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BATANGAS REGIONAL HOSPITAL

Appendicitis

CASE STUDY

In partial Fulfillment of the Requirements
In Nursing Care Management 102
Presented to:
Mrs. Annabelle Iturralde RN. MAN
Presented by:
BSN III - 5 Group C
Edmalyn Gozar

I. Introduction

Acute appendicitis is the inflammation of the appendix
often cause by obstruction to its narrow opening, fallowed by
swelling and bacterial infection. Acute appendicitis can lead to
rupture of the organ, formation of an abscess or peritonitis.
Symptoms include abdominal pain (usually in RL abdomen)
nausea, vomiting and fever. Early surgical removal of the
appendix is essential; any abscess requires drainage of pus and
delayed removal.
Appendicitis is the most common abdominal emergency
found in children and young adults. One person in 15 develops
appendicitis in his or her lifetime. The incidence is highest
among males aged 10 to 14. And among females aged 15 to
19. More males than females develop appendicitis between
puberty and aged 25. It is rare in infants and children under the

the aged of two. In the United States, appendicitis occur in
four out of 1000 children. It occurs in 5 to 6% of its
population.
I chose this case because I want to understand and
have more information about appendicitis. I am very much
curious on how an acute appendicitis developed and what
are the signs and symptoms accompanied it.

Specific Objectives My specific objectives are to: -Give an overview about the disease appendicitis. skills and attitude regarding my patient’s case. -Know the personal data of the client -Perform the Physical Assessment -Familiarize with different laboratory test and its significance to the disease -Analyze the system that is being affected of this disorder -Know the factors that lead to appendicitis -Apply interventions that may help client’s condition -Know the drugs that the client is taking -Know the improvement of clients’ condition . II. Objectives General Objectives At the end of the study I will be able to acquire knowledge.

2008 Physician’s Name: Dr. 9.vomiting fever and loss of appetite Admitting Diagnosis: Acute Appendicitis Final Diagnosis: Periappendecial abscess . X Age: 39years old Sex: Female Birthday: September 13. III.1969 Civil Status: Female Address: Quilo. Ibaan Batangas Nationality: Filipino Religion: Iglesia ni Cristo Date of Admission: Dec. Patient’s Profile Name: Mrs. Reyes Chief Complaint: Two days prior to admission the client experienced RLQ pain.

Clinical Appraisal On December 9. Mrs. Mrs. a 39 years old was admitted in Batangas Regional Hospital due to Acute Appendicitis. Mrs. cough and cold. X. She used over the counter drugs like Paracetamol for fever. Solmux for cough and neosep for cold. X didn’t experience any accident or injury. Past Health History According to Mrs. . A. foods animals or any insects bites. she had history of Pulmonary Tuberculosis treated for six months. X. X experienced common illnesses like fever. IV. 2008. She has no allergies to drugs. she completed her childhood immunization. According to her husband.

X was not choosy in her meal. C. X and her family is living in a rural area. D. Personal History Mrs. According to her she and her relatives has low blood pressure. She finish elementary and her husband finished high school. Mrs. X daily activities was cleaning the house. X has 9 siblings and twin sister. Social History Mrs. X is responsible in managing the house and their small .B. She had enough sleep and resting hours. She was blessed with 5 children which are all boys. Family History Mrs. meat specially vegetables and fruits because it is available in the farm. heart diseases and asthma. Mrs. hypertension. she eat fish. washing clothes and manage their small sari-sari store. Her family has no history of diabetes.

. According to her. X her husband is a farmer.sari-sari store. Her major stressor s their financial status. She consulted first to their health center before her husband decided to brought her to BRH. Psychological History According to Mrs. X has a belief not to take a bath during her menstrual period. To cope with this problem she keeps on praying and asking God for more blessings and assistance. Mrs. There is a health center available in their community. before she was admitted to the hospital she has a menstruation for 5 days and she didn’t take a bath for the said days. X. E. It was very difficult for her to budget their monthly income to support all their needs. while Mr.

F. . vomiting and loss of appetite for 2 days. She was diagnosed of having acute appendicitis and scheduled for emergency appendectomy. 2008 because of experiencing abdominal pain. fever. X brought to Batangas Regional Hospital last December 9. History of Present Illness Mrs.

