Acute Appendicitis

INTRODUCTION 

Acute Appendicitis is a condition in which your appendix becomes inflamed and filled with pus. The main symptom of appendicitis is dull, poorly localized, visceral pain that typically begins around your navel and then shifts to your lower right abdomen as inflammation progresses. 



On palpation, localized and rebound tenderness are noted at McBurney¶s point. In addition to pain, a low-grade temperature, loss of appetite, nausea, and vomiting are often present. 

bacteria may subsequently invade rapidly. If not treated promptly. your appendix is likely to rupture.Predisposing Factors:  Obstruction  Infection In both cases. causing the appendix to become inflamed and filled with pus. .

  . but is more common in adolescents and young adults. thus making perforation more likely. but it may be as high as 5 percent or more in young and elderly patients. in whom diagnosis may often be delayed. Acute appendicitis can occur at any age. The mortality rate in non-perforated appendicitis is less than 1 percent. About 7% of the population will have appendicitis.

physical exam. . and imaging studies (ultrasound. CT. xray). The diagnostic procedures for appendicitis are blood count.

This study aims to help and guide nursing students. staff nurses and clinical instructors as well the patient himself to deal with curative and rehabilitative aspect of Acute Appendicitis. skills. and attitude in handling patient with Acute Appendicitis. . the students will be able to apply knowledge.OBJECTIVES General Objectives  After Related Learning Experience.

Explain the diagnostic procedures and significant laboratory findings.Specific Objectives At the end of two days. Devise and implement appropriate nursing care plan and health teachings applicable to the patient. the students will be able to:      Determine the probable causative factors and risk of Acute Appendicitis Analyze potential complications that may develop following Acute Appendicitis. . Evaluate effectiveness of nursing interventions and health teachings for patient with Acute Appendicitis through return demonstration and verbalized apprehension.

Bulacan. 2008 at 5:10 pm. Joseph College. male. 20 years old. A college student from St.L. Mercado Memorial Hospital (RMMMH) on August 27. Filipino. 1988. single. Roman Catholic. Presently residing at San Jose Del Monte. Admitted for the first time at Rogaciano M.NURSING HISTORY GENERAL DATA      J. . Born on January 9.

intermittent epigastric pain. the patient experienced a sudden dull. the patient was noted to be apparently well until seven hours prior to admission.HISTORY OF PRESENT ILLNESS  The patient is currently on a good condition. .  Since then.

still with the above condition.  . loss of appetite and vomiting. generalized abdominal pain was now noted to be continuous.  Four hours prior to admission still with the above condition.Six hours prior to admission.  Accompanied by a low-grade fever.  Upper abdominal pain intensifies and localizes on the right lower quadrant of the abdomen.

persistence of the above condition. Mercado Memorial Hospital hence admission. . prompted consults at Rogaciano M. Two hours prior to admission.

 Immunization: Received Hepatitis B vaccine. drugs and any other environmental agents.  He has no past hospitalization. flu. . and chickenpox. DPT and MMR when he was still young.  He has no allergies to any food. BCG.PAST MEDICAL HISTORY  J.L. Oral Polio vaccine. experienced the common illnesses afflicting a child like cough and colds.

FAMILIAL HISTORY  Has familial history of hypertension on paternal side. .

his family conducts a small gathering. since most of his siblings are already married.  During weekends. . after going to church. like a small reunion.  He has a sedentary lifestyle. All are apparently well.PERSONAL AND SOCIAL HISTORY  He is the youngest among five (5) siblings.

Grow rich VCO 500 mg capsule once daily. He urinates 6-10 times a day. He likes to drink juices and water for about 6-9 glasses a day.       Primary compositions of his diet are rice. depending on how much fluid he consumes. beef. He also takes food supplement. typically. . pork. Bowel movement is 3-4 times a week. He sometimes experience pain on defecation. stool consistency is hard. and chicken. He seldom eats fruits and vegetables.

