APPENDECTOMY

Case Study Presented to

The Faculty of the College of Nursing
Of The University of St. La Salle
Bacolod City

In Partial Fulfillment
Of the Requirements for the Degree
Bachelor of Science in Nursing

Submitted By:

Kathrina Ella Abong

Alyssa Altaras
Audrey Arevalo
Steven Ashida
Allyssa Bailon
Angela Mae Baloco
Neil Efren Bitun
Jerica Bonete
DJ Evan Jules Cañada
Seymour Caram
BSN3-E
Group 1

December 2020
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Table of Contents
I. Introduction 1
II. Objectives 2
III. Anatomy and physiology 3
IV. Definition of terms 4
V. Baseline data 5
VI. Nursing history 6
VII. Health history 9
VIII. Assessment 10
IX. Laboratory 12
X. Pathophysiology 16
XI. Nursing care plan 17
XII. Drug study 21
XIII. Health Teaching Plan 26
XIV. Conclusion/ Recommendation 30
XV. References 31
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I. Introduction

Whether or not you believe in evolution, you must admit that there are a variety of body parts
that simply have no explanation as to why they are there. The most commonly understood reason as to
why we have what are known as vestigial structures is the fact that our long ago ancestors once had more
pronounced versions of these structures that served some purpose in their daily lives, that over time,
became less and less useful, and as a result became obsolete, slowly becoming the vestigial structures we
see in ourselves today. For example, why do we have wisdom teeth? Why do we have tailbones? Why do
we have muscles that can control the movement of our ears? All of these are prime examples of vestigial
structure in our bodies. Another example of a vestigial structure that we have in our bodies is what is
known as the appendix.

The appendix is not known to have any useful function in the body, or at least, not one we 100%
know of. Located in the lower right abdomen, this small vestigial organ simply exists for no other
confirmed reason other than it simply does. It does not seem to do anything beneficial for the human
body, and one can live their entire lives without ever having a clue that it is there. However, it is when the
appendix decides to ‘say hello’ in a sense, that issues may arise.

This can be seen in the case of our client, Z.A. Z.A., a 25 year old married man, who suffered
from appendicitis, which is when the appendix becomes inflamed and poses a threat to bursting or
rupturing. Although the inflammation itself is painful, it is not inherently dangerous. It is the rupturing of
the appendix that is the more worrisome issue. If the appendix were to rupture, this may cause
complications and issues resulting from a spread of infection. This could pose life threatening issues if
left untreated, and as a result it is crucial that the patient seeks immediate treatment in order to have
an appendectomy to remove the affected tissue from the body. Our client Z.A. was admitted into the
surgical ward with a chief complaint of severe pain in the right lower quadrant of the abdomen, with a
pain scale of 10/10. He was subsequently diagnosed with appendicitis and scheduled to have an
appendectomy to have his appendix removed. Upon our assigning to his case, he was already in post-
operative care, having undergone the procedure to successfully remove his inflamed appendix. As a
result, all treatment done by the student nurses was towards the recovery of the patient, who was
experiencing some acute pain, deficient knowledge, and a risk for infection.
Our exposure in the surgical ward gave us the opportunity to care for this young man who had
just undergone appendectomy, along with the chance to understand and learn more about appendicitis.
After learning about the condition, we passed our knowledge onto the patient and his family via health
teaching and nursing interventions. By doing so, we hoped that the client and his family would be better
suited to assist in his recovery from his surgical procedure. We admit that time constraints, along with
the inability to meet up in person due to the COVID-19 pandemic heavily impacted the completion of
this case study, however, through the diligence and hard work of the group, we were able to finish this
case study. As such, we can only hope that by completing this case study and subsequent presentation,
we further ourselves along on our journeys to one day become Registered Nurses.
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II. OBJECTIVES

General Objectives

After this Nursing Case Study, the student nurse would be able to obtain knowledge, skills and
attitudes related to the disease process and assume the proper role of a nurse in rendering care for a
client after undergoing an Appendectomy.

Specific Objectives

Student-Nurse Centered

After 1 hour of Nursing Case Study, the student nurse will be able to:

1. Discuss the Anatomy and Physiology of the Digestive System.

2. Define the different terms used to discuss appendicitis and appendectomy.

3. Describe the client’s functional patterns, health history, and S/Sx experienced.

4. Discuss the client’s present condition through assessment.

5. Discuss the client’s laboratory results that could confirm and justify interventions for
their present condition.

6. Discuss the Pathophysiology of Appendicitis.

7. Identify the actual and risk problems of the client and the necessary nursing
interventions for each.

8. Identify and discuss client’s medication through drug study and outpatient teaching
through the health teaching plan.

Client Centered

1. Verbalize to the student nurse accurate and fact-based information related to his health.

2. Show interest to cooperate in health assessments, interviews and health teachings of the
student nurse.

3. Participate in his health by complying with planned nursing interventions related to identified
health problems.

4. Understand the implications of having appendicitis and an appendectomy as an adult.

5. Verbalize understanding and willingness to carry out designated health interventions in order
to restore his wellness.
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III. ANATOMY & PHYSIOLOGY

Anatomy of the Appendix
The appendix is a small tubular extension of the right side of the colon, near where the small
intestine also inserts into the colon. Its length is quite variable, from an inch or so to up to eight or nine
inches in length. Most of the time it looks like a stubby #2 pencil. The colon has three outer longitudinal
muscle bands, called the tenia, that run the length of the colon as strips, equidistant around the
circumference of the colon. The appendix arises from the blind pouch of the cecum where the three
tenia merge. In fact, the easiest way of finding the appendix in surgery is usually to pull up the colon,
find a tenia, then run it backwards until the appendix is found. The appendix has its own blood supply in
leaves of fat arising off the mesentery of the cecum. There is a small appendiceal artery that runs as an
arcade along the lower edge of the organ.

