I. INTRODUCTIONAppendicitisis a condition in which the appendix becomes swollen, inflamed, and filled withpus. The appendix is a small pouch shaped like a small finger. It is on the right side of the abdomen, connected to the colon.

Experts are not sure what the appendix is for. Charles Darwin wondered whether it might have been an organ our ancestors used to digest plants. Recent studies indicate thatthe appendix may be a dedicated environment for friendly bacteria which facilitate digestion and fight infection.

Appendicitis generally affects people aged between 10 and 30, but it can strike at any age.II. SIGNIFICANCE OF THE STUDY

General Objective

This study aims to explore assessment of the digestive tract, identify disorder or diseases process which is Appendicitis and discuss medical treatment and nursing management.

Specific Objectives:

1. Assess client with Appendicitis.

2. Describe the pathophysiology and its clinical manifestations.

3. Discuss the medical and nursing care of client with Appendicitis.

4. Develop nursing diagnoses, client outcomes and plan of interventions.III. NURSING HEALTH HISTORYA. Biographical Data

Name:

Patient X

Age:

10 y/o

Gender:

MaleAddress: Blk 13 Lot 16 Phase 1 city homes Resort Ville Dasma Cavite Height:

43Weight:

36 kgCivil Status:

SingleReligion:

Roman Catholic

Diagnosis:

Acute AppendicitisB. Chief Complaint

Persistent vomiting, fever, rebound tenderness, pain at right iliac fossa region.C. History of Present Illness

One day prior to admission, the patient experienced abdominal pain associated with vomiting and was also febrile. The consultation was done at Divine Grace Medical Center and was diagnosed to have acute appendicitis. Appendectomy was immediately done.D. Past Health HistoryThe patient had childhood illnesses like cough and colds, mumps and chicken pox. He has no allergy in food and medications. Based on his grandmother, his grandson is a fully immunized child.E. Family History of IllnessHis family has no known history of diabetes mellitus, hypertension, cancer, tuberculosis, asthma, kidney disease, anemia, mental disorder and other cardiovascular diseases.F. Social DataThe parents of the patient are working abroad. His grandmother is the one who takes care of him. He is a grade five student and in school he gets to play with his classmates.G. Lifestyle HabitsPatient X is fond of eating salty and fatty foods like potato chips, barbecue, and foods from fast food chains. He only drinks 5 glasses of water a day. He usually consumes 3 bottles of soft drinks every day.H. ProsthesisPatient X does not have any prosthesis.

I. Activities of daily livingPatient X has a routinely daily living. He wakes up at 5am in the morning to prepare for school and travel at 6am and attend his class from 7am to 3pm. By the time he reached their house, he eat snacks and watch television programs, do assignments, eat dinner and sleep at around 10 pm.J. Patterns of Health CareThe client just usually takes medications such as Paracetamol during fever and Tuseran forte for cough and colds without any prescription of the doctor. He also takes his vitamins daily.IV. PHYSICAL ASSESSMENTA. VITAL SIGNS

Actual Finding

Normal ValuesAnalysis

Body Temperature37.0C36.5-37.5CNormal

Pulse Rate90bpm (80) 60-100 bpmNormal

Respiration18 cpm (16) 12-20 cpmNormal

Blood Pressure90/60 mmHg120/80 mmHgNormal

B. HEAD TO TOE ASSESSMENT

BODY PARTTechnique usedNORMAL FINDINGSACTUAL FINDINGSANALYSIS

SkinInspectionUniform in color; no abrasions or any lesions

Well moistened skin.Normal color, turgor and temperature. No ulcerations or rashes noted.Normal

HEAD

SKULL &FACEInspection PalpationRound or normocephalic; smooth, absence of nodules or masses; symmetric facial movement.Head is normocephalic and atraumatic. Extraocular muscles are intact.Normal

HAIRInspectionEven distribution of hair, resilient thick hair with no signs of infections or infestations.Normal hair distribution. No evidence of infestations.Normal

Eyebrow

Eyes

Eyelashes

Eyelids

Pupils (color ,shape andsymmetry of size)

Inspection

Inspection

Inspection

Inspection

InspectionEvenly distributed hair ;eyebrows symmetrically aligned;

Lids close symmetrically, shiny smooth, pinkish conjunctiva; no edema or tenderness

Equally distributed

,Curled slightly outward

No discoloration,

Lids close symmetrically.Black in color, equal in

size normally

3-7 mm in

diameter

,round smooth border , iris

flat and roundEvenly distributed hair ;eyebrows symmetrically aligned;Conjunctivae pink with no scleral jaundice

Equally distributed

,Curled slightly outward

No discoloration,

Lids close symmetrically.

