Republic of the Philippines

University of Northern Philippines

Tamag, Vigan City, Ilocos Sur

College of Nursing

CASE STUDY OF POST APPENDECTOMY

In Partial Fulfillment of

the Requirements under

CLINICAL DUTY

Presented to:

Maricris Florendo, RN, MAN

Clinical Instructor

Presented by:

Kyle Audrie A. Arcalas

BSN 3A Student

2021
 I. INTRODUCTION

According to Centers for Disease Control and Prevention (CDC), hepatitis means

inflammation of the liver. When the liver is inflamed or damaged, its function can be affected.

Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis,

but it is often caused by a virus. Hepatitis A is a highly contagious, short-term liver infection

caused by the hepatitis A virus, usually a short-term infection and does not become chronic.

People who get hepatitis A may feel sick for a few weeks to several months but usually recover

completely and do not have lasting liver damage. In rare cases, hepatitis A can cause liver failure

and even death; this is more common in older people and in people with other serious health

issues, such as chronic liver disease.

World Health Organization stated that hepatitis A occurs sporadically and in epidemics

worldwide, with a tendency for cyclic recurrences. Epidemics related to contaminated food or

water can erupt explosively, such as the epidemic in Shanghai in 1988 that affected about 300

000 people. They can also be prolonged, affecting communities for months through person-to-

person transmission. Hepatitis A viruses persist in the environment and can withstand food

production processes routinely used to inactivate or control bacterial pathogens. Infection is

common in low- and middle-income countries with poor sanitary conditions and hygienic

practices, and most children (90%) have been infected with the hepatitis A virus before the age

of 10 years, most often without symptoms.

Infection rates are low in high-income countries with good sanitary and hygienic

conditions. Disease may occur among adolescents and adults in high-risk groups, such as persons

who inject drugs (PWID), men who have sex with men (MSM), people travelling to areas of high

endemicity and in isolated populations, such as closed religious groups. In the United States of
America, large outbreaks have been reported among persons experiencing homelessness. In

middle-income countries and regions where sanitary conditions are variable, children often

escape infection in early childhood and reach adulthood without immunity. WHO estimates that

approximately 1.5 million people are infected with HAV each year.

In 2018, 12,474 cases of acute hepatitis A were reported nationwide to CDC. The overall

incidence rate for 2018 was 3.8 cases per 100,000 population, an increase from recent years. The

rate was similar for males and females but increased for persons older than age 20 years. WHO

estimates that Hepatitis A was the cause of death for 7,134 people in 2016. Hepatitis A case-

fatality estimates range from 0.3% to 0.6% for all ages and up to 1.8% among adults aged 50

years or older. During outbreaks concentrated in older individuals or higher proportions of

individuals with comorbidities, case-fatality rates can be significantly higher.

The Department of Health estimated that 6% to 10% of Filipino adults suffer from

chronic hepatitis A infection. Vaccination is still one of the most potent agents in the fight

against hepatitis. This case study gives a reminder how significant sanitation and hygiene and

must be reinforced to the public in food preparation, handwashing, and handling of food.

Prevention is better than cure.

 II. OBJECTIVES

General Objectives

 To identify the health factors affecting human in acquiring Hepatitis A disease.

 To formulate effective recommendation to improve the knowledge and depth

understanding about hypertension.

 To identify and promote the difference of Hepatitis A to other disease and basic

demonstration of the things that should be done or not.

Specific Objectives

 To be able to develop a better understanding on the use of medication and its implication

on the treatment of the disease.

 To be able to implement the appropriate plan of nursing management for patient disease.

Patient Centered Objectives

 Will be gain trust to the student nurse providing care to the patient.

 Feel comfortable while interacting with the student nurse.

 The patient will be able to cope up and cooperate in the management on the exiting

condition.

 The patient will be able to improve condition.

  The client will develop coping activities and will verbalize understanding of need to carry

emergency components for intervention, need to inform health care providers about

difficulty of breathing, and the importance of seeking emergency care.

III. DEMOGRAPHIC DATA

Name: J.L. Reburon

Age: 12 years old

Date of Birth: February 14, 2009

Address: Poblacion, Santo Domingo, Ilocos Sur Philippines

Gender: Male

Nationality: Filipino

Religion: Roman Catholic

Educational Attainment: Grade 7 at Benito Soliven Academy

Source/s of Healthcare: Health Centers, Clinics and Hospitals

Date of admission: October 25, 2021

Chief complaint: Fever and Vomiting

Attending Physician: Dr. Tulfo

Source of Information: Significant others (Mother)

IV. NURSING HISTORY OF PAST AND PRESENT ILLNESS

Present Illness History

Five days, prior to admission patient had intermittent fever with a temperature of 39.6°C

and was given Tempra 5 mL and was relieved for 3 hours and the fever will occur again. No

consult was done.