Physiology of the Appendix

When it comes to the physiology of the appendix, this is very hotly debated. There is no truly
confirmed physiology, as the appendix is widely considered to be a vestigial organ, or an organ that once
served a purpose in our distant ancestors, but nowadays serves little to know purpose. There have been
some signs that that appendix may have something to do with storing good bacteria in order to cleanse
the small intestine after a diarrheal affliction, but otherwise many other theories as to the modern day
physiology and workings of the appendix remain pure speculation.
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IV. DEFINITION OF TERMS

1. Appendicitis - Inflammation of the appendix, usually associated with infection of the appendix.
Appendicitis often causes fever, loss of appetite, and pain. Appendicitis may be suspected
because of the medical history and physical examination. The pain of appendicitis can be located
in various areas of the belly. If the appendix ruptures and infection spreads throughout the
abdomen, the pain becomes widespread as the entire lining of the abdomen becomes inflamed.

2. Appendectomy - Removal of the appendix by surgery, the small worm-like appendage of the
colon (the large bowel). An appendectomy is performed because of probable appendicitis,
inflammation of the wall of the appendix is generally associated with infection.

3. Open Appendectomy - A cut or incision about 2 to 4 inches long is made in the lower right-hand
side of your belly or abdomen. The appendix is taken out through the incision.

4. Laparoscopic Appendectomy - This method is less invasive. That means it’s done without a large
incision. Instead, 1 to 3 tiny cuts are made. A long, thin tube called a laparoscope is put into one
of the incisions. It has a tiny video camera and surgical tools. The surgeon looks at a TV monitor
to see inside your abdomen and guide the tools. The appendix is removed through one of the
incisions.
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V. BASELINE DATA

Name : Z. A.
Age : 25 years old
Gender : Male
Date of Birth : July 30, 1995
Place of Birth : Bacolod City
Ordinal Position : Youngest
Number of Siblings : 2
Marital Status : Married
Religion : Roman Catholic
Nationality : Filipino
Person next to Kin : Mother/Father
Educational Level : College Graduate
Date of Admission : September 14, 2020
Time of Admission : 7AM
Date of Care : September 14-17, 2020
Admitting Physician : Dr. Chua
Agency : Corazon Locsin Montelibano Memorial Regional Hospital
Admitting Complaint : Severe sharp pain on right lower abdominal quadrant, pain scale 10/10
Admitting Diagnosis : Appendicitis
Provider of History : Mother
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VI. NURSING HISTORY (GORDONS)

A. Health Maintenance Perception Pattern
Prior to admission, the patient lived a very active lifestyle. He doesn’t get an annual check-
up. He would experience common colds, flu and cough around two to three times a year.
According to the patient, every time the patient and his family do not feel well, they would
immediately consult the nearest hospital. The patient does not have any history of falls or
accidents. He also added that he believes it’s better to consult a doctor than hilots.
Two days before he was admitted to the hospital, he felt pain at his epigastric area and
thought he was having hyperacidity. He felt pain specifically on the right lower quadrant of
abdomen. On the first day that he experienced pain, he took antacids. He thought that if he could
pass gas it would make him feel better but it didn’t. On the second day, he said that he could not
endure the pain anymore. He could not straighten his body and he found relief when he was in a
curled position. He also vomited during the second day which is the reason he decided to seek
medical attention the next day.
During admission, the patient was advised to avoid eating and drinking for at least 8 hours
prior to the appendectomy. He exhibited guarding behavior on his right lower abdomen and
displayed a facial grimace. The patient is cooperative and not hesitant to take his medications and
follow health recommendations.

B. Nutritional Metabolic Pattern

Prior to admission, the patient has a good appetite with a healthy diet. He always eats
healthy food like fruits and vegetables. He also loves to eat meat. He is very experimental when
it comes to food. He is not a picky eater and eats anything. He also likes to try different spices. He
eats snacks in between meals and he is fond of eating savory food rather than sweets. He also
loves to drink coffee, and usually drinks 2-3 cups of coffee a day.
During admission, the patient had a poor appetite. The patient has dry lips and skin. There
are no presence of lesions and his capillary refill score was 2. His hair was smooth. He also does
not have any dental cavities. He weighs 68kg and his height is 173cm. The patient is considered
to have a normal value of BMI with 22.7.

C. Elimination Pattern
Prior to admission to the hospital, he defecates once a day every morning. The patient
described his stool as having good form and consistency. Every time he defecates, he smokes 1 or
2 sticks of cigarettes. He urinates four to five times daily. He doesn’t feel any discomfort during
defecation and urination.
During admission, he was constipated and urinating frequently around 7-8 times a day.
He defecated two days after surgery.
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D. Activity and Exercise Pattern

Prior to admission, the patient lived a very active lifestyle. He would go for outdoor
activities such as hiking, camping, or fishing during his free time with his friends. He would also go
biking or basketball every weekend. He was also a member of a band during his college years. He
loves music and he would play guitar and drums occasionally. When he is at home, he would
watch Netflix and read books. He also performs his daily hygiene routine which includes bathing,
brushing teeth, dressing, and grooming. He has two jobs and he works four or five days a week.
During admission, the patient limits his activity or movement due to the pain felt on the
right lower quadrant of his abdomen. The patient was able to stand and walk slowly 24 hours
after the surgery. He was also advised not to exert too much effort. He is very particular when it
comes to hygiene. He ensures that he is able to have his sponge bath and changing of clothes
daily. He also brushes his teeth every day.

E. Sleep and Rest Pattern

Prior to admission, he sometimes lacks sleep due to his part time job that starts at six in
the evening and ends at around 12 midnight or 1AM. His main job usually starts at 8AM and ends
at 4PM. During his two hour break before his second job starts, he would take a power nap for 1
hour and drink a cup of coffee before going to work again to keep him awake until midnight.
According to him, he is not a deep sleeper but he can sleep regularly and uninterruptedly when
he is tired from work. Other than sometimes lacking sleep, he does not have any trouble or
problems regarding sleep and rest.
During admission, according to him, his sleeping pattern was not disturbed since he stays
in a private room which he is also comfortable in even though nurses and doctors do their rounds.
He said that it wasn’t really a problem because he can go back to sleep right after they leave his
room.