Pupils are equal, round, and reactive to light and accommodationNormal

EARInspectionColor same as facial skin

symmetrical; mobile ,firm and not tender;

No notable discharges normal voice tones

AudibleNo acute purulent dischargeNormal

NOSE AND

SINUSESInspection

Symmetric and straight;

No discharge or flaring; not tender, no lesions.

Uniform in color

Air moves freely as the patient breaths through the nares.

No tenderness in maxillary and frontal sinuses.Normal mucosa and septumNormal

MOUTH

TONGUE

Inspection

Inspection

Uniform in pink color; symmetrical lips

In central position; pink in color

moves freely with no tenderness.Smooth tongue base with prominent veins.Uvula positioned in midline of soft palate.gag reflex present

The lips were moist and teeth are incomplete. There was no swelling or lesions. The jaw is perfectly aligned. No foul odor noted.The oral mucosa, tongue, gums and uvula are pink, moist and without lesions. There were no inflammations in the tonsils.

Uvula in midline position.

Normal

NECK MUSCLES

Lymph nodesInspection

Palpation

PalpationCoordinated, smooth movement with no discomfort.

Has equal muscle strength.

Not palpable

The skin is uniform in color. Neck muscles are equal in size. No tenderness and masses upon palpation.Normal

Upper extremitiesInspection

PalpationMuscle:

Equal size on both sides of the body No contractures

Bones:

No skeletal deformities.

Joints:

No swelling, tenderness, crepitation or nodules.

Moves freely

Without any cyanosis, clubbing, rash, lesions or edema.Normal

Thorax and LungsInspection Auscultation PalpationPosterior thorax:

Symmetry: Spine vertically aligned; spinal column is straight, right and left shoulders are the same in height

Skin intact; uniform temperature

No tenderness and no presence of masses

Vesicular and broncho-Vesicular breath sounds

Anterior thorax: Quite, rhythmic, and effortless respirations

No tenderness and no presence of masses

Chest is symmetric. Spine is vertically aligned. Chest wall intact; no tenderness and masses. With normal breath sounds.Normal

AbdomenInspection

Auscultation

Unblemished skin

Uniform in color

Flat, rounded or scaphoid

Symmetric movement caused by respiration.Audible bowel soundThere is a wound dressing at RLQ, dry and intact.

Audible bowel sound

Not Normal

Lower extremitiesInspection PalpationMuscle: Equal in size on both sides of the body No contractures. No lesions, swelling and inflammation

Bones:

No skeletal deformities.

Joints:

No swelling, tenderness,

crepitation or nodules and moves freely No swelling or effusion in any of the joints of the hands or feet. No peripheral edemaNormal

V. LABORATORY AND DIAGNOSTIC EXAMINATIONS RESULTSA. BLOOD TYPING:

ABO: B

RH: Positive

B. ROUTINE HEMATOLOGY

CBCResultsNormal Values

Hb1414-17 gms %

Hct0.430.42-0.48 vol %

RBC4.84.6-5.0 x 10/L

WBC160005,000-10,000/L

Platelet count250,000150-450,000 cumm

C. URINALYSISINVESTIGATIONResultsNormal Values

Appearancecloudyclear

ColorYellowyellow

Specific Gravity1.0281.003-1.030

pH6.04.6-8.0

AlbuminnegativeNegative

GlucoseNegativeNegative

Ketones1.5Negative

RBC10u/L1-9

VI. DRUG STUDYName of Drugs and ClassificationActionIndicationContraindicationNursing Management

Generic Name:

Paracetamol

Classification:

Non-narcotic analgesic

Brand Name:

Acetaminophen, biogesic, tempra,

Dosage:

260 mg IVP Decreases fever by a hypothalamic effect leading to sweating and vasodilatation. Also inhibit the effects of pyrogens on the hypothalamic heat-regulating centers. May cause analgesia by inhibiting CNS prostaglandin synthesis, acetaminophen has no anti-inflammatory or uricosuric effect. Does not cause any anticoagulant effects or ulceration of the GI tract. Control of pain due to headache, earache, dysmenorrhea,arthralgia, myalgia, muscoskeletal pain, arthritis, immunizations, teething, tonsillectomy,

To reduce fever in bacterial or viral infections.

As substitute for aspirin in upper GI disease, aspirin allergy, bleeding disorder.

Renal insufficiency, anemia, Client w/ cardiac or pulmonary disease is more susceptible to acetaminophen toxicity.

Side Effects:

Hematologic: Methemoglobinemia, hemolytic anemia, neutropenia, thrombocytopenia, pancytopenia, leucopenia.

