CHAPTER I

INTRODUCTION

The appendix is a thin tube that is joined to the large intestine. It sits in the lower right
part of your belly (abdomen). When you are a young child, your appendix is a working part of
your immune system, which helps your body to fight disease. When you are older, your appendix
stops doing this and other parts of your body keep helping to fight infection. As stated by
Cappiello, C. (2019) Appendicitis happens when the inside of your appendix is blocked.
Appendicitis may be caused by various infections such as virus, bacteria, or parasites, in your
digestive tract. Or it may happen when the tube that joins your large intestine and appendix is
blocked or trapped by stool. Sometimes tumors can cause appendicitis. John Hopkins Medicine
(2016) explains that the appendix then becomes sore and swollen. The blood supply to the
appendix stops as the swelling and soreness get worse. Without enough blood flow, the appendix
starts to die. Appendicitis can be diagnosed with the use or with the aid of Blood tests, Urine
tests, Abdominal ultrasound, CT scan, MRI.

According to Craig, S. (2022) appendicitis as an inflammation of the inner lining of the

vermiform appendix that spreads to its other parts. This condition is a common and urgent
surgical illness with protean manifestations, generous overlap with other clinical syndromes, and
significant morbidity, which increases with diagnostic delay. In fact, despite diagnostic and
therapeutic advancement in medicine, appendicitis remains a clinical emergency and is one of
the more common causes of acute abdominal pain. No single sign, symptom, or diagnostic test
accurately confirms the diagnosis of appendiceal inflammation in all cases, and the classic
history of anorexia and periumbilical pain followed by nausea, right lower quadrant (RLQ) pain,
and vomiting occurs in only 50% of cases (Park, K. B., Hong, J., Moon, J. Y., Jung, J., Seo, H.
S., 2022)

According to World Life Expectancy (2022), Appendicitis affects 1 in 1,000 people living
in the U.S. Most cases of appendicitis happen to people between the ages of 10 and 30 years.
Having a family history of appendicitis may raise your risk, especially if you are a man. For a
child, having cystic fibrosis also seems to raise the risk of getting appendicitis.

In the last few years, a decrease in frequency of appendicitis in Western countries has
been reported, which may be related to changes in dietary fiber intake. In fact, the higher
incidence of appendicitis is believed to be related to poor fiber intake in such countries. There is
a slight male preponderance of 3:2 in teenagers and young adults; in adults, the incidence of
appendicitis is approximately 1.4 times greater in men than in women. (Park, K. B., et al., 2022)
The incidence of primary appendectomy is approximately equal in both sexes. The incidence of

1
appendicitis gradually rises from birth, peaks in the late teen years, and gradually declines in the
geriatric years. The mean age when appendicitis occurs in the pediatric population is 6-10 years.
Lymphoid hyperplasia is observed more often among infants and adults and is responsible for the
increased incidence of appendicitis in these age groups. Younger children have a higher rate of
perforation, with reported rates of 50-85%. The median age at appendectomy is 22 years.
Although rare, neonatal and even prenatal appendicitis have been reported. Clinicians must
maintain a high index of suspicion in all age groups.

In Asian and African countries, the incidence of acute appendicitis is probably lower
because of the dietary habits of the inhabitants of these geographic areas (Craig, 2022). The
incidence of appendicitis is lower in cultures with a higher intake of dietary fiber. Dietary fiber is
thought to decrease the viscosity of feces, decrease bowel transit time, and discourage formation
of fecaliths, which predispose individuals to obstructions of the appendiceal lumen. According to
the latest WHO data published in 2020 Appendicitis Deaths in Philippines reached 276 or 0.04%
of total deaths. The age adjusted Death Rate is 0.32 per 100,000 of population ranks Philippines
#92 in the world. A study conducted by Dr. Caballes which encompasses 1501 cases, it resulted
to the study's subjects predominantly fell within the category of young adults, with a noteworthy
prevalence of males. Their living arrangements leaned towards non-private accommodations.
The research made a curious observation concerning Emergency Department (ED) wait times.
However, this intriguing finding was limited to a subset of cases with available symptom onset
data, primarily involving patients in non-private accommodations.
Initially, the prevailing belief was that most patients presented with non-complicated
appendicitis (CA). Yet, during surgical procedures, a surprising twist emerged. A substantial
portion of cases, initially suspected to be non-CA, were, in fact, diagnosed with CA during
surgery.
Among the subset of patients who exhibited acute surgical abdomen symptoms but
received different diagnoses, a staggering 77% grappled with intestinal obstruction. The origins
of these obstructions were multifaceted, ranging from malignancies to tuberculosis. The
remaining 23% of cases fell into the realm of other inflammatory conditions, encompassing
ailments such as cholecystitis and pancreatitis.

2
CHAPTER II
OBJECTIVES

3
 CHAPTER III
PATIENT’S DATA

PATIENT CASE PRESENTATION

A. Patient’s Profile
Name: Patient S.
Age: 31
Sex: Male
Civil Status: Single
Religion: Roman Catholic
Ward and Room Number: Room spr6, bed no. 2
Occupation: Slaughter (butchering of meal)
Address: P. Star apple ZONE 1, Digos city
Date of Admission on ER: 09/20/2023
Chief complaint/s: A 31 year’s old male presented to the Emergency department on September
20, 2023 with a Chief complaint of (Right lower quadrant) RLQ pain
Blood Pressure- 120/56 mmHg
Pulse Rate- 60 beats per minute
Respiratory Rate- 21 cycles per minute
Temperature- 36.1°C
Oxygen Saturation- 99%
Admitting Diagnosis: ACUTE APPENDICITIS
Final Diagnosis: ACUTE APPENDICITIS
Attending Physician: (only physician’s signature)
Source of Information: Case No.: 498895/ Himself

4
 CHAPTER IV
FAMILY BACKGROUND/HEALTH HISTORY (GENOGRAM)

Family Health History

Grandfather Grandmother Grandfather Grandmother

No history of No history of No history of

Hypertension
illness illness illness

Father Mother

No history of
illness Hypertension

Patient S.

