ACUTE APPENDICITIS

I. 3P’s 
A. Personal Profile 
Name: Ms. L
Age : 21 year old
Gender: Female
Birthdate : May 26, 2001
Marital Status: Single 
Address: Magsaysay Hill Bambang Nueva
Vizcaya
Religion:  Roman Catholic
Educational Attainment: College Undergraduate 
Occupation:  Cashier
Civil Status:  Single 
Nationality: Filipino
Primary Language: Tagalog
Name of the SO: Noreen Cruz
Age: 18
Gender: Female
Marital Status: Single
Educational Attainment: Senior High School 
Relationship to the Client: Sister
Attending Physician: Dra. Z
Source of Health Rural Health Unit
Information:
Patient’s Case: Ruptured Appendicitis
Date and Time of Admission: October 20, 2022
7:25 pm
Date of Discharge: October 25, 2022
No. of Hospital Days: 5 days 
Name of Hospital: Nueva Vizcaya Provincial Hospital
Type of Admission: Emergency Appendectomy
Chief Complaint: Right Lower Quadrant (RLQ) Pain, 
Admitting Diagnosis: Acute Appendicitis
Principle Diagnosis: Acute Congestive Appendicitis

According to the information acquired, Ms. L is a 21-year old and a single woman. She is a
college undergraduate but currently working as a cashier in a restaurant in Magsaysay Hill Bambang,
Nueva Vizcaya. Her significant other is her senior high school student sister, Ms. Noreen legal age.
She was especially helpful to the patient in terms of independent care and meeting her needs
throughout the hospitalization.
The patient, Ms. L, was admitted to Nueva Vizcaya Provincial Hospital on October 20, 2022 at
7:25 p.m. with the chief complaint of RLQ Pain. Her admitting diagnosis is Acute Appendicitis, with
the primary diagnosis being Acute Congestive Appendicitis. The attending physician, Dra. Z assessed
and diagnosed the patient, who then requested an emergency appendectomy immediately after
admission. On October 25, 2022, the patient was discharged and health education about self-care was
given
 B. HISTORY OF PAST ILLNESS
The patient stated that she had not been hospitalized since she was a child. She stated that
she had cough, cold, headache, and fever but that she and her family had always used self-
medication.

C. HISTORY OF PRESENT CONDITION

Ms. L, a 21-year-old female, had RLQ pain that intensified over three days prior to
admission. The pain scale is a 7/10, and she ignored it because she taught that pain would be gone
soon. She vomited twice and lost her appetite, so she lay down in bed and flexed her hip to
alleviate the pain. The pain interval is every hour, and as the pain became more severe, she
decided to seek medical attention with the assistance of a coworker. At 5:00 p.m., they arrived at
the Nueva Vizcaya Provincial Hospital's Emergency Room. on the 20th of October, 2022 The
vital signs obtained were as follows: BP: 150/100 mmHg, Temp: 36.9 degrees Celsius, RR: 24
bpm, PR: 118 bpm, and SpO2: 98%. Since ruptured appendicitis is suspected, an ultrasound is
being performed during her examination.
D. Environmental History
The patient lives in Magsaysay Hill, Bayombong, NV, she lives with her parents
together with her younger sister, they live in a semi concrete house. The patient states that
their house is surrounded with bushes and trees, and is located not far from the highway.
Their source of water is from a water pump near their house and they are buying mineral
water for drinking. According to him, the comfort room is 10m away from the house and
he states that they practice proper waste disposal though sometimes they also burn
garbage’s.