He takes a bath daily and brushes his teeth 2-3 times a day. consuming for about 10-18 bottles of beer per session. . He is an alcoholic beverage drinker. 5-8 sticks a day and 1-2 packs for special occasions together with his friends. He sleeps at around ten in the evening and wakes up at six in the morning.    He is a 4 year-smoker.

55 kg 170.69 cm Spontaneous.PHYSICAL ASSESSMENT & GENERAL APPEARANCE MEASUREMENTS Weight Height Level of consciousness FINDINGS 54. oriented to time. place & person Medium Body build Overall hygiene & grooming Satisfactory . coherent. conscious.

VITAL SIGNS Time Temperature Pulse Rate Respiratory Rate Blood Pressure DAY 1 (08/28) 11:30 PM 38ÛC 63 beats/min 24 bpm 120/80 DAY 2 (08/29) 11:30 PM 36.9ÛC 71 beats/min 21 bpm 120/80 .

HEAD-TO-TOE ASSESSMENT (8/29/08 5:30 AM) Post-operative Part Skin Technique Inspection & Palpation Findings Slightly pale in appearance Skin is hot to touch Good skin turgor With surgical incision at the right lower quadrant .

swelling or malformations. abrasions.Part Head and scalp Technique Inspection & Palpation Findings Normocephalic There is no bald spot. . The scalp has no scars.

it is oily.Part Hair Technique Inspection Findings patient has short. The . straight. and black hair equal in distribution There are no signs of dandruff.

His eyelashes are equally distributed.Part Eyes Technique Inspection Findings moves symmetrically as facial expression changes. present bilaterally. Eyebrows .

Teary eyes The .. Pupils constrict with increasing light and dilate in dim light. has normal shape and size and the color is black-brown.Eyes) Technique Findings eyes are symmetrical. He has pale conjunctiva.Part (.

No presence of foreign bodies. Responds to normal conversation.Part Ears Technique Inspection Findings with scant amount of cerumen and few cilia. Clean . and no swelling and no unusual odor.

Part Nose Technique Inspection Findings are no discharges Clean with few cilia Patent There .

The tongue is slightly dry. Halitosis was noted.Part Mouth Technique Inspection Findings are slightly red and dry. bleeding or discharges. Lips . There is no presence of swelling.

Part Neck Technique Palpation Findings  No palpable swollen lymph nodes .

Part Chest & Lungs Technique Inspection & Auscultation Findings no difficulty in breathing Has symmetrical chest expansion Respiratory rate is 22 bpm Has .

Part Abdomen Technique Findings Inspection & Palpation surgical incision and dry and intact dressing at the right lower quadrant Distended. tender With palpable pain With .

With good and equal pulses. Slightly .Part Upper & Lower Extremities Technique Inspection & Palpation Findings pale nail beds and smooth. He has the ability to do range of motion on his extremities but with weakness. Capillary refill in 2 seconds.

ANATOMY AND PHYSIOLOGY .

.

PATHOPHYSIOLOGY .

. .Constipation. intermittent abdominal pain Cont. low fiber diet Occlusion of fecalith Obstruction of proximal lumen Appendix becomes distended with fluid Pressure within the lumen Generalized.

edema. ulceration. anorexia.Cont. infection Pus fills the inflamed appendix Low-grade fever. Blood supply impaired Inflammation.. nausea and vomiting ACUTE APPENDICITIS .

LABORATORY AND DIAGNOSTIC PROCEDURES RESULTS .

Hematology TEST FOUND VALUE 8/27 (Pre-operative) 162. anemia High: Polycythemia Hemoglobin M=155-175 g/L .4 g/L NORMAL VALUE CLINICAL SIGNIFICANCE Low: hemorrhage.8 g/L FOUND VALUE 8/28 (Post-operative) 156.