Acute
Appendicitis

5
Client’s Health History

Patent X, a 31 year old family man who works at a slaughter house together with his
wife. As he loves to travel, so is his passion for the outdoors, he would often go out with an
organization he joined where they travel as a group with their motor bikes. His wife witnessed
that he was a hardworking man, he would or they would deliver fruits for their clients wherever
and would be selling fruits at their fruit stand at the market. They had a child together and is now
three years old, they've been together for 10 years already. He also go to the gym about thrice a
week even with his tight schedule for the week. Asking if he could recall his family history of
illnesses, he said that he couldn't recall his parent's past illnesses on his father's side but he said
that his grandfather on his mother's side had some history of hypertension. He confessed that
they wouldn't have time to make meals for them for their work's on a tight schedule already so
they would usually opt for an alternative which were fast food restaurants they would just order
things out and call it a meal, they also were a heavy consumer of carbonated beverages they
would just miss a day or two without consuming one the rest were their regular days with those.
Prior to his admission and surgery, he complained of some abdominal pain at the right side of his
abdomen for three days and progressed as days passed, with his admission he reported a pain
with a rating of 8 out of 10 with ten being the highest. He also had a history of 1 (one) day
history of RLQ pain associated with anorexia. His wife persisted him to have him checked up to
spell out or make out of what is happening to him. The result came, and the patient was later.
diagnosed with Acute Appendicitis.
Effects/Expectation of Illness on Self/Family
The patient's family, as well as himself, are all concerned about the patient's current
health status, knowing of his lack of knowledge could lead to complications. Taken into
consideration that he had no history of any kind of as serious as this condition it was a health
scare for them definitely. This current patient's health situation put them on a test as a family, but
they remained positive regarding this matter.

6
 CHAPTER V
DEVELOPMENTAL DATA

ERICKSON’S PSYCHOSOCIAL DEVELOPMENT THEORY

RESULT AND
THEORY STAGES
JUSTIFICATION
Erikson's theory, During this Generative vs. Stagnation The patient had reached this
stage. Individuals begin to (31 y.o) stage as he participate a role in
reflect on their life the society, raised his child and
experiences and became a father to his son, and
accomplishments and may During this stage, middle- man to his partner, reflected
experienced a desire to give aged adults strive to create with his decisions and tending
back to society. And to or nurture things that will for the future of the new
practice generativity is by outlast them, often by generations past him.
teaching and monitoring. parenting children or

However, struggling with fostering positive changes

generativity may feel sense that benefit others. At this
of stagnation. stage of life, individuals are
pulled in all directions with
work, family obligations,
and children. Depending on
their individual situation,
they may be taking care of
elderly parents, or facing an
emptyness. These are
moments of great change
and transformation. This
stage of life can open doors
to individual’s sense of

7
 belonging and contribution
to the next generation.

PIAGET’S THEORY OF COGNITIVE DEVELOPMENT

RESULT AND
THEORY STAGES
JUSTIFICATION
Jean Piaget's theory of Formal Operational Stages
cognitive development (Ages 12 and up)
The patient is able to think
suggests that individuals
abstractly and reasonably but
move through four different
he can also be incongruent with
stages of learning. His theory The formal operational
his decision making that he
focuses not only on stage begins at
would compromise his health.
understanding how approximately twelve and
Suppression is his adversary.
individuals acquire lasts into adulthood. The
knowledge, but on ability to use deductive
also
understanding the nature of reasoning, and an

intelligence grows and understanding of abstract

develops through a series of ideas. At this point,
stages. adolescents and young
adults become capable of
The goal of the theory is to
seeing multiple potential
explain the mechanisms and
solutions to problems and
processes by which the
think more scientifically
infant, and then the child,
about the world around
develops into an individual
them.
who can reason and think
using hypotheses.

HAVIGHURST’S THEORY OF DEVELOPMENT

8
 RESULT AND
THEORY STAGES
JUSTIFICATION
Havighurst's theory of Early adulthood 18-35 At this point, the patient
development stated that years old (31 y.o) acknowledged living with her
change and growth are partner for 10 years and having
continuous throughout the a wonderful son. He work
entire life, from birth through This stage is the time of everyday as a butcher, driver
death. He distinguishes them life of early adulthood. and a fruit vendor just to suffice
into three stages, and people During this stage the needs and wants of his
can move from one stage to we need to choose a life family.
the next by solving problems partner, establish a family,
or passing developmental take care of a home and
tasks. It is important to keep lastly to establish a career
mind that development is
continuous throughout a
person’s entire lifesplan,
occuring in stages.

SIGMUND FREUD THEORY

RESULT AND
THEORY STAGES
JUSTIFICATION
Sigmund freud theory Genital Stage (Puberty to The patient had reached and
suggests that human Adult) fulfilled this phase, he was in a
behavior is influenced by relationship with his partner for
unconscious memories, almost ten (10) years, and they
thoughts, and urges. This Beginning at puberty and had conceived their one and
theory also proposes that the lasting into adulthood. only child which was their son.
psyche comprises three During this stage, the libido
aspects. The id, ego, and re-emerges after its latent
superego. The id is entirely period and is directed

9
unconscious, the ego towards peers of the other
operates in the conscious sex, marking the onset of
mind and superego is the mature adult sexuality. This
component of personality stage, individual start to
composed of the internalized become sexually mature
ideals that we have acquired and begin to explore their
from our parents and sexual feelings and desires
society. more maturely and
responsibly.

10
 CHAPTER VI

DEFINITION COMPLETE DIAGNOSIS

An acute inflammation of the vermiform appendix is known as acute appendicitis. Most

likely as a result of appendix lumen occlusion. Appendicitis may result from gastrointestinal tract

infections such viruses, bacteria, or parasites and in some cases, appendicitis can be diagnosed or

occurs when there is a presence of fecalith and trauma. Your large intestine, located on the lower

right side of the body, extends a three and half inch. long tube of tissue. It can occur with any

fever-related symptoms, anorexia, nausea, vomiting, or an increase in neutrophil count.

The diagnosis of acute appendicitis is aided by information obtained from the history,

physical exam, and laboratory tests. The greatest symptoms to rule out acute appendicitis in

adults are right lower quadrant pain, abdominal rigidity, and peri umbilical pain spreading to the

right lower quadrant.

Physical Examination

- - Is a test to look for pain in the area of the lower right side of the abdomen that the

appendix located. The painful spot is being softly pressured. When the doctor softly

presses on the abdomen above the area of discomfort and then pushes and releases his

hand, there is typically moderate to severe tenderness in the right lower quadrant.

Complete Blood Count

- The CBC is a cost-effective and easily accessible test. It provides fast results and can be

used in the diagnosis of appendicitis. The blood test which may show if you have an

elevated white blood cell count as a sign of infection. In early appendicitis, before

infection sets in, it can be normal but most often there is at least mild elevation even

11
 early. Leukocyte count and NLR appear to be more accurate inflammatory markers in

acute appendicitis and can be helpful. Additionally, a laboratory test for acute

appendicitis was performed using neutrophil ratio. An increased neutrophil ratio has been

identified as a reliable diagnostic indicator for acute appendicitis in a retrospective

analysis.

Urinalysis

- Is a microscopic examination of the urine that detects red blood cells, white blood cells

and bacteria in the urine. Urinalysis is abnormal when there is inflammation or stones in

the kidney bladder. The urinalysis also may be abnormal with appendicitis because the

appendix lies near the ureter and bladder.

