PATIENT/FAMILY CARE STUDY

(A NURSING PROCESS APPROACH)

ON

ACUTE APPENDICITIS

BY

LARYEA JEFFERY NII

(092000…)

A FINAL YEAR STUDENT OF THE

NURSING AND MIDWIFERY TRAINING COLLEGE

37 MILITARY HOSPITAL,

ACCRA

…., 2023.
 PREFACE

The patient/family care study is a written report on the total nursing care rendered to a patient

and family within a specified period of time. The study is undertaken by a final-year student

nurse or midwife to appropriately apply the knowledge from various fields of study such as

surgery, psychiatry, medicine, public health, sociology, and practical experiences to render

quality care to the patient. In this study, the student nurse is made to select a patient of choice

and make a critical analysis and assessment of the patient's or family's health problems in order

to render optimum care and support. The patient/family care study is written and presented in

partial fulfillment for the award of a Diploma in Registered General Nursing or Midwifery by the

Nursing and Midwifery Council of Ghana at the end of the three-year program. It helps the

student nurse to have much insight and a broader idea of the patients’ condition so as to prepare

him or her to be able to manage and handle similar conditions in the work field. It also enhances

the development of good interpersonal relationships between the student nurse, the patient or

family, and the community, not forgetting the entire health team, which is a vital and

fundamental tool for good health care. Again, it prepares the student nurse to take initiative in

emergency situations that may come his or her way by using the nursing process approach as a

guide. In order to maintain confidentiality, my patient will be referred to as "Mr. E.A."

throughout the script.

i
ACKNOWLEDGEMENT

To God be the utmost glory for the great things He has done for me throughout my life, for the

strength, wisdom, knowledge, and life he has given me, and for helping me toward a successful

completion of this study. This work would never have been successful without the assistance and

support of some devoted individuals throughout this care study. My first and greatest

appreciation goes to Mr. EA and his family for agreeing to partake in this study and for their

cooperation and tolerance throughout the study. for their availability throughout our interaction,

for willingly giving me all the information I required of them in order to make my study a

success, and for trusting and opening up to me. I also express my profound gratitude to my

supervisor, Mr...., for his time and patience in going through the script, helping me with the

necessary corrections and alterations, and giving me all the assistance and guidance, I needed to

make a successful work. And to the entire tutorial staff of the Nursing and Midwifery Training

College 37 for their hard work and giving us their best to enlighten us with all the knowledge we

need to practice as qualified registered nurses and midwives. And to our principal... for his active

role in making our school one of the best

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 INTRODUCTION

Nursing care is instrumental and very useful in all phases of acute care and also in the

maintenance of general wellbeing, such as prevention of illness, rehabilitation, and a

maximization of health, or where it is impossible to attain complete wellbeing, the alleviation of

pain and discomfort, and a peaceful death. To attain this, the nursing profession has identified a

problem-solving process that "combines the most desirable elements of the art of nursing with

the most relevant elements of systems theory, using the scientific method" (Shore, 1988). The

patient/family care study is a report of the nursing care rendered to a patient and his or her family

and involves the interaction between the patient and the health team. The interaction occurs

within a specified period of time and lasts as long as the patient's care lasts. The trend in nursing

has undergone systematic development over the years. Currently, the holistic approach is being

emphasized. This stresses that the patient is a biopsychosocial entity and requires that the

physical, emotional, social, and spiritual needs of the individual within the context of his

environment be considered if he or she is to be held and cared for to regain optimal health. This

report is made on the care rendered to Mr. E.A., a 57-year-old young man who is dark in

complexion, 1.78 meters tall, and weighs 70 kg on admission. He was admitted on December 14,

2022, at exactly 1845 hrs. to the medical and surgical ward (tamaklo) of the 37 military hospital

through the trauma and surgical unit by a medical doctor with a history of bilateral flank pain,

vomiting, and general malaise, hence the provisional diagnosis of abdominal pain. but upon

examination and with the provided laboratory results, I was diagnosed as suffering from acute

appendicitis. I first encountered Mr. E.A. upon his arrival in the medical and surgical ward, when

iii
he was wheeled into the ward by a nurse and in the company of some relatives. On his arrival, he

appeared conscious, and his countenance revealed the presence of acute pain. Mr. E.A. and his

relatives were offered a chair while his details were taken, with continuous reassurance being

given to them. Since the ward had already been notified of his arrival, a room was already set up

with an admission bed ready to receive him. In his room, I approached him and his family and

introduced myself as a final-year student nurse from the nursing and midwifery training college-

37 military hospital. I went on to explain to them that, as part of my academic work, it is required

of me to provide a detailed written report on the care I give to a patient chosen by myself until

the patient becomes fully well. After my explanation, my request was gladly accepted, and my

care study report began right that moment. Upon explaining to them that I may be taking in a lot

of information with which some may be quite sensitive, they gave me their full assurance of

active participation and cooperation. Even though there were other clients on the ward that we

cared for, I always ensured that I was available as and when he needed my service. Due to the

active efforts of his family and for one or two reasons of which I could tell one to be the stage of

my client (the adolescent stage), my client somehow wasn’t very overbearing as he did most of

the minor things for himself and his relatives too actively did a lot of the care. My interaction

with Mr. E.A. on the ward lasted for 6 days (15th–21st of December, 2022) since I usually called

him to check up on him and see how he was doing. I started preparing my client for discharge on

the very first day of admission (December 14, 2019), with continuous assurance of the optimum

care and support he will receive. I explained to him that there will be continuity of care as I will

visit him myself to check up on him, and if he has any complaints, he can report them to the

hospital even before the review date. On December 21, 2019, Mr. E.A. was discharged by Dr. at

exactly 01:14 p.m. after being reviewed and being seen to have improved health both physically

iv
and physiologically. He was asked to return two weeks later, on January 10, 2022, at the 37

military hospital outpatient department for review. Mr. E.A. and his family couldn't contain their

joy at the competency and hard work observed in the health team and their capability in

delivering the good health care that moved Mr. E.A. to optimum health within the short period of

admission. They were very appreciative of the health team and didn't fail to let it be known.

Three home visits were made to the client's house before I finally handed him over to the

community nurse for continuity of care. one while he was on admission, and the rest after his

discharge. This study has really enlightened me on the process of healthcare delivery, the use of

therapeutic communication in patient interaction, and the use of the nursing process in patient

care. I chose Mr. E.A. and the condition acute appendicitis for my study due to the main reason

that appendicitis as a condition is unknown to a lot of people with it due to its similarities with

inflammatory bowel disease, gastroenteritis, and acute abdomen, and it is most often confused

since there is little or no knowledge at all on the condition, as evidenced in the case of my client,

Mr. E.A., and also to enlighten people on it so that people suffering from similar symptoms can

also look in that direction and not only focus on other conditions and therefore seek immediate

medical attention. Throughout the care, the nursing process, which is a scientific process of

identifying patient problems and systematically tackling them, was applied. The five major

phases accepted for use are: 1) assessment, 2) analysis, 3) planning, 4) implementation, and

lastly, 5) evaluation. Chapter 1 involves the assessment of my patient and his family for the

collection of data, which is the patient’s particulars, family’s history, socio-economic history,

patient’s developmental history, patient’s lifestyle and hobbies, patient’s past medical history,

patient’s present medical history, admission of the patient, patient’s concept of illness, literature

review on the disease condition, and validation of data. Chapter 2 consists of the analysis of the

v
data. This includes comparison of data with standards, laboratory and diagnostic investigations,

causes of patient condition, comparison of clinical features outlined in the literature review with

those exhibited by the patient, specific treatments for the patient, pharmacology of the drug

administered, complications developed by the patient, patient and family strength, health

problems identified, and a nursing diagnosis formulated. Chapter 3 is where the care plan for the

patient is prepared to solve the patient's identified health problems. It entails the use of a care

plan, which includes nursing diagnosis, objective and outcome criteria, nursing orders, nursing

intervention, and evaluation. Chapter 4 involves the implementation of patient and family care,

which is reported on a daily basis. This basically deals with implementing the patient and family

nursing care plan, a summary of the actual nursing care rendered to the patient and family,

preparation of the patient and family for discharge and rehabilitation, and follow-up, home visits,

and continuity of care. Chapter 5 deals with the evaluation of the care rendered to the patient and

family. This includes an evaluation of care rendered to the patient and family, a statement of

evaluation, amendment of the nursing care plan for partially met or unmet outcome criteria,

termination of care, a summary and conclusion, a bibliography, articles, and signatories.

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 Table of Contents
PREFACE.........................................................................................................................................i

ACKNOWLEDGEMENT...............................................................................................................ii

INTRODUCTION......................................................................................................................iv

1.0. ASSESSMENT........................................................................................................................1

1.1. Assessment of Patient..........................................................................................................1

1.2. PATIENT PARTICULARS.................................................................................................2

1.3. FAMILY’S MEDICAL HISTORY.....................................................................................2

1.4. FAMILY’S SOCIO-ECONOMIC HISTORY.....................................................................3

1.5. PATIENT’S DEVELOPMENTAL HISTORY...................................................................3

1.6. PATIENT LIFESTYLE /HOBBIE......................................................................................5

1.7. PATIENT’S PAST MEDICAL HISTORY.........................................................................6

1.8. PATIENT PRESENT MEDICAL HISTORY.....................................................................6

1.9. ADMISSION OF PATIENT................................................................................................7

1.10. PATIENT CONCEPT OF ILLNES...................................................................................9

1.11. LITERATURE REVIEW................................................................................................10

DESCRIPTION OF APPENDIX...............................................................................................10

Types of Appendicitis............................................................................................................10

Acute Appendicitis.................................................................................................................11

Sub-Acute Appendicitis.........................................................................................................11

Chronic Appendicitis..............................................................................................................11

Incidences...............................................................................................................................11

Etiology......................................................................................................................................12

Obstruction.............................................................................................................................12

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 Bacterial Infection..................................................................................................................12

pathophysiology.........................................................................................................................12

Clinical features of Appendicitis............................................................................................13

Diagnostic Investigation............................................................................................................14

Differential Diagnosis................................................................................................................14

Complications of Acute Appendicitis........................................................................................15

Post-Operative Complications................................................................................................15

Medical Treatment.................................................................................................................15

Surgical Intervention..............................................................................................................16

Preoperative preparation............................................................................................................16

Post-Operative Preparations.......................................................................................................18

Prognosis uncomplicated Appendicitis......................................................................................19

Prevention of Appendicitis.....................................................................................................19

Validation of Data......................................................................................................................20

CHAPTER TWO...........................................................................................................................21

ANALYSIS OF DATA..............................................................................................................21

COMPARISON OF DATA WITH STANDARD.....................................................................21

DIAGNOSTIC INVESTIGATION...........................................................................................22

BLOOD UREA AND CREATININE....................................................................................23

DIAGNOSTIC INVESTIGATION/TESTS..............................................................................23

TABLE 1................................................................................................................................23

2.3 Causes of Condition.............................................................................................................25

Table 2:...................................................................................................................................25

Comparison Of Treatment with Standard..................................................................................26

2.4. TREATMENT..................................................................................................................28

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 2.5. SURGICAL TREATMENT...............................................................................................29

TABLE 3................................................................................................................................29

Complications............................................................................................................................35

PATIENT PRE-OPERATIVE PROBLEMS 15/12/22..............................................................35

PATIENT PRE -OPERATIVE STRENGHT............................................................................35

PATIENT POST – OPERATIVE PROBLEMS 16/12/22.........................................................36

PATIENT POST – OPERATIVE PROBLEMS 17/12/22.........................................................36

PATIENT POST -OPERATIVE STRENGHT..........................................................................36

PATIENT POST -OPERATIVE STRENGHT..........................................................................36

NURSING DIAGNOSES..........................................................................................................37

3.0. CHAPTER THREE...............................................................................................................38

3.1. PLANNING FOR PATIENT /FAMILY CARE................................................................38

3.2. OBJECTIVES AND / OUTCOME CRITERIA................................................................39

3.3. Care Plan Table 4..............................................................................................................42

4.0. CHAPTER FOUR.................................................................................................................50

4.1. IMPLEMENTATION OF PATIENT AND FAMILY CARE..........................................50

Summary of Actual Nursing Care Rendered to Patient and Family..........................................50

Day of Admission: 15th of December, 2022...........................................................................50

SECONDAY ON ADMISSION 16TH DECEMBER, 20222.................................................51

DAY OF SURGERY..............................................................................................................51

Psychological preparation......................................................................................................52

Physical preparation...............................................................................................................53

Physiological preparation.......................................................................................................53

Socio-economic preparation...................................................................................................54

Spiritual preparation...............................................................................................................54

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 INTRA-OPERATIVE PREPARATION/ OPERATIVE CARE...............................................55

IMMEDIATE POST OPERATIVE CARE...............................................................................55

SUBSEQUENT POST OPERATIVE CARE ON THE WARD...............................................56

SECOND DAY ON ADMISSION, 17TH DECEMBER, 2022..............................................57

FIRST DAY POST-OP SURGERY.......................................................................................57

THIRD DAY ON ADMISSION 18TH DECEMBER, 2022...................................................58

SECOND DAY POST-OP SURGERY.................................................................................58

FOURTH DAY ON ADMISSION 19TH DECEMBER, 2022...............................................59

THIRD DAY POST-OP SRGERY........................................................................................59

FIVETH DAY ON ADMISSION 20TH DECEMBER, 2022.................................................60

FOURTH DAY POST-OP SRGERY....................................................................................60

SIXTH DAY ON ADMISSION 21TH DECEMBER, 2022....................................................61

FIVETH DAY POST-OP SRGERY......................................................................................61

4.2. PREPARATION OF PATIENT TOWARDS DICHARGE AND REHABILITATION..62

4.3. Exist Interview was carried out..........................................................................................62

4.4. Follow Up /Home Visit /Continuity of Care......................................................................63

FIRST HOME VISIT.............................................................................................................63

SECOND HOME VISIT........................................................................................................64

4.5. REVIEW DATE 3rd JANUARY, 2022..............................................................................65

THIRD HOME VISIT............................................................................................................66

5.0. CHAPTER FIVE................................................................................................................67

5.1. EVALUATION OF CARE RENDERED TO PATIENT/FAMILY..............................67

5.2. STATEMENT OF EVALUATION................................................................................67

5.3. AMENDMENT OF NURSING CARE PLAN...............................................................68

5.4. TERMINATION OF CARE...........................................................................................68

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5.5. SUMMARY....................................................................................................................69

5.6. CONCLUSION...............................................................................................................70

BIBLIOGRAPHY......................................................................................................................71

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1.0. ASSESSMENT

1.1. ASSESSMENT OF PATIENT

Assessment is the systematic and continuous collection, organization, validation, and

documentation of data (information). In effect, assessment is a continuous process carried out

during all phases of the nursing process. For example, in the evaluation phase, assessment is

undertaken to determine the outcome of the nursing strategies and to evaluate goal achievement.