Anemia High: polycythemia. dehydration .TEST FOUND VALUE 8/27 (Pre-operative) 48 FOUND VALUE 8/28 (Post-operative) 46 NORMAL VALUE CLINICAL SIGNIFICANCE Hematocrit 40-52 Low: hemorrhage.

toxicity.TEST FOUND VALUE 8/27 (Pre-operative) 25. specific infections High: inflammation.0x 10/L Low: aplastic anemia.0 x 10/L FOUND VALUE 8/28 (Post-operative) 15. trauma.0-11. drug toxicity.0 x 10/L NORMAL VALUE CLINICAL SIGNIFICANCE WBC 4. leukemia .

an end product of Hemoglobin breakdown. Color Amber . yellow orange : urobilinogen is produced in the intestine by the action of bacteria on bile pigment.Urinalysis TEST FOUND VALUE 8/27 (Pre-operative) Bright yellow FOUND VALUE 8/28 (Post-operative) Yellow orange NORMAL VALUE CLINICAL SIGNIFICANCE Amber: due to pigment called urochrome.

epithelial cells . urates. pus. Turbid: phosphates. bacteria.TEST FOUND VALUE 8/27 (Pre-operative) Turbid FOUND VALUE 8/28 (Post-operative) Turbid NORMAL VALUE CLINICAL SIGNIFICANCE Transparency Clear Clear: normal. but may become cloudy after standing awhile. mucus.

prolonged fever Alkaline: urinary tract infection. acidosis.0 FOUND VALUE 8/28 (Post-operative) 6.TEST FOUND VALUE 8/27 (Pre-operative) 6.5 .5 NORMAL VALUE CLINICAL SIGNIFICANCE Acidic: diabetes. alkalosis pH 6.0 to 7.

aldosteronism .026 NORMAL VALUE CLINICAL SIGNIFICANCE Specific gravity 1.025 Increase in Diabetes mellitus Decrease in acute nephritis. Diabetes insipidus.032 FOUND VALUE 8/28 (Post-operative) 1.015-1.TEST FOUND VALUE 8/27 (Pre-operative) 1.

TEST FOUND VALUE 8/27 (Pre-operative) 2-5 FOUND VALUE 8/28 (Post-operative) 1-4 NORMAL VALUE CLINICAL SIGNIFICANCE Presence of pus: urinary tract infection Pus cells (-) .

Diagnostic Procedures:  Blood count. . physical exam. imaging studies (ultrasound) Ultrasonography: (Preoperative)  Revealed a right lower quadrant density  Outer appendiceal diameter size of 6 mm on cross section.

NURSING CARE PLAN .

ASSESSMENT Subjective: ³Sumasakit ang sugat ko´ as patient verbalized. Objective: Pain Scale: 6/10 Moderate pain Incision @ right lower quadrant of the abdomen Distraction behavior Guarding behavior Facial mask of pain NURSING DX: Acute Pain related to surgical incision

PLANNING Partial compensatory Short Term Goal At the end of 1hour nursing interventions, patient¶s pain will decrease from 6/10 to 4 or less

INTERVENTIONS 
Facilitate

RATIONALE
tension on the incision and abdominal organs, helping to reduce pain. Lessens the complications and provides as a relaxation technique. Diverts patient¶s attention on others rather than the pain. Inhibits prostaglandin synthesis. Is an anti-inflammatory, antipyretic, and analgesic 
Reduces

EVALUATION Patient condition maintained. Pain scale: 3/10

patient in a high Fowler¶s position Facilitated instruction and demonstration of deep breathing exercise Facilitated the use of diversional activities such as reading newspapers, chatting with relatives & friends. Administer appropriate pain medication prescribed by the attending physician: Mefenamic Acid 500 mg/tab every 4 hours per orem Diclofenac Sodium 75 mg TIV every 12 hours