CT Scan

- CT technique is best, the accuracy rate of CT scanning is between 93 and 98 percent.

Disadvantages of CT include radiation exposure, cost, and possible complications from

contrast media. (CT) may help lower the rate of false-negative appendicitis diagnoses,

reduce morbidity from perforation, and lower hospital expenses. Abdominal CT is a well-

established technique in the study of acute abdominal pain and has shown high sensitivity

and specificity for diagnosing and differentiating appendicitis, providing an accurate

diagnosis in the early stages of disease.

Ultrasound

- - Although highly operator dependent and challenging in patients with a big body habitus,

ultrasonography is safe and widely available, with accuracy rates between 71 and 97

percent.

12
MRI

- When accessible, MRI is advised as the second-line modality for pregnant patients with

suspected acute appendicitis 14, 15. There are several different protocols, but the

majority contain three-plane imaging with a quickly recorded sequence and T2

weighting, and some also incorporate T2 fat-suppressed imaging. With luminal distension

and broadening, wall thickening, and periappendiceal free fluid, MRI results are similar

to those of other modalities.

13
 CHAPTER VII
DEFINITION OF MEDICAL TERMS
Appendicitis - is a medical condition that involves inflammation of the appendix, a small,
finger-shaped pouch of tissue located on the lower right side of the abdomen. This inflammation
can be caused by various factors, including infection, blockage, or inflammation of the appendix
itself.

Hyperplasia - a medical term used to describe an increase in the number of cells within an organ
or tissue, resulting in an enlargement or thickening of that tissue. This growth occurs because of
an excessive proliferation of cells in response to various stimuli or triggers.

Fecaliths- is a small, hardened mass or stone-like object made up of feces (stool) and other
materials that can develop within the colon or the appendix.

Dietary Fiber- is a type of carbohydrate found in plant-based foods that the human body cannot
digest or absorb.

Appendectomy- is a surgical procedure performed to remove the appendix, a small, finger-

shaped organ located in the lower right side of the abdomen. This procedure is commonly done
as an emergency surgery to treat appendicitis, a condition in which the appendix becomes
inflamed and infected.

Anorexia- is a serious and potentially life-threatening eating disorder characterized by an intense

fear of gaining weight and a distorted body image that leads to restrictive eating, extreme
thinness, and a preoccupation with food, weight, and body shape.

Necrosis- is a type of cell death that occurs as a result of irreversible damage to cells and tissues,
often due to injury, infection, or insufficient blood supply (ischemia).

Peritonitis- is a serious medical condition characterized by inflammation of the peritoneum, the

thin membrane that lines the inner wall of the abdominal cavity and covers most of the
abdominal organs.

14
Gastrointestinal Tract- also known as the digestive tract or alimentary canal, is a long tube-like
structure that extends from the mouth to the anus. It is responsible for the digestion and
absorption of food and the elimination of waste from the body.

15
 CHAPTER VIII
PHYSICAL ASSESSMENT

PARTS ASSESSMENT

HEAD/FACE Inspect: Symmetric facial feature.

Palpate: No masses and lesions noted.

HAIR Inspect: Black in Color. No dandruff.

Palpate: Not oily hair.

EYES Inspect: Brown in color appearance. Pupil is

not reactive to light.

NOSE Inspect: Symmetric. No discharges and no

tenderness in the nose noted.
Palpate: No tenderness noted.

THROAT Inspect: No visible mass, no swelling, and

lesion noted.
Palpate: No tenderness noted.

MOUTH Inspect: Lips were brown in color and the

outer lips were dry and teeth were yellowish.

SKIN Inspect: Dry skin and has no pigment

appearance. (-) edema. No lesion.
Palpate: Warm skin.

NAILBED Inspect: The color is a pale sort of pink.

Palpate: Capillary refill of 2 seconds.

CHEST/THORAX Inspect: Chest symmetric

Palpate: Temperature warm to touch. No
masses noted.
Auscultate: HR: 86 bpm RR: 21 bpm
BP: 120/90 mmHg (September 25, 2023)

CARDIOVASCULAR Inspect: Patient having normal breathing (+)

Palpate: Skin is Pallor
Auscultate: Normal Breathing sounds during
a heartbeat.

16
ABDOMEN Inspect: No abdominal distention noted.
Palpate: Normal bowel sounds noted.
Auscultate: No masses noted.

17
 CHAPTER IX
ANATOMY AND PHYSIOLOGY

Gastrointestinal tract is the part of an organ system in humans and other animals that take
in food, digest it, absorb nutrients and expel it out in the form of feces.
The digestive system prepares nutrients for utilization by body cells through its functions
including:

Ingestion
The first activity of the digestive system is to take in food through the mouth. This
process, called ingestion, has to take place before anything else can happen.

Mechanical Digestion
The large pieces of food that are ingested have to be broken into smaller particles that can
be acted upon by various enzymes. This is mechanical digestion, which begins in the mouth with
chewing or mastication and continues with churning and mixing actions in the stomach.

Chemical Digestion
The complex molecules of carbohydrates, proteins, and fats are transformed by chemical
digestion into smaller molecules that can be absorbed and utilized by the cells. Chemical
digestion, through a process called hydrolysis, uses water and digestive enzymes to break down

18
the complex molecules. Digestive enzymes speed up the hydrolysis process, which is otherwise
very slow.

Movements
After ingestion and mastication, the food particles move from the mouth into the
pharynx, then into the esophagus. This movement is deglutition, or swallowing. Mixing
movements occur in the stomach as a result of smooth muscle contraction. These repetitive
contractions usually occur in small segments of the digestive tract and mix the food particles
with enzymes and other fluids. The movements that propel the food particles through the
digestive tract are called peristalsis. These are rhythmic waves of contractions that move the food
particles through the various regions in which mechanical and chemical digestion takes place.

Absorption
The simple molecules that result from chemical digestion pass through cell membranes of
the lining in the small intestine into the blood or lymph capillaries. This process is called
absorption.

Elimination
The food molecules that cannot be digested or absorbed need to be eliminated from the
body. The removal of indigestible wastes through the anus, in the form of feces, is defecation or
elimination.

The gastrointestinal tract in humans begins at the mouth, continuing through the esophagus,
stomach, and small and large intestines. The GI tract is about 9 meters in length.There are many
supporting organs, such as the liver, which helps by secreting enzymes that are necessary for the
digestion of food.

The human GI tract can be divided into two halves, namely:

 Upper GI tract
 Lower GI tract

Upper Gastrointestinal Tract

The upper GI consists of the following organs:

 Mouth - it includes the teeth, tongue, and buccal mucous membranes containing the ends
of the salivary glands that continue with the soft palate, floor of the mouth, and underside
of the tongue. Mouth functions by chewing the food, constantly by the muscular action of
the tongue, cheeks, and teeth through the lower jaw and upper jaw.