A nursing assessment should include the patient’s perceived needs, health problems, related

experience, health practices, values, and lifestyle. (Barbara Kozier et al., 2008)

The four types of assessment are;

Initial nursing assessment

Problem-focused assessment

Emergency assessment

Time-lapsed reassessment

These assessment types were mostly adopted in my assessment procedure in obtaining

information from my patient and also comparing his current health status to his initial health

status.

Initial nursing assessment: it is performed within a specific time after admission of a patient to a

health care facility. Purpose of initial assessment is to establish a complete data for problem

1
identification, referencing, and future comparison. E.g.; - nursing admission assessment to plan

care.

Problem-focused assessment: it is the ongoing process integrated with nursing care. Purpose is to

determine the status of a specific problem identified in an earlier assessment and to identified

new problems. E.g.: hourly assessment of patient vital signs after a surgical procedure,

monitoring of client fluid intake and output chart.

Emergency assessment: Done during physiologic or psychologic crisis of the patient. Purpose is

to identify life- threatening problems. E.g.- rapid assessment of an accident victim’s airway,

breathing status and circulation.

Time-lapsed assessment: it is done several weeks or month after initial assessment. Purpose is to

compare the client’s current status to baseline data previously obtained. E.g.- reassessment of a

patient functional health pattern in a home care

Assessment of my patient Mr. E.A was done using the major methods of assessing patient and

also with the addition of other methods such as palpation, inspection, amongst others.

Information about my patient was obtained from patient himself, parents and significant others,

patient folder, history, and other sources.

1.2. PATIENT PARTICULARS

Patient particulars are all the details of the patient on whom the study is undertaken. They

include the name, age, gender, etc. Mr. E.A. is a 57-year-old man born on January 24, 1964, to

2
Mr. F.K. and Mrs. A.S. He hails from Akim Kyai in the Eastern Region of Ghana. He comes

from a nuclear family of eleven consisting of Mr. E.A., Mrs. K.A., Mr. K.A., and eight siblings,

and he is also the last born. Mr. EA resides at Kasoa with house number C1O32. He is a lottery

writer by profession. Mr. E.A. weighs seventy kilograms (70 kg) and is 1.78 meters tall. He is

dark in complexion and has no physical impairment. He also speaks Akan, Fanti, and English.

He is married to Mrs. F.A. and has three children, A.E., S.A., and F.A., who don’t stay with their

father. Mr. E.A. is a Christian and worships at the salvation church at Kasoa, of which he is not a

regular attendant. He has no allergies, and Mr. F.A. is the next of kin, the firstborn. Mr. E.A.

started schooling at age six. from class one to six and then from form one to form six in a middle

school called a local authority primary school in the years 1970 to 1980. He then continued with

his education at Cape Coast Technical College for three years after completing Form 6.

1.3. FAMILY’S MEDICAL HISTORY

Medical history is the history of the family’s health status, health issues and disorders or

disabilities, illnesses and infirmities recorded in the family of family members, and the

treatments and complications that arose from them. According to Mr. E.A., there are no known

hereditary diseases such as diabetes, hypertension, psychiatric disorders, or asthma among others

in the family, but they seldom suffer from minor ailments such as stomach aches, headaches, or

waist pain, for which they are treated either using herbal remedies or buying over-the-counter

drugs from the pharmaceutical shops. According to Mr. E.A., he could remember that they

normally use bams for the management of minor body pains and also the use of enema. The

family does not have any specific allergies to any substance. Currently, his grandparents and

parents, along with eight of his siblings, are all dead but didn’t die as a result of any medical

condition. Upon assessing their cause of death, it was unknown.

3
 1.4. FAMILY’S SOCIO-ECONOMIC HISTORY

Social deals with the concerns of people and the way they live together, and economic pertains to

trade, business, industry, and most importantly, the management of money. Therefore, socio-

economic status is the financial or economic status of an individual with regards to the society in

which they live or reside. According to Mr. E.A., his relationship with his family was not close

due to family issues as he developed. His father was a farmer, and his mother was a petty trader.

Mr. E.A. gets his financial support from his lotto work. He is also able to get an estimated

amount of 1000 to 1500 Ghana cedis a month. He is a lotto writer by profession, so he is able to

meet his family’s needs as well as other expenses. He does not have national health insurance,

and he is going to pay for his medical and surgical bills by himself. Mr. E. A.’s family belongs to

the middle socio-economic class. He follows the norms and values of his family but does not

believe in their cultural practices………..social

1.5. PATIENT’S DEVELOPMENTAL HISTORY

The term "development" is generally used to refer to the dynamic process by which an individual

grows and changes throughout its lifespan. Often, it is thought of as the process of qualitative

change taking place from conception to death. The term "development" is often used

interchangeably with "growth" and "maturation," but these terms all have different meanings.

Growth refers to the quantitative additions or changes in the organic structure, whereas

maturation refers to the natural unfolding of changes that are primarily biological in nature and

occur with increasing age and due to one’s individual genetic makeup. According to Mr. E.A., he

4
is a full-term baby who was delivered through a normal vaginal delivery at home. He also

believes he has received all the recommended immunizations, especially for the six killer

diseases. He also had exclusive breastfeeding for six months after birth until other

complementary feeds were added. Mr. E.A. also continued that; he went through the stages of

childhood development in the normal process, such as sitting, crawling, and murmuring words,

as well as the development of the pair of deciduous teeth. He started to experience his adolescent

characteristics at the age of 14. He started schooling at the age of 6, where he attended the local

authority primary school at age six, from class one to sixth grade. He completed high school at

age 16, which was middle school by then. He also continued his education in Cape Coast, where

he attended the Cape Coast Technical School for three years. He continued that, from class one

to six, his position in class was 4th, and he was good in English, history, and geography.

According to Mr. E.A., at age 19, he stayed with his brother at Cape Coast, where he started his

life journey as an adult. First, he worked as a government bus conductor at age 20. He later stops

to start his own work as a bus conductor at age 21 at Agona Swedru. At age 31, he went to

Nigeria to pursue another work opportunity; unfortunately, he wasn’t successful, so he returned

to Ghana in the following year. He then came back to Accra-Kasoa to start over, where he

developed his own nuclear family. According to Erik Erikson’s psychosocial theory of

development, every individual passes through eight stages or phases of development throughout

their lifespan, which end only when one dies. These stages are: trust versus mistrust stage (birth

to 18 months), autonomy versus shame and doubt (18 months to 3 years), initiative versus guilt

stage (3 years to 5 years), industry versus inferiority stage (5 years to 13 years), identity versus

role confusion stage (13 to 21 years), intimacy versus isolation stage (21 to 39 years),

generativity versus stagnation (40 to 65 years), and ego integrity versus despair (65 years and

5
older). A successful transition through all of these stages gives rise to a courageous individual,

readily prepared to face all challenges in life. But failure in any of these stages leaves an

individual stagnated or stuck at that particular stage, causing that individual to be lacking in that

stage. Mr. E.A. is now on his seventh stage of development, which is the generativity vs.

stagnation stage. since he is approaching his 57th birthday. A successful transition through this

stage will equip my patient to feel a sense of usefulness and accomplishment, while failure

results in shallow involvement in the world.

1.6. PATIENT LIFESTYLE /HOBBIE

According to Mr. E.A., he doesn’t follow the normal circadian rhythm of sleep and wake

patterns. He normally wakes up at 3:30 a.m. to prepare for the day’s activities. He continued that,

due to the bus conductor work he did when he was young. It has become part of him to wake up

at that time. He normally wakes up to urinate if there is the urge to. He says his quick prayers,

maintains his oral hygiene, and takes his bath after he has emptied his bowls if there is the urge.

Upon interaction, he said he normally prefers heavy foods before going to work, which will help

him work for a long period of time. He doesn’t also have any exercise regime that he follows but

claims walking to work has been his only exercise. According to Mr. E.A., when he gets to his

work place, he always has a one-way routine that he does, which includes sitting and writing for

a long period of time, during which he is prone to waist pain. According to Mr. E.A., he

sometimes buys food outside when he is not able to get home early. He has no bedtime rituals.

He further verbalized that his major stressors at work are when he has to re-calculate all the

lotteries written for the day to be able to make an account of them. His only remedy for the

stressor is to bathe and sleep, which he continues with the next day. He resumes his commute

from work to home at 7:00 a.m. He mostly focuses on his nuclear family, especially his wife,

6
because his children are all working and he has fewer father duties to play on their side. He is an

introvert who mostly spends time with himself and also sometimes takes in alcohol. On

weekends, the wife mostly does most of the cooking and washing in the house. He is not much of

a church attendant since his work demands a lot of attention and focus, and he doesn’t play with

his sleep since it is the only remedy for his stress. Mr. E.A. doesn’t involve himself in any social

activities. He has no allergies. He basically ignores the behaviors of his subordinates and doesn’t

provide either positive or negative reinforcement. He also likes music a lot; according to him,

music is a food that feeds his soul. Upon assessing my patient, I realize he is a talker-thief, but

upon everything else, he is a good and kind person.

1.7. PATIENT’S PAST MEDICAL HISTORY

According to Mr. E.A., he hardly fell ill as an infant but has fallen sick enough to warrant

admission only on three occasions. At age 10, he was diagnosed with a hernia, which caused his

admission to the hospital. He was scheduled for surgery at the Cape Coast Central Hospital,

where he had his first surgery. He also continued that; in 1987, he had an accident when he was a

bus conductor. As he narrates the accident scene, he fell from the bus and had a minor laceration

on some part of his body and some minor fractures that weren’t that severe. After his accident,

he decided to move to Agogo to farm after he stopped working as a bus conductor the same year,

he had his accident. In the course of farming, he started developing back pain and fatigue, and he

reported to the Agogo Presby Hospital for a medical checkup for one month for his treatment. He

took a series of x-rays, and the doctor confirmed that his back pain was caused by his accident.

He was then referred to St. Joseph's Hospital at Koforidua in the Eastern Region for further

treatment. He continued that he was given anti-parasitic drugs (dewormer) and multivitamins. He

7
also receives a multivitamin injection every day. The doctor had then prescribed the antiparasitic

drug because Mr. E.A. was later diagnosed with hookworm infestation. He was reviewed by Dr.

K.

1.8. PATIENT PRESENT MEDICAL HISTORY

Mr. E.A., with no known chronic condition, had a sudden bout of vomiting after supper for six

days, after which he started experiencing bilateral flank pain. He took an antiparasitic and an

antimalarial but did not get any relief. He noticed the pain was mainly in the lower abdomen and

felt maximally in the right iliac fossa. Pain worsened one day ago, which was on December 14,

2022, when he reported to a peripheral facility (St. Grogery Catholic Hospital), where an

ultrasound scan was done to confirm his condition. He was given paracetamol (1 g), intravenous

ciprofloxacin (500 mg), and metoclopramide (10 mg) and later referred to the trauma and

surgical emergency unit of 37 military hospitals for further management. where he was

diagnosed with acute appendicitis by Dr. A.N. He was later transferred to the Tamakloe ward for

further preparation for his surgery. He was sent to Tamakloe on December 15, 2022, where I

admitted him as my patient. His initial vital signs were as follows: T-36.7, P-97 bpm, R-23 cpm,

BP-127/82 mmHg, and Spo2-96 %. He had a clinically clear chest, abdomen soft, generalized

tenderness but maximum in the right iliac fossa, and roving’s sign was positive. He was

conscious and alert, oriented to time, place, and people.