F. Cognitive Perception Pattern

Prior to admission, the patient doesn’t have any sensory deficit. He is fully aware of what
is going on around him. He can also make decisions on his own. He also has a good memory.
According to him, during elementary and high school his grades were above average.
During admission and after surgery, the patient does not have any sensory deficit. He is
fully aware of what’s going on around him even when he is in pain. He can also make decisions on
his own.

G. Self-Perception and Self-Concept Pattern

Prior to admission, the patient feels good about himself. He is confident in everything he
does and he is doing well in his job. He perceived himself as an average person. He also has a
strong conviction that he is really sure in what he believes is true. He also thinks that he can do
more on his given status in life but he is happy and blessed with what he has in life right now.
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During admission, he was able to interact with the student nurses with a moderate tone
of voice and he was able to make eye contact while communicating. The patient has a proper
body posture.

H. Role relationship Pattern

The patient is the youngest among two siblings. He owns a house and he lives with his
wife. His parents live a few blocks away from his home. He is very close to his mother and he has
a good relationship with his parents and his sister.
Prior to admission, he is doing very well in his work and he has a good relationship with
his workmates. He also got promoted in his main job. He is also very outgoing and he makes
friends easily.
During his admission, he was friendly with the student nurses and he interacted with them
cheerfully.

I. Sexual Reproductive Pattern

The patient is fully aware of his sexuality. He also doesn’t have any problems with his
sexual reproductive system as well as his sexual engagements.

J. Coping and Stress Tolerance Pattern

During and prior to the patient's admission, whenever he feels down, he would go out
and do things that he likes. He especially liked to go on adventure activities so that he could forget
about his problems and likes these types of activities because it comforts him. He does not ask
help from others when he has problems and he likes to keep it to himself or just confide in those
around his circle of family only. He also believes that he can manage his problems on his own.
When he got married, whenever he got issues or arguments with his wife they would talk it out
and fix their problems by themselves. He also doesn't have major issues with his workmates.

K. Values and Beliefs Pattern

The patient was raised as a Roman Catholic although he cannot attend mass
regularly due to the demands of work. He also attended a catholic school during his elementary
and high school years. Prior to admission, when he is not busy he attends bible study with his
wife. According to him, he has a strong faith and God is his refuge and strength when he is facing
battles in life.
During admission, his faith became stronger and he believes that God will help him survive
this trial and he is very optimistic about it. He also believes that it's important to seek medical
attention through doctors and other health care providers right away.
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VII. HEALTH HISTORY

A. History of Present Illness
The client experienced a severe sharp pain on the RLQ (right lower quadrant) of the abdomen. He
rated his pain as 10/10 and after being assessed was diagnosed with appendicitis. Before he was admitted,
the pain was focused on his epigastric area then transferred over to the left side of his abdomen and
eventually to the RLQ. The pain he experienced was of sudden onset, sharp and colicky. The surgery was
successful and he was under S/P appendectomy.

B. Past Health Illness

a. Childhood Illness
The client only experienced fever, cough, and colds around three times in a year.
b. Past Hospitalization
None
c. Serious/Chronic Illness
The client doesn’t have any serious/chronic illness before being diagnosed with appendicitis.
d. Previous Surgery
None
C. Family/Social History
The client’s family claims that they have a history of hypertension and asthma on the paternal
side.
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VIII. ASSESSMENT
General Appearance
- Patient was received awake, responsive and coherent with an IVF #3 PNSS 1L @ 100 cc/hr, infusing
well at the right metacarpal vein. Client weighs 68 kilograms and stands 173 cm tall. He was able
to deal with his emotions positively and participated cooperatively in the interview. Wearing a
cotton shirt and sweatpants.

BP TEMPERATURE PR RR

120/80 mmHg 37.5 78 bpm 22 cpm

SYSTEM’S CHARTING (CEPHALO-CAUDAL)

LOC
● Awake, aware of surroundings
● The client was certainly oriented to time, place, and persons.
● Responsive to verbal, nonverbal and pain stimuli
HEENT
● Hair is smooth and neat, scalp was slightly oily
● Pupils equally round and reactive to light and accommodation.
● Ears and nose discharge not noted
● Lips and skin were dry
● No dental cavities were assessed.
● Neck was symmetrical and proportioned to head and shoulder, was able to turn her head in any
position. No lesions and tenderness noted.
CARDIOVASCULAR
● Blood pressure of 120/80mmHg, taken at the right arm in a high fowler’s position
● Cardiac rate of 78 bpm
● Capillary refill score of 2
RESPIRATORY
● With Respiratory Rate of 22 cpm
● O2 cannula attached, O2 at 2 Lpm PRN
● No abnormal sounds noted upon auscultation
GIT
● Clear liquid diet
● He has an incision on his RLQ

MUSCULOSKELETAL
● Client is ambulatory and can perform activities of daily living such as eating, drinking and
brushing his teeth. The client is not allowed to do any strenuous activities after surgery.
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GUT
● Able to defecate and void without any discomfort
● Defecated after surgery was done
INTEGUMENTARY
● With temperature of 37.5°C upon initial assessment, has fever
● Skin was warm to touch with good skin turgor
● Fingernails were trimmed neatly
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IX. LABORATORY

LABORATORY AND RADIOLOGY

DEPARTMENT OF DIAGNOSTIC IMAGING AND RADIOLOGIC SCIENCES

EXAMINATION: Abdominal Ultrasound

RESULTS:

Noncompressible, blind-ended, aperistaltic tubular structure in right lower quadrant arising from the
base of cecum

Target lesion or Bull's-eye appearance of appendix

Appendiceal diameter >6 mm

Lumen distended with anechoic and hypoechoic material

Appendicolith

Circumferential loss of submucosal layer of appendix

Loculated and prominent pericecal fluid

Prominent pericecal fat.