Two days prior to admission, patient had 1 episode of vomiting with watery with few

chunks of gastric contents and still had fever with a temperature of 38.7°C. No consultation was

done.

One day prior to admission still had vomiting and fever of 38.5°C. and 4 hours prior to

admission patient had persistent vomiting and fever of 38.1°C hence consulted Attending

Physician and was advised admission and referred to an admitting.

Past Health History

IMMUNIZATION:

 Complete immunization when he was a child in a health center.

CHILDHOOD ILLNESSES:
  Measles, German measles, and mumps

Surgical History

 No surgical history.

Medical History

 Diagnosed with bronchial asthma when she was 3 years old and was admitted in

Magsingal District Hospital and was given nebulization and was being confined for 3

days.

 Diagnosed with urinary tract infection last April 2017 and was given unrecalled

antibiotics and was being confined for 5 days here at Tolentino Clinic and Hospital.

Family History

 Her grandfather on his father’s side has Diabetes Mellitus Type II diagnosed 15 years ago

and was being controlled by Metformin and with regular check-ups.

 His grandfather was also diagnosed with hypertension last 13 years ago and was having a

drug maintenance of Losartan with regular doctor visitation.

Social History
 ASSESSMENT

He does not smoke, he does not drink alcohol beverages does not drink coffee, instead

she drinks milk and milo. He has cats and dogs at home, no travel history. No identified

allergies.

V. PHYSICAL ASSESSMENT

VITAL SIGNS

Blood Pressure

Respiratory Rate

Pulse rate

Temperature

INTEGUMENTARY FINDINGS
The client’s skin is uniform in color,

unblemished and no presence of any foul

Skin
odor. Warm, dry and intact without rashes

or lesions.
Patient hair is thick, silky hair is evenly

distributed and has a variable amount of

Hair
body hair. No signs of infection and

infestation observed
Nails Nailbeds pink with no cyanosis or clubbing.
 Has a light brown nail and has the shape of

convex curve
Head is normocephalic and atraumatic

Head without tenderness, visible or palpable

masses, depressions, or scarring.

Visual acuity is 15/20 without corrective

lenses. Sign of Conjunctiva exudates or

hemorrhage. Sclera is non-icteric. EOM are

intact, PERRLA. No signs of nystagmus.

The client’s eyebrows are symmetrically

Eye aligned and showed equal movement when

asked to raise and lower eyebrows. no

presence of discharges, no discoloration and

lids close symmetrically with involuntary

blinks approximately 10-20 times per

minute. Eyelids are normal in appearance

without swelling or lesions

Appeared symmetric, straight and uniform

in color. There was no presence of discharge

Nose or flaring. When lightly palpated, there were

no tenderness and lesions. Nasal mucosa is

pink and moist.

Throat Oral mucosa is pink and moist with good

dentition. Tongue normal in appearance

without lesions and with good symmetrical

 movement. No buccal nodules or lesions are

noted. The pharynx is normal in appearance

without tonsillar swelling or exudates.

Supple without adenopathy. Trachea is

midline. Thyroid gland is normal without

Neck masses. Carotid pulse 2+ bilaterally without

bruit. No JVD. lymph nodes of the client

are not palpable

The external chest is normal in appearance

without lifts, heaves, or thrills. Heart rate

Cardiac
and rhythm are normal. No murmurs,

gallops, or rubs are auscultated.

The chest wall is symmetric and without

deformity. No signs of trauma. Chest wall is

non-tender. No signs of respiratory distress.

Respiratory Lung sounds are clear in all lobes bilaterally

without rales, ronchi, or wheezes.

Resonance is normal upon percussion of all

lung fields.
Abdominal Abdomen is soft, symmetric, and non-tender

without distention. There are no visible

lesions or scars. The aorta is midline

without bruit or visible pulsation. Umbilicus

is midline without herniation. Bowel sounds

are present and normoactive in all four

 quadrants. No masses, hepatomegaly, or

splenomegaly are noted.

Neck and back are without deformity,

external skin changes, or signs of trauma.

Curvature of the cervical, thoracic, and

lumbar spine are within normal limits. Bony

Spine
features of the shoulders and hips are of

equal height bilaterally. Posture is upright,

gait is smooth, steady, and within normal

limits.
Awake, alert and oriented. No acute

General distress. Well developed, hydrated and

nourished. Appears stated age.

Upper and lower extremities are atraumatic

in appearance without tenderness or

deformity. No swelling or erythema. Full

Extremities range of motion is noted to all joints.