ALVARADO’S SCORE

Migration of pain -1

Anorexia -1

Nausea -1
8
Tenderness in the right lower quadrant-2

Rebound pain -0

Elevated temperature -1

Leukocytosis -0

Shift of white blood cells to the left-1

Total= 7/10
Which confirms his diagnosis as high risks of acute appendicitis. Upon accessing Mr. E.A, Dr A

confirms his admission to tamakloe ward with plans for his care. As part of his pre operational

care, Mr. E.A was to maintain NPO, Urethral catheter to be passed, to do FBC, BUE and CR,

GXM. To be transfused with IV lactates ringers plus 5% dextrose 2L in 24hours, IV

metronidazole 500mg TDS and IV paracetamol 1g TDS.

1.9. ADMISSION OF PATIENT

Mr. E.A. was admitted at 1500 hrs. through the trauma and surgical unit on the account of acute

appendicitis under the care of a general surgery team of doctors. He was brought to the ward in a

wheel chair, accompanied by two relatives and a student nurse. He was assessed as being in mild

pain and weak but stable. A patient with no known chronic condition had a sudden bout of

vomiting after six days, after which he started experiencing bilateral flank pain. He took an anti-

parasitic drug and an anti-malaria drug but was not doing well. According to Mr. E.A., the pain

was maximal in the right iliac fossa. The pain was said to have worsened yesterday, and he

reported to a peripheral facility when he was managed and referred here for further management.

He was admitted, lapt on NPO, and managed on IV ciprofloxacin 400 mg bd, IV metronidazole

500 mg tds, IV p’mol 1 g tds, ringer lactate, and 2L 5% dextrose. On review, in general surgery,

9
one team led by Dr. A. He was admitted to the ward and ordered to start a light diet as part of his

pre-op care. He was made comfortable on arrival to the ward; an admission bed was made in

which he was received, reassured of competent care, and vital signs was checked as

Temperature - 37.6

Pulse - 86

Respiration - 14 cycle per minute

Blood pressure - 103/51

SPO2 – 97 %
Medication was administered per-chart and patient was informed to start light diet per order;

Intravenous Paracetamol 1g tds x 24hrs

 Intravenous ciprofloxacin 400mg bd x 24hrs

 Intravenous metronidazole 500mg tds x 24hrs

The following Intravenous fluids were prescribed in addition to the medication;

 Intravenous 5% Dextrose

 Intravenous Ringer Lactate 2 Litres

 Intravenous Normal Saline

A physical examination was done on him by the doctor using McBurney’s point and Rovsing’s

sign to assess him. patient’s condition is stable but ill. Monitoring is ongoing. He was also

encouraged not to stress himself too much, to have enough rest, and to report any problems to

any of the nurses. The doctor made it known to him that the next day was booked for the surgery,

and he was advised not to take anything by mouth. He was also educated on the need to undergo

10
surgery as it was the best option. He was then orientated to the ward, reassured that he was in

competent hands, and told to expect the best service with the encouragement of a speedy

recovery. The patient’s relatives were very participatory and cooperative in the care of the

patient. Assisting with healthcare delivery as and when necessary and ensuring that what must be

done is duly performed Preparation for discharge was put in place right there and then, with the

provision of education on the condition and encouragement for lifestyle changes and diet

therapies. The patient was then excused to have some time with relatives before they left. I

approached patients and relatives at this point and introduced myself as student nurse J.L., a

student of the 37 military hospital nursing and midwifery training college, undertaking the three-

year diploma course in general nursing. I then explained to them that, as part of my curriculum

requirements, it is required of me to choose a patient of my choice with any medical or surgical

condition, render professional nursing care from the time of admission till discharge, continually

keep in touch to ensure the patient’s health is stable, help the patient out with any health

challenges, and if necessary, refer the patient to the nearest health center. I further explained that,

after discharge, I would visit the patient at least three times and then hand him over to the

community nurse in the area for continuity of care. After which I am to provide a detailed written

report on the care given, in which their names will not be fully stated for confidentiality’s sake,

so they can feel free to provide all needed information. I then asked if I was permitted to use

him, which was gladly accepted. And that started my patient- and family-centered care study. I

chose my patient mainly to enlighten the general public and also gain more knowledge on the

condition of acute appendicitis, which is mostly confused with conditions such as Crohn’s

disease and gastroenteritis.

11
 1.10. PATIENT CONCEPT OF ILLNES

According to Mr. E.A., he had no knowledge about his present condition but believed that the

excessive intake of alcohol could have resulted in the disease condition or something he might

have taken in. He believed that, with God and appropriate nursing care, he would get better

again. The patient also shared his concept of fear in relation to his condition, saying, "I pray that

after the surgery my hospital fees should not be much," as verbalized by the patient.

1.11. LITERATURE REVIEW

The appendix is a small, fingerlike appendage about 10cm (4 in) long that is attached to the

cecum just below the ileocecal valve. The appendix fills with food and empties regularly into the

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

obstruction and it particularly vulnerable to infections (i.e., appendicitis).

Appendicitis, the most common cause of acute surgical abdomen in the United States, is the most

common reason for emergency abdominal surgery. Although it can occur at any age, it more

commonly occurred between the ages of 10 and 30 years (Hennelly & Banchur,2011;

Spirit,2010; Visser’s & Lennarz, 2010).

DESCRIPTION OF APPENDIX

The Vermiform appendix is a finger-like structure which is closed ended, narrow tube. It is

attached to the caecum of the ascending color. It measures about 2.5 centimeters to 15

centimeters long depending on the individual 7 centimeters on average. It fills with food and

12
empties regularly into the caecum. Because of it empties insufficiency and its lumen is small, the

appendix is prone to obstruction and particularly vulnerable to infections (appendicitis). The

function of the appendix remains controversial in the field of human physiology. When the

appendix becomes inflamed and infected, may rupture within hours, which leads to peritonitis

(Hinkle & Cheever, 2016).

Types of Appendicitis

There are three types of Appendicitis. Namely;

a. Acute appendicitis

b. Sub-acute appendicitis

c. Chronic appendicitis

Acute Appendicitis

The onset of sign and symptoms are sudden and reaches its peak within short period of time. The

patient experiences abdominal pain with rapid deterioration and can lead to death if untreated.

Acute appendicitis may lead to chronic appendicitis.

Sub-Acute Appendicitis

Here the mucosa and the sub mucosa are inflamed and edematous and the appendix may be

swollen and the serosa red with increased vascularity. If untreated, resolution occurs but with

formation of fibrous adhesion either within the lumen or on the serosa forming kink. This may

obstruct the lumen and may cause much more severe pain.

13
Chronic Appendicitis

This has gradual onset and recurrent episodes which may be due to obstruction from the

adhesion and endoluminal obstructions. It may also arise as a result of hyperplasia of the

lymphoid tissues, (Kumar and Abbas, 2017).

Incidences

Appendicitis may occur in any age but rare in patient under 2 years and uncommon between 2

and 4 years, males are affected more than females and teenagers more than adults. The disease is

more prevalent in countries in which people consume low fiber and high carbohydrates diet. It

occurs most frequently between the ages 10 and 30 years, (Waugh and Grant,2018).

ETIOLOGY

Appendicitis is generally caused by obstruction or bacterial infection. Other causes

include;
Obstruction

Since the appendix is small, figure-like appendage of the occum, it is prone to

obstruction as it regularly Fills and empties with intestinal content.

The obstruction may cause by;

A fecalith (A hard mass of faeces).

Foreign body in the lumen of the appendix.

Fibrous disease of the bowel wall.

14
Twisting of the appendix by adhesions.
Bacterial Infection

Escherichia coli

Streptococcal organism

Infection of parasite

Of all cases, approximately 60 percent are associated with hyperplasia of the sub mucosa

lymphoid follicles and 35 percent faecal stasis or fecalith. (Waugh & Grant,2018).

PATHOPHYSIOLOGY

The appendix becomes inflamed and edematous as result of becoming klinked or occluded by

fecalith (i.e., hardened mass of stool), tumor, lymphoid hyperplasia, or foreign body. The

inflammatory process increases intraluminal pressure, initiating a progressively severe,

generalized, or periumbilical pain that becomes localized to the right lower quadrant of the

abdomen within a few hours. Eventually, the inflamed appendix fills with pus (Spirit,2010).

Once obstructed, the appendix becomes ischemic, bacterial overgrowth occurs, and eventually

gangrene occur. (Hinkle and cheever,2016).

15
Clinical features of Appendicitis

Abdominal pain

Vomiting and migration of pain to the right iliac fossa (Murphy, 1904).

Colicky peri-umbilical pain followed by migration of pain to the right iliac fossa with a

progression to a more constant severe pain (Wagner et al. 1996).

Loss of appetite and Nausea

Vomiting

Low Grade Fever

Constipation and anticipation of relief of pain with defecation but this does not occur

(cope,2000).

The presence of atypical signs and symptoms which includes; fatigue, weakness, numbness or

tingling in the upper extremities, palpitations, indigestion, and confusion (Paulson et al. 2003).

Rebound tenderness

Diarrhea

Dysuria

Pyuria

Pyrexia

16
 DIAGNOSTIC INVESTIGATION

History: The patient complains about the nature of pain, when it started for how long it has

lasted, the severity and many more.

Physical examination: on palpation, there is muscular rigidity and rebound tenderness.

Rousing’s sign may be present. Rectal examination is done to locate the appendix in the pelvis.

Urinalysis and intravenous pyelogram: this may be done to rule out genitourinary conditions

that present manifestations of appendicitis.

White blood cell and differential count: this may show moderately elevated cells with

increased number of immature cells.

Laparoscopy: this is viewing the abdominal cavity by passing and endoscope through the

abdominal wall. It is done when appendicitis is difficult to diagnose.

Abdominal x-ray may reveal calculus in the right upper quadrant or localized ileus may be

demonstrated.

Abdominal ultrasound is the effective test; it may reveal an inflamed appendix.

Computerized Tomography Scan may reveal right lower quadrant localized distension of the

bowel. (Hinkle and Cheever, 2016)

17
 DIFFERENTIAL DIAGNOSIS

1. Gastroenteritis-usually there is vomiting or diarrhea before the abdominal pain. There may be

other ill contact with similar symptoms.

2. Inflammatory bowel disease- usually symptoms are mere chronic and history of poor weight

and height gain.

3. Testicular torsion and other intra-scrotal pathology.

4. Ovarian cyst and twist.

5. Inflammatory disease.

6. Intestinal obstruction.

COMPLICATIONS OF ACUTE APPENDICITIS

1. Perforation of the appendix

2. Appendiceal abscess

3. Peritonitis

4. Portal pyemia or portal abscess

5. Septicemia

6. Shock

7. Sub hepatic or sub phrenic abscess

8. Appendicular mass

18
9. Pyelophlebitis (Hinkle and Cheever, 2016)

Post-Operative Complications

1. Wound infection

2. Secondary Hemorrhage

3. Paralytic and mechanical ileus

4. Peritonitis

5. Pelvic or lumbar abscess: This may occur if perforation or infected pus spill into the pelvic

cavity

6. Phrenic abscess

Medical Treatment

1. Antibiotics therapy with third generation cephalosporin effective against gram negative

bacteria. Example ceftriaxone, cefuroxime.

2. Analgesic. Example intravenous morphine and sedatives may be administered as start dose to

lower anxiety and calm patient. Example Intravenous Diazepam 10mg stat.

3. Intravenous fluids such as Dextrose or Ringer Lactate

4. Nasogastric tube is inserted to empty the stomach.

19
Surgical Intervention

Appendectomy (that is the surgical removal of the appendix) is performed as soon as possible to

decrease the risk of perforation. It may be performed under general or spinal anesthesia with low

abdominal incision laparoscopy. (Hinkle and Cheever 2016).

PREOPERATIVE PREPARATION

Pre-operative care is given to patient going through appendectomy to make them suitable for the

surgery. This helps to identify conditions that may impair the patient’s ability to comply with

post-operative care. Pre-operative preparation includes; psychological, physical and

physiological.

The general preoperative care of a patient pending on appendectomy is considered under the

following headings;

1. Psychological preparations

2. Physiological preparations

3. Socio-economic preparations

4. Spiritual preparations

5. The Following were done:

- Patient is reassured that the surgery will relieve his pain and not interfere with his normal

gastro-intestinal functioning.

20
- Reassure patient he will be put under anesthesia to relieve him of pain during the surgical

procedure.

- Patient wound after healing, he can go about his normal activities.

- Allow patient to ask questions and express his fear, the nurse provide answers to the questions

asked in plain terms that patient can understand.

- Patient can be introduced to other patients who have done similar surgery and are recovering to

help allay patient fears and build confidence.

- Tell patient of pains to expect after recovering anesthesia and analgesics to be given to relieve

pain.

- The skin should be prepared by shaving and draped with sterile towel.

- Patient should be hydrated without intravenous fluids and monitored carefully for changes in

pain. The nurse should keep patient on nil per Os to the surgery.

- Consent form must be explained to patient's understanding and properly signed by patient or

relative.

POST-OPERATIVE PREPARATIONS

1. Patient is put in flawless position to decrease the risk of contaminated fluids spilling into the

upper abdomen.

2. The nurse should administer prescribed analgesics to decrease post -operative pain.

3. The incision site should be observed for bleeding and drainage tubes for draining if any.

4. Monitor vital signs every 15 minutes for the first 1 hour and 30 minutes for the next 2 hours

until patient condition is stable.

21
5. Prescribed medication should be administered and aseptic wound care provided.

Discharge Education

1. Educate patient on the possible complications from the surgery and when to notify the

surgeon if it occurs.

2. The nurse should educate patient the names, dosage and side effects of all prescribed

medications.