Indication:

The normal appendiceal lumen contains gas, and its absence may suggest inflamed appendix in
the presence of other findings. The normal appendix has a thin central echogenic line corresponding to
the submucosa surrounded by a hypoechoic outer zone representing the muscularis mucosa with a
collapsed lumen.

Implication:

Abdominal ultrasound tests can show the size of the abdominal organs and can help evaluate
injuries to or diseases of the abdominal organs. Specific conditions that ultrasound can help diagnose
include: appendicitis (inflammation of the appendix)
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Urinalysis

Exam Name Results Unit Normal Value Implication

pH 5.0 – 8.0 7.35 to 7.45 Indicates that

blood is more
acidic.

Specific Gravity 1.005 – 1.030 1.005 to 1.030 NORMAL

Protein (-) mg/dL 0 to 14 NORMAL

Glucose (-) mmol/L 0 to 0.8 NORMAL

Ketone (-) mmol/L <0.6 NORMAL

RBC 0 – 2/HPF WBC/ HPF 11 …

Pus Cells 0– 5-10 …

2
/
H
P
F

Amorphous
Urates

Calcium Oxalate

Mucus
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Implications

A urinalysis is a test of your urine. A urinalysis is used to detect and manage a wide range of
disorders, such as urinary tract infections, kidney disease and diabetes. A urinalysis involves checking
the appearance, concentration and content of urine. Abnormal urinalysis results may point to a disease
or illness. A urinalysis is a common test that's done for several reasons; to screen for a variety of
disorders, such as diabetes, kidney disease and liver disease; if you're experiencing abdominal pain, back
pain, frequent or painful urination, and blood in your urine, or other urinary problems. A urinalysis may
help diagnose the cause of these symptoms and to monitor your condition and treatment.

CBC

Exam Name Results Unit Normal Value Implication

HCT Hematocrit 0.37 g/L 0.42-0.52 g/L Indicates insufficient supply of

healthy blood cells; a large
number of white blood cells.

HGB Hemoglobin 140 g/L 140-180 g/L NORMAL

RBC Red blood 4.3 10^12/L 4.3-5.9 10^12/L NORMAL

cells

WBC White 11.6 10^9/L 4.5-11.0 10^9/L Infection or Inflammation

blood cells

Segments 60 % 50-70% NOMAL

Lymphocytes 27 % 20-40% NORMAL

Monocytes 2 % 0-6% NORMAL

Eosinophils 1 % 1-5% NORMAL

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Basophils 1 % 0-1% NORMAL

PLATELET 200 10^9/L 150-400 10^9/L NORMAL

IMPLICATIONS:

The total blood tally (CBC) is a gathering of tests that assess the cells that flow in blood, including red
platelets (RBCs), white platelets (WBCs), and platelets (PLTs). The CBC can assess your general wellbeing
and recognize illnesses and conditions such as infections, iron deficiency and leukemia.

C- REACTIVE PROTEIN

RESULTS: NORMAL VALUE IMPLICATION

15mg/L Less than 10mg/L More than normal value which

may indicate that there is a sign
of serious infection, trauma or
chronic disease.

Implication:

The CRP testing is used to patients with suspected ruptured appendix this will assist with diagnosing an
infected appendix before, keeping away from hole and therefore evading the financial and legitimate
outcomes related with inconveniences of an infected appendix.
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X. PATHOPHYSIOLOGY

The cause of appendicitis is unknown, although it is thought to be related to intraluminal

obstruction with a fecalith (i.e., hard piece of stool), twisting, tumor, or a foreign body. When an
obstruction is the cause of appendicitis, it leads to an increase in intraluminal and intramural pressure,
resulting in small vessel occlusion and lymphatic stasis. Once obstructed, the appendix fills with mucus
and becomes distended, and as lymphatic and vascular compromise advances, the wall of the appendix
becomes ischemic and necrotic. Bacterial overgrowth then occurs in the obstructed appendix, with
aerobic organisms predominating in early appendicitis and mixed aerobes and anaerobes later in the
course. Common organisms include Escherichia coli, Peptostreptococcus, Bacteroides, and
Pseudomonas. Once significant inflammation and necrosis occur, the appendix is at risk of perforation,
leading to a localized abscess and sometimes frank peritonitis.

Appendicitis usually has an abrupt onset, with pain referred to the epigastric or periumbilical
area. This pain is caused by stretching of the appendix during the early inflammatory process. At
approximately the same time that the pain appears, there are one or two episodes of nausea. Initially,
the pain is vague, but over a period of 2 to 12 hours, it gradually increases and may become colicky.
When the inflammatory process has extended to involve the serosal layer of the appendix and the
peritoneum, the pain becomes localized to the lower right quadrant. There is usually an elevation in
temperature and a white blood cell count greater than 10,000/mm3.

Predisposing Factors:

● Male
● 10 to 30 years of age
● Genetic

Precipitating Factor/s:

● Low fiber diet

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XI. NURSING CARE PLAN

Actual: Acute Pain
Assessment Cues Nursing Diagnosis Pathophysiologic/ Schematic Desired Outcome Nursing Rationale Evaluation
Diagram Intervention