Allergic: Uticarial and erythematous skin reactions, skin eruptions, fever.

Miscellaneous: CNs stimulation, hypoglycemic coma, jaundice,drowsiness, glossitis.

Do not exceed a dose of 4g/ 24 hr in adults and 75 mg/kg/day in children.

Do not take for more than 5 days for pain in children, 10 days for pain in adults, or more than 3 days for fever in adults or children w/out consulting provider.

Store suppositories below 27c.

Take extended relief product w/ water; do not crush, chew, or dissolve before swallowing.

Bubble gum flavored OTC pediatric products (Liquid and chewable tablet) are available for children to treat fever and/ or pain.

Generic Name:

Ranitidine hydrochloride

Classification:

Histamine H-2 receptor blocking drug

Brand Name:

Zantac

Dosage:20 mg TIV Competitively inhibits gastric acid secretion by blocking the effect of histamine H-2 receptors.

Both daytime and nocturnal basal gastric acid secretion, as well as food and pentagastrin- stimulated gastric acid are inhibited Short term (4-8 weeks) and maintenance treatment of duodenal ulcer

Short term treatment of active, benign gastric ulcers.

Maintenance of healing gastric ulcers.

Pathologic hypersecretomy conditions such as Zollinger- Ellison syndrome and systemic mastocytosis

Cirrhosis of the liver, impaired renal or hepatic function

Side Effects:

GI: Constipation, N&V, diarrhea, abdominal pain, pancreatitisCNS: Headache, dizziness, malaise, insomnia, vertigo, anxiety, agitation, fatigue.

CV:Bradycardia or tachycardia, premature

Cardiac arrest

Hematologic: Thrombocytopenia, granulocytopenia, leukopenia, pancytopenia

Hepatic: Hepatotoxicity, jaundice, hepatitisDermatologic: Erythema, multiforme, rash, alopeciaGive antacids concomitantly for gastric pain although they may interfere w/ ranitidine absorption.

Dissolve effect dose tablets and granules in 6-8 oz of water before talking.

About one-half of clients may heal completely w/in 2 weeks; thus, endoscopy may show no need for further treatment.

No dilution is required for IM use.

Store the syrup bet. 4-25C

Generic Name:

Cefuroxime sodiumClassification:

CephalosporinsBrand Name:

Zinacef

Dosage:750mg TIVSecond-generation cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal-Uncomplicated skin and skin structure infection-Perioperative prevention-hypersensitivity to drug-patients hypersentive to penicillin because of possibility of cross-sensitivity

Side-effects:

CV: phlebitis

GI: diarrhea, nausea, anorexia, vomiting

Hematologic: thrombocytopenia

Skin: maculopapular rash, pain, temperature elevation1.) Ask patient if he is allergic to penicillins or cephalosporins2.) Obtain specimen culture and sensitivity before administering drug.

3.) Tell patient to notify prescriber about rash, loose stools, diarrhea, or evidence of superinfection

Generic Name:

Metronidazole

Classification:

Antiprotozoans and amebicides

Brand Name:

Flagyl

Dosage: 500mg TIVEnter the cells of microorganisms that contain nitroreductase, forming unstable compounds that bind to DNA and inhibit synthesis, causing cell death.-Intestinal amoebiasis-To prevent postoperative infection in contaminated or potentially contaminated colorectal surgery-Patients hypersensitive to nitroimidazole derivatives and in women in first trimester of pregnancy.-Use cautiously in patients with history of blood dyscrasia, CNS disorder or retinal, visual changes

Side effects:

CNS: headache, fever, seizures, vertigo, dizziness

CV: flushing, edema, thrombophlebitis

GI: nausea, vomiting, abdominal pain, anorexia, diarrhea

Respi: upper respiratory tract infection1.) Tell patient he may experience a metallic taste and dark or red-brown urine2.) Tell patient to report prescriber immediately any neurologic symptoms.

Generic Name:Ketorolac tromethamine

Classifications:

Nonsteroidal anti-inflammatory drug

Brand Name:

Toradol

Dosage:

10 mg TIV 3 doses Possesses anti-inflammatory, analgesics and antipyretic effects. Indicated for short term (up to 5 days) management of moderately severe acute pain that requires analgesia at the opioid level.

Not to be used for minor or chronic painful conditions

Side-effects:

CV: Vasodilation, pallor

GI: GI pain, peptic ulcers, nausea, dyspepsia, flatulence, GI fullness, stomatitis, excessive, thirst, GI bleeding, perforationCNS: Headache, nervousness, abnormal thinking, depression, euphoria

Hypersensitivity:Bronchospasm, anaphylaxis Use as part of a regular analgesic schedule rather than on an as needed basis.