E. LIFESTYLE AND PRACTICES

The patient claims she ate soft drinks and junk food for breakfast and lunch, and one cup of rice
and a protein-rich food for dinner. She also stated that she enjoys fast food, street food, and ready-
made meals. On her days off, the patient also admitted to smoking cigarettes and drinking alcoholic
beverages. Furthermore, the patient's recreational activities include badminton, nature picnics, mobile
game play, road trips, and music listening. Her sleeping pattern was good; she went to bed at 10:00
p.m. and awakens at 6:00 a.m. There have been no reports of sleep disturbances. They use herbal
medicine such as oregano, lagundi, sambong, and yerba buena as an alternative treatment and believe
in quack doctors due to financial constraints. They usually do these practices for minor health issues
and go to the nearest public hospital for major illnesses.
GORDONS FUNCTIONAL PATTERN
Functional Before Hospitalization During Hospitalization Analysis 
Health Pattern
Health Patient viewed health as a The patient is oriented, The client shows
Perception/ state in which she can conscious and coherent. Her interest in fast
Health perform her daily routine concern about her surgical site recovery.
Management with the absence of illness after incision and repair. The
Pattern and disease.  patient is willing to accept and
listen to health teachings.
Nutritional The patient has no allergies
Metabolic to food and drugs, she eats
Pattern 3x a day with snacks in
between, he drinks 5-6
glasses of water. She ate a
low fiber diet like meat,
processed foods and junk
foods.
Elimination The patient usually void 6
Pattern to 7 times a day with total
output of 800-1000 cc he
defecates once or twice
daily, he defecates yellow
to brown formed stool.
Activity- The patient claimed that
Exercise she does not have problems
Pattern with his daily activities,
such as; bathing, dressing,
eating and or any difficulty
with his locomotion. He
loves playing basketball
which serves as his daily
exercise.
Cognitive- The patient is oriented to
Perceptual people, time and place. She
Pattern can read and write, and
responses to stimuli
verbally and physically.
Sleep Rest The patient usually sleeps
8-10 hours, his earliest
time of going to sleep is
10:00 pm and she wakes up
at 6 am, sometimes she
takes a nap for about 40
mins. She doesn’t have any
difficulties going to sleep
and doesn’t use medication
to promote sleep.
Self- The patient is able to
Perception/ express her feelings about
Self Concept his condition, he feels
Pattern weak and she wants to get
better. Hopeful to be
relieved and treated
Roles- The patient is single and
Relationship the 3rd child of the 4
The patient is in NPO and Due to preparation
decrease appetite for operation and as
ordered by the
Wt: 47 physician.
Ht: 5’2
BMI: 18.5
Formula: BMI=(WT in kg/HT
in m^2)
He has irregular bowel Prior to admission,
movement and he urinates the client has
yellow colored urine with a irregular bowel
total amount of 300 to 400cc. movement due to
decreased motility
due to the
inflammatory
process in the area
decreases peristalsis.
The patient is on bed rest and Impaired mobility
shows evidence of weakness. due to pain.
She is able to communicate No deviation
and comprehend effectively
during nurse patient
interactions.
During assessment, the patient Interrupted sleep due
was complaining about not to pain and
being able to sleep because of environmental
her pain in his RLQ abdomen factors.
and environmental factors.
the patient major concern is Positive thinking on
her recovery health recovery after
surgery.
Well, supported by the family Strong relationship
and maintains a good with the family.
 Pattern siblings and lives with her
family. Well, supported
and loved by his family
with close relationships.
Sexuality The patient is single, had
Reproductive her menstrual period at the
Pattern age of 12. No history of
any disease affecting
genitals.
Coping/ Stress The patient copes up with
Intolerance stress by watching TV,
Pattern playing games and
listening to music. When
they have a problem in the
family, they resolve it by
means of talking to each
other.
Values Belief The patient religion is
Pattern Roman Catholic. Have
strong faith in God. They
use herbal medicines like
guava, lagundi and
oregano. They also believe
in “Quack Dr.” and have
no religious restrictions.
relationship with her parents
and other relatives while under
confinement.
The patient is single, no history No deviation
of any disease affecting
genitals.
She is irritable because of the Patient felt fear but
pain he felt. She verbalizes his still exhibited strong
fear for the operation but faith with the support
strongly desires to recover, and of her family.
is able to accept his condition.
Patient was cooperative with
medical advice because he
wanted to be cured of his
illness. The parents
continuously guided and
supported him throughout her
hospital stay. 
The patient always prays to get Her religious beliefs
well soon for her fast recovery. still remain.
Admission and operation don’t
interfere with spiritual
practices.

Physical Assessment (Pre-OP: September 5, 2021)

General appearance: received sitting in a wheelchair, conscious, hooked with an IV (D5NSS to
his right hand, was wearing a hospital gown.
Vital Signs Assessed Findings Analysis
Pre OP Post OP
Pulse 60-100 118 56 bpm During the pre op, the pulse rate was elevated due to
bpm bpm the pain of the patient. While during the post op the
pulse rate was decreased due to the pain of the patient
Respiration 12-20 24 bpm 21 bpm During the pre op, the respiration was elevated due to
cpm the pain of the patient. While during the post op the
respiration was decrease due to too much anesthesia
Temperatur 36.5 oC- 38.2 37.2 During the pre op the temperature was elevated due to
e 37.5 oC the inflammatory response of the body. While during
to the post op the temperature was decrease
Blood 90-140 During the pre op the blood pressure was elevated
mmHg 150/100 100/60 due to anesthesia. While during to the post op the
 Pressure 60-90 blood pressure was decrease due to anesthetic drugs
mmHg
Height 5’2 No No changes
changes
Weight 47kg 46kg This is due to vagal stimulation.
BMI 19.1 No Indicates normal BMI that is appropriate for her age
changes and height.

