TAGUM DOCTORS COLLEGE INC.

Mahogany St., Rabe Subd., Visayan Village Tagum City

Davao Del Norte

Bachelor of Science in Nursing

Acute Appendicitis
A Case Study Presented to the Faculty of
Bachelor of Science in Nursing
in Partial Fulfillment of the
Requirements in Related Learning
Experience 116

Submitted by:
Group 5
Deporkan, Rhica Montanses, Jane
Donga, Karolien Moscosa, Elengil Mae
Ermias, Zendy Neri, Charisse Mae
La Torre, Shemaah R. Padillo, Allona Marie S.
Malabad, Catherene G. Pislan, Sherin Dune E.
Maquidato, Jea Gywen Saavedra, Chindymare
Minta, Mariane Britz

Submitted to:
John Nathaniel G. Lucero, RN USRN
Clinical Instructor

February 2024
 TABLE OF CONTENTS
Cover Page
Table of Contents
Acknowledgement
Definition of Terms
I. Introduction
II. Objectives
III. Patient’s Data
IV. Family Background/Health History
V. Genogram
VI. Developmental Data
VII. Definition of Complete Diagnosis
VIII. Physical Assessment
IX. Anatomy and Physiology
X. Etiology and Symptomatology
XI. Pathophysiology
XII. Doctor’s Order
XIII. Diagnostic Exam
XIV. Drug Study
XV. Surgical Procedure
XVI. Nursing Theories
XVII. Nursing Care Plan
XVIII. Discharge Plan (METHODS)
XIX. Recommendation
XX. References/Bibliography
 ACKNOWLEDGEMENT
We have been taking efforts in this case presentation; however, it would
not have been possible to complete this study without the continuous support
and useful advice of numerous individuals who contributed to the success of
the final outcome of this presentation. With this, the researchers would like to
extend their deepest gratitude and thanks to them all.

To our dearest educational institution, Tagum Doctors College, INC. who

have been the core source of knowledge and opportunities to the students; To
our dean, Prof. Anabel Franada, RN, who have made our hospital exposure
possible and for exerting her utmost effort to the betterment of the Nursing
Department;

To our clinical instructors, most particularly Sir John Nathaniel G. Lucero,

RN USRN who have been with us since day one of our exposure and have
been giving us all the useful critiques, moral support, knowledge, guidance,
expertise, and patience that we needed for us to learn and succeed in
conducting both on-field and academic learning;

To our family and friends, who have been the topmost source of support
both financially and morally, as well as rendering constructive and valuable
suggestions that have helped a lot in our study. Most especially to our parents
and guardians, thank you for the utmost love, care, support, and
understanding;

And last but never the least, we extend our deepest and most sincere
thanks to our Almighty God, for the gift of life, wisdom, knowledge, loved
ones, and all the blessings he has given us. Your unending glory and love
serve as an inspiration and source of strength to us to continue in reaching
our dreams and goals for the betterment and the good of all people.
Once again, we thank you all!
 DEFINITION OF TERMS
 Appendectomy - is a surgical procedure to remove the appendix.
 Appendix - a closed-ended, narrow tube that attaches to the cecum (the
first part of the colon) like a worm.
 Appendicitis - is the inflammation of the vermiform appendix. It typically
presents acutely, within 24 hours of onset, but can also present as a more
chronic condition.
 Gastrointestinal Tract - The gastrointestinal tract, also known as the
digestive tract, is a series of organs that process food and nutrients as it
passes through the body, including the mouth, esophagus, stomach, small
intestine, large intestine, rectum, and anus.
 PCOS - PCOS stands for Polycystic Ovary Syndrome, a hormonal
disorder common among women of reproductive age. It can lead to
irregular periods, infertility, and other health issues due to imbalances in
reproductive hormones.
 Peritonitis - Peritonitis is inflammation of the peritoneum, the thin tissue
lining the inner wall of the abdomen and covering most of the abdominal
organs. It is often caused by bacterial infection and can be life-threatening
if not treated promptly.
 Perforation - Perforation often implies a breach in the integrity of tissues
or organs, which can lead to serious complications like infection or
leakage of fluids.
 Sepsis - Sepsis is a severe medical condition caused by the body's
response to an infection, leading to widespread inflammation and organ
dysfunction.
 Shock - Shock is a critical condition in which the body's tissues do not
receive enough oxygen and nutrients due to inadequate blood flow, often
resulting from severe injury, illness, or loss of blood.
I. INTRODUCTION
The appendix is a closed-ended, narrow tube that attaches to the cecum
(the first part of the colon) like a worm. (The anatomical name for the
appendix, vermiform appendix, means worm-like appendage.) The inner lining
of the appendix produces a small amount of mucus that flows through the
appendix and into the cecum. The wall of the appendix contains lymphatic
tissue that is part of the immune system for making antibodies. Like the rest of
the colon, the wall of the appendix also contains a layer of muscle (The
Editors of Encyclopedia Britannica, 2024).

