will be able the pain goal was met as
patient scale of 9/10, and a to: evidenced by:
facial grimace. 2. Assist and instruct Helpful in
Before admission: Report relief from patient to do relaxation decreasing Relived by pain as
pain, appearing at techniques such as deep perception and reported, and
Pain scale of 6/10 ease and capable breathing (mind over response to pain. appeared relax and
of getting the matter) Provides a sense of capable of getting
Right lower quadrant proper amount of having some proper amount of
pain radiating to the rest or sleep, and control over the rest
epigastric area demonstrating the situation
use of relaxation
Upon consultation: techniques 3. Place ice bag on Soothes and
abdomen relieves pain
Pain scale of 9/10 through
desensitization of
Abdominal cramping nerve endings
at hypogastric area
 NCP #1

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

OBJECTIVE: Long term goal: Dependent: Long term:

(+) Blumberg sign After 24-48 hrs of 4. Administer medication After continuous
continuous nursing as doctor’s order such nursing
Facial grimace w/ intervention, the as: intervention, the
abdominal guarding patient will be able goal was met as
to: A. Morphine It can relieve evidenced by:
Restlessness B. Paracetamol moderate to severe
Maintain desire tramadol or pain Maintain desired
Vital signs: comfort with a total Ketorolac comfort with no
BP: 100/60 mmHg absence of pain pain, and exhibited
PR: 72 bpm throughout the Collaboration: a healthy lifestyle
RR: 17 cpm course of the
Temp: 36.7C action. Exhibit new 5. Assist the surgeon in It is surgery to
02 sat: 98% behaviors that the procedure like remove the
reflect lifestyle laparoscopic appendix when it is
changes, such as a appendectomy infected to lighten
healthy diet and the pain of the
regular exercise. patient
11
DISCHARGE
PLANNING
Medication
- Medication should be taken at the right
time, dosage, route of administration as
prescribed by the physician.
Ciprofloxacin Ketesse
- 500 mg/tab - 25 mg/tablet
- 1 tab 2x a day for 7 - 1 tab every 8 hrs as
days needed for pain

Metronidazole Duphaston
- 500 mg/tab - 10 mg/tablet
- 1 tab every 8 hrs - 1 tab 2x a day for 5
for 5 days days if NO MENSES by
March 6,2023
Environmental
- Instruct the patient to avoid straining
activities that may cause dehiscence of the
wound

Treatment
- Continue to monitor the incision site for any
signs of infection such as redness, swelling,
drainage, or increased pain
Health Teachings
- Frequent hand washing to avoid infection
especially on the wound site
- Educate the patient to change the dressing.
Keep it clean and dry to avoid spread of
microorganisms.
- Drink plenty of water to help prevent
constipation
- Have adequate rest. Having enough rest may
lead to fast recovery.
- Avoid lifting heavy objects to avoid strain of
abdominal muscle
Outpatient Follow-up
-Follow-up after 2 weeks as instructed by the
physician

Diet
- May have low residue diet
Spiritual
Encourage the patient and family to always
support each other not just physically but
also Spiritually.

"Therefore encourage one another and

build each other up, just as in fact you are
doing." "May the God who gives endurance
and encouragement give you the same
attitude of mind toward each other that
Christ Jesus had”

1 Thessalonians 5:11
 THANK
YOU!

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