Assessment Assessment Findings Analysis

Normal Findings Pre OP Post OP
Skin turgor above
Integumentary Snaps back Decrease skin turgor Decrease skin 2-3s may indicate
immediately (2-3s) (3-4s) turgor (3-4s) inadequate
hydration
Varies from light to With dark brown With dark brown Due to excessive
deep brown; with complexion on the complexion on the sun exposure
uniform color with extremities and light extremities and causing excessive
rest of the body brown in the central light brown in the melanin
body. central body. production
Due to
Skin Moist skin With dry skin With dry skin inadequate fluid
intake
Presence of
Intact skin right surgical incision Post op: due to
lower quadrant of on the lower right appendectomy
the abdomen. quadrant of the
abdomen (2-3in) 
Evenly distributed Evenly distributed
Hair Evenly distributed hair. With short, hair. With short, A normal finding
hair. black and dry hair. black and dry
hair.
Smooth and has
intact epidermis Smooth and has
intact epidermis
With short and dirty With short and
fingernails and dirty fingernails
Nails Smooth and has toenails. and toenails. No changes
intact epidermis
Convex and with a Convex and with
good capillary refill a good capillary
time of 2-3 seconds. refill time of 2-3
seconds.
Rounded, Rounded,
normocephalic and normocephalic
Skull Rounded, symmetrical, smooth and symmetrical,
normocephalic and and has uniform smooth and has
symmetrical, consistency. uniform No changes
smooth and has Absence of nodules consistency.
uniform or masses. Absence of
consistency. nodules or
Absence of nodules masses.
or masses.
Symmetrical facial Symmetrical
Symmetrical facial movement, facial movement,
Face movement, palpebral fissures palpebral fissures No changes
palpebral fissures equal in size, equal in size,
equal in size, symmetric symmetric
symmetric nasolabial folds. nasolabial folds.
nasolabial folds.
Nose and
sinuses
Symmetric and Symmetric and
Symmetric and straight, no flaring, straight, no
straight, no flaring, uniform in color, air flaring, uniform in
External Nose uniform in color, air moves freely as the color, air moves No changes
moves freely as the clients breathe freely as the
clients breathe through the nares. clients breathe
through the nares. through the nares.
Mucosa is pink, no Mucosa is pink,
Mucosa is pink, no lesions and nasal no lesions and
Nasal Cavity lesions and nasal septum intact and in nasal septum No changes
septum intact and in the middle with no intact and in the
the middle with no tenderness. middle with no
tenderness. tenderness.
Symmetrical, Symmetrical, Symmetrical, Dryness due to
Mouth and pinkish lips, pinkish pinkish lips, pinkish pinkish lips, inadequate fluid
Oropharynx to brown gums and to brown gums and pinkish to brown intake
able to purse lips able to purse lips gums and able to
No changes
purse lips
Teeth Smooth, white, Smooth, white Smooth, white No changes
shiny tooth enamel
Central position, Central position, Central position,
pink but with pink but with pink but with
Tongue and whitish coating whitish coating whitish coating No changes
floor of the which is normal, which is normal, which is normal,
mouth with veins with veins with veins
prominent in the prominent in the prominent in the
floor of the mouth. floor of the mouth. floor of the
mouth.
Tongue Moves when asked Moves when asked Moves when
movement to move without to move without asked to move
 difficulty difficulty without difficulty No changes
Positioned midline Positioned midline Positioned
Uvula  of soft palate of soft palate midline of soft No changes
palate
Positioned at the Positioned at the Positioned at the
Neck midline without midline without midline without
tenderness and tenderness and tenderness and No changes
flexes easily. No flexes easily. No flexes easily. No
masses palpated. masses palpated. masses palpated.
Coordinated, Coordinated, smooth Coordinated,
smooth movement movement with no smooth movement
Head with no discomfort, discomfort, head with no No changes
movement head laterally rotates laterally rotates and discomfort, head
and hyperextends. hyperextends. laterally rotates
and hyperextends.
Muscle With equal strength With equal strength With equal No changes
strength strength
Lymph nodes Non-palpable, non- Non-palpable, non- Non-palpable, No changes
tender tender non-tender
Not visible on Not visible on
Not visible on inspection, glands inspection, glands
Thyroid gland inspection, glands ascend and visible ascend and visible No changes
ascend and visible during swallowing during swallowing
during swallowing
Thorax and
lungs
Posterior Chest symmetrical Chest symmetrical Chest symmetrical No changes
thorax
Spine vertically Spine vertically Spine vertically
aligned, spinal aligned, spinal aligned, spinal
Spinal column is straight, column is straight, column is straight, No changes
alignment left and right left and right left and right
shoulders and hips shoulders and hips shoulders and hips
are at the same are at the same are at the same
height. height. height.
With normal breath With normal breath With normal
Breath sounds sounds without sounds without breath sounds No changes
dyspnea. dyspnea. without dyspnea.
Anterior Quiet, rhythmic and Quiet, rhythmic and Quiet, rhythmic No changes
thorax effortless respiration effortless respiration and effortless
respiration
With direct and With direct and Numbness of the Initial numbness
rebound tenderness rebound tenderness surgical site due of the surgical
Abdomen on the right lower on the right lower to the presence site due to the
 quadrant; with quadrant; with anesthesia presence of
indirect tenderness. indirect tenderness. anesthesia and
nerve damage.
Symmetrical Episodes of Decreased bowel The
Abdominal movements caused constipation sounds. inflammatory
movements by respirations. process in the
area decreases
peristalsis
Auscultation With audible sounds With audible sounds With audible Due to the
of bowel of 10-15 bowel of 10 bowel sounds of 6-8 presence of
sounds sounds/min sounds/min bowel sounds/min anesthesia
Abdominal rigidity Dunphy’s sign:
and tenderness Sharp stabbing pain Verbalized pain in The inflammation
on the right lower the surgical of the appendices
quadrant with a incision with a compresses the
scale of 9/10 when scale of 7/10 visceral nerve
Abdominal instructed to cough fiber ending
palpation causing
Rovsing’s Sign:
abdominal pain
sharp pain on the
right iliac region
when palpating from
left iliac region
upwards
With tenderness
Upper Without scars and Without scars and Without scars and
extremities lesions on both lesions on both lesions on both No changes
extremities. extremities. extremities.
Lower Without scars on Without scars on Without scars on No changes
extremities both lower both lower both lower
extremities extremities extremities
Equal sides both
Equal sides both sides of the body,
sides of the body, smooth coordinated
smooth coordinated movements, 100%
Muscles movements, 100% of normal full Immobilize in Due to the effect
of normal full movement against lower extremities of anesthesia
movement against gravity and full
gravity and full resistance in arms
resistance in arms and minimal
and full movement movement in leg
in leg
Bones and No deformities or No deformities or Immobilize in Due to the effect
joints swelling, joints swelling, joints lower extremities of anesthesia
move smoothly move smoothly
Mental status
 Can express oneself Can express
Languages Can express oneself by speech or sign. oneself by speech No changes
by speech or sign. (Pt: natatakot ako) or sign.
Oriented to a Oriented to a person, Oriented to a
Orientation person, place, date place, date and time. person, place, date No changes
and time. and time.
Able to concentrate Able to concentrate Able to
Attention span as evidence by as evidence by concentrate as
answering the answering the evidence by No changes
questions questions answering the
appropriately. appropriately. questions
appropriately.
A total of 15 points No changes
A total of 15 points indicative of A total of 15
Level of indicative of complete orientation points
consciousness complete orientation and alertness.
(Glasgow Coma
and alertness.
(Glasgow Coma scale)
scale)
Motor
Function
Gross Motor
Balance
Has upright posture Has a poor posture
and steady gait and unsteady gait
Walking gait opposing arm swing with arms on both Patient is in flat Pre op: patient is
unaided and sides unaided and bed in showing signs
maintaining balance. maintaining balance. of pain