Acute appendicitis can occur when a piece of food, stool or object

becomes trapped in the appendix, causing irritation, inflammation, and the
rapid growth of bacteria and infection. Acute appendicitis can also happen
after a gastrointestinal infection. Rarely, a tumor may cause acute
appendicitis. Sometimes the cause of acute appendicitis is not known. The
inflammation is usually caused by a blockage, but may be caused by an
infection. Without treatment, an inflamed appendix can rupture, causing
infection of the peritoneal cavity (the lining around the abdominal organs) and
even death (Jones, 2023b).

Appendicitis is a global disease. The incidence of appendicitis is 7–12% in

the population of the USA and Europe, and, stable in most western countries.
Data from newly industrialized countries are sparse but suggest appendicitis
is rising rapidly, although it is still lower than the reported incidence amongst
patients in the developed world. Appendicitis trends in South Africa are
consistent with those in developing regions. The lifetime risk of developing
acute appendicitis requiring surgery is 7% which is maximal in childhood and
declines steadily with increasing age as the lymphoid tissue and vascularity
atrophy. Acute appendicitis can occur at any age but it is rare in infants
because of their larger appendiceal ostium. The incidence rises rapidly in
children above the age of 5 years and reaches a peak in teenage hood with a
median age of 10–11 years. The disease is not uncommon in the elderly and
can occur in extreme old age. Some authors have reported a sex difference in
the younger age group (15–25 years) where it may be twice as common
amongst males. However, it is not surprising that women continue to have a
higher appendicectomy rate with 30% revealing normal appendices because
of various gynecological conditions mimicking appendicitis (Weledji, 2022).

For the National settings, according to the latest WHO data published in
2020, In Southeast Asia, Philippines Is the second highest incidence of acute
appendicitis with a prevalence of 0.022%. Appendicitis Deaths in Philippines
reached 276 or 0.04% of total deaths. The age adjusted Death Rate is 0.32
per 100,000 of population ranks Philippines #92 in the world.

In Davao Region, Philippines, appendicitis is also one of the most

common causes of sudden and severe abdominal pain with incidence
reported of 3 out of every 500 cases (Philippines: Leading Diseases in Davao
| Statista, 2024).

Acute appendicitis that is not treated promptly leads to life-threatening

complications. Complications of acute appendicitis include: Abdominal
abscess, Peritonitis (infection of the lining that surrounds the abdomen),
Ruptured appendix, Sepsis, Shock. As teen-agers living in a fast-phased
world and governed by schedules, they too are predisposed to lifestyle
modification especially diet and food preferences which can contribute to the
disease. With this study, the student nurses hope to apply their learning in
taking care not only of their patients but also of themselves.

As nursing students and future nurses, they would want to understand

and appreciate more on what is happening to a patient with acute
appendicitis. Consequently, they are interested on what will be the necessary
management that will be given. All in all, these will help them to become
efficient nurses and better persons later on.
II. OBJECTIVES
General Objectives
Within our Ward exposure, we are able to choose a case study that will
contribute to increasing our knowledge, and develop our nursing skills in
relation to our educational concept. This case study is designed to identify
and provide a broader understanding of chronic kidney disease and its
nursing intervention and management.

To achieve the general objective, the proponents will;

1. KNOWLEDGE
a) Reviewing the patient's laboratory and diagnostic tests/examinations
and its indications.
b) Analysis of the Anatomical and Physiological landmarks of the
involved organs and system.
c) Assessing and evaluating the patient's general health and
identification of the drugs administered to the patient.
d) Additional research and scanning about the background of the
disease and its treatment.