Physical Assessment Done: December 9. X is a newly admitted client. V. 2008. Vital Signs: Temperature: 38. body weakness. 7:35pm General Appearance Status Mrs.1°C Pulse Rate: 72 Beats per minute Respiratory Rate: 26 Breaths per minute Blood Pressure: 100/60 mmHg . and pain felt on the RLQ of her abdomen. She is on supine position showing anxiety.

Body Parts Method Findings Analysis Skin >Inspection >Varies from >Normal light to deep brown >Good skin >Normal turgor >Not tender  Palpation >Normal >Short and Hair  Inspection black with >Normal normal distribution .

Body Parts Method Findings Analysis Scalp >Inspection >Absence of >Normal seborrhea >No abrasion >Normal Head >Inspection >rounded. >Normal smooth skull contour >Absence of >Palpation masses or >Normal nodules .

Body Parts Method Findings Analysis Face >Inspection >facial features >Normal & facial movements are symmetrical >no enlargement of Neck >Inspection & lymph nodes >Normal Palpation >no enlargement of thyroid gland Thyroid Gland >Inspection & >Normal Palpation .

Body Parts Methods Findings Analysis Eyes >Eyebrow >Inspection >symmetrically >Normal aligned >hair evenly >Normal distributed >normal >Eyelashes >Inspection >Normal distribution >Conjunctiva >Inspection >Normal >Pink palpebral conjunctiva >Auricles are Ears >Inspection firm & not tender >Normal .

Body Parts Methods Findings Analysis >symmetrically >Normal aligned >no discharges >Normal >color of the >Normal auricle is the same as the face >no discharges Nose >Inspection >Normal >symmetrically aligned >color is the >Normal same as the rest >Normal of the face >not tender >Palpation >Normal .

smooth >Normal texture >Tongue >Inspection >moves freely & >Normal at the midline >at the midline >Uvula >Inspection >Normal .Body Parts Method Findings Analysis Sinuses >Palpation >Frontal & >Normal maxillary sinuses are not tender Mouth >uniform pink >Lips >Inspection color.

rhythmic >Normal & effortless respiration >Tachypnic 26 bpm >May be normal response to fever >Auscultation and anxiety >65 beats per Heart >Normal minute >Normal >no murmur .Body Parts Method Findings Analysis Chest and >Inspection and >Equal chest >Normal Lungs Auscultation expansion >Quiet.

. Due to inflammation of the appendix.Body parts Method Findings Analysis Abdomen >Inspection >Uniform color >Normal >Auscultation >audible bowel >Normal sound. absence of arterial bruit >Tympanic >Normal >Percussion sound heard >Flat and not >Normal >Palpation tender >Tenderness on RLQ noted >Abnormal.

Due to >Inspection & >Pink in color poor hygiene. >Normal Lower extremities >Abnormal. Palpation >Long dirty nails > Normal >No edema .Body Parts Method Findings Analysis Upper extremities >Hands >Inspection >Presence of IV >Abnormal. Fluids fluid are regulated to prevent >Pulse >Palpation >distal pulses are dehydration and to provide access for palpable >Nails >Inspection administration of medication.

Her respiratory rate was increase it was a normal response to fever and anxiety. She was tachypniec. Physical Assessment was done by inspection. percussion and auscultation. As I assessed her general appearance I noticed her weak appearance. This will serve as a baseline guide for her progress. . palpation.Summary of Physical Assessment She is a newly admitted client. feeling anxious and pain felt on her abdomen. it was a normal response to fever and anxiety. Upon inspecting I noticed her dirty long nails which indicates poor hygiene. Her temperature was above normal due to the inflammation of the appendix.

Upon inspecting her hand I noticed that there is a presence of IV fluid on her right hand. It is abnormal because IV fluid are regulated to prevent dehydration and provide access for administration of medication. . Upon palpation tenderness on the RLQ was noted. It was abnormal because it indicates inflammation of the appendix.

9.015 character: slightly turbid . Laboratory and Diagnostic Test Urinalysis Done: Dec. Gravity: 1. 2008 Color: dark yellow Sugar: negative Albumin: Plus 2 (++) Pus Cells: 4-6/hpf Reaction: 6– acidic RBC: too numerous to count Sp.