3. Nurse should advise patient to observe activities restrictions or limitations strenuous

activities such as lifting heavy objects which can cause stress to the incision in order to

prevent strain on the abdominal muscle until healing is completed.

4. Any dietary restrictions should be explained to patient.

5. The need for follow up medical visit should be emphasized.

6. Teach patient and family how to care for incision wound at home and if he is taking dressing

in home place, can it to a nearby health Centre for dressing.

7. Patient should be educated on how to observe the incision site for swelling, redness, bleeding

and warmth daily.

PROGNOSIS UNCOMPLICATED APPENDICITIS

Appendicitis (acute) is a surgical emergency. If it is detected and treated early, it gives good

results but if it is delayed it result in perforation of the appendix and then leads to peritonitis and

other associated complications and eventually death.

Prevention of Appendicitis.

The following measures should be observed in the prevention of Appendicitis.

22
1. Health education. The general public should be educated to report at the hospital a sudden,

acute abdominal pain and other illness promptly.

2. There should be education on good and environment hygiene.

3. Periodic medical examination should be encouraged.

4. Eating of high fiber diet and adequate fluid to prevent the formation of fecalith.

5. The general public should be taught the clinical features of Appendicitis

Such as peri-umbilical pain accompanied by anorexia, vomiting, nausea, diarrhea or

constipation.

6. Person with such Clinical features should not self-medicated since some medications may

mask the symptoms and make diagnosis difficult. (Kumah and Abbas,2017)

VALIDATION OF DATA

Validation is then act of ‘double-checking’ or verifying data to confirm that it is accurate and

factual. Validating data helps the nurse complete the task. (Barbara Kozier et al, 2008).

Validation of data obtained from Mr. E.A was done upon home visit when he was also

questioned, and also observations made by nurses, Doctors and others obtained from the

patient’s history and the laboratory results provided. Upon cross checking and comparing the

23
various data obtained with the set standards, the data confirmed to the diagnoses therefore the

data obtained is valid and as free from errors and unbiased as possible.

CHAPTER TWO

ANALYSIS OF DATA

This is the classification of data by organizing and grouping significant and related information

and the comparison of the data obtained with standard information provided in literature.

Areas that are covered under analysis of data are;

1. Comparison of data with standard

2. Patient/family strength

3. Health problems

4. Nursing diagnoses

24
 COMPARISON OF DATA WITH STANDARD

Under comparison of data with standard, data or information obtained on patient and patient’s

condition is tallied with standard compiled data on disease condition by expects and from clinical

experience, experiments and general data given or provided by individuals who have suffered

same condition and from whom accurate data has been obtained.

Comparison of data comprises of these major areas under literature review on condition;

a) Diagnostic investigations

b) Causes

c) Clinical manifestations

d) Treatments

e) Complications

DIAGNOSTIC INVESTIGATION

Diagnostic investigations are procedures, tests, investigations, analysis and research that are

carried out on an individual to determine the state of the individual’s health and to conclude

hypothesis of a disease condition made by a medical practitioner. Diagnostic investigations help

the doctor arrive at a concrete diagnosis and either confirms or disproves it.

To help doctors confirm their hypothesis on the condition of Mr. E.A., the following diagnostic

investigations were carried out on him;

25
1.Blood for red blood cell count

2.Blood for white blood cell count

3.platelet count

4.Haemoglobin level

5.Abdomino -pelvic ultrasound scan

26
 BLOOD UREA AND CREATININE

Na+, Potassium (plasma/urine), chloride, Bicarbonate, Urea, Creatinine

Provision was done for my patient for Blood, in which grouping and cross-matching was requested for which Blood type O was made available.

In case of any emergency blood transfusion that may be required for my patient.

DIAGNOSTIC INVESTIGATION/TESTS

TABLE 1

Date Specimen / Investigations Results Normal Values Interpretations Remarks

Body Part

15/12/2 Blood Hemoglobin level 15.7g/dl Male; 12-16g/dl Hemoglobin level No blood
2 estimation (Hb) was within the transfusion was
Female; 11-16g/dl
normal range patient needed
is not aneamic.

15/12/2 Blood Platelet count 245x10^3/ 150-400x10^3/UL The platelet count Patient was at
2 UL was normal lower risk of
bleeding

27
15/12/2 Blood Electrolyte analysis Patient’s kidney IV fluids were
2 functioning normally administered to
Sodium (Na) 139.0mmol/l 135-150mmol/l and can withstand IV correct patient’s fluid
fluid administration loss
Potassium (K) 3.9mmol/l 95-110mmol/l

Chloride (Cl) 102mmol/l 23-29mmol/l

Red blood cells (RBC) 5.6x10^6/ul 4.5-5.50[10^6/ul]

15/12/2 Blood White blood count 14.17x10^6/ 5 -10x10^6/UL Indicative of Antibiotics were
2 (WBC) UL infection prescribed for
treatment
13 Abdomen Ultrasound scan of the Revealed A thin tube-like Abnormality Appendectomy
/12/22 abdomen inflammatio structure attached to the detected was requested.
n of the caecum of the large
appendix intestine. It is 10-17cm
long

15/12/2 Blood Bicarbonate 21mmol/L 2.8-7.2 mmol/L Acid-base(pH) Patient was at

2 balance was lower risk for
balanced within Acid and Base
range Imbalance

15/12/2 Blood Grouping and cross Patient blood A, B, AB, O Patient can only receive Patient was educated on
take blood transfusion his blood group and the
2 matching type was O from a Doner of blood blood he can donate
type O and receive blood from.

28
 2.3 CAUSES OF CONDITION

With reference to the literature review on acute appendicitis and from the post-operative

notes of Mr. E.A, his disease was precipitated by an obstruction of the Appendiceal lumen by

the fecalith according to the surgical findings.

Table 2: comparison of patient clinical features with the Literature Review

N Clinical Features in Literature Clinical Features Presented by

O Patient

1 Onset of illness Onset was sudden

2 Abdominal pain at the right iliac The patient had abdominal pain at
fossa his right lower quadrant (iliac fossa)
of the abdomen.

3 Low-grade fever The patient exhibited a high-grade

fever of 37.6 degree Celsius.

4 Constipation The patient wasn’t constipated

5 Localized tenderness On palpation, there was localized

tenderness at the right iliac fossa of
the patient.

6 Nausea and vomiting The patient had nausea and

vomiting.

7 constipation may be present Patient complained of constipation.

8 positive rovsing’s sign The patient had a positive rovsing's

sign

29
9 There may be Diarrhea The patient had no diarrhea

10 Dysuria Patient complained of mild pain

when urinating

11 Pyuria There was no presence of pus in the

urine

30
 COMPARISON OF TREATMENT WITH STANDARD

STANDARD TREATMENT TREATMENT ORDERED FOR PATIENT

MEDICAL TREATMENT

a. Antibiotics therapy a. IV metronidazole 500mg tid ×24hrs intravenously was

given.

b. Analgesics b. Paracetamol 1g, 8hourly x 3 days Intravenously Then

1g, 6hourly x 48hours intravenous was given

c. Dextrose saline, normal saline and ringer’s lactate infusions

c. Hydration
+KCL, 1000ml at 4drops per minutes intravenously was
given.

SURGICAL TREATMENT

a. Appendicectomy
a. Appendicectomy was done

b. McBurney’s incision
b. Incision at the McBurney’s point was made (lanz incision)

31
 2.4. TREATMENT

Treatment is defined by the Oxford dictionary as care provided to

improve the situation (especially medical procedures or applications that are intended to

relieve illness or injury. To treat acute Appendicitis, one can undertake either medical, or

surgical management as stated by literature review.

In terms of medical treatment, the following specific medications were prescribed for my

patient with reference to the Treatment indicated from the literature review:

Pre-operative:

a. IV Metronidazole 500mg tds × 24hrs

b. IV Ringers Lactate 1000mls dly x 24hrs

c. IV 5% dextrose 2000mls dly x 24hrs

d. IV Paracetamol 1g tds

e. Ciprofloxacin 200mg bd x 24hrs

Post-operative:

1. IV metronidazole 500mg tds x 24hrs

2. IV Paracetamol 1g tid

3. IM morphine 5mg qid x 24hrs

4. IVF 5% dextrose 2000mls x 24hrs

5. IVF ringers’ lactate 1000mls x 24hrs

6. IV Metoclopramide 10mg tds

7. I.V Rocephin 2g daily

32
 2.5. SURGICAL TREATMENT

My patient was treated with reference to the literature review surgically by

appendectomy.

TABLE 3 PHARMACOLOGY OF DRUGS

33
 Date Drug Dosage /Route of Classificatio Desired Actual Action Side Effects /
Administration n Effects Observed Remedies
15/12/22 METRON Adult: 400 mg every class- Produces Infection was Nausea,
IDAZOL 8 hours Nitroimidazo bactericidal controlled vomiting, furred
E le with high tongue. None
(FLAGY Child 12–17 years: derivatives.
400 mg every 8 activity was experienced
L
hours Antibacterial, against
antiprotozoal anaerobic
Route:
bacteria and
intravenously
protozoa.
Patient: 500mg tds
for 24hrs
15/12/22 IV Adult: 200mg- Class- Produces Bacterial Nausea and
CIPROFL 400mg quinolones bactericidal eliminated from vomiting,
OXACIN effect, by blood and abdominal pain,
Child: 6mg/kg- Second inhibiting infection was headache,
10mg/kg generation bacteria DNA controlled diarrhoea. None
Route: Broad- were observed
intravenously spectrum
antibiotic
Patient: 200mg bd
for 24hrs
15/12/22 IV Adult: 500mg- Class- To treat pain The patient was Nausea,
PARACE 1000mg Analgesic. and reduce a relieved of pain vomiting,
TAMOL high body and body constipation.
34
 Child: 10mg/kg Antipyretic temperature(fe temperature None was
Route: ver) reduced. observed.
intravenously
Patient: 1g tds for
24 hrs

Date IV Dosage /Route of Classification Desired Actual Action Side Effects /

FLUIDS Administration Effects Observed Remedies
15/12/22 NORMA Adult: 500ml- crystalloid Restores Patients’ fluid Sodium
L 2400ml normal fluid and electrolyte accumulation,
SALINE Isotonic
Child: 20ml/kg solution and balance were Edema, and fluid
INFUSIO
electrolyte maintained overload
N Route: balance.
intravenously None were
observed
Patient: 2 litres x
2days, intravenously
15/12/22 RINGER’ Adult: 500ml- crystalloid Replaces Patient fluid and Heart failure,
S 2400ml fluid and electrolyte edema, phlebitis
LACTAT Isotonic electrolytes balance was Serum
E Child: 20ml/kg solution in the body maintained electrolyte
INFUSIO Route: imbalance.
N intravenously These side
effects were not

35
 Patient: 2 litres x 2 observed
days intravenously
15/12/22 DEXTRO Adult: 500ml crystalloid To Patient energy Glycosuria,
SE supplement was restored and confusion, and
Child: 20ml/kg Hypertonic
SALINE caloric and volume regained pulmonary
INFUSIO Route: solution replace fluid edema. None of
N intravenously volume them was
observed
Patient: 2 liters x 2
days intravenously.

Date Drug Dosage /Route of Classification Desired Effects Actual Side Effects / Remedies
Administration Action
Observed
16/12/2 IV Adult: Class- Inhibit bacterial Infection Nausea and vomiting,
2 ROCEPH cephalosporins cell wall rate was difficulty in breathing,
Child:
IN , third- synthesis by minimized severe skin reaction.
Route: generation
binding to and Patient had no reaction.
intravenously Anti-biotic. transpeptidase patient’s
Patient: that catalyses’ condition
the cross linking improved
of peptidoglycan
polymers

36
 forming the
bacterial cell
wall

16/12/2 IV Adult: 10 mg every Class- Depresses pain The pain Hypertension, nausea,
2 MORPHI 4 hours, Opiate(narcoti impulse was vomiting, constipation,
NE c) transmission at minimized. urine retention.
Child: 5–10 mg the spinal cord None was observed
every 4 hours Analgesic level
Route:
intravenously
Patient: 5mg
17/12/2 I.V Adult: 10mg tds class- it blocks Patient Diarrhoea, dizziness,
2 METOCL x24hrs Dopamine dopamine and stopped fatigue, headache and
OPRAMI receptor serotonin vomiting restlessness none was
DE Route: antagonists receptors in the and was observed
intravenously (prokinetic CR trigger zone relaxed in
Patient: 10mg tds x agent) of the CNS. bed.
3days Anti-emetics

37
 COMPLICATIONS

A complication is any disease or disorder that occurs during the

Course of or because of another disease. Based on the literature review, the complications of

acute Appendicitis are abscess, wound infection and hemorrhage therefore, it can be

concluded that patient had no complications due to early recognition and treatment.