19
 Esophagus- a muscular tube-like structure that functions by carrying food to the
stomach. Once the chewed food reaches the esophagus from the mouth, the action of
swallowing becomes involuntary and is controlled by the esophagus.
 Liver- the liver has many functions, but its main job within the digestive system is to
process the nutrients absorbed from the small intestine. Bile from the liver secreted into
the small intestine also plays an important role in digesting fat and some vitamins.

- The liver is your body's chemical "factory." It takes the raw materials absorbed by
the intestine and makes all the various chemicals your body needs to function.

- The liver also detoxifies potentially harmful chemicals. It breaks down and
secretes many drugs that can be toxic to your body.
 Stomach- this is where most of the digestion takes place. The stomach is a J-shaped bag-
like organ that stores the food temporarily, breaks it down, mixes and churns it
with enzymes and other digestive fluids and finally, passes it along to the small intestine.
 Lower Gastrointestinal Tract
The lower GI consists of the following organs:

 Gallbladder- the gallbladder stores and concentrates bile from the liver, and then
releases it into the duodenum in the small intestine to help absorb and digest fats.
 Pancreas- the pancreas secretes digestive enzymes into the duodenum that break down
protein, fats and carbohydrates. The pancreas also makes insulin, passing it directly into
the bloodstream. Insulin is the chief hormone in your body for metabolizing sugar.
 Small Intestine- the small intestine is a coiled thin tube, about 6 meters in length, where
most of the absorption of nutrients takes place. Food is mixed with enzymes from the
liver and the pancreas in the small intestine. The surfaces of the small intestine function
by absorbing the nutrients from the food into the bloodstream, which carries them to the
rest of the body.
 Large Intestine - the large intestine, also known as the Colon, is a thick tubular organ
wrapped around the small intestine. Its primary function is to process the waste products
and absorb any remaining nutrients and water back into the system. The remaining waste
is then sent to the rectum and discharged from the body as stool.
 Vermiform appendix - is a part of the digestive tract which lies in right lower quadrant
of abdomen. It has a worm-like structure and arises during embryological life from the
posteromedial wall of the cecum, about 2 cm below the ileocecal valve. According to
researchers from the Duke University Medical Center, the appendix does have a key
function - it produces and stores good microbes for the human gut.

20
  Rectum- the rectum is a straight, 8-inch chamber that connects the colon to the anus. The
rectum's job is to receive stool from the colon, let you know that there is stool to be
evacuated (pooped out) and to hold the stool until evacuation happens. When anything
(gas or stool) comes into the rectum, sensors send a message to the brain. The brain then
decides if the rectal contents can be released or not. If they can, the sphincters relax and
the rectum contracts, disposing its contents. If the contents cannot be disposed, the
sphincter contracts and the rectum accommodate so that the sensation temporarily goes
away.
 Anus- the anus is the last part of the digestive tract. It is a 2-inch-long canal consisting of
the pelvic floor muscles and the two anal sphincters (internal and external). The lining of
the upper anus is able to detect rectal contents. It lets you know whether the contents are
liquid, gas or solid.
- the anus is surrounded by sphincter muscles that are important in allowing control
of stool. The pelvic floor muscle creates an angle between the rectum and the
anus that stops stool from coming out when it’s not supposed to. The internal
sphincter is always tight, except when stool enters the rectum. This keeps us
continent (prevents us from pooping involuntarily) when we are asleep or
otherwise unaware of the presence of stool.
- when we get an urge to go to the bathroom, we rely on our external sphincter to
hold the stool until reaching a toilet, where it then relaxes to release the contents.

OVERVIEW OF THE NORMAL AND INFLAMED APPENDIX

NORMAL APPENDIX

21
 Appendix, formally vermiform appendix, in anatomy, a vestigial hollow tube that is
closed at one end and is attached at the other end to the cecum, a pouchlike beginning of the
large intestine into which the small intestine empties its contents. It is not clear whether the
appendix serves any useful purpose in humans. Suspected functions include housing and
cultivating beneficial gut flora that can repopulate the digestive system following an illness that
wipes out normal populations of these flora; providing a site for the production of endocrine cells
in the fetus that produce molecules important in regulating homeostasis; and serving a possible
role in immune function during the first three decades of life by exposing leukocytes (white
blood cells) to antigens in the gastrointestinal tract, thereby stimulating antibody production that
may help modulate immune reactions in the gut. While the specific functions of the human
appendix remain unclear, there is general agreement among scientists that the appendix is
gradually disappearing from the human species over evolutionary time. Blockage of the
appendix can lead to appendicitis, a painful and potentially dangerous inflammation. The
appendix is usually 8 to 10 cm (3 to 4 inches) long and less than 1.3 cm (0.5 inch) wide. The
cavity of the appendix is much narrower where it joins the cecum than it is at its closed end. The
appendix has muscular walls that are ordinarily capable of expelling into the cecum the mucous
secretions of the appendiceal walls or any of the intestinal contents that have worked their way
into the structure.
ABNORMAL APPENDIX
A person experiencing an attack of appendicitis may feel pain all over the abdomen, only
in the upper abdomen, or about the navel. This pain is usually not very severe. After one to six
hours or more the pain may become localized to the right lower abdomen. Nausea and vomiting
may develop sometime after the onset of the pain. Fever is usually present but is seldom high in
the early phases of the attack. The patient’s leukocytes (white blood cells) are usually increased
from a normal count of 5,000–10,000 in an adult to an abnormal count of 12,000–20,000; this
phenomenon can be caused by many other acute inflammatory conditions that occur in the
abdomen.

In a person with a normally sited appendix, the pain of appendicitis is situated at a point
between the navel and the front edge of the right hipbone. But many people have the appendix
lying in an abnormal position and may feel the pain of an appendicitis attack in a different or
misleading location, which makes their symptoms difficult to distinguish from the abdominal
pain caused by a variety of other diseases. Careful diagnostic examination by a physician can
usually determine if acute appendicitis is indeed causing a patient’s abdominal pain. Ultrasound
or computed tomography (CT) scanning may also be useful in the diagnosis of appendicitis.

If anything blocks the opening of the appendix or prevents it from expelling its contents
into the cecum, appendicitis may occur. The most common obstruction in the opening is a
fecalith, a hardened piece of fecal matter. Swelling of the lining of the appendiceal walls
themselves can also block the opening. When the appendix is prevented from emptying itself, a
series of events occurs. Fluids and its own mucous secretions collect in the appendix, leading to
edema, swelling, and the distention of the organ. As the distention increases, the blood vessels of
the appendix become closed off, which causes the necrosis (death) of appendiceal tissue.