2. SKILLS
a) Develop a nursing care plan for the patient's improvement in health.
b) Perform a comprehensive physical examination of the patient to check
for any anomalies.
c) Provide and give advice, ideas, and a treatment plan regarding the
patient's condition.
d) Clarify misconceptions and provide accurate information in simple
ways regarding the patient’s condition.
e) Provide different scenarios that will help the patient understand and
have more knowledge about the changes in her condition.
f) Provide appropriate nursing interventions and management.

3. ATTITUDE
a) Establish good rapport with the patients to gain trust and cooperation.
b) Show respect, genuine concern, and empathy to the patient by giving
care and attention.
c) Follow instructions given by the clinical instructors for formulating
appropriate nursing care plans.
d) Be open to learn and experience nursing skills.
III. PATIENT’S DATA
A. Biographical Data
● Patient’s Code Name: IHO
● Age: 21 years old
● Sex: Female
● Birthday: March 4, 2002
● Address: Blk. 24 Lot 50, Salisi Bermudez Plaines, Apokon Tagum
City
● Nationality: Filipino
● Civil Status: Single
● Religion: Roman Catholic
● Date of Admission: February 14, 2024 @11:59PM
● Room Number: 215
● Vital signs upon admission:
o BP – 140/90mmHg
o T – 38°C
o PR – 110 bpm
o RR – 20 cpm
o SpO2 – 96%

o Height – 167 cm

o Weight – 75 kg

o BMI – 26.9 kg/m² (Overweight)

B. Chief Complaints

The patient arrived at the emergency room of Medical Mission Group Hospital
on February 14, 2024 around 11:59PM in the evening, complaining of
abdominal pain.
 a) Admitting Diagnosis: To consider Acute Appendicitis

b) Attending Physician: Dr. Magallanes, Dr. Prudencio, Dr. Tolentino

and Dr. Maranan
Date of Discharge: N/A
Time of Discharge: N/A
Surgical procedure: Appendectomy
Surgeon: Dr. Tolentino
Anesthesiologist: Dr. Maranan
Date of Operation: February 15, 2024
Operation
Started: 11:00 am
Ended: 12:20 pm
Source of Information: Patient’s chart/ Patient/ Patient’s FAmily
IV. FAMILY BACKGROUND/HEALTH HISTORY
The patient is 21 years old, she is the middle child among her three
siblings and was baptized as a Roman Catholic. She was born in Tagum City
on March 4, 2002. She is single and currently residing in Blk. 24 Lot 50, Salisi
Bermudez Plaines, Apokon Tagum City.

A. Family Health History

On the maternal side, Mrs. A (Grandmother) had a polycystic ovary
syndrome (PCOS), and Mr. B (Grandfather) of Pt. IHO had diabetes mellitus
and hypertension.

On the paternal side, Mrs. C (Grandmother) has no medical condition, and

Mr. D (Grandfather) of Pt. IHO had tuberculosis.
Her mother had polycystic ovary syndrome (PCOS) and her father had
hypertension.

B. Patient’s Health History

PAST MEDICAL HISTORY
As per what Patient IHO verbalized, she was diagnosed with polycystic ovary
syndrome (PCOS) when she was 19 years old. Her lifestyle was eating
unhealthy food like processed foods, streets food and high in sugarfoods.