ASSESSMENT Subjective: ³Mainit ang pakiramdam ko´, as patient verbalized. Objective: Watery eyes Dry and red lips Skin hot to touch Incision site @ right lower quadrant of the abdomen Temperature: 38ÛC NURSING DX: Alteration in body temperature related to post surgical procedure

PLANNING Supportive educative Short Term Goal At the end of 45 minutes nursing interventions, patient¶s body Temperature decreases to 3637ÛC

INTERVENTIONS 
Facilitate

RATIONALE 
Cools

EVALUATION Patient condition improved. Temperature:
36.8ÛC.

tepid sponge bath. Facilitate fluid intake Restrict tight clothing Focus on temperature taking Administer paracetamol as prescribed by the physician. Biogesic 500 mg 4-6 hr as needed.

down

body temperature because of the concept of conduction Avoids fluid and electrolyte imbalance Provides good ventilation To recheck the temperature Antipyretic Inhibition of the enzyme COX-3 in the brain and spinal cord.

ASSESSMENT Subjective: ³Mahirap dumumi, matigas at kakaunti parang meron pa,´ as pt. verbalized. Objective:
hard, formed stools Straining with defecation Percussed abdominal dullness 
Dry,

PLANNING Partial compensatory Short Term Goal At the end of 1 hour nursing interventions, patient will be able to verbalize understanding of etiology and appropriate interventions for Individual situation and demonstrate behaviors or lifestyle changes to prevent recurrence of problem.

INTERVENTIONS 
Facilitate

RATIONALE
For prevention or modification of such causes. Provides privacy to perform self-care activities wherein he can be comfortable, safe and relaxed and to stop ignoring his urge To improve consistency of stool and facilitate passage through colon. To promote soft/moist stool. For him to identify specific actions to be taken if problem recurs, to promote timely intervention, enhancing client¶s independence.

EVALUATION Patient condition maintained.

NURSING DX: Constipation related to insufficient physical activity, low fiber intake, and lack of privacy.

identification of causative factors Facilitate privacy and routinely scheduled time to defecate. Focus on increasing intake of fiber and bulk in diet Focus on adequate fluid intake, including high-fiber fruit juices and suggest drinking warm, stimulating fluids. Focus on providing information about relationship of diet, exercise, fluid, and appropriate use of laxatives as indicated.

HEALTH TEACHINGS Medication All medications must be explained in detail as prescribed to client and family. Advise patient to take his medicines on time and as prescribed by the physician. Inform them on the purposes and side effects of the medications. Mefenamic Acid 500 mg/tab per orem for pain. Cefalexin 500 mg/tab per orem three x a day. For continuous improvement of patient condition. .

Environment Instruct the patient¶s relatives to provide a conducive environment. His room should be clean. peaceful. properly ventilated. . and free from insects. To have adequate rest and sleep. Client should have good sleeping habits to avoid fatigue.

Instruct him to observe the incision daily and to report any swelling. and warmth at the site. redness. .Treatment Educate the patient how to care for the incision. drainage. Demonstrate how to change it properly. To prevent infection and any complications after the operation. bleeding.

Encourage the patient to gradually quit smoking as well as drinking alcohol. . This prevents strain on abdominal muscles until healing is complete.Health Teaching Teach the patient relaxation techniques such as deep breathing exercises. Teach the importance of maintaining good personal hygiene.

to know the follow up instructions of the attending physician. .Out Patient Advise to comeback for follow-up check up upon dismissal. and to make an appointment to have the surgeon remove the sutures between the fifth and seventh days after surgery. To know if the patient¶s condition improved.

soft diet can be given. Encourage to eat foods that are high in fiber such as whole grain cereals. .Diet When normal bowel sounds are present. To combat constipation and for body resistance. fresh fruits especially rich in vitamin C and vegetables.

Never apply heat to the lower right abdomen. Frequently assess the dressing for wound drainage and other complications possible to come out after the operation. . Place in Fowler¶s position to reduce the pain.Safety Demonstrate appropriate activity restrictions. Discuss postoperative activity limitations with the patient. Caution him to avoid lifting heavy objects for 6 weeks after surgery. Normal activity can usually be resumed within 2 to 4 weeks.