22
Meanwhile, the bacteria normally found in this part of the intestine begin to propagate in the
closed-off pocket, worsening the inflammation. The appendix, weakened by necrosis and subject
to increasing pressure from within by the distention, may burst, spilling its contents into the
abdominal cavity and infecting the membranes that line the cavity and cover the abdominal
organs (see peritonitis). Fortunately, peritonitis is usually prevented by the protective
mechanisms of the body. The omentum, a sheet of fatty tissue, often wraps itself around the
inflamed appendix, and an exudate that normally develops in the areas of inflammation behaves
like glue and seals off the appendix from the surrounding peritoneal cavity.
Suppurative appendicitis has traditionally been considered a later stage of appendicitis, in
which bacteria and inflammatory fluids accumulated in the lumen of the appendix enter the wall
of structure and subsequently cause intense pain when the inflamed membrane rubs against the
parietal peritoneum lining the abdominal cavity. Also, acute appendicitis is more frequently
linked to mucosal ulceration than suppurative appendicitis, which is more often caused by
obstruction of the appendix.

The basic treatment of appendicitis is the surgical removal of the appendix in a minor
operation called an appendectomy. The operation itself requires little more than a half hour under
anesthesia and produces relatively little postoperative discomfort. If a diagnosis of acute
appendicitis cannot immediately be made with reasonable certainty, it is common to wait and
observe the patient’s symptoms for a period from 10 to 24 hours so that a definitive diagnosis
can be made. This wait does slightly increase the risk that the appendix will rupture and
peritonitis set in, so the patient is kept under careful medical surveillance at this time.

23
 CHAPTER X
ETIOLOGY AND SYMPTOMATOLOGY

Basic Present/Absent Rationale

Predisposing Factors:
 Aging is one of the
 Age factors of getting
appendicitis.
(31 years old)
- Acute appendicitis is a severe
and sudden case of
appendicitis. It’s most common
in children and young adults
between the ages 10-35 years
old.

 Gender
 Appendicitis is a
(Male) painful medical
condition in which
the appendix becomes
inflamed and filled with
pus, a fluid made up of
dead cells and
inflammatory tissue
that often results from
an infection.

-According to the National

Institutes of Health (NIH).
Appendicitis is one of the
leading causes of sudden
severe abdominal
pain requiring surgery in the
United States and it is more

24
 prevalent among males.

Precipitating Factors:

 Sedentary Lifestyle  In our case, one of the

factors that our patient
developed appendicitis
is due to its sedentary
lifestyle specifically his
food intake. Being a
driver or engaging in
any particular
occupation does
inherently increase the
risk of developing
appendicitis.
- Appendicitis is a
medical condition that
can affect anyone,
regardless of their
occupation or lifestyle.

 Bowel Movement  Appendicitis can lead to

several changes in
bowel movements and
gastrointestinal
symptoms. You may
notice changes in the
frequency of bowel
movements. Some
people with
appendicitis report
increased urgency or
more frequent trips to
the bathroom. But in
our case, the episode of
bowel movement of our
patient is not normal as
it should be. He
developed altered
bowel movement and it
is one of the
contributing factors that

25
 developed medical
emergency called
appendicitis.

 Environmental
(Workplace)  In our case, the
patient’s occupation is
Butcher and a part time
Delivery guy.
- Environmental factors
indirectly influence an
individual's risk of developing
this condition. Environmental
factors can influence
theoretically increase the risk
of fecal matter obstructing the
appendix.

SYMPTOMATOLOGY
BASIC Present/ Absent JUSTIFICATION

Anorexia - It is common for

individuals with
appendicitis to
experience anorexia
as one of the
associated symptoms.
However, anorexia
itself is not a direct
cause of appendicitis
but rather a
manifestation of the
condition.

- The patient
experienced this
symptom prior to his
admission.

26
Nausea and Vomiting
- The presence of
nausea and vomiting
can be common
symptoms in
appendicitis. Nausea
is often one of the
early symptoms of
appendicitis. The
inflammation in the
abdominal area can
irritate the stomach
lining, leading to a
feeling of queasiness.
On the other hand, as
the condition worsens
and the inflammation
becomes more severe,
nausea can escalate to
vomiting. Vomiting in
appendicitis can occur
due to the irritation of
the stomach or as a
response to severe
pain and discomfort.
- The patient complains
of being queasiness
and emesis before
admission.

Right Lower Quadrant - Appendicitis pain is

Pain often sharp and
localized in the lower
right abdomen, near
the area where the
appendix is located.
The pain may initially
start around the belly
button and then
migrate to the lower
right quadrant. The
presence of right
lower quadrant pain,
especially when
combined with other

27
 symptoms like nausea,
vomiting, loss of
appetite and
discomfort.
- The patient
experienced prior
admission.

Discomfort - a common symptom

in appendicitis, and it
often progresses to
become more intense
pain. The discomfort
experienced in the
early stages of
appendicitis is
typically located in
the central abdomen,
near the belly button.
As the inflammation
worsens and the
condition progresses,
this discomfort can
develop into more
localized and severe
pain in the lower right
quadrant of the
abdomen, which is a
hallmark symptom of
appendicitis.
- The patient
experienced this
symptom before
hospitalization.

28
 CHAPTER XI

PATHOPHYSIOLOGY

Precipitating Factors
Predisposing Factors
 Sedentary Lifestyle
 Age (31 years old)  Bowel Movement
 Gender (Male)  Workplace Environment

Presence of Etiological
Factor
(Fecalith)

Prevents the Normal Flow Obstruction of the Peripheral Vascular

of Mucus Appendiceal Lumen Irregularities

Increased in Pressure
Right Lower Quadrant
Inside the Appendiceal Increased Lumen Pressure
Pain
Lumen

Nausea and Vomiting Decreased Blood Flow

Discomfort E. Coli Present in Fecalith29

Infect the Lining of the Wall
 Impaired Venous Return

Lesion on the Appendix

Mucosal Lining

Bacterial Invasion and

Necrosis
Manifestation

Start of Inflammatory
Process

Release of Chemical Mediators Activation of the Vomiting Neutrophils to Area

Center in the Medulla

Histamine, Prostaglandin Stimulation of Vagus Suppression of Puss Formation

Leukotrienes, Bradikinin Nerve Sympathetic GI Function (Phagocytized bacteria
ended Cells)
Swelling of Appendix

Prostaglandin, Bradykinin Nausea + Vomiting Anorexia Risk for Infection (If appendix
ruptured)

Pain in the RLQ of Abdomen Risk for Deficient Risk for Imbalance
Fluid volume Nutrition loss than
Body requirements
Acute Pain Interleukin- 1

30
 WBC

CT Scan, MRI, Abdominal Diagnostic Treatment/ Test

Acute Appendicitis Blood Tests
Ultrasound Laboratories

Appendectomy

Tissue Trauma Nociceptors of the Dermis

Open Wound Disruption of Cell

Send Impulse to CNS
Membrane

Impaired Pain on Surgical Site

Risk for Start of Inflammatory
Tissue
Infection Process
Integrity
Activity Intolerance
Release Prostaglandin
Bradykinin

If not Treated If Treated

Complication Strong Antibiotic

- Septic shock
- Perforation Peritonitis Fluid Volume Replacement
- Urinary Tract Ingestion Therapy

Recovery

31
Coma
GOOD PROGNOSIS
DEATH

CHAPTER XII
DOCTOR’S ORDER

Date Ordered Doctor’s Order Rationale

9/ 21/ 23 Admit -To be kept nothing by mouth
 Nothing Per Orem or before surgery was a safety
mouth (NPO) precaution by the doctors
 Vital Signs every 4 enable to avoid being
hrs. nauseous during procedure
 IV: D5LR 1L @ and it might be cause the
120cc/hr fluids or stomach content will
flow into the lungs.