If given on PRN basis, base the size of a repeat dose in duration of pain relief from previous dose.

Shortening the dosing intervals recommended will lead to an increased frequency and duration of the side effects.

Correct hypovolemia prior to administering

VII. REVIEW OF SYSTEMSSYSTEMS OF THE BODYFindings

GENERAL No weight loss, fever, chills, weakness or fatigue.

EENT EYES

EARS, NOSE AND THROAT No visual loss, blurred vision, double vision or yellow sclerae.

No hearing loss, sneezing, congestion, runny nose or sore throat

SKIN No rash or itching.

CARDIOVASCULAR No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY No shortness of breath, cough or sputum.

GASTROINTESTINAL Positive for nausea and vomiting, complains of pain at RLQ.

GENITO-URINARY No dysuria, frequency or urgency.

HEMATOLOGIC No pallor, bruising or bleeding.

NEUROLOGIC No headache or loss of consciousness.

ALLERGIES With history of asthma. No eczema or rhinitis.

VIII. ANATOMY AND PHYSIOLOGY

IX. PATHOPHYSIOLOGY

X. NURSING CARE PLANASSESSMENTNURSING DIAGNOSISPLANNINGNURSING INTERVENTIONSEVALUATION

Subjective:

Sumasakit po ang tahi ko sa tiyanas verbalized by the patient.

Pain Scale:

>7/10

Objective:

>Temp. 37c

>RR: 18cpm

>PR: 90bpm

>BP: 90/60mmHg

>facial grimace

>irritable

>guarding behavior

>self-focusing

Acute pain discomfort related to surgical incision.> After 3hrs. of Nursing Intervention the pain will be lessen at the surgical wound site.

Pain scale

> 7/10 to 3/10

Independent

>Promote bedrest and position patient in low-fowlers or any position of his comfort. R: To lessen the pain of the patient, Bed rest in low-fowlers reduces intra-abdominal pressure.

> Provide non- pharmacological

Therapies ex.:

Radio, Books, Socialization w/ others. R: > To relax & provide comfort to the patient.

> Encourage relaxation techniques such as deep breathing. R: To provide comfort, and reduce risk of complication such as pneumonia.>Teach patient to use pillow splinting when coughing to reduce pain and prevent tension on suture lines.

Dependent

> Administer analgesic as ordered.> After 3hrs. of Nursing Intervention the pain was lessened from 7 to 3.

ASSESSMENTNURSING DIAGNOSISPLANNINGNURSING INTERVENTIONSEVALUATION

Objective:

>Temp. 37c

>RR: 18cpm

>PR: 90bpm

>BP: 90/60mmHg

-wound dressing at RLQRisk for infection related to post surgical incisionShort term goal:

Within the shift, patient will be able to identify factors to reduce risk for infection

Long term goal:

At the end of hospitalization, patient will not manifest any signs and symptoms of infection

Independent

>Assess signs and symptoms ofinfection especially temperature.

>Emphasize the importance of handwashing technique.

>Maintain aseptic technique when changing wound dressing.Dependent

> Emphasize necessity of taking antibiotics as ordered.> Patient was free from any signs and symptoms of infection as manifested by absence of redness, swelling, heat on surgical incision and absence of fever.

XI. DISCHARGE PLAN

M MEDICINE-Advice patient and guardian to continue to take medications as prescribed by the physician.E ENVIRONMENT AND EXERCISE

-Maintain a quiet, pleasant, environment to promote relaxation.

-Provide clean and comfortable environment.

-Encourage walking every day.

T TREATMENT

-Continue home medications.

-Teach patient and guardian about wound care.-Encourage patient to take multivitamins for immunity.H HEALTH TEACHING

-Provide written and oral instructions about wound care, activity, diet recommendations, medications, and follow-up visits.

-Instruct patient to limit his activity for 24 to 48 hrs after discharge.

O OUT PATIENT FOLLOW-UP

-Patient will be advised to go back in the hospital in a specific date to have a follow-up checkup after discharge.

-Consult doctor for any problems or complications encountered.

D DIET

-Encourage patient to increase protein intake for tissue repair

-Advice patient to eat foods that are rich in fiber like vegetables and fruits and an increase in fluid intake to avoid constipation.S SPIRITUALITY

-Encourage patient to communicate with God.

-Encourage patient to communicate with other people.

Peritonitis

Perforation (24 to 36 hours)

Gangrene

Abscess

-Lymphoid swelling

-Decreased venous drainage

-Thrombosis

-Bacterial Invasion

Intraluminal pressure

Inflammation

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