LABORATORY RESULT
DATE: 10/20/2022 7:25 PM
SEROLOGY/IMMUNOLOGY
TEST RESULT REFERENCE PATHOPHYSIOLOGICAL BASIS
VALUE

HGB(Hemoglobin) 132g/L 110-160g/L Indication: 

Within normal range

Significance: 

Protein in RBC that carries oxygen to your

body organs and tissues and transport CO2
from your organs and tissues back to your
lungs
 Implication:

High level of HGB may lead to dizziness,

fatigue, easy bruising and other symptoms.
Below normal may lead to hypoxia.

HCT(Hematocrit) 40.3% 37-54% Indication:

Within normal range

Significance

Ratio of the volume of red blood cells to the

total volume of blood

Implication:

High level of HCT indicates dehydration and

polycythemia vera. Below normal may lead to
anemia.

RBC 4.81× 3.50- Indication:

10^12L 5.50×10^12L
Within normal range

Significance

Responsible for transporting O2 from lungs to

the rest of the body.

Implication:

A high level of RBC may lead to blood clots.

Below normal indicates folate deficiency.

PLT(Platelet Count) 343×10^9L 150- Indication: 

350×10^9L
Within normal range

Significance: 

 Small, colorless cell fragments in our blood

that forms clots and stop or prevent bleeding

Implication:

A high level of PLT indicates blood clots. Low

Below normal may lead to dangerous internal
bleeding.

WBC 21.02 × 4.00-12.00 L Indication: 

10^9L
Above normal
 Significance: 

WBC is a type of cell that helps the body fight

infection. Below normal could indicate viral
infections that temporarily disrupt the work of
bone marrow.

Implication: 

A high  level of WBC  value may indicate

leukocytosis

Neu#(Neurophils) 17.23 × 2.00-7.00 × Indication: 

10^9L 10^9L
Above normal

Significance: 

An absolute neutrophil count identifies how

many neutrophils are in a sample of your
blood. Below normal may lead to severe
complications

 Implication:

A high level of Neu# value may indicate of

risk of neutrophil condition

Lym#(Lymphocytes) 2.23 × 0.80-4.00 × Indication: 

10^9L 10^9L
Within normal range

Significance: 

Are white blood cells and one of the body's

main tupes of immune cells.