Diagnostics: - CBC used to look at overall

CBC, Platelet, Blood Typing health, provides fast results
CXR diagnosing AA and
RAT measuring severity of the
USD (Ultrasound of Whole infection.
Abdomen) - Blood typing is a fast and
easy way to ensure that you
receive the right kind of
blood during surgery or after
an injury.
- Ultrasound provides an
imaging method that
produces images of structure
within of our body.

32
 - Medicine used to prevent
Medications: acid reflux that is a proton-
pump inhibitor. It is used to
1. Cefoxitin 2q, IVTT treat conditions including
now then per qms. GERD and noncancerous
IVTT q 8 stomach ulcers caused by
2. Omeprazole 40mg excess stomach acid.
IVTT OD (once a Zollinger-Ellison syndrome,
day) an active duodenal ulcer, and
 Schedule stat erosive esophagitis. It works
appendectomy by preventing the generation
 Secure consent of stomach acid.

-It requires pt. few hours to

Post-op under recovery room to monitor
 To recovery Room X closely for any complication
1 hour- ROM (Range and wear off the anesthesia
09/21/23 of Motion/ Exercise) used during operations
 NPO -NPO after surgery is critical
 VS q 15 min. X 1 used of care in ensuring high
hour, q hourly X 2 quality outcomes in surgical
11: 45 AM hours then q hrs. patients.
 IVF D5LR @40cc/hr.

33
 Medications:

1. Cefoxitin 7g, q 8 hrs.

IVTT -Ketorolac used to short-term
2. Omeprazole 40mg IV treatment of moderate to
OD severe pain in adults
3. Ketorolac 3 mg. q 6 -Tramadol is a strong pain
hrs. IV X 9 doses then medication. It is used to
q 8 hours severe pain that is not being
4. Tramadol 50mg q 6 relieved by others types of
hrs. IV X 4 dose then medicine.
PRN for severe pain
5. ISO q 4 hours
6. Multivitamins +
glucose 500cc
@60cc/hr. X 3 cycles

09/22/ 23  Keep NPO

 Continue Meds. - To alleviate pain
 Encourage to sit/
ambulate
 Refer

09/23/23  May have progression

diet
 Discontinue IV meds.
 Shift to oral meds

Medications:
1. Eperisone 50mg tab -Eperisone used to treat
BID muscle spasm.
2. Celecoxib 200mg per -Celecoxib is nonsteroidal
tab BID PRN for pain anti-inflammatory drug
(NSAID). It works by
reducing hormones that cause

34
 inflammation and pain in the
body.

09/24/23  Progressive diet - it involves gradually

 Continue IVF @ same introducing more
rate palatable, healthy
 Continue Medications foods. Eating without
 Refer being anxious or
preoccupied with
food-related decisions
is simple.

09/25/23  May go home

 Discontinue IVF
 Home Meds.

Medications: -A class of medications called

1. Cefuroxime 200 mg 1 cephalosporin antibiotics. It
capsule 3X a day X 7 works by stopping the growth
days of the bacteria.
2. Celecoxib 200mg by 1
tabs BID

For check-up after 5

days

CHAPTER XIII
DIAGNOSTIC EXAM
HEMATOLOGY

EXAMINATION RESULT NORMAL UNITS

35
 VALUES
White Blood Cell 18.2 H 5.0-10.0 10^9L
Lymphocyte 7.2 L 10.0-58.5 %
Monocyte 8.1 4.8-11.6 %
Segmenters 83.9 H 41.8-79.7 %
Eosinophil 0.3 0.3-7.5 %
Basophil 0.5 0.1-0.6 %

Red Blood Cell 5.38 4.2-6.3 10^12/L

Hemoglobin 170 140-180 g/L
Hematocrit 0.498 0.400-0.540 L/L
MVC 92.5 80.0-97.0 Fl
MCH 31.6 26.0-32.0 Pg
MCHC 341 310-360 g/L
RDW 13.5 11.5-14.5 %CU

Platelet Count 164 150-400 10^9/L

MPV 6.2 L 7.0-10.0 fL

ABDOMEN ULTRASOUND

36
37
 ULTRASOUND REPORT

The liver is normal in size and configuration with homogenous parenchymal echopattern and
smooth external outline. No focal no diffuse lesion seen. The intrahepatic ducts and vessels are
not dilated. The common duct measures 0.3 cm.

The gallbladder is adequately distended with non-thickened walls. No abnormal intraluminal

echoes/calculus seen.

The pancreas, spleen, abdominal aorta, and para-aortic areas are unremarkable. No lesion seen.

There is no disparity in the size, shape, and location of both kidneys.

The right kidney measures 10.5 x 5.3 x 4.3 cm (LWT) with a cortical thickness of 1.6 cm. The
left kidney measures 11. X 5.6 x 5.9 cm (LWT) with a cortical thickness of 2.0 cm. Both renal
parenchymal echopatterns are hypoechoic relative to the liver and spleen with intact central
echocomplexes. The corticomedullary differentiations are maintained. No mass or calculi seen.
Both ureters are not visualized and probably not dilated. The urinary bladder is adequately
distended non-thickened walls. No abnormal intraluminal echoes seen.

The prostate is normal in size. The parenchymal echopattern is homogenous with smooth
external outline. No focal lesion see.

The appendix is visualized and slightly enlarged, measuring up to 0.8 cm in diameter. No

appendicolith nor periappendiceal fluid collection.

No intraperitoneal fluid collection noted.

38
IMPRESSION:

 CONSIDER ACUTE APPENDICITIS

 ULTRASONICALLY NORMAL LIVER, BILE TREE, GALLBLADDER,
PANCREAS, ABNOMINAL AORTA, SPLEEN, KIDNEYS, URINARY
BLADDER, AND PROSTATE.

