CASE PRESENTATION ON IMMEDIATE

POST OPERATION DAY AFTER

APPENDECTOMY WAS DONE FOR THE
INDICATION OF ACUTE APPENDICTIS

BY:MISGANA ZEMEDE ID 4326/06

 Patient detail
2

 Name: B.M Date of admission:11/07/10

 Age: 11 Address: Haramaya
 Sex: female card no :413257
 BED NO 34
 Ethnicity: oromo
 Religion : muslim

07/23/2023
 Patient detail…
3

c/c – Abdominal pain of 5 days duration

HPI- she was relatively healthy 05 days back at

which time she started to experience crampy
type of abdominal pain which occur at the
amblical later become at RL abdomen, in
associated to these she was Hx of Anorexia,
Nausea, loss of appetite and LGIF.

07/23/2023
 Patient detail…
4

Other wise
she has no hx of Vomiting, failure to pass faces.
No hx of diarrhea
PMH – she has no hx of DM,HTN, & kidney disease .

Medication history - no past medication history

FH – she has no self & family hx of chronic disease.

SH – she is elementary school student and lives with her father

and mother.

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 Patient detail…
5

Drug allergy – She has no hx of drug allergy

ADR – She has no hx of ADR

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6

Day Pulse BP RR Temperatur SPO2

e

11/07/10 104 114/67 24 37.8 92 on O2

12/07/10 116 110/70 30 37.1 94 on O2

16/07/10 96 110/70 26 37 93 on O2

07/23/2023
 Physical examination
7

G/A - well Looking

HEENT – pink conjunctiva

RS – clear chest with good air entry

CVS – s1& s2 well heard, No M and G

07/23/2023
 Con…
8

Abdomen – Flat moves with respiration, No

sign of fluid collection
There is direct tenderness over RLQ
IGS – No rash
MSS – No deformity and no edema
GUS – No CVAT
CNS -COPPT

07/23/2023
 Investigations
9

 WBC= 10.04 Neutro= 65

 RBC= 5.16 Lympho= 21
 HGB= 14.2 Basophl= 14
 HCT= 41.5 RDW= 12.9
 MCV= 80.4

 Ultra sound report: RLQ pericecal inflammatory

change with thick collection likely 2ndry to ruptured
appendix.
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 Assessment
10

IMMEDIATE POST OPERATION DAY

AFTER
APPENDECTOMY WAS DONE FOR
THE INDICATION OF ACUTE
APPENDICTIS

07/23/2023
 Drug therapy
11

 Ceftriaxone 750mg IV BID

 Diclofenac 50 mg IM BID

 MF = 850ml/12hr which contains

85 ml of D40
482ml of D5
283ml of N/S

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 Discussion AND CRITIQUE OF
CURRENT Treatment
12

Appendicitis, is an inflammation of the vestigial vermiform



appendix, is one of the most common causes of the acute

abdomen and one of the most frequent indications for an
emergent abdominal surgical procedure worldwide.
The appendix is a true diverticulum of the cecum.


Appendiceal obstruction has been proposed as the primary



cause of appendicitis

07/23/2023
 …
13

 Appendiceal obstruction may be caused by

fecaliths (hard fecal masses), calculi, lymphoid
hyperplasia, infectious processes, and benign
or malignant tumors.

 Common organisms involved in gangrenous

and perforated appendicitis include
Escherichia coli, Peptostreptococcus,
Bacteroides fragilis, and Pseudomonas species

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 …
14

Clinical manifestations
Right lower quadrant (right anterior iliac fossa) abdominal

pain
Anorexia


Nausea and vomiting



Treatment
Surgery is the mainstay of treatment and it’s process is


known as Appendectomy

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15

Non operative treatment includes the following:

 Intravenous fluids should be administered. Oral

intake may be resumed as tolerated.

 Parenteral nutrition is indicated if the child is

unable to eat after one week.

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 …
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 Antibiotics should be prescribed (as for

advanced appendicitis) and continued until
the child is afebrile, tolerating a regular diet,
and has a normal WBC.

 Appropriate pain management

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 Pharmacotherapeutic plan
17

Goal of therapy

 For preventing post operative complications of

perforated appendicitis.
 To prevent or reduce recurrence (re-infection)
rate of Appendicitis.
 To correct electrolyte abnormalities
 Minimize hospitalization

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18

 There is Drug Therapy Problem/DTP/

Needs Additional Drug Therapy

Metronidazole 500mg IV,TID is require as

appendicitis is raptured or perforated to cover
anaerobic pathogen we should be give
metronidazole with Ceftriaxone as treatment.

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 …
19

Care plan

 To continue the above medication with good

adherence of the patient.

 To monitor and evaluate the ADR of the drug.

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 Monitoring parameter
20

 Vital signs
such as Pulse, BP, RR and Temperature

 Oxygen saturation

 Wound site infection

 Sign and Symptoms

 Appetite of the patient 07/23/2023

 Patient education
21

 I counsel the care giver to ambulate the patient to

prevent the occurrence of DVT.
 I counsel the care giver to limit the physical
activity of the patient to make the healing of the
tissue to be faster.
 I counsel on fiber containing meals for the patient
such as vegetables like cabbage.
 I counsel the care giver to offer clear liquids the
day after surgery until she progress to a regular
diet.
07/23/2023
22

THANK

YOU!!!!!!
07/23/2023