Capillary refill is less than 3 seconds in all

extremities. Pulses palpable. Steady gait

noted.

VI. PEARSON ASSESSMENT

ASSESSMENT PHASE 1
02-03-20
PHYSIOLOGICAL Blood Pressure: 150/80 mmHg

Respiratory Rate: 24 cpm

Pulse rate: 88 bpm

Temperature: 36.5°C

O2 Saturation: 98%

Patient DC experienced Dizziness, Fatigue and Headache.

His vital sign taken and clearly monitored.

Conscious
ELIMINATION Patient DC had normal urination and free from abnormal

signs.

He was able to control defecation.

No diaphoresis noted.

Normal sweating and respiration.

ACTIVITY AND REST ACTIVITIES

Well postured

Going to farm

Taking care his grandchildren

REST

No sleep disturbance

Take an afternoon nap everyday

SAFETY AND The patient was nervous and difficulty to understand what

SECURITY happened to him.

Healthcare team provide health teaching and best therapist

for him.

He was spending time with his family in treating his illness.

OXYGENATION No Oxygen supplements

No cyanosis noted

Normal breath sounds

 VII. ANATOMY AND PHYSIOLOGY

The liver is located at the upper right-hand portion of the abdominal cavity, beneath the

diaphragm, and on top of the stomach, right kidney, and intestines. Shaped like a cone, the liver

is a dark reddish-brown organ that weighs about 3 pounds.

There are 2 distinct sources that supply blood to the liver, including the following:

 Oxygenated blood flows in from the hepatic artery.

 Nutrient-rich blood flows in from the hepatic portal vein.

The liver holds about one pint (13%) of the body's blood supply at any given moment. The

liver consists of 2 main lobes. Both are made up of 8 segments that consist of 1,000 lobules

(small lobes). These lobules are connected to small ducts (tubes) that connect with larger ducts to

form the common hepatic duct. The common hepatic duct transports the bile made by the liver

cells to the gallbladder and duodenum (the first part of the small intestine) via the common bile

duct.

Functions of the liver

The liver regulates most chemical levels in the blood and excretes a product called bile. This

helps carry away waste products from the liver. All the blood leaving the stomach and intestines

passes through the liver. The liver processes this blood and breaks down, balances, and creates

the nutrients and metabolizes drugs into forms that are easier to use for the rest of the body or

that are nontoxic. More than 500 vital functions have been identified with the liver. Some of the

more well-known functions include the following:

  Production of bile, which helps carry away waste and break down fats in the small

intestine during digestion.

 Production of certain proteins for blood plasma.

 Production of cholesterol and special proteins to help carry fats through the body.

 Conversion of excess glucose into glycogen for storage (glycogen can later be converted

back to glucose for energy) and to balance and make glucose as needed.

 Regulation of blood levels of amino acids, which form the building blocks of proteins.

 Processing of hemoglobin for use of its iron content (the liver stores iron).

 Conversion of poisonous ammonia to urea (urea is a product of protein metabolism and is

excreted in the urine).

 Clearing the blood of drugs and other poisonous substances.

 Regulating blood clotting.

 Resisting infections by making immune factors and removing bacteria from the

bloodstream.

 Clearance of bilirubin, also from red blood cells. If there is an accumulation of bilirubin,

the skin and eyes turn yellow.

When the liver has broken down harmful substances, its by-products are excreted into the

bile or blood. Bile by-products enter the intestine and leave the body in the form of feces.

Blood by-products are filtered out by the kidneys and leave the body in the form of urine.

VIII. Pathophysiology

Risk Factors: Ingestion of contaminated Hepatitis A virus replicates

food (street foods, juice in oropharynx and GI tract
 poor sanitation
drinks and buying snacks
 eating
outside
contaminated foods
 Signs and symptoms of Shed in bile, Transported to liver for
Hepatitis A Disease transported to replication
intestines, shed in feces

Explanation

HAV is typically acquired through ingestion (through fecal-oral transmission) and

replicates in the liver. After 10 to 12 days, virus is present in blood and is excreted via the biliary

system into the feces. Peak titers occur during the 2 weeks before onset of illness. Although virus

is present in serum, its concentration is several orders of magnitude less than in feces. Virus

excretion begins to decline at the onset of clinical illness and decreases significantly by 7 to 10

days after onset of symptoms. Most infected persons no longer excrete virus in the feces by the

third week of illness.

IX. DIAGNOSTIC PROCEDURES

A. Ideal

Management

A. Medical and Surgical (Ideal and Actual)

B. NCP

C. Promotive and Preventive

Drug Study

Discharge Plan

Updates

Organization

Bibliography