39
CHAPTER XIV
DRUG STUDY

40
 CHAPTER XV
SURGICAL PROCEDURE

APPENDECTOMY

An appendectomy is surgery to remove the appendix when it is infected. This condition is called
appendicitis. Appendectomy is a common emergency surgery that cures appendicitis.

The appendix is a thin pouch that is attached to the large intestine. It sits in the lower right part of
your belly. If you have appendicitis, your appendix is usually removed right away. If not treated,
your appendix can burst (rupture). This is a medical emergency.

There are two types of surgery to remove the appendix. The standard method is an open
appendectomy. A less invasive method is a laparoscopic appendectomy.

 Open appendectomy. A cut or incision about 2 to 4 inches long is made in the lower right-hand
side of your belly or abdomen. The appendix is taken out through the incision.

41
 Laparoscopic appendectomy. This method is less invasive. That means it’s done without a large
incision. Instead, 1 to 3 tiny cuts are made. A long, thin tube called a laparoscope is put into one
of the incisions. It has a tiny video camera and surgical tools. The surgeon looks at a TV monitor
to see inside your abdomen and guide the tools. The appendix is removed through one of the
incisions.
During laparoscopic surgery, your surgeon may decide that an open appendectomy is needed.

If your appendix has burst and infection has spread, you may need an open appendectomy. If an
area of infection called an abscess has formed around the appendix, the surgeon may use
antibiotics and drain the abscess before the appendectomy.

A laparoscopic appendectomy may cause less pain and scarring than an open appendectomy. The
scar is often hard to see for either type of surgery once it has healed.

Both types of surgery have a low risk for complications. A laparoscopic appendectomy has a
shorter hospital stay, shorter recovery time, and lower infection rates. Some studies suggest that
intravenous antibiotics alone could treat appendicitis without the need for surgery. But
appendectomy remains the standard of care since antibiotics alone do not always cure
appendicitis.

42
 CHAPTER XVI

NURSING THEORIES

Nursing theories and model serve as the foundation upon which the nursing profession is
built. These theories and model are essential for guiding nurses in their practice, providing a
framework for understanding and addressing patient needs, and fostering professional growth. In
this chapter, it directly explains the profound nursing theories and model in contemporary
healthcare, examining their role in improving patient care, enhancing nursing practice, and
contributing to the development of evidence-based nursing that associates with the chosen case
study.

21 Nursing Problems Theory

Faye Glenn Abdellah

Among the nursing theories, one of the theories that being used was the Abdellah’s 21
Nursing Problems Theory. According to Faye Glenn Abdellah’s theory, “Nursing is based on an
art and science that molds the attitudes, intellectual competencies, and technical skills of the
individual nurse into the desire and ability to help people, sick or well, cope with their health
needs.” In our case, deliberate assessment of the patient, family history and medical history was
undertaken. The next step was sorted out the relevant and significant data such as Cephalocaudal
Assessment, next was, made a generalization about the available data in relation similar nursing
problems presented by other patients, then identified the therapeutic plan for the said disease.
Next in line was, tested the generalizations with the patient and validated the patient’s
conclusions about his condition. Moreover, we continue observed and evaluated the patient over
a period of time to easily identify any attitudes and clues affecting his behavior. Additionally, we
explored the patient and his family’s reactions to the therapeutic plan, in this state we performed
some of the remedial methods in easing the discomfort of the patient such as, assessing vital
signs, encouraged to have a healthy lifestyle and gave health teaching about managing the said
medical emergency such as keeping the wound site clean to avoid wound infection. Additionally,

43
we discussed and identified how our co-nursing student feels about the patient’s nursing
problems and in the rear of the thorough discussion we developed a comprehensive nursing care
plan that are smart, measurable, attainable, realistic and time – bounded kind of interventions.
Using Abdellah’s 21 Nursing Problems Theory it views nursing an art and science for the
reason that it addresses a range of patient care issues and offers a framework for holistic nursing
care. Faye Glenn Abdellah's Theory of 21 Nursing Problems is significant in nursing due to its
holistic and individualized approach to patient care, its emphasis on evidence-based practice, its
impact on nursing education and research, and its potential to improve patient outcomes. This
theory continues to shape and inform contemporary nursing practice and education.

Environmental Theory
Florence Nightingale

In analysis of the patient’s case, Florence Nightingale’s Nursing Theory known as the
Environmental Theory was applied. Wherein, Nightingale’s work laid the foundation for modern
nursing practice and highlighted the critical role of nursing in patient care and recovery.
Conversely, the patient uttered that he work as a butcher and a sideline driver. The ambiance/
exposure to that environment makes him developed the aforementioned medical emergency.
Thus, the role of the healthcare provider is to tailored care to meet the specific needs of the
patient, taking into consideration his physical, emotional, and psychological well-being. Next in
line is to promote the sanitation and hygiene. As what Nightingale’s Theory approach the
importance of clean and hygienic environment in patient care is one of the central tenets that aids
the patient’s risk for infections. In addition, Nightingale's theory influenced the design of
healthcare facilities. So, the focus of the healthcare provider is to put emphasis on natural light,
proper ventilation and well- organized patient wards to give better patient comfort and outcomes.
Furthermore, this Environmental theory is utilized in this study owing the fact that the resistance
of older adults to being hospitalized is a common phenomenon in healthcare, and it can be
attributed to various factors. Understanding these reasons is crucial for healthcare providers and
institutions to provide patient-centered care and address the concerns and preferences of older
adults.

44
Self-care Deficit Theory
Dorothea Orem
Upon reviewing the patient’s case, Dorothea Orem’s Theory known as the Self- Care
Deficit Theory was being initiated. According to Orem “The act of assisting others in the
provision and management of self-care to maintain or improve human functioning at the home
level of effectiveness.” It focuses on each individual’s ability to perform self-care, defined
as “the practice of activities that individuals initiate and perform on their own behalf in
maintaining life, health, and well-being.” Dorothea Orem's Self-Care Deficit Theory is a nursing
theory that focuses on the individual's ability to perform self-care activities to maintain their
health and well-being. While this theory is not directly applicable to the treatment of
appendicitis, it does have some relevance in the broader context of nursing care and patient
education for individuals recovering from appendectomy, the surgical removal of the inflamed
appendix.
After undergoing an appendectomy, patients need to engage in self-care activities to
promote their recovery. This includes activities such as wound care, pain management, and
adherence to a prescribed diet. Nurses can use Orem's theory to assess the patient's ability to
perform these self-care activities and provide education and support as needed. In addition,
Nurses play a critical role in educating patients about postoperative care and helping them
develop the skills and knowledge necessary for self-care during their recovery. Orem's theory can
guide nurses in tailoring their teaching strategies to meet the individual needs and abilities of
each patient. Also, Orem's theory emphasizes the importance of assessing a patient's ability to
perform self-care activities. Nurses can use this theory to identify any deficits in a patient's self-
care capabilities and develop care plans that address these deficits to promote optimal recovery.
Moreover, Orem's theory encourages nurses to promote patients' independence in self-
care activities whenever possible. For individuals recovering from appendectomy, this means
empowering them to actively participate in their recovery process and take responsibility for
their health. Furthermore, Orem's theory underscores the importance of considering the physical,
psychological, and social aspects of a patient's self-care needs. This holistic approach is valuable
in providing comprehensive care to individuals recovering from surgery for appendicitis.