PRESENT HEALTH HISTORY

9hrs prior to assessment, sudden onset of abdominal pain associated with
vomiting, persistence with increase severity prompted for consult, hence
admitted.
V. GENOGRAM
VI. DEVELOPMENTAL DATA
Erik Erikson’s “Theory of Psychosocial Development”
Humans’ personalities continued to develop past the age of five, and
he believed that the development of personality depended directly on the
resolution of existential crises like trust, autonomy, intimacy, individuality,
integrity, and identity.
STAGE ACTUAL FINDINGS INTERPRETATION
Stages: 1 The trust was established
Trust vs. in relation to Erik Erikson's This phase is an improvement
Mistrust Trust vs Mistrust. It is above Freud's developmental
suggested that all these stage that is oral. According to
Age: Infancy qualities promoted at Erikson, every newborn goes
from Birth to IHO's infant stages through a phase when it must
18 Months fostered her ability to have instinctively choose whether to
a healthy trust during this trust or mistrust other people or
Important stage. Patient IHO’s mom objects. At this point, an
event: mentioned that she loved individual is totally reliant on
Feeding to be carried or strolled by other individuals for their bodily,
her mother’s friends at mental, and emotional needs.
their place as a baby, and Most often, the mother (or
that she developed a primary caregiver) and child
sense of trust during this exhibit the initial signs of this
period. Every Sunday, her stage. The patient expressed
mom would go to the store that finishing the baby phases
to buy some groceries, had strengthened her ability to
and she let IHO's aunt to have a sound trust at this point.
baby sit her for a while.
Her aunt had no problem
doing so.
Stages: 2 The autonomy was This developmental stage is
Autonomy vs. attained in relation to Erik characterized by a child's
Shame and Erikson's Autonomy beginning to crave a certain
Doubt versus Shame and Doubt. degree of independence and
Around this age, the the freedom to make their own
Age: Toddler patient shows signs of decisions in the outside world.
Years from 18 autonomy and deliberate From the dependent stage that
Months to control over her life for the a child want throughout infancy,
Three Years first time. She didn't let her this represents a complete
mother's restrictions on advancement. At this point, the
Important her ability to go outdoors majority of kids could walk,
event: Toilet deter her from exploring climb on objects, and move
Training the world outside of her around independently. Now,
house, which is where she armed with these acquired
feels most comfortable. abilities and
She would continue to talents, a youngster frequently
play outside with her yearned to discover the limits of
friends. what the outside world has to
offer. (McLeod, 2018) Patient
IHO finishes this phase by
learning how to take care of
herself, gaining self-control,
and developing a fundamental
feeling of confidence in her own
skills.
Stages: 3 In the patient's instance, Children start making more of
Initiative vs. she became curious to try an effort to express themselves
Guilt out new activities, such as when they are three years old
riding a bicycle, but and older, according to Erick
Age: thankfully this was not Erikson. It's a "time of vigor of
Preschool short-lived. When her action and of behaviors that the
Years from mother stops to ask her parents may see as
Three to Five what's going on when she aggressive," according to Bee
 accidentally crashes on (1992). During this time, a
Important their playground's hill. She child's imagination, curiosity,
event: replies that she was and level of inquiry all increase.
Exploration injured because of this, They also begin to ask the
and her mother warns her important scientific question,
for what happened. But "Why?"". To accomplish a goal,
this encourages patient they have a tendency to master
IHO from turning her everything and get involved in
interest into a skill. As a everything. That would then
result, the patient has cause the youngster to begin to
completed this develop a sense of purpose,
developmental stage which is this stage's virtue.
because, she feels no guilt Erikson, however, claims that
about what happened, she the child's shame every time
chose to drive carefully the they fail to reach a goal could
next time she drove. damage this newly developed
sense of interest and mastery.
Stages: 4 The Industry was reached According to Erick Erickson,
Industry vs. in relation to Erik Erikson's this stage is when children
Inferiority Industry versus Inferiority. begin to learn how to read and
She keeps doing well in write. It is when they start to go
Age: school and is able to attain to school and teachers play an
Middle school the virtue of competence. important role in teaching them
years from Six Despite not making the some basic skills. In this stage,
to 11 honor roll, she doesn't let it they will learn the importance of
make her feel less of a their abilities to achieve their
Important person because she goals. They begin to feel
event: School continues to receive good industrious as they want to gain
grades, which in turn a sense of pride. Success in
makes her feel proud of this stage will lead to the virtue
herself. She never of competence.
doubted her talents and
still maintains her
 confidence in her grades
because her parents
support her efforts and
don't put any pressure on
her to get good grades.
She was also a class
officer at the time, just to
add. During his primary
school years, she was
very popular and enjoyed
playing with her close
friends.
Stages: 5 Identity was established. Adolescence is the time of
Identity vs. Patient IHO from Senior stage 5 in Erikson's
Role High School reported that psychosocial development.
Confusion she loved doing masculine Adolescents go through a deep
style things and felt self-examination at this period
Age: comfortable dressing in order to find their identity and
Teen years manly or boyish. sense of self. The passage
from 12 to 18 from childhood to adulthood is
crucial since it marks the
Important beginning of children's
event: Social independence; without it, they
Relationships would not develop into socially
acceptable adults. They start
looking at every option that
might help in the development
of their own identity during this
time.
Stages: 6 At the Intimacy phase, Ms. The main obstacle of this stage,
Intimacy vs. IHO succeeded. She according to Erik Erikson, is
Isolation manages to maintain a about forming close, loving
strong friendship group, relationships with other people.
Age: has a live-in partner, and Currently, we are searching for
19 to 40 years their relationship is steady. partnerships that lead to
longer-term commitments with
Important individuals that are not related
events: to us.
Relationships
Jean Piaget’s “Theory of Cognitive Development”
This theory suggests that intelligence changes as children grow. A child’s
cognitive development is not just about acquiring knowledge, the child has to
develop or construct a mental model of the world. Cognitive development
occurs through the interaction of innate capacities and environmental events,
and children pass through a series of stages.
STAGE ACTUAL FINDINGS INTERPRETATION