Implication:

High level of lymphocytes may lead to severe

complication. Below normal may lead to
HIV,AIDS, TB or typhoid fever

Mon#(Monocytes) 0.99 × 0.12-1.20  × Indication: 

10^9L 10^9L
Within normal range

Significance: 

Are critical component of innate immune

system.

Implications:
 A high level of monocytes may lead to
mononucleosis. Below normal may lead to
susceptible to infection. 

Eos#(Eosynophil) 0.55 × 0.02-0.50 × Indication:

10^9L 10^9L
Above normal

Significance: 

A type of disease-fighting white blood cell

Implication:

A high level of eosinophils indicates inflamed

tissues and causes damaged organ. Below
normal indicates multiple organs damage. 

Bas#(Basophils) 0.02 × 0.00-0.10 × Indication

10^9L 10^9L
Within normal range

Significance:

Type of white blood cell that protects the body

from infection.

Implication:

A high level of Basophils can be a sign of

chronic inflammation in the body. Below
normal may lead to severe allergic reaction

27.4 pg 27.0-34.0pg Indication

Within normal range

Significance

HCV(Hepatitis C 83.7 fL 80.0-100.0 fL Indication

Virus)
Within normal range

Significance:

A type of blood test enable to determine if an

individual has ever been infected with the
Hepatitis C virus

Implication:

A high level of HCV indicates high viral load.

 Below normal indicates low viral load

MCHC(Mean 328g/L 320.0-360.0g/L Indication

corpuscular
hemoglobin Within normal range
concentration)
Significance:

To assess the function and health of RBC in

order to check for signs of anemia and other
blood disorders

Implication:

A high level of MCHN indicates autoimmune

hemolytic anemia. Below normal may
indicates low level if hemoglobin 

RDW-CV 12.2% 11.00-16.00% Indication

Within normal range

Significance:

Used to diagnose anemia

Implication:

A high level of RDW--CV indicates abnormal

size of RBC. Below normal may lead
macrocytic anemia 

RDW-SD 38.9 fL 35.0-56.0 fL Indication

Within normal range

Significance

Used to diagnose anemia

Implication:

A high level of RDW-SD indicates difficulty

in making red blood cekk. Low level indicates
different size variation from typical
measurement.

Neu% 82.0% 50.0-70.0% Indication

Above normal

Significance:
 Important for fighting certain infections,
especially those caused by bacteria

Implication:

A high level of Neu% is a sign that the body

has an infection.

Low level of Neutrophils makes it harder for

the body to fight germs and prevent infections.

Lym% 10.6% 20.0-40.0% Indication

Below normal

Significance

They help the body’s Immune system fight

cancer and foreign viruses and bacteria.

Implication

A high level of lymphocytes might be evidence

of infection, cancer of the blood or lymphatic
system.

low level of lymphocytes is a high risk of

infection.

Mon% 4.7% 3.00-12.00% Indication

Within normal range

Significance

They help fight bacteria, viruses, and other

infections in the body

Implication

Low level of monocytes tend to develop as a

result of medical conditions that lower the
overall WBC count.

A high monocyte count is a potential sign of

many different medical conditions.

Eos% 2.6% 0.05-5.00% Indication

Within normal range

Significance

eosinophils are a type of disease-fighting wbc.

 implications

low eosinophil count will not be a threat to the

overall health

High eosinophil levels can indicate a mild

condition such as drug reaction or allergy, or a
severe condition could cause it, including some
disorders.

Bas% 0.01% 0.00-1.00% Indication

Within normal range

Significance

An absolute basophil count identifies how

many basophils are present in a sample of your
blood.

Implication

High may be a sign you have an infection or a

more serious medical condition like leukemia
or autoimmune disease.

Low basophil level can indicate other

basophilic disorders. (cancer, acute infection,
serious injury)

PCT 0.274% 0.108-0.282 Indication

Within normal range

Significance

Procalcitonin helps to detect sepsis and severe

bacterial infections in the early stage.

Implications:

Low PCT levels may indicate that the person’s

symptoms are due to a cause other than a
bacterial infection, such as a viral infection.

high level of PCT indicates sepsis

PDW(platelet 15.7 9.00-17.0 Indication

distribution width)
Within normal range

Significance
 tells how similar the platelets are in size

Implication:

low PDW correlated with a shorter overall

survival in gastric cancer.

High PDW means there is a great variation in

size, which may be associated with vascular
disease or certain cancers.

MPV 8.00fL 6.5-12.0 fL Indication

Within normal range

Significance

Diagnose bleeding disorders and disease of the

bone marrow

Implication:

High level of MPV indicates that the platelets

are larger than what’s considered normal.