PATIENT PRE-OPERATIVE PROBLEMS 15/12/22

Patient complains of pains at the right iliac fossa

Patient was anxious

Patient complains of difficulty in sleeping

Patient has no knowledge on his condition

Patient has urethral catheter

PATIENT PRE -OPERATIVE STRENGHT

Patient can verbalize the intensity and location of pain

Patient could express his level of anxiety

Patient can sleep for few hours when position in supine

Patient is willing to be educated on his condition

Patient has items for urethral catheter care

38
 PATIENT POST – OPERATIVE PROBLEMS 16/12/22

Patient complains of pains at the incisional site

Patient has wound at the lower abdomen (iliac region) due to surgery

Patient complains of difficulty in sleeping because of pain

PATIENT POST – OPERATIVE PROBLEMS 17/12/22

Patient was seen vomiting

Patient could not care for himself (bathing)

PATIENT POST -OPERATIVE STRENGHT

Patient can verbalize the location and the intensity of pain

Patient has items for wound dressing

Patient can sleep when positioned well

PATIENT POST -OPERATIVE STRENGHT

Patient has medication for vomiting

Patient is willing for bed bath

39
 NURSING DIAGNOSES

A nursing diagnosis is a clinical judgement about individual, family,

Or community experiences/responses to actual or potential health

Problems/life processes. It provides the basis for the selection of nursing

Interventions to achieve outcomes for which the nurse is accountable.

The nursing diagnoses are derived from the problems identified. The nursing diagnoses

formulated for patient and family include:

Acute pain (right iliac fossa) related to inflammation of the appendix as evidenced by patient

reporting pain.

Anxiety related to impending surgery as evidenced by patient exhibiting facial tension,

restlessness and focusing on self.

Impaired sleeping pattern related to pain at the incisional site

Deficient knowledge related to inadequate information on disease

Condition as evidenced by patient requesting for information.

Risk for infection related to urethral catheter in-situ

Risk for infection related to surgical incision

Risk for fluid and electrolytes imbalance related to vomiting

Self-care deficit (bathing) related to general body weakness secondary to surgical procedure

(appendicectomy)

40
3.0. CHAPTER THREE

3.1. PLANNING FOR PATIENT /FAMILY CARE

Planning is a deliberative, individual, systematic phase of the nursing process that involves

decision making and problem solving. In planning, the nurse refers to the patient’s

assessment data and diagnostic statement for direction in formulating care goals and

designing the nursing intervention required to prevent, reduce or eliminate the patient’s

health problems. A nursing intervention is ‘any treatment, based upon clinical judgement and

knowledge, that a nurse performs to enhance patient outcomes’ (Barbara Kozier et al, 2008).

It’s important in providing a written guide that is used as a form of communication between

the health team members and the nursing staff to help solve the patient’s problems. It

provides a direction for

individualized nursing care and also serves as a continuity of care. The steps in planning care

include;

1. Set priorities among identified problems.

2. Establish patient goals and predict outcomes.

3. Weigh alternative actions and predict actions.

4. Determine nursing interventions.

5. Develop the nursing care plan.

41
 3.2. OBJECTIVES AND / OUTCOME CRITERIA

The objective outcome criteria should be simple, measurable, accurate or

Achievable, realistic and time bound and must be patient centred. The following were drawn

based on the patient and family problems that were identified.

Patient will be relieved of right iliac fossa pains within 2-3 hours as

Evidenced by

(a). Patient verbalizing that pain has subside

(b). Nurse observing patient’s pain to be less than 3 on the pain rating scale (0-10).

Patient will be relieved of anxiety within 45 minutes as evidenced by

(a). Patient verbalising his readiness for the surgery

(b). Nurse observing that patient is calm and ready for the surgery

Patient will resume his normal sleep pattern within 24 hours of hospitalization as evidenced

by

(a). The nurse observed the patient sleep uninterrupted for 6 to 8 hours at night

(b). The patient verbalizing, he was able to sleep for longer hours

42
Patient would acquire more knowledge about appendicitis within 45minutes as evidenced by:

(a). patient verbalizing that he has received more knowledge on the disease condition.

(b). Nurse observing that patient is able to answer at least 70% of question asked on his

condition.

Patient will be free from catheter infection during his stay at the hospital as evidenced by

(a). patient exhibiting a normal urine flow

(b). Nurse observing no sign of infection as the catheter is in situ

43
Patient wound will be free from infection within 3 days as evidenced by

(a). Observing no occurrence of pus, swelling and dehiscence throughout the healing process.

(b). The vital signs remaining within the normal range.

Patient will maintain normal fluid volume and electrolytes balance within 48 hours as

evidenced by.

(a). The patient maintaining normal skin elasticity and turgor.

(b). The patient maintaining moist mucous membrane

(c). Patient confirming the absence of vomiting.

Patient will be assisted to maintain self-care (bathing) within 45 minutes as evidenced by

(a). Patient verbalizing, he had bed bath

(b). Nurse observing patient looking neat and well-groomed in bed.

44
 3.3. CARE PLAN TABLE 4

Date/ Nursing Objective/ Nursing Nursing Date/ Evaluation Sign

Time Diagnosis Outcome Criteria Order Intervention Time

15/12/22 Acute pain 8/10 The patient's pain . Reassure the patient. Patient was reassured that with 15/12/22 Goal fully
(right iliac [right iliac fossa] proper nursing care his pain will at met as
fossa) related to will reduce within 1- reduce. patient
inflammation of 2 hours as evidenced 2050hrs verbalized
. Assess the patient's Patient's level of pain was
appendix by level of pain. that the
assessed using a pain rating intensity of
a. Patient verbalizing scale. his pain has
that the pain has reduced.
subsided. . Assist the patient to Patient was assisted to assume a
assume a comfortable supine position to ensure
b. The nurse position. comfort.
observing patient
pain to be less . Maintain a quiet A quiet environment was
than 3 on the pain environment. ensured by switching off the
rating scale (0-10) televisions and restricting
Provide diversional visitors to ensure rest.
therapy
Patient was given a Diversional
therapy such as music.

. Administer prescribed Prescribed intravenous

analgesics. paracetamol 500mg was
administered to relieve pain.

45
 Date/ Nursing Nursing Nursing Nursing Date/ Evaluation Sign
Time Diagnosis Objective Order Intervention Time
15/12/22 Anxiety Patient level Reassure the patient . Patient and relatives were 15/12/22 The goal was
related to the of anxiety will and family. reassured that the surgery will fully met as the
unknown be reduced be successfully. nurse observed
Assess the level and
outcome of within 24 that patient has a
cause of anxiety. Patient's level and cause of
surgical hours, relaxed facial
anxiety were assessed.
intervention evidenced by Check vital signs expression and
Patient vital signs was checked the patient
a. Patient .
and recorded verbalized that
verbalizing
Encourage the he feels less
that he feels Patient was encouraged to ask
patient to ask anxious
less anxious questions to clear his doubts.
questions.
b. Nurse Patient was educated on the
. Educate the patient.
observing that surgical process to allay fear
patient is calm Show patient to other and anxiety.
and ready for patients whose
Patient was shown to other
surgery. undergone same
patients who have undergone
surgery and their
similar surgery and their
wound has healed
wound have healed by first
completely.

46
 intention

Date/ Nursing Objective/ Nursing Nursing Date/ Evaluation Sign

Time Diagnosis Outcome Criteria Order Intervention Time
15/12/22 Impaired sleep Patient will resume Reassure the patient. Patient was reassured that he Goal fully met
pattern related to his normal sleep will sleep well after the pain as patient slept
pain in the pattern within 24 Give patient a warm subsided. uninterrupted
incisional site. hours of bath before bedtime. for 8hours.
hospitalization as Warm bath was given before
Assist the patient to bedtime to induce sleep.
evidenced by assume a comfortable
a. The nurse sleeping position. patient was assisted to assume
observed the patient a supine position to aid in his
Recommend relaxing comfort.
sleep uninterrupted activities
for 6 to 8 hours at patient was recommended a
night relaxing activity such as
Subdue noise on the reading
b. The patient ward during bedtime.
verbalizing, he was Television was switched off at
able to sleep for bedtime to ensure a quiet and
longer hours Serve prescribed conducive environment to
analgesics enhance sleep

Prescribed IV paracetamol 1g
was administered to relieve
pain.

47
 Date/ Nursing Objective/ Nursing Nursing Date/ Evaluation Sign
Time Diagnosis Outcome Criteria Order Intervention Time
15/12/22 Deficient 1.Patient would acquire Educated more on Patient was more
knowled more knowledge on the condition. enlightened on his
ge appendicitis within condition.
related to Ask patient’s Patient shared his view
45minutes as evidenced
inadequa view on his on his condition.
te by condition.
informati patient verbalizing that . Ask patient Patient questions were
on on questions on his answered in plain
he has received more
condition condition. simple sentence.
knowledge on the disease
condition and nurse Serve patient and Leaflet was served to
observing that patient is family leaflet patient and family.
able to answer at least concerning the . Routinely repetition of
70% of question asked disease condition. teachings was done
on his condition.
Routinely Identification of family
repetition of support was done to
teachings ease pressure for
effective teaching can
Identify family

48
 support take place
Date/ Nursing Objective/ Nursing Nursing Date/ Evaluation Sign
Diagnosi
Time Outcome Criteria Time
s Order Intervention
15/12/22 Risk for Patient will be free from put patient in a Patient was placed in a
infection catheter infection during supine position supine position
related to his stay at the hospital as
urethral Patient urethra orifice
evidenced by was assessed for signs
catheter
in-situ . Assess urethra of infection
a. patient exhibiting a
orifice for signs of
normal urine flow infection Patient vital signs was
assessed
Check patient vital
b. Nurse observing no signs Patient urethra catheter
was cared for
sign of infection as the . Care for patient aseptically
catheter is in situ catheter
aseptically Patient urine was
recorded
Record urine
output Prescribe prophylactic
antibiotic was
Administer administered as
prescribed prescribed
prophylactic
antibiotic.

49
 Date/ Nursing Objective/ Nursing Nursing Date/ Evaluation Sign
Time Diagnosis Outcome Criteria Order Intervention Time
16/12/22 Risk for patient will not Dress the wound Wound was dressed Goal fully met
infection develop any aseptically. with sterile instruments as patient slept
infection within 2. Inspect for and dressings while uninterrupted
related to
3 days as sterility and wearing gloves and face for 8hours.
surgical
evidenced by expired date mask.
incision before opening 2. Ward environment
(wound). a. Observing no supplies and was made clean before
occurrence of instrument. opening supplies and
pus, swelling 3. Monitor the instruments were made
and dehiscence vital signs 4hourly sterile.
throughout the and record. 3. Temperature, pulse,
healing process. 4. Wash hands respiration and blood
before and after pressure were
b. The vital wound dressing. monitored 4hourly and
signs remaining 5. Observe for recorded.
within the signs of infection. 4. Hands were washed
6.Administer before and after every
normal range
procedure.
prescribed 5. Patient was observed
antibiotics and had no infection.
(ciprofloxacin 6. Prescribed
200mg bd). ciprofloxacin 200mg
were administered

50
Date/ Nursing Nursing Nursing Nursing Date/ Evaluation Sign

Time Diagnosis Time

Objective Order Intervention
17/12/22 Risk for Patient will . Ensure proper Mouth care was done by Goal fully met
fluid and maintain oral hygiene brushing of his teeth as patient
normal fluid every morning and wound look
electrolytes
volume and Assess vital signs evening and regular clean and dried
imbalance without signs
electrolytes mouth wash was done.
related to balance within Avoid and remove Patient vital signs was of infection.
vomiting. 48 hours as all nauseous assessed.
evidenced by. substances from . All nauseous
the ward. substances such bed
a. The patient pan, urinal etc. were
maintaining Set up Iv fluids kept at their usual place
normal skin and kept clean.
elasticity and Oxygen was given to
turgor. patient as needed.
b. The patient Administer
maintaining oxygen as needed Normal saline 500ml,
moist mucous dextrose saline 500ml
membrane. and ringers’ lactate
c. Patient 500ml + 20mmol of
confirming the KCL infusion were
absence of given.
vomiting. Monitor and keep Intake and output

51
 input and output records was monitored,
record. kept and balanced.
Date/ Nursing Objective/ Nursing Nursing Date/ Evaluation Sign

Time Diagnosis Time

Outcome Order Intervention
Criteria
17/12/22 Self-care Patient will be 1. Explain 1. Procedure was Goal fully met
deficit assisted to procedure to explained to patient. as patient self-
maintain self- patient. care [bathing]
[bathing]
care (bathing) 2. Privacy was provided was done with
related assistance.
within 2. provide privacy by screening patient
general 45minutes as bedside
body evidence by; 3.Bed bath patient
weakness a. Patient using a sponge, 3. Patient was bathed in
secondary verbalizing, he soap, and water. bed using a sponge,
to surgical has bed bath. soap, and water.
procedure b. Nurse 4. Change patient 4. Patient bed linen was
observing bed linen. changed from side to
(appendicec
patient looking side to promote
tomy neat and well- 5. Groom patient comfort.
groomed in bed. neatly in bed.
5. Patient was groomed
6. Make patient neatly in bed.
comfortable in bed
6. Patient was made to
rest comfortably in bed.

52
 4.0. CHAPTER FOUR

4.1. IMPLEMENTATION OF PATIENT AND FAMILY CARE

In the nursing process, implementing is the phase in which the nurse implements the nursing

interventions. Implementing consist of doing and documenting the activities that are the

specific nursing action needed to carry out the interventions. The nurse performs or delegates

the nursing activities for the intervention that were developed in the planning step and then

concluded the implementing step by recording nursing activities and the resulting patient

responses. (Barbara Kozier et al, 2008).

This chapter constitutes the following;

1) Summary of actual nursing care rendered to patient and family from time of admission till

discharge.

2) Preparation of patient and family for discharge and rehabilitation.

3) Follow ups and home visit and continuity of care.