45
 CHAPTER XVII

NURSING CARE PLAN

46
CHAPTER XVIII

PROGNOSIS

47
 CHAPTER XIX

DISCHARGE PLAN (M.E.T.H.O.D)

MEDICATIONS
Patient X was confined last September 20, 2023, for Acute Appendicitis and was scheduled to
have surgical removal of his appendix last September 22, 2023. His attending Physician
prescribed the following home medications:

 Cefuroxime 200 mg 1 capsule TID x 7 days

 Celecoxib 200 mg by 1 tab BID

EXERCISES
Patient X is advised to have minimal exercise at home.

TREATMENT
Pharmacologic Therapy:

 Cefuroxime is used to treat bacterial infections in many different parts of the body. It

belongs to the class of medicines known as cephalosporin antibiotics. It works by killing

bacteria or preventing their growth. However, this medicine will not work for colds, flu,

or other virus infections

 Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing

hormones that cause inflammation and pain in the body.

HEALTH TEACHING

48
Teach the patient to track his food intake, the importance of rest, a healthy lifestyle, hospital
visits, and following the doctor’s orders.

DIET OF THE PATIENT

High Fiber Diet
Fiber helps improve digestion and can prevent constipation, which is a common problem after
surgery. Foods that are high in fiber include fruits, vegetables, whole grains, and legumes.

49
 CHAPTER XX
SUMMARY, FINDINGS AND RECOMMENDATION

SUMMARY
The appendix or vermiform appendix is a muscular structure attached to the large
intestine in the human body. It is a narrow tube resembling a worm and is named after the Latin
word "vermiform" which means ‘worm-shaped’. The appendix extends from the lower end of the
cecum, a pouch-like structure in the large intestine.
Patient X went to the hospital last September 20, 2023 with a chief complaint of pain in
RLQ, a day after that he underwent some test such us abdominal ultrasound and hematology test.
The result came on that day and it confirmed that the patient was suffering from acute
appendicitis. The doctor ordered patient x to have an open appendectomy, scheduled a day after
the result came. From what we have known of the patient’s history, we found out that his
sedentary lifestyle together with his work environment as well as his age and gender these
factors contributed to the development and progression of his condition.
After his successful surgery, the open appendectomy, the physician ordered some
medications to aid in his recovery. The medications namely, Cefoxitin, Omeprazole, Ketorolac,
Tramadol, ISO, and Multivitamins + glucose.
To sum it up, we suppose that this medical condition is life-threatening since if this is left
untreated it could lead to complications such as septic shock, for one, or worse death.
FINDINGS
The researcher found out that Patient X chief complained of RLQ pain a 31 years old,
male, and is residing at P. Star Apple Zone 1 Digos City, who is a post-operative client suffered
from acute appendicitis. In appendicitis, the appendix becomes inflamed and edematous as a
result of either becoming kinked or occluded by a fecalith (ie, hardened mass of stool), tumor, or
foreign body. The inflammatory process increases intraluminal pressure, initiating a
progressively severe, generalized or upper abdominal pain that becomes localized in the right
lower quadrant of the abdomen within a few hours. The following sources of difficulty were
identified base on the three dimensions;
For biological, Acute pain, difficulty in breathing, difficulty in moving, fluid electrolyte
imbalance, self-care deficit: grooming and hygiene, risk for infection, risk for imbalance
nutrition less than the body requirement. In physiological only one identified, was eating
disorder or restriction of food intake. For socio-cultural the lifestyle and habits of the patient
Goals were formulated according to each source of difficulty and planned interventions were

50
implemented and consequences were checked if there were changes in status happen after
sources of difficulty were managed specially to pain. Upon evaluation, the patient was able to
move safely with less discomfort and eventually able to ambulate freely in going to the bathroom
with assistance for personal hygiene, which facilitated faster recovery until the patient finally
went home.

RECOMMENDATION

Based on the outcome of this study, the following will be benefited to the following:

Patients. The patient should be well informed about the disease and how to choose the
procedures and methods that are most suited to his condition. And this study can also make the
person aware of what adjustments he or she has to do or what things he or she should perform
after operation for fast recovery.

Family. In order to support the patient and determine where and what the patient needs,
the patient’s family must have a thorough understanding of the patient’s condition and disease.
This is one of the essential methods that will help with patient management and recovery.

Community. This study will benefit the community since it will act as a reference tool on
how to more effectively comprehend the lifestyle of a patient suffering from acute appendicitis.

Nurses. This study matters for nurses in particular since it will act as a guide for them in
developing therapeutic and non-therapeutic approaches that can truly deliver quality care to
patients suffering from this condition.

51
 Future Researcher. The study's findings served as a reference and recommendations for
future researchers who intend to undertake the same study or any study involving patients with
acute appendicitis.

CHAPTER XXI
REFERENCES/ BIBLIGROPHY
Ansari, P. (2023, September 26). Appendicitis. MSD Manual Professional Edition.
Appendicitis in Philippines. (2022). World Life Expectancy.
Appendicitis. (2021, December 9). Johns Hopkins Medicine.
Appendicitis - Symptoms and causes - Mayo Clinic. (2023, August 18). Mayo Clinic.
Baltes, P. B. (1987). Theoretical propositions of life-span developmental psychology: On
the dynamics between growth and decline. Developmental psychology, 23(5), 611.
Caballes, A. B., Diagnosis and Treatment of Acute Appendicitis: 2020 update of the
WSES Jerusalem guidelines. World J Emerg Surg. 2020;15 (27). do: 10.1186/s13017-
020-00306-3.
Craig, S., MD. (2022). Appendicitis: practice essentials, background, anatomy.
Freud, S. (2012). The basic writings of Sigmund Freud. Modern library.
McLeod, S. (2018). Jean Piaget’s theory of cognitive development. Simply
Psychology, 18(3), 1-9.
Park, K. B., Hong, J., Moon, J. Y., Jung, J., & Seo, H. S. (2022). Relationship between
appendectomy incidence and computed tomography based on Korean nationwide data,
2003–2017. Journal of Korean Medical Science, 37(4).
Sokol, J. T. (2009). Identity development throughout the lifetime: An examination of
Eriksonian theory. Graduate journal of counseling psychology, 1(2), 14.

52
53
54