54 0. 2008 Description Ref. Basophils 0-1% 0.007 decrease in acute phase of infection.2 normal F:120-140 Hct M:0.5-11x10/L 26.052 decrease.28x10/L 2. It indicates increase adrenosteroid production. Eosinophils 1-3% 0.40-0. 9.47 Leukocyte 4. Value Result Analysis Erythroctes M:4.012 decrease.38-0.6-6.060 decrease may be due to drug therapy .377 normal F:0.24 decrease. It indicates inflammation. Lymphocytes 25-40% . It indicates anemia F:4.00 increase.869 increase. It indicates infection or inflammation Neutrophils 45-65% 0.4 or dietary deficiency Hgb M:140-180g/dl 127. Indicate leukemia Monocyte 3-7% .2-5.Blood Chemistry Done: Dec.

5-14.5mmol/L 4. It indicates hypokalemia. 12.Thrombocyte 150-400x10/L 348 normal MCH 27-31 pg 29. It indicates hypernatremia. Dec. Potassium 3.32-.28 normal .96 decrease.5-5.3 normal Potassium 3.5 10% normal Dec.5-5.2 increase.34 normal RDW 11.99 normal MCV 80-96 f1 88.80 normal MCHC .36 .5mmol/L 2. 2008 Sodium 135-148mmol/L 140. 10. 2008 Sodium 135-148mmol/L 150.

The neutrophils which is the most numerous and important type of leukocytes in the body's reaction to inflammation such as appendicitis was elevated. Lymphocyte is decrease which indicate leukemia. The erythrocyte is decreased which indicates anemia and dietary deficiency. Basophils is decrease in acute phase of infection and may indicate hyperthyroidism. . Decrease circulating eosinophil is usually cause by increase adrenal steroid production that accompanies most conditions of bodily stress and is associated with Acute bacterial infection with a marked shift to the left. The patients hematocrit and hemoglobin are normal.Summary of Diagnostic and Laboratory Result As the laboratory result has been released it shows some abnormalities in the blood. The leukocytes is elevated because it fight infection and defend the body by the process called phagocytosis.

The sodium was increase which indicate hypernatremia. The dark yellow urine may indicate bilirubin in the urine. Slight turbid may indicate UTI. . The Potassium was decrease which indicate electrolyte imbalance such as hypokalemia.The other blood component are normal.

VII. Anatomy and Physiology .

The term "vermiform" comes from Latin and means "worm-like in appearance". Its position within the abdomen corresponds to a point on the surface known as McBurney's point. the right iliac fossa. The appendix is located in the lower right quadrant of the abdomen. The appendix averages 10 cm in length. The longest appendix ever removed measured 26 cm in Zagreb. from which it develops embryologicallly. The appendix is near the junction of the small intestine and the large intestine. or more specifically. While the base of the appendix is at a fairly constant location. Croatia. The diameter of the appendix is usually between 7 and 8 mm. . also cecal (or caecal) appendix. The cecum is a pouch-like structure of the colon. but can range from 2 to 20 cm. 2 cm below the ileocaecal valve. The appendix (or vermiform appendix. also vermix) is a blind ended tube connected to the cecum (or caecum).

the appendix may be located in the lower left side. . In rare individuals with situs inversus.the location of the tip of the appendix can vary from being retrocaecal (74%) to being in the pelvis to being extra peritoneal.

Pathophysiology Non Modifiable Factor Modifiable ACUTE APPENDICITIS Age Gender Diet Obstruction of the lumen Obstruction of the outflow of the secretion Increase mucosal secretions Increase intraluminal pressure Distention of the appendix Abdominal pain Tenderness on RLQ Inflammation of the appendix Fever. vomiting Loss of appetite Localized Peritonitis Periappendiceal Abscess . VIII.

The obstructed lumen does not allow drainage of the appendix and the mucosal secretions continues. Typically acute appendicitis progresses from obstruction of the lumen and distention of the appendix to spread . intraluminal pressure increases. It develops when the lumen of the appendix becomes obstructed. foreign body or tumors. The resultant increase pressure decreases mucosal blood flow and the appendix becomes hypoxic. abdominal surgery. The obstructed appendix become distended because of continued secretion of mucus by the lining cell. usually by fecalith.Summary of Pathophysiology Appendicitis is the most common cause emergency.

The pain is usually accompanied by a low grade fever. nausea and often vomiting. initiating a progressively severe generalized or upper abdominal pain which within a few hours becomes localized in the RLQ of the abdomen. If unrecognized and untreated.Of the inflammation beyond the appendix. The inflammatory process increases intraluminal pressure. Initially there is a localized peritonitis confined to the area of the appendix. Local tenderness is noted when pressure is applied and loss of appetite is common. . this may lead to rupture and abscess.