SUMMARY OF ACTUAL NURSING CARE RENDERED TO PATIENT AND

FAMILY

Day of Admission: 15th of December, 2022

The decision to admit the patient was made on December 15, 2022, and so the patient was

admitted that afternoon around 1500 hrs after being diagnosed with acute appendicitis by Dr.

A of the general surgery one team. Mr. E.A. was wheeled into the ward by a nurse in the

company of two relatives. Seats were offered to them, and the necessary information was

53
taken and documented as needed. The patient was conscious and alert upon admission and

was therefore directed to a room with an already prepared bed for him. The patient and

family were then assured of competent health care and a speedy recovery. On admission, the

patient complained of abdominal pain, was anxious about his condition, had difficulty

sleeping, and had no knowledge of his condition. Observation revealed discomfort—a clear

chest but an abdomen that felt full and soft. There was pain, which was maximal in the right

iliac fossa, tenderness, and diminished bowel sounds. Vital signs were then checked and

recorded as temperature (37.3 °C), blood pressure (125/73 mmHg), pulse (88 bpm), and

respiration (20 cpm). The patient was reassured continually since he expressed feelings of

anxiety and distress and was encouraged to try and take in more fluid diets and drink more

water. The patient was then infused with normal saline (1 L) over a 24-hour period. The

patient was then oriented to the ward environment, made comfortable in bed, and left to have

some sleep. Laboratory tests requested were retrieved when the results were ready, and then

the patient was put on the following medications, which were obtained at the hospital’s

pharmacy unit and administered.

1. Intravenous ciprofloxacin 200mg bd x 24hrs

2. Intravenous metronidazole 500mg tds x24hrs

3. Intravenous paracetamol 500mg tds x24hrs

The following Intravenous fluids was also prescribed for Mr. E.A

1. Ringer lactate 2 litres x 24hrs

2. Normal saline 2 litres x24hrs

3. 5% dextrose saline 2 litres x24hrs

Upon assessment made by doctors on duty, my patient was scheduled for surgery on the next

day. Patient relatives were informed the day of the surgery and my patient was asked not eat

54
anything by mouth. Patient was informed that the surgery was the best solution to his

condition and would also prevent further complications. Patient was introduced to other

patient on the ward who have undergone similar surgeries successfully and are doing well.

SECONDAY ON ADMISSION 16TH DECEMBER, 20222

DAY OF SURGERY

In the morning after I assisted patient to have his warm bed bath with soap and warm water

and successfully brushing of teeth with toothbrush and paste. Patient was made comfortable

in bed. Since he was to go for surgery on this day, pre-operative preparation was made for

him to go through successful surgery. This involves psychological, physiological, physical,

socio-economic and spiritual preparation. This was done to ensure safe surgery, promote

speedy recovery and to prevent post-operative complications.

Preoperative preparations refer to all the preparations given to the patient before surgery.it is

written under five main headings which includes;

Psychological preparation

Physical preparation

Physiological preparation

Socio-economic preparation

Spiritual preparation

55
Psychological preparation

This involves preparing the patient’s mind to allay fears, anxiety, and misconceptions about

the impending surgery. The knowledge level of the patient about his condition and impending

surgery is assessed. The patient is educated based on his existing knowledge. Necessary

information about the need for the patient’s admission and surgery is provided (for example,

complications such as rupture or generalized peritonitis). Since the surgery is likely to elicit

some fears of emotional reactions in the patient, I prepared my patient psychologically to

allay his anxiety and fears. The patient was informed that, due to the diagnosis made on him,

he would undergo planned surgery. The patient and his relatives were reassured that

competent health care would be rendered by qualified professionals who would do their best

to take good care of him. I explained the disease condition to the patient and father and the

need for immediate surgery for him. I also added the preventive measures, complications, and

what could possibly happen if left untreated. All procedures were explained to the patient,

and I educated him on the theater settings, the people he would meet there, and how he would

feel after the surgery so that he would be well prepared for it. I told him that during the

surgery, anesthesia would be administered to him so that he would not feel any sensation of

pain. And also, all post-operative pain will be taken care of by prescribed analgesics. Patients

and relatives were encouraged to ask questions pertaining to the duration of the surgery. I

answered them by telling them that it is a procedure that will take about one to two hours. He

was introduced to other patients who had undergone similar surgery and recovered. Mr. E. A.

was made to sign a consent form, which he gladly did and was witnessed by me. The patient

was prepared. For surgery.

Physical preparation

Physical preparation of the patient includes skin preparation, elimination, nutrition and fluids,

rest, and sleep. I prepared Mr. E.A. A physically by cleaning him from below the chest to the

56
upper thigh and shaving the right lower quadrant. The place was washed with soap and water,

rinsed, and dried with a clean towel, then lathered with soap and water for about 3-5 minutes

and shaved with a razor in strokes. It was rinsed again with water and dried with a sterile

towel. The area was then cleaned with Savlon and covered with a sterile towel. He was

examined for any prosthesis, like dentures, but did not have any. Contrast surgical items like

rings and others were also checked, but he did not have any. A urethral catheter was inserted

and connected to the bag, and I helped him change into his theater gown.

All items needed for the surgery including intravenous infusions, diathermy cable, gauze, and

other medications were packed and labelled with his name together with his consent form and

sent to the theatre. His vital signs were checked and recorded as follows;

Temperature – 37.4 degree Celsius

Pulse-96 beat per minute

Respiration-20 cycles per minute

Blood pressure-127/70 milliliters per mercury

Oxygen saturation-98%

This also served as the immediate baseline vital signs prior to surgery by which any deviation

could be detected and corrected after surgery. Exactly at 1430hrs a telephone call was

received from the theatre to send patient. He was sent and received by the theatre team at

1440hrs with some infusions and the signed consent form.

57
Physiological preparation

This is done to know how the body is functioning it includes laboratory investigations,

nutrition and elimination. Laboratory investigations such as urinalyses, blood for grouping

and cross matching, full blood count and coagulation time are done. Assess patient’s

nutritional status to rule out weight loss or weight gain. Adequate intravenous fluids are

prescribed for the patient to correct fluid and electrolyte balance as well as to maintain

nutritional status.

This was done to ensure that patient was fit and in good health for the surgery. The following

investigations were requested;

 Full blood count

 Blood urea and electrolyte creatine

 Abdominal ultrasound scan which was already done for the patient from the referred

facility which confirms his diagnosis.

The night prior to surgery, patient was advised to suspend taking oral nutrition to prevent

vomiting and aspiration during the surgery. He was also monitored in the morning of the

surgery to ensure that he does not take anything by mouth in order not alter the surgical

process.

Socio-economic preparation

This involves discussing certain socioeconomic problems that may arise with the patient and

family in order to find solution to them. Inquire about patients’ social roles and

responsibilities and address any concerns expressed regarding the effect of his condition on

him and others. Patient didn’t have a valid national health insurance scheme with him in

58
which I explained to him some services the NHIS covers and the once it doesn’t. . However,

his relatives was informed to have enough money on them so that if the need arises, they

could pay. I educate patients relative to recognize the impact of their support on the wellbeing

of the patient. Patient’s perception was addressed, and the cause of his condition.

Spiritual preparation

As part of the pre-operative phase, spiritual preparation of the patient was done as patient was

about to be taken to the theater. The family and I prayed with him for a successful surgery. I

encourage the not to despair but rather put their trust in the Lord and that with him all things

are possible. We also prayed for the surgical team for the operation.

INTRA-OPERATIVE PREPARATION/ OPERATIVE CARE

This begins when the patient arrives at the operation theater and ends when patient is

transferred to the recovery room after the surgical procedure. It involves all intervention to

ensure patient safety throughout the period of the operation. It is done by maintaining high

aseptic methods to prevent any possible complication that may occur during or after surgery.

Providing the surgical team with all the necessary instruments and supplies needed for the

surgery must be done before surgery commences.it must be also ensured that all instrument

provided are in a good condition and functioning properly before surgery commences.

59
Appendectomy was done by Dr. A and assisted by Dr. E.O under general anesthesia. Patient

was put in the supine position, cleaned and sterile draping was done under general anesthesia.

Afterwards patient was intubated to make sure his lungs were well ventilated to prevent lung

collapse after the surgery. Lanz incision was made and used to enter the abdomen, deepened

in layers to peritoneal cavity. Peritoneum tented, appendix identified and mesoappendix

dissected off, clamped and abdomen closed using vicryl 2.0 nylon fascia and nylon 2.0

subenticular stitches fastened. Sterile dressing was applied. The findings were acute inflamed

retrocecal appendix.

Intravenous Ringer’s lactate 1/2litre was used in the theatre. Patient was transferred to the

recovery room. After successfully surgery, Mr. E.A was sent to the recovery ward and when

he gained consciousness, he was sent to the ward to continue with the post-operative

management based on the surgeon's instructions.

IMMEDIATE POST OPERATIVE CARE

The main objective for post-operative nursing care is to assist the patient to recover from

anesthesia and surgery quickly, comfortably and safely as possible. It focuses on recognizing

significant signs and anticipatory complications.

Immediate post-operative condition was semi-conscious. Mr.E.A was nursed in a flawless

position with head turned to one side to facilitate breathing, drain secretions and also prevent

the tongue from falling back as he was semi-conscious and that could block the airway

leading to aspiration of fluid which could be fatal. Patient was given Intravenous Ringer

lactate hanged up dripping at 40 drops per minute. His skin color was observed for cyanosis,

the incisional site was observed for bleeding but it was intact. Vital signs were quarterly

checked for first 1 hour and then every 30 minutes until patient gained consciousness.

Respiration distress and pain were managed and his first vital signs were recorded as follows;

60
 Temperature – 37.5 degree Celsius

Pulse-100 beat per minute

Respiration-20 cycles per minute

Blood pressure-130/70 milliliters per mercury

Oxygen saturation-98%

Repeated for every 15 minutes for the first hour and 30minutes until patient gain

consciousness.

Patient was then transferred to the ward after he had gained consciousness at 2045hrs.

SUBSEQUENT POST OPERATIVE CARE ON THE WARD

Mr. was brought into the ward at 2048hrs via the main theatre after the appendectomy done

by Dr. A and Dr. E.O under general anesthesia given by Alen Boateng. Findings was pre-iliac

appendix with abscess. estimated blood loss 100mls.patient was being managed with; IV

Rocephin 2g dlyx24hrs, IV Metronidazole 500mg tdsx24hrs, IV paracetamol 1g qid x24hrs.

The vital signs were checked again and recorded to compare with the baseline data and was

normal. An observation chart to monitor patient vital signs was prepared and was monitored

quarterly for an hour, 30minutes for two hours, every one hour for 4 hours and then four

hours in a day.

Patient was managed post operatively on the following medications;

1. Intravenous Ringers lactate1 litre for 24 hours.

2. Intravenous 5% dextrose 1 litre for 24 hours.

3. Intravenous ciprofloxacin 200mg 12 hourly for 48 hours.

61
4. Intravenous paracetamol 500mg 8 hourly for 48 hours.

5. Intravenous metronidazole 200mg 8 hourly for 48 hours.

6. Injection morphine 10mg 6 hourly for 24 hours.

Nil per Os until bowel sound is present.

Patient post-operative vital signs on the ward were recorded as;

Temperature – 37.2 degree Celsius

Pulse- 80 beats per minute

Respiration- 20 cycles per minute

Blood pressure- 132/75 milliliters per mercury

Oxygen saturation- 96%

Opiate (morphine 10mg) was served after he has complained of pain at the incisional site and

all procedures carried out on patient were documented. The wound site was inspected for

bleeding but was found to clean and dry. Intravenous 5% dextrose was set up when the

intravenous Ringers lactate finished at 2130hrs.

Since patient had surgical incision, he was at risk of developing infection. Therefore,

appropriate intervention was put in place to help prevent infection at the surgical site.

SECOND DAY ON ADMISSION, 17TH DECEMBER, 2022

FIRST DAY POST-OP SURGERY

Mr. E.A. woke up early in the morning looking worried, as reported by the night nurse, due to

his inability to sleep well due to the pain felt at the incisional site. He was weak and unable to

perform any of the normal daily personal hygiene duties. As a result of this, the patient was

given a warm bed bath with warm water, soap, and a sponge and assisted in brushing his

teeth with a toothbrush and toothpaste. The patient complained that he could not sleep at

62
night due to the pain that resulted from the surgery. The following interventions were

undertaken to enable him to sleep well this night: The patient was reassured that he would be

able to sleep well after the pain subsided. A warm bath was given to induce sleep; the patient

was assisted to assume a supine position to aid in his comfort; nursing interventions like drug

administration were grouped and performed once to avoid waking him up during nighttime

sleep; and prescribed intravenous paracetamol (500 mg) was administered to relieve pain. IV

Metronidazole 500 mg and IV Ciprofloxacin 200 mg were administered as part of the

medication. Still on nil per os, the doctor also ordered to continue all antibiotics, analgesics,

and IV fluid with 20 mmol of KCL to help balance patient fluid and electrolytes and also to

prevent any infection after the surgery. The incisional site was inspected for bleeding and

signs of inflammation, but no abnormalities were detected. The dressing was dry and intact.

Vital signs were checked and recorded as follows:

Temperature - 36.2 degrees Celsius

Pulse - 78 beat per minute

Respiration - 25 cycle per minute

Blood pressure -134/94 mmHg

Spo2 - 98%

In the morning I informed my patient about my first home visit in which he allowed me to,

accompanied by his relatives to help me familiarize myself with my patient’s house. But

before patient was seen vomiting in which he was at risk for fluid and electrolytes imbalance.