A low MPV indicates that the average platelet

size is small.
 ANATOMY OF THE APPENDIX

The appendix is a wormlike extension of the cecum and for this reason, has been called the
vermiform appendix. The average length of the appendix is 8 – 10 cm. (ranging from 2 – 20 cm). The
appendix appears during the fifth month of gestation, and several lymphoid follicles are scattered in its
mucosa. Such follicles increase in number when individuals are aged 8 – 20 years.
The appendix is contained within the visceral peritoneum that forms the serosa, and its exterior
layer is longitudinal and derived, from the taenia coli; the deeper, interior muscle layer is circular.
Beneath this layer lies the submucosal layer, which contains lymphoepithelial tissue. The mucosa consists
of columnar epithelium with few glandular elements and neuroendocrine argentaffin cells.
Taenia coli converge on the posteromedial area of the cecum, which is the site of the appendiceal
base. The appendix runs into serosal sheet of the peritoneum called the mesoappendix, within which
courses the appendicular artery, which is derived from ileocolic artery. Sometimes, an accessory
appendicular artery (deriving from the posterior cecal artery) may be found.
Appendiceal Vasculature
The vasculature of the appendix must be addressed to avoid intraoperative hemorrhages. The
appendicular artery is contained within the mesenteric fold that arises from a peritoneal extension from
the terminal ileum to the medial aspect of the cecum and appendix; it is a terminal branch of the ileocolic
artery and runs adjacent to appendicular wall. Venous drainage is via the ileocolic veins and the right
colic vein into the portal vein; lymphatic drainage occurs via ileocolic nodes along the course of the
superior mesenteric artery to the celiac nodes and cisterna chyli.
Appendiceal Location
The appendix has no fixed position. It originates 1.7 – 2.5cm below the terminal ileum, either in a
dorsomedial location (most common) from the cecal fundus, directly beside the ileal orifice, or as a
funnel – shaped opening (2 – 3% of patients). The appendix has a retroperitoneal location in 65% of
patients and may descend into the iliac fossa in 31%. In fact, many individuals may have an appendix
located in the retroperitoneal space; in the pelvis; or behind the terminal ileum, cecum, ascending colon,
or liver. Thus, the course of the appendix, the position of its tip, and the difference in appendiceal position
considerably changes clinical findings, accounting for nonspecific signs and symptoms of appendicitis. 
Physiology of Appendix
The lumen of the appendix communicates with the cecum 3cm (about 1inch) before the ileocecal valve,
thus making it an accessory organ of the digestive system. Its functions are not certain, but some
biologists believe that the appendix serves as a sort of “breeding ground” for some of the nonpathogenic
intestinal bacteria thought to aid in the digestion or absorption of nutrients.
Follicles of lymphoid tissue appear in the wall of the appendix shortly a few births, become more
prominent during the first 10 years of life and then progressively disappear. The defense of immune
system function of lymphatic tissue present in the appendix of young children is not fully understood.
DRUG STUDY
DRUG MECHANI INDICATI CONTRAINDICAT SIDE NURSING
SM OF ON ION EFFECTS CONSIDERATI
ACTION & ON
ADVERSE
EFFECTS
Generic Tramadol Tramadol is Patients who have Side If sweating or
Name: modulates used to treat had an opioid effects: CNS effects
TRAMADO the moderate to hypersensitivity Headache, occur, modify the
L descending severe pain, reaction. drowsiness, environment
pain including constipation (temperature,
Brand pathways in post-surgical The medication , low lighting).
Name: the central pain. should not be used by energy,
nervous patients under the age nausea, Monitor vital
Classificati system via of twelve. vomiting signs and look
on: binding of and for signs of
Opiate the parent Patients under the age sweating orthostatic
(narcotic) and M1 of eighteen who have hypotension or
analgesic metabolite to had a tonsillectomy Adverse CNS depression.
-opioid or adenoidectomy effects:
Type: receptors and should not be given Agitation, If S&S of
subcutaneou weak the medication. hallucinatio hypersensitivity
s inhibition of ns, occur,
norepinephri Suicidal Patient tachycardia, discontinue the
Doctor’s ne and shivering, drug and notify
Order: serotonin Severe renal severe the physician.
50 mg IV reuptake. impairment muscle
PRN stiffness or Examine bowel
Lactation twitching, and bladder
Date loss of function and
Given: coordinatio report on urinary
October 20 n and frequency or
2022 changes in retention.
hear beat.
Date ARDS Patients with a
Discontinue history of
d: seizures or who
October 20, are taking drugs
2022 that lower the
seizure threshold
Duration:  should be given
1 day seizure
precautions.