Nursing Care Process Assessment Nursing Diagnosis S> ”Parang nahihiwa ang tyan Acute pain related to surgical ko ” incision. IX. O>facial grimace connotes pain. >weak appearance >pain scale 6/10 >provokes pain when moving >dull pain >RLQ of the abdomen >intermittent .

Scientific Explanation Planning Usually a recent onset associates a After 2 hours of nursing specific injury. (Medical Surgical Nursing Smeltzer et. acute pain indicates that intervention the client level cause pain may heal spontaneously or of pain from 6/10 will be may require treatment. The level. A stimulus may result on pain at one time but not in another. sensitivity of this system component can be affected by several factors and may differ among individuals. al pp. Pain receptors are free nerve endings in the skin that respond only to intense potentially damaging stimuli. A number of algogenic substances that affect the sensitivity of nociceptors are released into the extra cellular tissue as a result of tissue damage. 264) . The system involved in the perception of pain is minimized into tolerable referred to as nociceptal system.

of postoperative pain experienced. aged/cognition. (dull) . ( NANDA Doenges et al) of pain. > To establish baseline data. (NANDA. (NANDA Doenges et. Al) > Noted location of surgical >This can influence the amount procedure. Al) >It assist the patients perception >Used pain rating scale for of pain. Doenges et. (6/10) (NANDA Doenges et al) > Pain is subjective and cannot >Accepted client description be felt by others. Nursing Interventions Rationale > V/s taken and recorded.

by refocusing attention. ( NCP 6’th edition Doenges et al) Administered pain >Reduce metabolic rate and medication as ordered. Nursing Interventions Rationale Provided comfort measures >Promotes relaxation and may such as therapeutic touch enhance patients coping abilities and repositioning. which aids in pain Tromethamine 30 mg IV q8. >Maintain Hydration and provides access for administration of medications. Adminisred IV fluid as (NANDA Doenges et al) ordered. relief and promotes healing. (Delmar's Critical Care NCP Sheree Comer) . intestinal irritation from circulating/ Kotorolac local toxins.

(Medical Surgical Nursing Smeltzer et al) . Nursing Interventions Rationale > placed the patient in high >This position reduces the fowler position. tension on the incision and abdominal organs helping to reduce pain.

. Evaluation The clients level of pain was minimized as evidence by pain scale of 4/10.

” preoperative procedure. O>voice quivering >anxious >restless >poor eye contact >increase respiration . Assessment Nursing Diagnosis S> “Kinakabahan ako dahil Anxiety related to operasyon ko na mamaya.

It is an altering signal that warns of impending danger and enables the individual to take measures to deal with treat. (NANDA Doenges et al) . a feeling of apprehension caused by anticipation of danger. source often non specific or unknown to the individual). Scientific Explanation Planning Vague uneasy feeling of After an hour of nursing discomfort or dried intervention the clients anxiety accompanied by an will be lessened in a tolerable autonomic response (the level.

consciousness. (NANDA Doenges et al) . al) Can point the client level of  Observed behaviors. To identify physical responses associated with both physical and emotional conditions. (NANDA Doenges et al) Helps client to identify what is Provided accurate reality based. (NANDA Doenges et information about the situation. Nursing Interventions Rationale V/s taken and recorded.

Nursing Interventions Rationale >Stayed with client. al) > Provided preoperative >Can provide reassurance and education. Discuss routine alleviate patients anxiety as well procedures that frightened as provide information for the patient. confident provide comfort. (NANDA Doenges et manner. > To decrease anxiety and maintaining a calm. (NANDA Doenges et al) . formulating intraoperative care.

. Evaluation The clients anxiety was lessened as evidenced by being able to communicate her feeling to her significant others.

Assessment Nursing Diagnosis O>T: 38.1 C Elevated body temperature >warm to touch related to inflammation of the appendix. >weak >teary eyed .

. and promotes the repair of damage tissue. agent. (Fundamentals of Nursing. prevents further spread of the injury. Scientific Explanation Planning Inflammation is a local and After 2 hour of nursing non specific defensive intervention the clients body response of the tissues to an temperature will decrease to injurious or an infectious normal range. The inflammatory process causes elevation of the body temperature to fight infection. Kozier et al page 634) . It is an adaptive mechanisms that destroys or dilutes a injurious agent.