The Sensorimotor The patient claims that In this early period of cognitive
Stage when she was a kid, her development, babies and
mother told her that she toddlers learn by their senses
was good at reading and by using objects to

(Birth to 2 Years) letters. She followed up manipulate. During the initial

on her parents' part of this stage, a child's
instructions quickly and whole experience is through
was aware of her basic reflexes, perceptions,
surroundings. Her and motor responses. At this
mother said that her point, the patient became
toddler years were aware of viewing, touching,
spent playing with her sucking, and experiencing her
coloring books. entire existence. The patient
has good motor abilities. She
stated that she first mastered
the idea of letters when she
was a young child. She will be
able to establish the
groundwork for her
 comprehension of English as a
result. She also enjoys reading
books, which gives the infant a
hands-on way to learn about
things around her. Interactions
and encounters within their
surroundings will aid in the
development of their brains and
encourage the formation of
cognitive skills in children and
adults.

The Preoperational As previously stated, Children play pretend because

Stage patient IHO developed they are using symbols to
an interest in cycling. represent words, images, and
She is able to keep up concepts in the preoperational

(2 to 7 Years) her outstanding grades. stage. Preoperational children

When she was in also start using language, but
primary school, she they are unable to mentally
enjoyed playing with her manipulate information or
friends. Along with some comprehend adult logic. The
childhood memories, the patient finishes this phase by
patient also talks about using mental imagery to think
playing "Tigso" with her and starting to play pretend,
neighbors. She recalls as shown by the childhood
spending several hours memories he shared. She also
there with her peers, possesses strong social skills,
making up stories. They which may help her develop
would always have so greater mental and cognitive
much fun inventing capacities.
whole new universes
with their minds. Some
 of her happiest
recollections are those
ones. She escapes to
play with her friends
even though her mother
won't let her go outside.

Concrete At this point, the patient Children go through this stage

Operational Stage was able to learn self- where they learn how to solve
care skills like choosing issues, think logically, and
(7-12 years old)
her own clothes and make decisions. They learn
brushing her teeth. She more about the world around
still does well in her them and how it functions as
homework. Even though they mature and develop. In
she is not on the honor the patient's instance, she
roll, she still manages to finishes this stage having
retain high grades and discovered how to produce
positive relationships great enhanced social and
with others. She was decision-making abilities. At
able to comprehend her this point, she made good use
parents' instructions and of her time balance.
what to do. She
balances her time
between her hobbies,
playtime, and
schoolwork.

The Formal As she said, patient The patient successfully

Operational IHO's reasoning is more completed this step by being
systematic, intellectual, receptive to the given question.
and thoughtful. She is When the patient fails to do so,
an online seller who she doesn’t know how to find a
 (12 and up) possesses the ability to solution to difficult situations
use reasoning when given to her.
assessing the possible
consequences of any
action before taking it.
employs creative
thinking, abstract
reasoning, market
calculations, and seeing
the outcomes of
particular actions.

Havighurst's “Developmental Task Model”

STAGE ACTUAL FINDINGS JUSTIFICATION

Infancy & Early Patient IHO was able to Among other physical activities.
Childhood learn to do physical He or she also gains the ability
activities and skills such to grasp and acquire new
Age: Birth to 6 years as walking, standing, concepts through reading.
old and running. At this age, Finally, the child starts to
she was able to learn gradually learn about the
how to read and talk. As surroundings and people around
she mentioned she got them. After learning the
interested helping her fundamentals of walking,
mom to do basic crawling, standing, and running
household chores. during her toddler years, Patient
IHO finished this phase. She
gained new abilities, acquired a
talent, and began to take up
language skills.
Middle Childhood The patient claims that During the middle childhood
at this age, she had era, the child eventually picks
Age: 6 to 12 years many friends. She up social skills and everyday
old enjoys interacting and concepts through play,
having fun with children engaging in fun activities, and
around her. As she performing well academically
continues to do well with peers their own age. By
academically, she also the time the patient finished this
succeeded in achieving phase, she had made more
the virtue of complex connections and peer
competence. Despite relationships and felt more
not making the honor proud of herself.
roll, she doesn't let it Her success in her academic
make her feel less than work as well as her social
since she somehow interactions
gains a feeling of pride at this point.
in her continued
achievement in school.