Therefore, the appropriates intervention was implemented to help minimize the vomiting. He

also In the morning, I informed my patient about my first home visit, which he allowed me to

do, accompanied by his relatives to help me familiarize myself with his house. But before the

63
patient was seen vomiting, he was at risk for fluid and electrolyte imbalances. Therefore, the

appropriate intervention was implemented to help minimize the vomiting. He also

complained that, due to weakness, he wasn’t able to take his bath as he used to. Complained

that, due to weakness he wasn’t able to take he’s bath as he used to.

THIRD DAY ON ADMISSION 18TH DECEMBER, 2022

SECOND DAY POST-OP SURGERY

Mr. E.A. was feeling well, as his condition is gradually improving. He had a sound sleep

during the night, as confirmed by the night staff. The patient was supported as she sat up on

the bed. He could not care for himself, and therefore some nursing intervention was carried

out to make him comfortable. He was first bed-bathed using warm water, soap, and a sponge,

making sure the wound dressing was not wet by the water. His dirty bed linen was changed

from side to side to promote comfort, and he was nicely groomed and made comfortable in

bed. His vital signs were checked and recorded as

Temperature - 38.0 degrees Celsius

Pulse - 94beat per minute

Respiration - 21 cycle per minute

Blood pressure -138/90 mmHg

Spo2 - 100%

Based on Mr. E. A’s temperature, he was given tepid sponging to help reduce his

temperature, according to one night nurse. which was later rechecked, and the value was 37.2

degrees Celsius. He was advised to splint the incision site when coughing or sneezing to

64
avoid pain and was made to assume a comfortable position. He was seen on ward rounds by

team doctors. He was still to maintain NPO and to hydrate more with 3 litres of IV fluids,

which were 2L 5% DEXTROSE and 1L RINGERS LACTATE + 60 mmol of KCL.He was

put on subcut morphine (5 mg qid x 48 hours). Post-op findings were a pre-illial appendix

with an abscess. 200 ml of frank pus were drained. Mattered edematous small bowel together

with greater omentum estimated blood loss of 100 ml; catheter care was also done to reduce

infection. Mr. E.A. complained of pain at the incisional site. The wound looked clean and

dry, and tenderness at the incisional site was observed. Patient vitals were checked again, and

all medications were served. The patient took his bath and was made comfortable in bed.

FOURTH DAY ON ADMISSION 19TH DECEMBER, 2022

THIRD DAY POST-OP SRGERY

The patient woke up at 0530 hours; he was well and had no complaints. He was able to brush

his teeth, and he was given an assisted bed bath. The patient was able to pass a semi-solid

stool in the morning, and his vital signs were checked and recorded as follows:

Temperature - 36.25 degrees Celsius

Pulse - 78 beat per minute

Respiration - 20 cycle per minute

Blood pressure -132/94 mmHg

Spo2 - 98%

65
Ward doctors came on rounds and requested that Mr. E.A. start oral sips of water and plain

tea and those intravenous fluids be discontinued. The patient's wound was opened by the

surgeon, the wound was healing by first intention, and there was no infection on the surgical

site. My patient’s wound was dressed aseptically with methylated spirit and sterile gauze by

the surgeon, and he requested that the wound be dressed alternatively. IV fluid was

discontinued, and the patient was served liberal fluids. The patient was encouraged to splint

the wound site whenever he coughed or defecated. The patient was served coffee and light

soup for dinner, which he tolerated really well. The patient was assisted to bathe in the

evening, and his bed was straightened. Due to medication, his vital signs were checked and

recorded. The patient decided to listen to music on his phone with his headphone, and he

slept off at about 2100 hrs.

FIVETH DAY ON ADMISSION 20TH DECEMBER, 2022

FOURTH DAY POST-OP SRGERY

Mr. E.A. looked cheerful in the morning, and according to him, he had a sound sleep over the

night and experienced minimal incisional pain. He was supervised to have his bath and

perform his oral hygiene. This was done twice a day, making sure the wound did not get wet.

The vital signs were checked at 6:00 a.m. and were recorded as follows:

Temperature - 37.0 degrees Celsius

Pulse - 80 beat per minute

Respiration - 20 cycle per minute

Blood pressure -125/72 mmHg

66
 Spo2 - 98%

The medications for 0600hrs were also served as prescribed, and are as follows:

IV ciprofloxacin 200mg x 24hrs

IV metronidazole (flagyl) 500 mg tid x 24hrs

IV paracetamol tds x 24hrs

Injection morphine 50 mg 8 hourly PRN.

The bowl sound had returned and was asked to start taking sips of plain tea and water.

He was encouraged to sit up in bed and walked around the bed in order to promote early

ambulation. The doctor in-charge came on ward rounds and ordered previous treatment to be

continued and also wound drain to be removed alongside urethral catheter. He was reassured

of speedy recovery and helped to assume a comfortable position to relieve pain and promote

enough sleep.

The wound at the incision site was observed for redness, swelling, tenderness, and bleeding

but none was observed. The vital signs were checked and recorded in the afternoon and

evening and his prescribed medications was also served. He took his bath and performed his

oral hygiene before retiring to bed.

67
SIXTH DAY ON ADMISSION 21TH DECEMBER, 2022

FIVETH DAY POST-OP SRGERY

Mr. E.A. was already seated on a bed at around 8:00 a.m. when I entered the ward. I helped

him prepare the stuff he needed to bathe. He went to the washroom, took his bath, and

brushed his teeth. He took leap tea, and the prescribed medications were administered. At

1000 hours during ward rounds, the doctor ordered for my patient to be discharged home

since there was no new complaint from him and when he inspected the surgical site, there

were no complications. The doctor then advised my patient and his relatives to go to the

referred hospital for dressing every three days and come for review on January 3, 2023. The

patient was told to report any problem he would encounter to the hospital if the need arose

even before the time for review. I took my patient's hospital card to the records department to

clear his debts, and he needed to pay for some medications that the insurance does not cover.

His relatives settled those bills and took the receipt back to the ward. By the instructions of

my ward-in-charge, I discharge him from the admission and discharge book and the daily

ward state book. I emphasized the need for review and the importance of practicing personal

hygiene. I also advised him on vital issues like keeping the area around the wound dry and

allowing fresh air to circulate the wound area, not lifting heavy objects, and putting the hand

on the incisional site when coughing. He was again educated to always wash his hands with

soap under running water before and after coming into contact with the wound or the area

around it. Taking in nutritious foods like protein foods such as fish, eggs, beans, milk, cheese,

and fruits such as apples, watermelon, pineapples, and green vegetables to help promote

wound healing Drugs that were not used were returned, and he gave those he had to take

home to him and explained how he should take them and indicated the need to do so. The

68
patient and his relatives were told to store the drugs in a cool, dry place and also keep them

out of reach of children.

These drugs include tablets of metronidazole 200 mg three times daily for seven days.

Tablet paracetamol 1 g three times daily for five days.

Tablet Orelox 200 mg twice daily for 7 days.

I asked his relatives to call me anytime if he did not understand anything. Patient belongings

were packed, and they were reminded of the review date. Mr. E.A. and his relatives were

thanked for their cooperation throughout the hospitalization. He said goodbye to other

patients in the room and some nurses who were around. I handed over his review card and

other receipts to his relatives. I escorted them to the taxi rank and bid them goodbye. I

promised them my next home visit would be soon. Their car moved at 1500 hours.

4.2. PREPARATION OF PATIENT TOWARDS DICHARGE AND

REHABILITATION

The preparation of Mr. E.A. and his family toward discharge and rehabilitation started on the

day of admission, December 15, 2022, after there had been the establishment of a good

interpersonal relationship between the healthcare team and the patient and family. On

admission, they were warmly welcomed and reassured that the patient would surely be

discharged within the shortest possible time since his condition was noticed early and due to

the competency of the healthcare team. The main aim of this preparation is to maintain health

and prevent the reoccurrence and onset of complications. The patient and family were

provided with education on the condition, its causes, risk factors, clinical manifestations

(signs and symptoms), complications, and prevention of acute appendicitis. They were further

educated on the treatment regimen and the need to continue treatment even after discharge.

They were also told about the need to make some lifestyle changes to prevent recurrence of

69
the condition. They were told about the review after discharge and why it was necessary to

show themselves to the doctor after discharge. They were encouraged to report any issues,

side effects of medications, or changes to the hospital as soon as they arise. The discharge of

Mr. E.A. occurred on December 21, 2022. He was made aware of his discharge after it was

ordered by the doctor during ward rounds that morning. All entries were done, discharge

papers signed, documentation completed, and then the hospital bill was obtained from the

accounts office after prescribed medications were retrieved. Payment of the bill was then

made, and they expressed their gratitude to the healthcare team as they were leaving. I then

made them aware of my next visit, which was to happen on December 28, 2022.

4.3. EXIST INTERVIEW WAS CARRIED OUT

On the account of patient discharge, an interview was carried out with the patient with the

aim of getting information as to how he is feeling as he is being discharged and problems he

would like to address before he leaves, which may include services provided, facility

equipment, food that was provided, etc. The patient was able to give a detailed account of his

existence.

70
 4.4. FOLLOW UP /HOME VISIT /CONTINUITY OF CARE

Home visit section of the patient and family care study is made by the health personnel to

familiarize him or herself with the patient’s home conditions. It is very important because;

1. It allows for continuity of care at home.

2. It also helps the nurse to know the progress of patient health after discharge.

3. It also offers the chance to see the real situation of the patient, at home and check on

pieces of advice giving.

4. It also helps the health professional to Identify some problems that which might

contributed to the occurrence of the patient condition.

5. It also helps the health professional to know whether the health education given during

the hospitalization and on discharge were effective.

FIRST HOME VISIT

I made my first visit to Mr. E.A.'s home for the first time on December 17, 2022. while he

was still on admission. I went there with his relatives. My aim was to familiarize myself with

the direction to the area, which will help me in my next visit, and to identify problems that

may be detrimental to patient health after discharge and correct them before his arrival. We

boarded the car from the 37-taxi rank, which was a taxi to Kasoa, Big Apple. straight I was

welcomed by Mrs. F.A., who offered me a seat and introduced me to his children, although

his children do not reside in the same house with them. My patient and his wife live in a four-

71
bedroom self-contained hall with a kitchen and bathroom inside the room. They have a

private toilet in the rooms. The house is built with cement and topped with aluminum

sheeting. It is painted blue, and it has a tiled part from the lower part of the house to the floor

of the house compound. Their sources of water supply are piped water, which they store in a

reservoir, and they also store some in a small polyethylene tank. Electricity is their source of

light, and they use rechargeable lamps when there are power outages. An inspection was

made, and it was realized that their compound was well swept and clean. The trash was kept

in a dustbin, which was later emptied into the main refuse container. They have no gutters in

front of the house, but they also have all of their sewage water connected to a well-

constructed well that collects all their sewage water. They took me around the house to learn

much about the surrounding area. After going around the house, I congratulated them for

keeping the house clean and their environment neat. I suggested to them that the mini farm

that they have on their compound should be weeded and cleared off. I told them that if not

done, it may serve as a breeding ground for mosquitoes and also attract flies, which may

predispose them to malaria, cholera, and typhoid fever. I educated them to always cover the

trash can after using it. I also advised them to protect themselves from mosquito bites by

using treated mosquito nets, sprays, or coils in order to prevent malaria. I thanked them for

their cooperation, asked permission to leave, and promised to visit again when Mr. E.A. had

been discharged from the hospital.

72
SECOND HOME VISIT

My second home visit to my patient's house was on December 28, 2022. At 1300hrs. On

arrival, they welcomed me warmly, and my mission was made known to them. This visit was

embarked upon to remind the patient of the review date, to also remind them of the date on

which the stitches will be removed, which will be on December 31, 2022, to assess his health

status and find out whether he was taking the medication, abiding by the instructions given to

him, rendering necessary health education, and to remind them of possible termination of

care during the third visit. I inspected his wound for bleeding and discharges, but it was well

kept; no signs of infection were observed, and the sutures were also inspected for

complications like broken sutures, loose sutures, imminent wound dehiscence, etc., but

neither of these were present. At that time, the patient was already done with his discharged

medications, and I realized that the patient and family were complying with the instructions

given. I observed that the patient was well and looked cheerful. No concern was raised by the

patient and his family, and he had been going for his three-day dressing of the wound at the

St. Grogery hospital at Liberian Champ at Kasoa. The patient was asked to report to any

hospital available for his subsequent wound dressing and also to report any health problems

that may arise. I congratulated the patient and family and encouraged them to continue with

the practice. I stressed keeping the wound dry at all times and advised him on the benefits of

eating vitamin C-rich fruit and green leafy vegetables such as kontomire, garden egg leaf, and

more. The patient was once again reminded of the routine intake of medication as prescribed

by the doctor, and again the importance of maintaining good hygiene was emphasized.

Before I left the house, I reminded them again about the review date, which will be January 3,

2023, and informed them of my third visit. I made them aware that it would be the last one to

their house. on the 31st of December, 2022. Mr. E.A. came to Tamakloe Ward at 7:30 a.m.,

73
which was on a Saturday. He was seen by Dr. A, who assessed his wound and ordered suture

removal. The suture was removed by staff nurse P under an aseptic technique. Five stitches

were removed and counted. The patient's wound was redressed, and she was told not to forget

the review date.