Subjective Cues: Acute pain r/t Pathophysiology: After 6 hours of Nursing Intervention, Independent After 6 hours of Nursing
“Ga sakit akon tahi presence of surgical the patient and significant other will be Interventions: Intervention, the
na budlayan ko mag incision as Tissue Injury able to: patient and significant
giho” as verbalized evidenced by other will be able to:
by the patient. reports of pain
Release of Arachidonic Acid
Objective Cues: Report pain is relieved /controlled Assessed pain, Useful in monitoring “Wala na mayo ga sakit
Definition: noting location, effectiveness of akon tahi kay nag
> Vital Signs: Acute pain usually PGE Synthesis characteristics, medication, breathing technique ko”
comes on suddenly severity progression of as verbalized by the
BP:120/80 mmHg
and is caused by healing. patient. Pain scale of
RR: 22 cpm something specific. Nociceptor Activation 2/10 from 6/10. GOAL
It is sharp in MET
T: 37.5°C
quality. Acute pain
PR: 78 bpm usually does not Kept at rest in To lessen the pain Patient was seen
last longer than six “Peripheral Sensitization” Appear relaxed, able to sleep/ rest Semi-Fowler's comfortable and resting
months. It goes (Primary Hyperalgesia) appropriately. position peacefully. GOAL MET
> Pain scale of 6/10 away when there is
no longer an Encouraged early Promotes Patient were able to use
> Facial grimace underlying cause ambulation normalization of relaxation skills and
noted for the pain. Acute Pain organ function diversional activities
(stimulates such as breathing
> Muscle guarding Signs and Symptoms: Demonstrate use of relaxation skills and peristalsis and techniques, music
noted Reference: > Fatigue diversional activities, as indicated, for passing of flatus, therapy and spiritual
Vera, 2019 4 > Numbness individual situations. reducing abdominal practices. GOAL MET
> Incision noted in Appendectomy > Muscle Spasms discomfort).
right lower abdomen Nursing Care Plans >Insomnia
retrieved from > Weight loss
 18

https://nurseslabs. > Anxiety Dependent

com/4- > Flu-like symptoms Interventions:
appendectomy- Administered Relief of pain Patient was able to take
nursing-care-plans/ Predisposing Factors: analgesics as facilitates analgesics as prescribed.
1. Age indicated cooperation with GOAL MET
2. Family History other therapeutic
3. Gender interventions.

Precipitating Factors:
1. Sedentary Lifestyle
2. Low Fiber Diet

Reference:
Ghori, M., Zhang, Y., & Sinatra,
R. (2009). Pathophysiology of
Acute Pain. In H. McQuay
(Author) & R. Sinatra, O. De
Leon-Cassasola, E. Viscusi, & B.
Ginsberg (Eds.), Acute Pain
Management (pp. 21-32).
Cambridge: Cambridge
University Press.
doi:10.1017/CBO97805115767
06.004
 19

Actual: Deficient Knowledge

ASSESSMENT NURSING DIAGNOSIS PATHOPHYSIOLOGIC DESIRED OUTCOME NURSING RATIONALE EVALUATION
DIAGRAM INTERVENTION

Subjective: Deficient Knowledge Predisposing Factors: After 6 hours of After 6 hours of Nursing
>25 y/o, male regarding condition, self- 1. Age Nursing Intervention, Intervention, the patient
care, and discharge needs 2. Education the patient will be was able to:
>Pain scale- 10 related to lack of recall as 3. Responsibilities able to:
evidenced by 4. Appendicitis
>Verbalized concern on verbalization of concerns. Appendectomy 1) Verbalize Independent: 1.a. Provide information to Verbalize understanding
pain and how to do self understanding of 1.a. Conduct health the patient to better of disease process and
care Precipitating Factors: disease process and teaching regarding understand his condition potential complications
“ Paano mag tinlo sng gin 1. Discomfort potential Appendicitis and and the healing process GOAL MET
operahan? Asta sano Definition 2. Anxiety complications. Appendectomy and elicit cooperation to
madula ang sakit?” Deficient Knowledge- 3. Lack of sleep attain recovery and good Patient was able to state
2) State the Dependent : health. that medication can help
>Verbalized A lack of cognitive Appendicitis / importance of 1.b. Refer to physician his healing but has to be
misconception about information needed for Appendectomy medication adherence for any signs and 1.b.Prompt intervention taken correctly. “May ari
condition “Indi na ko mag health restoration, | symptoms of reduces risk of serious na ko pill box para indi ko
basketball kada tapos preservation, or health v complications complications malitan.”
kaon” promotion. Impairment GOAL MET
| Dependent:
Wayne, G. 2019. Deficient v 3) State how to care 1. c. Consult the 1.c. A good diet supplies Patient was able to state
Objective: Knowledge. Nursing Care Identified needs for for incision and change dietician for meals nutrients to the body to that the incision has to be
Plans and Diagnosis. health restoration / self dressing. appropriate for the heal and function cleaned and kept dry and
>Medical Diagnosis: Retrieved from care patient’s condition and effectively. that the dressing should
Appendicitis https://nurseslabs.com/d | healing. be changed regularly. He
eficient-knowledge V was able to demonstrate
>Noted Incision on lower Lack of Cognitive Independent: 2.a proper hand washing
right abdomen. Information 2.a Review medication To ensure that patient is techniques.
| list with patient taking medications as GOAL MET.
>Exhibited facial grimace v mentioning therapeutic prescribed to avoiding
of pain and discomfort Knowledge Deficit action, dosage, time and complications, disease
 20

route, considerations getting worse, and longer

V/S and adverse reactions hospitalizations
T = 37C
P= 75 bpm Dependent
R= 20 cpm 2.b. Refer to physician 2.b. Immediate medical
BP= 120/80 mmHg for any adverse reaction attention reduces risks of
brought by a certain complication
medication

Independent
3. a. Discuss care of
incision, including 3.a.
dressing changes, Understanding promotes
bathing restrictions, and cooperation with
return to physician for therapeutic regimen,
suture and staple enhancing healing and
removal. recovery process.

3. b. Demonstrate 3.b. Proper hand washing

proper hand washing. prevents spread of
microorganisms that may
cause infection.