Take appropriate
safety
precautions and
monitor
ambulation.
 DRUG MECHANIS INDICATI CONTRAINDICAT SIDE NURSING
M OF ON ION EFFECTS CONSIDERATI
ACTION & ONS
ADVERS
E
EFFECTS
Generic The primary It is Hypersensitivity Side Correct
Name: mechanism indicated for effects: hypovolemia prior
KETOROL of action the short- Hypertensive  Nausea, to administration
AC responsible term (5-day) stomach of drug
for management Active peptic ulcer pain,
Brand ketorolac's of disease diarrhea, Monitor for fluid
Name: anti- moderately drowsiness retention and
TORADOL inflammatory severe acute Gastrointestinal , headache, edema 
, antipyretic, pain that bleeding swelling
Classificati and analgesic requires Monitor for s/sx
on: effects is the opioid Allergic-type Adverse of GI distress or
nonsteroidal competitive analgesia, reactions such as effects: bleeding
anti- inhibition of typically in asthma urticarial  Tachycard
inflammator the enzyme a ia, Monitor urine
y drug cyclooxygen postoperativ Prophylactic fainting, output
(NSAID)  ase. e setting. analgesic before severe
surgery headache, Physiological
Type:  vision disturbances
IV Renal impairment changes sx should be
of heart monitored and
Doctor’s Pregnant & Lactation failure, reported.
Order: easy
30 mg IV bleeding, Anaphylaxis
q8h x 3 sx of symptoms should
doses kidney be monitored.
ANST problem,
sx of Pain assessment
Date infection
Given: sx of Assess the
October 20 meningitis, paresthesia sign
2022 sx of liver
damage Assess BP
Date
Discontinue
d:
October 21,
2022

Duration: 
2 days
NURSING CARE PLAN
ASSESSMENT DIAGNOSI PLANNIN INTERVENTIO RATIONAL EVALUATIO
S G N E N
Subjective data: Acute pain Short term: Independent After 15
related to After 15 Assess pain, Changes in minutes of
“Masakit yung
the minutes of noting location, characteristic nursing
kanang tagiliran
compression nursing characteristics, s of pain may intervention,
ko,” as verbalized
of visceral intervention onset, duration, indicate the patient
by the patient.
nerve fiber , the patient frequency, developing would be able
ending would be quality, and abscess or to demonstrate
Objective data: secondary able to severity of pain  peritonitis, relaxation
 Pain scale appendicitis. demonstrat requiring techniques like
9/10 e relaxation prompt deep breathing
techniques Monitor vital medical and
 Facial
like deep signs every 15 evaluation verbalization
grimace
breathing minutes. and of pain scale
 Restlessne
ss and intervention. reduced from
verbalizatio 9/10 to 7/10.
n of pain Instruct/ To have a
scale demonstrate deep baseline data.
Vital Signs: reduced breathing
from 9/10 technique.
Vital Signs:
to 5/10
T:38.2 Discovering
PR:116 Ask the patient to new coping
be in his methods
RR:24 comfortable provides the
BP:130/80 position. patient with a
variety of
ways to
Keep at rest in manage fear.
semi-Fowler’s
position.
To relieve
the pain.

To lessen the
pain. Gravity
localizes
Dependent:
inflammatory
Administer
exudate into
ketorolac as
the lower
ordered
abdomen or
pelvis,
Collaborative: relieving
abdominal
tension,
 Secure all which is
laboratory and accentuated
diagnostic by supine
procedures. position.

To relieve
the pain on
the RLQ as
prescribed by
the
physician.

For further
evaluation
and
management.

NURSING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNIN INTERVENTI RATIONA EVALUATI
G ON LE ON
Subjective data: Fear related to Short term: Independent After 20 min
pre – After 15 Introduce to the Discovering of nursing
“Natatakot ako sa
operational minutes of patient fear – new coping intervention,
gagawin sa akin,” as
procedure/treat nursing reducing methods the patient
verbalized by the
ment; interventio techniques (ex. provides verbalized
patient.
appendectomy n, the Relaxation and the patient the
as evidenced by patient will deep breathing) with a understandin
“Ate magiging restlessness, verbalize variety of g through use
successful kaya ang jitteriness and and Use simple ways to of effective
operasyon ko?” as expressed demonstrat language and manage coping
verbalized by the concerns. e brief fear. behaviors.
patient. understand statements with
ing a therapeutic The patient GOAL
Objective data: through approach. may find it MET.
use of hard to
 Restlessness effective understand
 Jitteriness/ coping any given
tremors behaviors explanation
and Avoid during fear.
relaxation unnecessary Simple,
Vital Signs techniques. reassurance clear and
and undo brief
worry. instructions
are
Encourage the necessary.
patient to
consider Reassuranc
positive self – e is not
talk like “kaya helpful to
ko to.” lessen the
fear.

Focus on
changing
thoughts
replacing
negative
self –
statements
with
positive self
–
statements
to reduce
fear.