. >To increase heat loss through conduction. (Fundamentals of Nursing 8’th edition Kozier et al) >To minimize shivering. Nursing Interventions Rationale >Monitored the client >provide information about the temperature. (NANDA Doenges et al) >Provided tepid sponge bath. effectiveness of care. (NANDA > Monitored use of Hypothermia Doenges et al) blanket and wrap extremities with bath towels.

center. . Nursing Interventions Rationale >Reduced physical activity. (Fundamentals of nursing 8th edition Kozier et al) >Maintained and regulated IV >To met the increase fluid as ordered. metabolic demand and prevent D5 LR 1L@30 gtts/min dehydration. >To limit heat production. (Fundamentals of nursing 8th edition Kozier et al) > May relieve fever through central action to the >Administered antipyretic hypothalamic regulating medicine as ordered. (Nursing 2008 Drug Handbook Williams and Wilkins) Paracetamol 300 mg IV q6.

. Evaluation The clients body temperature back to normal range.

Drug Study Drug Name Classification and Mechanism of Action Generic Name: Anti-infective Drugs Cefoxitine Sodium Second generation Dose: cephalosporins that inhibits cell wall synthesis. Route: Through IV Frequency: q8 . X. promoting 1g osmotic instability: usually bactericidal.

eosinophilia. transient neutropenia. CNS: fever CV: hypotention GI: nausea and vomoting Hematologic: Thrombocytopenia. hymolitic anemia. Indication Adverse Reaction >Perioperative prevention. anemia Respiratory: Dyspnea .

Contraindication Nursing Responsibilities >Contraindicated in >Tell the patient to report patients hypersensitive to adverse reactions and s/s of drugs and other super infection. other beta lactam antibiotics. hypersensitive to penicillin >Advise patient to notify because of possibility od prescriber about loose stools cross sensitivity to with or diarrhea. >Instructed the patient to >Use cautiously in patients report discomfort at IV site. . cephalosporin's.

May decrease neutrophil and platelet count. . May decrease hemoglobin level. AST. > May increase eosiniphil count. Monitoring Parameters >May increase alkaline phosphate. ALT.bilirubin and LDH levels.

The drug may IV relieve fever through central action in the hypothalamic regulatory center. Drug Name Classification & Mechanism of action Generic Name: Nonophioid Analgesics Acetaminophen (APAP and antipyretics Paracetamol) Thought to produce analgesia by blocking pain Dose: impulses by inhibiting synthesis of prostaglandin in the CNS or 300mg of other substances that synthesize pain receptors to Route: stimulation. Frequency: q6 .

Hepatic: jaundice Metabolic: hypoglycemia . Indication Adverse Reaction >Mild pain or fever Hematologic: hymolitic anemia. leukopenia. pancytophenia.

>Use cautiously in patient with long term alcohol use because therapeutic dose can cause hepatotoxicity in these patients. Contraindication >Contraindicated to patients hypersensitive to drugs. .

. >Warn patient that high doses or unsupervised long term used can cause liver damage. be counted when calculating total daily dose. > Tell patient not to used for marked fever (temperature higher than 103 F. acetaminophen and should WBC. products contain >May decrease nuetrophils. Excessive alcohol used may increase the risk of liver damage. RBC. and platelet count. Nursing Responsibilities Monitoring Parameters > Advice patient and >May decrease glucose and caregiver that many OTC hgb levels and hct.

analgesics and 30mg anti pyretic effects. Drug Name Classification & Mechanism of action Generic Name: Nonsteroidal Inflammatory Ketorolac Drugs (NSAIDs) May inhibit prostaglandin Dose: synthesis. Route: Through IV Frequency: q8 . to produce anti- inflammatory.

moderately severe. diaphoresis Hematologic: decreased platelet adhesion. Indication Side Effects Short term management of CNS: headache. constipation. diarrhea. prolonged bleeding time. palpitations GI: dyspepsia. sedation pain for single dose treatment CV: arrythmias. stomatitis Skin: rash. pruritis. acute drowsiness. peptic ulceration. GI pain. vomiting. dizziness. purpura Other: pain in the injection site . nausea. flatulence. edema. hypertension.