4.5. REVIEW DATE 3RD JANUARY, 2022

On January 3, 2022, the patient was in for review by Dr. B. at 0945 hrs. in the outpatient

consulting room with his wife. The patient had no complaints, and the site of the incision

showed no sign of infection. The patient's wound was healing well by first intention, and he

was told to report to the hospital if he was not feeling well. Stitches were already removed;

the patient's wound was secured lightly, and he was seen off to the taxi rank. The patient was

reminded of the last visit that would terminate care from me to him, and then we bid farewell

to each other.

THIRD HOME VISIT

My third home visit to Mr. E.A. was undertaken on January 10, 2023, at 6:00 a.m. with the

aim of enquiring about the patient’s health and showing my appreciation to him and his

family for their cooperation throughout the study. On arrival, I was welcomed as usual and

74
offered a seat. We discussed the review that they went for the previous Tuesday, the results of

the laboratory investigations, and what the doctor has said so far about the patient’s health

status. Patient review took place on January 3, 2023. My patient called me when they arrived

at the hospital, and I gladly went to meet them, accompany them, and provide my help as and

when needed. On review, the need for continuity of care was stressed, and so with that, St.

Grogery Hospital Liberian Champ at Kasoa was recommended since it was closer to them, or

better yet, they could visit 37 military hospitals again. I congratulated my patient and his wife

for the active work done to help my patient quickly recover and achieve optimum health. I

once again expressed my utmost congratulations on their active work in helping my patient

recover fully. The patient’s wife requested education on acute appendicitis disease, which I

readily gave her with additional information to add to what she already knew. They were

appreciated for their cooperation and active participation during the study, as I told them that

the home visit was officially over but I would visit them anytime I came around. I then

assured them of my support whenever they needed it. I requested permission to leave after

about 2 hours and was then escorted as usual to the roadside, where I bid them farewell and

took my leave at exactly 1700 hrs.

75
 5.0. CHAPTER FIVE

5.1. EVALUATION OF CARE RENDERED TO

PATIENT/FAMILY

To evaluate is to judge or to appraise. Evaluating is the fifth and last phase of the nursing

process. In this context, evaluating is a planned, ongoing, purposeful activity in which

patients and healthcare professionals determine (a) the patient’s progress toward achievement

of goals / outcomes and (b) the effectiveness of the nursing care plan. Evaluation is an

important aspect of the nursing process because conclusions drawn from the evaluation

determine whether the nursing interventions should be terminated, continued or changed.

(Barbara Kozier et al, 2008).

5.2. STATEMENT OF EVALUATION

Mr. E.A. received competent nursing care throughout his stay in the hospital, with seven

nursing diagnoses formulated and objectives set to achieve them. On December 15, 2022, the

patient complained of pain at the right iliac fossa. An objective was set that the patient would

be relieved of right iliac pain within 2–3 hours. Upon evaluation, the objective was fully met

as the patient verbalized that the pain had subsided and the patient's pain was seen to be less

than 7 on the pain rating scale. The patient was also seen to be anxious, and other objectives

were set that the patient would be relieved of anxiety within 45 minutes, as evidenced by the

patient verbalizing his readiness for the surgery. The patient was also seen to be calm and

ready for the surgery. The patient also added on December 15, 2022, that he could not sleep,

and another objective was set that the patient would resume his normal sleep pattern within

76
24 hours of hospitalization, as evidenced by the nurse's observation that patient sleep was

uninterrupted for 6 to 8 hours at night and the patient's verbalization that he was able to sleep

for longer hours. Upon assessing the patient based on his level of knowledge of the condition,

the patient had no knowledge of the condition. Another objective was set that the patient

would acquire more knowledge about appendicitis within 45 minutes, as evidenced by the

patient verbalizing that he has received more knowledge on the disease condition and the

nurse observing that the patient is able to answer at least 70% of the questions asked about

his condition. Finally, on that same day, the patient had a urethra catheter on, and an

objective was set that the patient would be free from catheter infection during his stay at the

hospital, as evidenced by the patient exhibiting a normal urine flow and the nurse observing

no sign of infection as the catheter was in situ. On the second day of admission, on December

16, 2022, which was also the day of surgery, After the surgery, the patient complained of pain

at the incisional site, also complained of difficulty sleeping because of pain at the incisional

site, and lastly, the patient also had a wound at the right iliac region. On evaluation,

objectives that were set for the patient were fully met as patient pain subsided and the

patient's normal pattern of sleep was restored, while the patient's wound will be free from

infection within 3 days as evidenced by no signs of occurrence of pus, swelling, or

dehiscence throughout the healing process, along with patient vital signs remaining within the

normal range. on the 17th of December, 2022. The patient was seen vomiting. An objective

was set that the patient would maintain normal fluid volume and electrolyte balance within 48

hours, as evidenced by the patient maintaining normal skin elasticity and turgor, a moist

mucous membrane, and verbalizing the absence of vomiting.

77
 5.3. AMENDMENT OF NURSING CARE PLAN

This is done for unmet or partially achieved goals. This is an act of modifying the

interventions put in place or extending the time period for unrealized goals to be successfully

achieved.

There was no amendment of the care plan throughout the nursing of Mr. E. A. since all the

goals or objectives set were fully met due to the competent nursing and medical care rendered

and the support he received from the family in his ailment.

5.4. TERMINATION OF CARE

Termination of care focuses on bringing the care rendered to the patient to a successful end. It

involves the gradual withdrawal of the services and visits given to the patient and family. The

care of Mr. E.A. was officially terminated on January 10, 2023, on my last home visit to my

patient’s house. Patient and family were already informed of my termination of care during

the second home visit, so it wasn’t a surprise to them when I officially declared it on my last

home visit, which happened to be that very day, which was Tuesday, January 10, 2023. I

expressed my sincerest gratitude for their cooperation and support and for allowing me to use

them for my study. My patient looked healthier and more cheerful. I told them to report

promptly to the hospital if they noticed any abnormalities or unusual happenings. They were

also given additional education on acute appendicitis and its related causes before leaving.

They also expressed their gratitude to me for my care and support during the study, and I also

thanked them for making my study a success. I assured them of my continual support and

encouraged them to get in touch with me if need be. I then departed.

5.5. SUMMARY

This is a brief description of the whole work done, organized chapter by chapter. The nursing

care study is a documentary on the nursing care rendered to Mr. E.A., a 57-year-old man who

78
was admitted to the Surgical Medical Tamakloe of the 37 Military Hospital on December 15,

2022, based on the diagnosis of acute appendicitis. On admission, he looked ill and was in

pain, but with good management, a competent healthcare team, and effective nursing care,

together with active support from the patient’s family, his condition improved satisfactorily.

His stay in the ward lasted for five days, from December 15 to December 21, 2022. He was

discharged without any complications. He looked healthier and more cheerful on the day of

discharge. Chapter one deals with the assessment of the patient, in which information about

the patient was collected and compiled to arrive at diagnosing the patient’s condition. It also

focuses on the patient’s condition as documented in the literature. This literature review on

the condition included a definition of the condition, its causes, incidence, pathophysiology,

clinical manifestations, diagnostic investigations, complications, treatment and management

modalities, and prevention of the condition. and ended with the validation of the information

obtained from the patient to confirm if it was correct or contained errors. Chapter two deals

with the analysis of the data obtained in the assessment of the patient and focuses on the

comparison of the information obtained from the patient on the condition with standard

documented information on the condition, the identification of the patient’s health problems,

and then the patient's and family's strengths. And then, lastly, generated nursing diagnoses for

the identified problems that are to serve as a guide for the plan of care. Problems identified

for my patient were: severe abdominal pain at the right iliac fossa; risk for deficient fluid

volume; anxiety; impaired sleeping pattern; knowledge deficit; risk for infection; and

knowledge deficit on condition. Chapter three deals with the plan of care. Here, objectives,

goals, or aims are set that are expected to be achieved within a set time frame to complete the

care. Achievement of these objectives signified the solving of the patient’s problems, which

are determinants of whether the patient can be discharged or not. For my patient, all goals

that were set were duly met within the specified time periods. In Chapter 4, the interventions

79
ordered to be done are implemented or put into action for the realization of the set goals. All

interventions were implemented successfully and exactly as ordered to achieve the goals set.

Daily care for the patient was stated, and three home visits were done for the patient to check

on his condition and progress after discharge. The last chapter, Chapter 5, evaluated the total

nursing care that was given to the patient. Goals set were analyzed to ensure their

achievement, while unmet goals (of which there were none in my patient’s case) were

amended. The care was also terminated after three home visits, and the patient's and family’s

satisfaction level were evaluated and found to be very pleasing. The patient and family were

given various educations, including education on the condition, acute appendicitis,

medications, and lifestyle modifications.

5.6. CONCLUSION

This study has really enlightened me on the process of healthcare delivery, the use of

therapeutic communication in patient interaction, and the use of the nursing process in patient

care. It has helped me, the student nurse, to have much insight and a broader idea of the

patients’ condition, so as to prepare me to be able to manage and handle similar conditions in

the work field. It has also enhanced the development of good interpersonal relationships

between myself, the patient or family, and the community, not forgetting the entire health

team as I looked for information from place to place, which is a vital and fundamental tool

for good health care. Again, it has prepared me, the student nurse, to take initiatives in

emergency conditions that may come my way by using the nursing process approach as a

guide and the ability to prioritize problems in the healthcare setting. This care study really

helped me apply the theoretical knowledge imparted to me by tutors at the Nursing and

80
Midwifery Training College, 37 Military, and sharpen my research skills and techniques. The

patient- or family-centered care study is that aspect of nursing and midwifery training that

incorporates the application of all the theoretical knowledge that the student gains in college

even before they get to the working field. This helps prepare the student nurse or midwife for

a principled and responsible working experience once the student graduates. It also prepares

the student nurse or midwife to completely take charge of a patient and be responsible for the

patient's wellbeing.

81
 BIBLIOGRAPHY

Hinkle, J. L., & Cheever, K. H. (2016). Brunner & Suddarth's textbook of

medical-surgical nursing (Edition 13.).

Kumar, V., Abbas, A. K., & Aster, J. C. (2017). Robbins Basic Pathology (10th ed.). Elsevier

Health Sciences Division.

Waugh, A. & Grant, A. (2018). Ross and Wilson Anatomy and Physiology in
health and illness (Edition 13)

Herdman, H. T., & Kamitsuru, S. (2021). NANDA International nursing

diagnoses: definitions & classification 2021-2023: Thieme.

George Burkitt .H et al, (2007). Essential surgery problems, diagnosis and

management (edition 4). Church Hill Livingstone Elsevier

Caroline keyzer &Pierre Alain Gevenois (2011). Imaging of appendicitis in

adult and children E-Book: Springer Science

Barbara K et al. (2008). Assessment as part of the nursing process.

Fundamentals Of Nursing.1,141-153.

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83
 SIGNATORIES

NAME OF STUDENT: ……………………………………………….

SIGNATURE: ………………………………………………………....

DATE: ………………………………………………………………….

NAME OF SUPERVISOR: …………………………………………...

RANK: …………………………………………………………………

SIGNATURE: …………………………………………………………

DATE: ………………………………………………………………….

NAME OF PRINCIPAL: …………………………………………….

SIGNATURE: …………………………………………………………

84
DATE: ………………………………………………………………….

STAMP: ……………………………………………………………….

85
DATE AND TIME KIND OF DOSAGE DATE AND SPECIMEN REMARKS OR
FLUIDS TIME COLOUR
15/12/22 IV cipro 200ml 15/12/22 Urine
IV metro 100ml 700ml Amber
IV Dextrose 500ml
Saline Urine
IV Dextrose 500 550ml Amber
Saline 1000ml
100
Iv p’mol 100

TOTAL 1400mL TOTAL 1650ml

BALANCE=INTAKE-
OUTPUT
=1400-1650
=250ml

i
16/12/22 16/12/22
Normal Saline 500ml Urine Amber Colour
Dextrose Saline 500ml 650ml
Ringers Lactate x 2500ml
5 450

IV metro x 2 200ml

TOTAL 3700ml TOTAL 1100ML

BALANCE= INTAKE – OUTPUT

= 3700 - 1100
= 2,600ml
DATE AND TIME KIND OF DOSAGE DATE AND SPECIMEN REMARKS OR
FLUIDS TIME COLOUR

ii
17/12/22 17/12/22
Dextrose 5% 500ml Urine Amber
Dextrose 505ml 750ml
Saline+10mmol kcl Urine Amber
Ringer Lactate 400ml
+20mmol kcl 510ml Urine Amber
Ringer lactate 500ml
+20mmol kcl 510
5% dextrose
500

TOTAL 2525ml TOTAL 1650ml

BALANCE = INTAKE-OUTPUT
= 2525-1650
= 875ML

iii
18/12/22 18/12/22
Dextrose 5% 510ml Urine Amber
+20mmol kcl 350
Dextrose 5% 510ml Urine Amber
+20mmol kcl 400ml
Ringer Lactate 500ml Urine Amber
Dextrose 5% 250ml
500ml
Dextrose 5% 510ml

TOTAL 2530ml TOTAL 1000ml

BALANCE = INTAKE-OUTPUT
= 2530-1000
= 780ml

iv