In handling a patient with Acute Appendicitis. and attitude in handling an AP patient. the student nurses were able to achieve general and specific objectives of this study. and evaluate the effectiveness of nursing interventions and health teachings through patient¶s demonstration of the use of relaxation skills. . The patient showed an improvement in perception and attitude towards ways to promote comfort and to restore his health. explained the diagnostic procedures results and as well as significant laboratory findings. proper wound dressing techniques and verbalized apprehension about his condition. devised and implemented appropriate nursing care plan and health teachings applicable to the patient. we were able to: apply knowledge. analyzed potential complications that may develop following the illness. determined the probable causative factors and risks.EVALUATION After rendering Nursing Interventions. skills.

DRUG STUDY .

hyperten sion. or impaired renal function (None was noted) Instruct patient to take drugs with milk. meals or antacids to minimize GI distress . analgesi c& antipyreti c effects.GENERIC NAME BRAND NAME CLASSIFI CATION DOSAGE MECHANI SM OF ACTION INDICATI ON CONTRAI NDICATIO N SIDE EFFECTS NURSING RESPON SIBILITIE S D I C L O F E N A C SODIUM Cataflam NSAID 75 mg TIV every 12 hrs for 2 doses Produce s antiinflamma tory. fluid retention . cardiac disease. possibly by inhibits prostagla ndin synthesi s Manage ment of acute & chronic types of pain Use cautiousl y in patient with history of peptic ulcers disease hepatic dysfuncti onal.

promoting osmotic instability usually bactericidal INDICATI ON CONTRAI NDICATIO N Contraindi cated with pregnant mother. and skin Drowsines s . respiratory tract. with hypersens itivity to food & drugs SIDE EFFECTS NURSING RESPON SIBILITIE S Report adverse reactions or sign & symptom of superinfection promptly Advised patient to notify prescriber about loose stools or diarrhea C E F A L E X I N Keflex AntiInfective 500 mg/tab per orem three x a day Infections of the urinary tract. soft tissue. joints. bones. biliary tract.GENERIC NAME BRAND NAME CLASSIFI CATION DOSAGE MECHANI SM OF ACTION Third generation cephalosp orin that inhibit its cell-wall synthesis.

GENERIC NAME BRAND NAME CLASSIFI CATION DOSAGE MECHANI SM OF ACTION INDICATI ON CONTRAI NDICATIO N SIDE EFFECTS NURSING RESPON SIBILITIE S P A R A C E T A M O L Biogesic Antipyret ic/ analgesi c 500 mg/tab per orem 4-6 hours Inhibition of the enzyme COX-3 in the brain and spinal cord. maximum of 8 tablets per 24 hours only. Hepatic or severe renal disease. . Can be given with or without food. Used to relieve pain and fever Anemia. Discontinue if fever persists for more than 3 days. cardiac & pulmona ry disease. (None was noted) Monitor intake.

GENERIC NAME BRAND NAME CLASSIFI CATION DOSAGE MECHANI SM OF ACTION INDICATI ON CONTRAI NDICATIO N SIDE EFFECTS NURSING RESPON SIBILITIE S Report adverse reactions or sign & symptom of superinfection promptly Advised patient to notify prescriber about loose stools or diarrhea. biliary tract. M E F E N A M I C ACID Ponstel Analgesi c/ NSAID 500 mg/tab per orem every 4 hours Third generati on cephalos porin that inhibit its cell-wall synthesi s. promotin g osmotic instability usually bacterici dal Infection s of the urinary tract. and skin Contrain dicated with pregnant mother. joints. soft tissue. respirato ry tract. with hypersen sitive to food & drugs Drowsin ess . bones.

Sign up to vote on this title
UsefulNot useful