Contraindication Nursing Responsibilities Contraindicated in patients Correct hypovolemia hypersensitive to drugs and before giving in those with active peptic Don’t give epidurally ulcer disease and recent GI because of alcohol content bleeding NSAIDs may mask sign Contraindicated as and symptoms of infection prophylactic analgesic before because of their antipyretic major surgery of and anti inflammatory intraoperatively when actions hemostasis is critical Serious GI toxicity Use cautiously in patients including bleeding and peptic who are elderly or have ulcers. can occur in patients hepatic or renal impairment taking NSAIDs. despite lack of symptoms .

past allergic reactions to aspirin and during labor and delivery or breastfeeding . Contraindication Nursing Responsibilities Contraindicated to children Carefully observe patients younger than age of two and with coagulopathies and those in patients with history of taking anticoagulants peptic ulcer disease.

Monitoring Parameters May increase ALT and AST level May increase bleeding time .

Prognosis After four days of confinement at Batangas Regional Hospital the client prognosis is good because the patient was recovering well after the surgery. . XI. According to the doctor the patient will be discharge after three more days.

T-Instructed the significant others to cleanse and change the dressing of the client wound regularly. Ketorolac 30 mg three times a day 3. Explained to the client that her normal activity can be resumed after 2 to 4 weeks. . 1. 2.Instructed the significant others to continue giving the patients medications as ordered. H-Instructed the significant others to always bath the patient but avoid soaking the wound in the water. Discharge Planning M.Advised the client to exercise in moderation with a gradual build up in intensity. Metronidazole 500 mg three times a day E. XII. Paracetamol 30 mg as necessary for fever.

S. O. Reyes after one week for the removal of the sutures.Provided health teaching of sexual responsibility.Advised the patient to always cut the nails.Advised the client to strengthen her faith in GOD. S.Instructed to eat foods rich in protein and Vit. Because Jesus is the only source of healing. . C. D.Instructed the patient to have a follow up check up to Dr. Instructed the significant others to provide clean and safe environment for the clients early recovery.

First of all to our Almighty God for the strength .Acknowledgement I would like to extend my deepest and heartfelt gratitude to all those people who helped and supported me while I’m doing this study. To the staff of the IMC. To my parents who always there for me and supported me emotionally and financially.knowledge and wisdom He gave me while I’ doing this study. Mrs. for allowing me to borrow books and use their internet. To my dear clinical instructor. Annabelle Iturralde for sharing us her knowledge and guiding us in the clinical area. .

and group mates for all the ideas and advices you shared to me. . To all my friends. To all of you THANK YOU SO MUCH AND GODBLESS. classmates.

Bibliography Delmar's Critical Care NCP Sheree Comer Essentials Anatomy and Physiology by Seeley.com . Tate & Stephens Fundamentals of Nursing. Kozier et al Laboratory and Diagnostic Test with Nursing Implication. 7th edition by Joyce Lefever Lee Medical Surgical Nursing 7th edition by Joyce Black & Jane Hokanson Medical Surgical Nursing 8th edition by Brunner & Suddarths Medical Surgical Nursing Smeltzer et. al NCP 6’th edition Doenges et al MIMS17th edition2005 NANDA Doenges et al Nursing Care Plan 7th edition by Marilynn Doenges et.al Nursing Drug Handbook 28th edition Nursing 2008 Drug Handbook Williams and Wilkins Electronic References www.yahoo.

the therapeutic helping relationship is client and goal oriented. Nurse Patient Interaction Therapeutic Communication >it promotes understanding and helped establish a constructive relationship between the nurse and the client. . where there may not be a specific purpose or direction. >Unlike the social relationship.

Ex.Providing general leads – Using statements or questions that encourage the person to verbalize . choose a topic of conversation and facilitate continued verbalization. Rate your pain on a scale of 0-10.” 3. 2. Sitting quietly and waiting attentively until the client is able to put thoughts and feelings into words. Ex. “Can you tell me how it is for you?” “Perhaps you would like to talk about…” “And then what….Therapeutic communications technique 1. Ex.Being specific and tentative – Making statements that are specific rather than general and tentative rather than absolute.Using silence – Accepting pauses or silences that may extend for several seconds or minutes without interjecting any verbal response. (specific statements) Are you in pain? (general statements) .

Ex. “Client: I couldn't manage to eat any dinner last night – not even the dessert. “Nurse: You had difficulty eating yesterday. Putting your hand over the clients hand.Restating or paraphrasing – Actively listening to the client’s basic message and then repeating those thoughts or feeling in similar words.” . “I’d like to hear more about that. Ex.Using touch – providing appropriate form of touch to reinforce caring feelings. “I’m not sure I understand that.” “Tell me about…” “How have you been feeling lately?” 5. Ex.Using open ended question – asking broad questions that lead or invite the client to explore thoughts and feelings.4. 7.” 6. Seeking clarification – A method of making a clients broad overall meaning of the message more understandable. “Putting an arm over the clients shoulder. Ex. “I’m puzzled”.