NURSING CARE PLAN

ASSESSMENT DIAGNOS PLANNING INTERVENTI RATIONA EVALUATIO
IS ON LE N
Subjective data: Risk for Short term: Independent After 15
fluid After 15 Monitor BP and Variations minutes of
“Nagsuka ako
volume minutes of pulse. help identify nursing
ng 2 beses,” as
deficit nursing fluctuating intervention, the
verbalized by
related to intervention, the intravascula patient would be
the patient.
vomiting as patient would be r volumes able to:
manifested able to: Inspect mucous
Objective data: by dry membranes; Indicators of
mucous assess skin adequacy of 1. Underst
 Dry
membranes turgor and peripheral and the
mucous
, decreased 1. Underst capillary refill. circulation possible
membra
nes skin turgor, and the and cellular cause
and dry possible Monitor I&O; hydration. and
 Decreas
skin  cause note urine color effect of
ed skin
and and Decreasing fluid
turgor
effect of concentration, output of losses
 Dry
fluid specific gravity. concentrated or
skin
 Decreas loss or urine with decreas
ed fluid decreas increasing ed fluid
intake ed fluid specific intake.
intake. Provide clear gravity 2. Underta
2. Underta liquids in small suggests ke
ke amounts when dehydration measure
Vital Signs:
measure oral intake is and need for s to
T:38.2 s to resumed, and increased treat or
PR:116 treat or progress diet as fluids. prevent
prevent tolerated. fluid
RR:24 fluid Reduces risk volume
BP:130/80 volume Monitor IV of of gastric deficit.
deficit. the patients. irritation
and
Maintain vomiting to GOAL MET.
moisture of the minimize
skin. fluid loss.

Dependent: To prevent
fluid
Infuse D5LRS overload.
as prescribed by
the physician. To prevent
dryness of
Collaborative: the skin.

Secure all
laboratory and
diagnostic
procedures. Fluids are
necessary to
maintain
hydration
 status.

For further
evaluation
and
management
.

NURSING CARE PLAN

ASSESSMEN DIAGNO PLANNING INTERVENTI RATIONA EVALUATION
T SIS ON LE
Subjective After 15 minutes Independent After 15 minutes
data: Knowledg of nursing of nursing
e Deficit rt intervention, the Educate the To promote intervention, the
“Paano po ba
unfamiliari patient would be patient the circulation patient would be
ang tamang
ty with able to: importance of and faster able to: 
paglinis ng
informatio early healing of
sugat ko?,” as
n resources ambulation. the incision.
verbalized by
AEB 1. Maintain 1. Maintain
the patient.
questions, intact Review  Provides intact
request for sutures. postoperative information sutures.
Objective data: informatio 2. Keep the activity for patients 2. Keep the
n, wound restrictions to plan for wound
 Surgic
verbalizati dry and (heavy lifting, return to dry and
al
on of have an exercise, sex, usual have an
incisio
problem intact sports, driving). routines intact
n at
regarding wound without wound
the
wound dressing. Discuss care of untoward dressing.
lower
care 3. Keep the incision, incidents. 3. Keep the
abdom
inal incision including incision
site free dressing Understandi site free
area.
from changes, ng from
 3–4
inflamma bathing promotes inflamma
inches
tion’ restrictions, cooperation tion’
incisio
redness and return to with redness
n
and physician for therapeutic and
wound
purulent suture and regimen, purulent
.
discharge staple removal. enhancing discharge
. healing and .
Vital Signs 4. Emphasiz Instruct the recovery 4. Emphasiz
e the patient to keep processes. e the
importan the area clean importan
ce and or dry and ce and
early intact. To prevent early
ambulatio infection of ambulatio
n related Advise the the incision n related
to wound patient to eat and to wound
healing. food containing promote healing.
proteins, proper
vitamins and wound
minerals. healing. GOAL MET.

Promotes
faster
wound
healing and
helps fight
Dependent: off
infection.
Administer
ampicillin
sulbactam 1.5g
 every 8 hrs. as
ordered

        
For
antibacteria
l
medication
as
prescribed
by the
physician.

NURSING CARE PLAN

ASSESSMEN DIAGNOSI PLANNIN INTERVENTIO RATIONAL EVALUATIO
T S G N E N
Subjective Risk for After 30 Independent After 30
data: infection min. of minutes of
related to nursing Emphasize the It serves as nursing
“Kakaopera ko
surgical intervention importance of the first line interventions to
lang kaninang
incision/sutur the client HANDWASHIN defense prevent or
3pm,” as
e in the right will identify G against reduce risk of
verbalized by
lower interventions infection. infection and
the patient.
abdomen as to prevent or have
manifested reduce risk Maintain aseptic understanding
Objective data: by broken of infection technique when Regular infection
skin. and have changing dressing wound control.
Dressing on
understandin and caring dressing
the surgical
g in wounds. promotes
site.
infection faster healing.
control. GOAL MET.
Maintain or teach
Vital Signs asepsis for
dressing changes Aseptic
and wound care. technique
decreases, the
changes of
Discuss the transmitting
importance of the or spreading
intake of protein – pathogens to
rich and calorie – the patient.
rich.
Promotes
faster wound
Emphasize the healing.
necessity of
taking antibiotics
as directed when
at home or when Premature
discharged. discontinuatio
n of treatment
when client
Administer begins to feel
antibiotics as well may
prescribed by the result in
physician.  return of
infection.

Antibiotic
medication
helps reduce
the infection.