Dependent:
3.c. Give antihistamine 3.c. Antihistamines are
medication as used for the relief of itching
prescribed if the incision
site itches.
 21

XII. DRUG STUDY

Name of Drug Dosage, Frequency, Mechanism of Action Indication Contraindication Adverse Effects Nursing Responsibilities
Rate
Generic Name: Dosage: 500 mg After diffusing into the Preoperative Contraindicated to Dizziness, headache, Instruct patient to notify
organism, interacts with DNA prophylaxis in patients with: diarrhea, nausea, health care professional
Metronidazole Frequency: q8h to cause a loss of helical DNA emergency stomach pain, loss of promptly if rash occurs.
structure and strand appendectomy • Hypersensitivity to appetite, constipation,
Timing: 12am, 8am, breakage resulting in metronidazole or any changes in taste, and Discontinue therapy
4pm inhibition of protein IV metronidazole is component of the dry mouth may occur. immediately if symptoms of
Brand Name: synthesis and cell death in used for the formulation Allergic reaction, mood CNS toxicity develop. Monitor
Flagyl Route: IV susceptible organisms treatment of • Pregnant patients (first changes, CNS toxicity especially for seizures and
serious infections trimester) with signs and symptoms peripheral neuropathy (e.g.,
Classification: caused by trichomoniasis such as seizures, numbness and paresthesia of
Antibacterial, susceptible • Use of disulfiram within sensitivity to light, extremities)
anaerobic bacteria the past 2 weeks vision changes,
antiprotozoal, amebicide in intraabdominal • Use of alcohol during numbness, tingling. Monitor for S&S of sodium
infections, skin therapy or within 3 days retention
infections, of therapy
septicemia, and for discontinuation Instruct patient to not drink
both pre- and alcohol during therapy; may
postoperative induce a disulfiram-type
prophylaxis reaction and avoid alcohol or
alcohol-containing
medications for at least 48 h
after treatment is completed.

Assess for infection (vital

signs; appearance of wound,
sputum, urine, and stool;
WBC) at beginning of and
throughout therapy.

Name of Drug Dosage, Mechanism of Action
Frequency, Rate
Generic Name: Dosage: Decreases fever by For relief of
Paracetamol 500mg/tab 1 tab inhibiting the effects of pain and fever
pyrogens on the
Frequency: hypothalamus heat
Q4h PRN for fever regulating centers & by a
and pain hypothalamic action
Brand Name: Tylenol leading to sweating &
Route: vasodilatation.
Classification: PO
Relieves pain by
Antipyretic and analgesic inhibiting prostaglandin
synthesis at the CNS but
does not have anti-
inflammatory action
because of its minimal
effect on peripheral
prostaglandin synthesis
22
Indication Contraindication Adverse Effects Nursing Responsibilities
Contraindicated to patients Drowsiness, nausea, Use liquid form for children
with: vomiting, abdominal and patients who have
pain, hepatotoxicity, difficulty swallowing.
 Hypersensitivity Renal failure(high,
prolonged doses), Assess patient’s fever or
 Intolerance to hemolytic anemia pain: type of pain, location,
tartrazine (yellow dye (long term use), rash, intensity, duration,
#5), alcohol, table urticaria, temperature, and
sugar, saccharin hypersensitivity, diaphoresis.
cyanosis, anemia,
 Contraindicated with jaundice, convulsions, Assess allergic reactions:
allergy to coma, death. rash, urticaria; if these
acetaminophen occur, drug may have to be
discontinued.
Teach patient’s significant
other(s) to recognize signs
of chronic overdose:
bleeding, bruising, malaise,
fever, sore throat.
 23

Name of Drug Dosage, Frequency, Mechanism of Indication Contraindication Adverse Effects Nursing Responsibilities
Rate Action
Generic Name: Dosage: 500 mg Binds to bacterial Treatment of: Contraindicated in: CNS: SEIZURES (high  Observe patient for signs
cell wall Respiratory tract Hypersensitivity to doses). and symptoms of
Ceforuxime membrane, causing infections, Skin cephalosporins; Serious GI: anaphylaxis (rash,
Frequency: q8h cell death. and skin structure hypersensitivity to PSEUDOMEMBRANOUS pruritus, laryngeal edema,
Therapeutic infections, Bone penicillins. COLITIS, diarrhea, wheezing). Discontinue
Brand Name: Timing: 12am, 8am, Effects: Bactericidal and joint nausea, vomiting, the drug and notify health
4pm action against infections (IV), cramps. care professional
ceftin susceptible Urinary tract Derm: rashes, urticaria, immediately if these
Route: IV bacteria. Spectrum: infections , diaper dermatitis. symptoms occur. Keep
Classification: Similar to that of Gynecological Hemat: bleeding, epinephrine, an
first generation infections, eosinophilia, hemolytic antihistamine, and
Second generation cephalosporins but Septicemia (IV), anemia, leukopenia. resuscitation equipment
has increased Otitis media (PO), Local: pain at IM site, close by in the event of an
cephalosporin activity against Meningitis (IV), phlebitis at IV site. anaphylactic reaction.
several other gram- Lyme disease Misc: allergic reactions  Monitor bowel function.
Antibiotic negative pathogens (PO). including ANAPHYLAXIS, Diarrhea, abdominal
Perioperative superinfection. cramping, fever, and
prophylaxis (IV). bloody stools should be
reported to health care
professional promptly as a
sign of
pseudomembranous
 Assess for infection (vital
signs; appearance of
wound, sputum, urine,
and stool; WBC) at
beginning of and
throughout therapy.
 24

Name of Drug Dosage, Frequency, Mechanism of Indication Contraindication Adverse Effects Nursing Responsibilities
Rate Action

Generic Name: Dosage: 100mg Binds to mu-opioid Indicated for the Contraindications: The main adverse -Assess for level of pain relief
receptors in CNS, management of - Hypersensitivity to reactions to and administer prn dose as
Tramadol Frequency: BID inhibiting moderate to Tramadol, opioids. tramadol therapy are needed but not to exceed the
ascending pain moderately - Pediatric pts under nausea, dizziness, and recommended total daily
Brand Name: Timing: 8am, 6pm pathway. Inhibits severe chronic 12 yrs of age vomiting, particularly at dose.
reuptake of pain in adults - Post-op the start of the therapy. -Monitor V/S and assess for
Ultram, Ultram ER, Ryzolt Route: P.O. norepinephrine, who require management in pts orthostatic hypotension or
serotonin, around-the clock under 18 yrs May have prolonged signs of CNS depression
or ConZip. inhibiting treatment of their following duration of action, -Educate the client on how to
descending pain pain for an tonsillectomy and/or cumulative effect in pts take the drug, the purpose of
Classification: pathways. extended period adenoidectomy with hepatic/renal the drug, and ensure they are
of time. - Severe respiratory impairment, serotonin taking the proper amounts, as
Centrally acting, oral Therapeutic Effect: depression syndrome addiction can occur by taking
Reduces pain. - Acute bronchial (agitation, this drug.
analgesic asthma in absence of hallucinations, - Instruct to avoid alcohol,
appropriate tachycardia, other narcotics, sedatives.
monitoring hyperreflexia). - Drug may cause drowsiness,
- Concomitant use dizziness, blurred vision.
with or within 14 May cause suicidal Instruct to avoid tasks
days following MAOI ideation and behavior. requiring alertness, motor
therapy. skills until response to drug is
established.
 25