“Your surgery is scheduled for 11 am tomorrow. Ex. specific factual information the client may or may not request.” “I’ll helped you to dress to go home if you like.Perception checking or seeking conceptual validation – A method similar to clarifying that verifies the meaning of specific words rather than the overall meaning of the message.Giving Information – Providing in a simple and direct manner .” . an effort the client has made. “You trimmed your beard and mustache and washed your hair. Ex. Client: “My husband never gives me any present” Nurse: “You mean he has never given you a present for your birthday or Christmas?” 9. Ex.Offering Self – Suggesting ones presence.” 10. of a change of behavior. in a non judgmental way. Ex. interest or wish to understand the client without making any demands or attaching conditions that the client must comply with to receive the nurses attention.” 11.8.Acknowledging –Giving recognition . or a contribution to a communication. “I’ll stay with you until your daughters arrives.

Clarifying time or sequence – Helping the client clarify an event. what’s for dinner that night. and they’re always after her about something. Ex. situation or happening in relationship to time. Ex. what with the children to take care of. Ex.12. homework.” 14Focusing – Helping the client expand on and develop a topic of importance. Nurse: “Sounds like you are worried how she can manage.clothes. Client: “I vomited this morning. but I don’t think she can.” . Presenting Reality – Helping the client to differentiate the real from the unreal.” Nurse: ”Was that after breakfast?” 13. Client: “My wife says she will look after me. ”The telephone ring came from the television.

15. Reflecting – Directing ideas, feelings, questions, or content back to
clients to enable them to explore their own ideas and feelings about the
situation.
EX. Client: “What can I do?”
Nurse: “What do you think would be helpful?”

16. Summarizing and planning – Stating the main points of a discussion to
clarify the relevant points discussed.
EX. “During the past half hour we have talk about……”
“Tomorrow afternoon we will explore this further.”

Attentive listening
It is listening actively using all the senses, as
opposed to listening passively with just the ear. It is
probably the most important technique in nursing and is
basic to all other techniques. Attentive listening is an
active process that requires energy and concentration. It
involves paying attention to the total message, both verbal
and nonverbal, and noting whether this communication is
congruent . Attentive listening means absorbing both the
content and the feeling the person is conveying, without
selectivity.

The Helping Relationship
Nurse-client relationship are referred to by some as
interpersonal relationships, by others as therapeutic
relationships,

The Helping Relationship
Nurse-client relationship are referred to by some as
interpersonal relationships, by others as therapeutic
relationships, and by still others as Helping relationships.
Helping is a growth facilitating process that strive to achieve
to basic goals.
1.Helps client manage their problems in living more
effectively and develop unused or underused opportunities
more fully.
2.Helps client become better at helping themselves in
their everyday lives.

The key to the helping relationship are:
a. the development of trust and acceptance between
the nurse and the client.
b. an underlying belief that the nurse caresabout and
wants to help the client.

>the client and the nurse closely observed each other and form judgments about the others behavior. >getting to know each other and developing a degree of trust. >it is important because it sets tone to the relationship. . >the nurse has information about the client before the first face to face meeting. Such information may include. medical history and social history. age.Inroductory Phase >also referred to as the orientation phase or the prehelping phase. Preinteraction phase >it is similar to the planning stage before the interview. address. the clients name. 2.Phases of helping relationship 1.

.3. and each person needs to developed a way of saying goodbye. Working Phase >the nurse and the client begin to view each other as unique individuals. >the client generally has a positive outlook and feels able to handle problems independently. Caring is sharing deep and genuine concern about the welfare of another person. >it is natural to expect some feeling of loss. 4. Termination Phase >often expected to be difficult and filled with ambivalence. they begin to appreciate this uniqueness and care about each other .

7. 8.Know your roles and your limitations.Be honest.Listen actively.Developing a Helping Relationship 1.Be genuine and credible. 4. 3.Maintain client confidentiality. 5. 9.Use your ingenuity.Help to identify what the person is feeling.Be aware of cultural differences that may affect meaning and understanding. 2. 6.Put yourself in the other persons shoes. .