Name of Drug Dosage, Frequency, Mechanism of Indication Contraindication Adverse Effects Nursing Responsibilities
Rate Action
Generic Name: Dosage: 300 mg Paracetamol Symptomatic Contraindicated in Skin eruption, -Assess for fever
produces analgesia relief of fever and nephropathy, and those with hematological toxicity and pain: type of
Paracetamol Frequency: by raising the pain hypersensitivity to eg, thrombocytopenia pain, location,
Q4h rtc for 24 hours threshold of the acetaminophen and leukopenia, intensity, duration,
Brand Name: pain center in the methemoglobinemia temperature
Route: brain and by which can result in diaphoresis.
Aeknil IV obstructing cyanosis, and on long-
impulses at the term use, renal damage Assess allergic
Classification: pain-mediating can result. reactions: rash,
chemoreceptors. urticarial, if these
Antipyretic and analgesic The drug produces occur, drug may
antipyresis by an have to be
action on the discontinued.
hypothalamus;
heat dissipation is Teach patient to recognize
increased as a signs of chronic overdose:
result of bleeding, bruising, malaise,
vasodilation and fever, sore throat.
increased
peripheral blood
flow.

XIII. HEALTH TEACHING PLAN
MEDICATION EXERCISE
Medication 1: Generic Name: Metronidazole >Slowly increase your
activity level to help
with your recovery.
Brand Name: Flagyl
Start by doing light
activities around your
1. Classification: home once you feel able
Antibiotics; nitroimidazoles to do so.
> Deep Breathing
2. How does it work:
Exercise improves
Disrupts DNA and protein synthesis in oxygenation that can
susceptible organisms. Treats Bacterial help with recovery, and
infection. reduce risk of infection.
Patient is to breathe
slowly through the nose
3. Exact time:
until the chest expands
Every 8 hours and the abdomen rises
visibly. Patient is to hold
4. Key to administration: maximum inspiration for
>Metronidazole 500mg/100ml Intravenous 3-5 seconds then slowly
exhale through the
Infusion should be infused intravenously at an
mouth.
approximate rate of 5 ml/minute.
>Oral medication should be substituted as > Do deep breathing
soon as feasible. Do not use a kitchen hold breath for 1 to 2
teaspoon as it will not give the right amount. seconds. Contract
abdominal muscles,
5. Client Teaching:
cough forcefully and
expectorate secretions
>Adhere closely to schedule without
26
TREATMENT HYGIENE OUTPATIENT DIET
>Surgical procedure of > Keeping a sanitary > Return for follow up check- >Include a healthy diet to
Appendectomy environment and good up and comply with strengthen the immune
needed to be done to hygiene affects the healing medication or any other
system.
remove the inflamed process and recovery. treatment regimen.
appendix. This is to
avoid further >Hand hygiene is the single >Open surgery means you >Drinking plenty of fluids,
complications when most important measure in may have staples or stitches especially water is highly
the appendix ruptures, reducing the risk of in your incision. Return to recommend-
such as peritonitis. infection especially in your doctor as it will be
ed. Fluids flushes out
incision care. Wash hands taken out in 7 to 10 days.
toxins especially from the
>If the appendix has regularly with soap and
water, as often as needed. >Check incision every day, medications.
burst and an abscess
checking for signs of
has formed around it,
>You may wash the area >Food rich in protein
the abscess will be infection.
with warm, soapy water 24
drained by placing a Change the dressing as your helps repair and build
to 48 hours after your
tube through the skin doctor recommends. damaged tissues, caused
into the abscess. surgery, unless your doctor
by the infection, in the
Appendectomy will tells you not to. Pat the
> Wash and dry hands and body.
then be performed area dry.
several weeks later clean the incision as
>Keep the area clean and recommended by the doctor. >Green leafy vegetables
after controlling the
infection dry. You may cover it with a Hold a clean, sterile gauze contain antioxidants that
gauze bandage if it weeps pad by the corner and place protect the body against
>Health care providers or rubs against clothing. over the incision. Tape all infectious agents.
will prescribe Change the bandage every four sides of the gauze pad.
medications to help day. >Drink 6 to 8 glasses of
Put all trash in a plastic bag
you control your pain, water a day, unless
such as Paracetamol, and seal. Wash hands after
 27

interruptions or changing of doses. into tissue while after the surgery. >Don't bathe or soak in a care. directed otherwise.
splinting incision areas tub or swim in a pool until
>Take them with a meal or a snack. Do not with pillow. Controlled >The antibiotics used your incisions are well >Call and seek immediate >Take a fiber-based
drink alcohol while you are taking coughing promotes for appendicitis help medical attention if you laxative if you are
healed.
metronidazole ventilation, clearing the prevent wound experience the following: constipated. You may also
airways to prevent infections after use a stool softener.
>Make sure to wear clean
infection due to over surgery such as Lost consciousness
dry clothes. Change to new > Eat a bland, low-fat diet,
Medication 2: Generic Name: Cefuroxime secretions. Metronidazole and clothes when soiled or such as:
Brand Name: Ceftin, Zinacef Cefuroxime. when sweating. Have shortness of breath
> You can do post
surgery bed exercises. -Mashed potatoes
1. Classification: Cephalosporin antibiotics >Take medicine as Cannot drink fluids.
Starting off with basic prescribed or
leg lifts to help improve Cannot pass stools / gas -Plain toast or bread,
2. How does it work: medication adherence crackers
Stopping the growth of bacteria blood flow and for treating conditions,
circulation in the lower and overall long-term Pain that does not get better
-Soup
3. Exact Time: portions of your body. health and well-being. even with pain medicine
500mg, every 8 hours. -Cottage cheese
> You can do moderate
>Don’t self-medicate. Manifests signs of infection,
exercise like walking.
4. Key to administration: Don’t take medicine such as: -Low-fat yogurt
IVTT or IM that is not prescribed
>Support your abdomen Increased pain, swelling, -Low-fat milk
by the doctor.
>Shake IM suspension gently before when you cough. Place a warmth, or redness.
administration. Rotate injection sites. pillow over your Red streaks leading from the -Very ripe bananas
abdomen and apply wound, pus draining from
5. Client Teaching: the wound, fever. >Try to avoid constipation
pressure before you
Report loose stools or diarrhea, and any sign and straining with bowel
cough, laugh or move to movements. You may
of hypersensitivity. >As your body heals, you
help reduce pain. want to take food rich in
Medication 3: may find that you feel
fiber every day.
Generic Name: Acetaminophen sleepier than usual. Take it
> Do not do any heavy easy and rest when you need
lifting for 2 weeks after to.
Brand Name: Tylenol, Panadol laparoscopic surgery or
4 to 6 weeks after open
 28

1. Classification: surgery.
Analgesics

2. How does it works:

Reduce the production of prostaglandins in
the brain. Prostaglandins are chemicals that
cause inflammation and swelling.

3. Exact Time: 500mg tab every 4 hours as

needed.

4. Key to administration:
Do not administer with high carbohydrate
meal; absoroptin rate may be significantly
retarded.

5. Client Teaching:
>Do not exceed the recommended dose as it
can cause liver damage .

>Do not take other medications containing

acetaminophen without medical advice.

Medication 4:
Generic
Tramadol Hydrochloride

Brand:
Zydol
 29

Classification:
Analgesic, Narcotic Agonist

How Does it Work:

Effective agent for control of moderate to
moderately severe pain

Exact Time:
100 mg
8AM / 6PM

Key to Administration:
Assess for level of pain relief and administer as
needed but not to exceed the recommended
total daily dose

Client Teaching:
Exercise caution with potentially hazardous
activities until response to drug is known.
 30

XIV. CONCLUSION AND RECOMMENDATION

Conclusion

The patient is diagnosed with Appendicitis. His appendix, by definition of appendicitis, was inflamed and
posed a risk of bursting or rupturing if left untreated, which may result in potentially life threatening
complications. Due to his diagnosis, and the potential consequences from an untreated inflamed
appendix, the patient had an appendectomy, which went successfully and smoothly. Deficient knowledge
of the patient, along with acute pain experienced post-op are two things the patient must cope with and
resolve before being able to recover fully from his surgery and return to good health. Not following post
op recommendations and treatments by outpatient healthcare workers may result in complications in his
recovery.

Recommendation

The patient, having just been operated in order to remove his appendix, should take it easy on physical
activities, and follow any orders given by the doctor, whether that be medications or exercises needed to
do in order to have a full and proper recovery.

For the patient a healthy diet should be introduced in the home, such as a high-protein diet, egg, milk and
meat. Diet is very necessary, encourage him to take a high fiber diet with a soft to regular diet and promote
a fluid intake.

Families should seek referrals from hospitals or government entities to provide financial support for
surgery.

Health workers in local centers, especially to far-reaching areas in the province, should promote their
health promotion campaigns. The education in health they can offer can be of benefit to families. These
families, particularly in rural areas, can gain a great deal of insight into their health and, consequently,
their livelihoods.
 31

XVI. REFERENCES
Aeknil | MIMS Philippines. (n.d.). Mims. Retrieved November 2020, from
https://www.mims.com/philippines/drug/info/aeknil?type=full

Appendix (Anatomy): Appendix Picture, Location, Definition, Function, Conditions, Tests, and
Treatments. (2019, May 18). Retrieved November 28, 2020, from
https://www.webmd.com/digestive-disorders/picture-of-the-appendix

Bs, R. K. J., & Hodgson, K. (2019). Saunders Nursing Drug Handbook 2020 (1st ed.). Saunders.

Carpento-Moyet, L.J. (2010). Nursing Diagnosis: Application to Clinical Practice.Philadelphia, PA:

Lippincott Williams and Wilkins.

EdS Rn, M. B. A. J. (2016). [Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care] [By:
Ackley MSN EdS RN, Betty J.] [February, 2016]. Mosby.

Healthwise Staff. Kaiser Permanente. Appendectomy: What to Expect at Home. (2020, April 15).
Retrieved November 27, 2020 from
https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.appendectomy-
what-to-expect-at-home.ug3573

John Hopkins Medicine. Appendectomy. Retrieved November 26, 2020 from

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/appendectomy

John Hopkins Medicine. Appendicitis. Retrieved November 26, 2020 from

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/appendectomy

Wayne, G. 2019. Deficient Knowledge. Nursing Care Plans and Diagnosis.

Retrieved from https://nurseslabs.com/deficient-knowledge

Vera, 2019 4 Appendectomy Nursing Care Plans retrieved from https://nurseslabs.com/4-

appendectomy-nursing-care-plans/

Jones, M., Lopez, R., Deppen, J. (2020). Appendicitis. https://www.ncbi.nlm.nih.gov/books/NBK493193/

OpenStax, L. (n.d.). Anatomy and Physiology II. Retrieved November 28, 2020, from
https://courses.lumenlearning.com/suny-ap2/chapter/overview-of-the-digestive-system/

Tramadol | MIMS Philippines. (n.d.). Mims. Retrieved November 2020, from

https://www.mims.com/philippines/drug/info/tramadol?mtype=generic

Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2019). Davis’s drug guide for nurses (Sixteenth edition). F.A.
Davis Company.