Adolescence Patient IHO claims that During this stage, the child
she began to recognize becomes fully aware of the
Age: 13 to 18 years
her own gender rapid changes happening in
old
identification in her their physique; as well as their
senior year of high individualism as a person by
school. She marketed assessing their set of skills and
items online as well to abilities for their future careers,
pay for her wants. getting to know their true
Because of her social identity, developing better
connections with her relations, and integrating a
coworkers, she was able sense of maturity and
to cultivate the virtue of independence - preparing
loyalty. When she was his/herself for the future years
among coworkers, she to come. The patient completed
saw and felt herself with this phase as she learned to be
 other people. independent and have a sense
of maturity as evidenced by
being a working student to buy
her wants without asking
anymore from her parents.
They have a good social
experience with her friends,
which helped her achieve the
virtue of fidelity. Being with her
friends made her see and
experience herself being with
other people.

Early Adulthood Patient IHO finished her At this point, the person is no
Age: 19 to 30 years high school senior year. longer a child but rather a
old After high school, she grown-up who is able to move
began selling items toward both economic and
online. She currently personal independence. They
makes money from it would be prepared to begin a
while living with her new life with a new family and
partner. settle down.
VII. DEFINITION OF COMPLETE DIAGNOSIS
Final Diagnosis: Acute Appendicitis

Appendicitis is inflammation of the appendix, a small, tubular organ in the

right lower abdomen that is attached to the large intestine. Common causes of
acute appendicitis include infections, tumors, or accumulation of calcified
feces (appendicolith) in the appendix. The most common symptom of acute
appendicitis is pain in the right lower abdomen. More than half of patients first
experience discomfort in the midabdominal area, which later becomes more
localized to the right lower abdominal area. Other symptoms include loss of
appetite, nausea, vomiting, and low-grade fever. Acute appendicitis is defined
as uncomplicated if the appendix has not ruptured. Complicated appendicitis
occurs when the appendix ruptures, resulting in a widespread infection in the
abdomen (peritonitis) or a contained pocket of pus in the abdomen. Men and
older adults are at higher risk of developing complicated appendicitis (Walter,
2021b).

Diagnosis of acute appendicitis is made based on a patient’s history,

physical examination, laboratory values (such as a high white blood cell
count), and imaging. In the US, computed tomography (CT) of the abdomen is
the most common form of imaging used to diagnose acute appendicitis.
Abdominal ultrasound may also be used and is helpful to avoid radiation
exposure in children and pregnant people. However, the appendix may be
challenging to see on ultrasound in patients with obesity or pregnancy
(Walter, 2021b).
VIII. PHYSICAL ASSESSMENT
Physical examination follows a methodical head to toe format in the
cephalocaudal assessment. This is done systematically using the techniques
of inspection, palpation, percussion, and auscultation (IPPA) with use of
materials and investments such as the penlight, thermometer,
sphygmomanometer, tape measure stethoscope, and also the senses. During
the procedure, we made every effort to recognize and respect the patient’s
feelings, provide comfort measures, and follow appropriate safety
precautions.

Vital signs were taken on February 15, 2024 at 12:00 NN

 BP- 110/80 mmHg
 T- 36.5°C
 PR- 91 bpm
 RR- 20 cpm
 SPO2- 99%

ASSESSMENT NORMAL ACTUAL INTERPRETATION

FINDINGS FINDINGS
NEUROLOGIC Oriented to people - Used a It reveals normal
- Interview and places. neurologic mental status,
Comprehensible; assessment speech and normal
able to speak tool such as function of cranial
clearly. Glasgow coma nerves.
scale with
. score of 15.
 - Patient
appears weak
but conscious,
oriented to
people and
place, speaks
clearly and
obeys
command.
INTEGUMENTARY
Skin - Skin is uniform in Skin is uniform No significant
(Inspection color, unblemished in color manifestation was
and Palpation) and no presence of Skin turgor is observed on the
any foul odor. normal hair.
- No lesions, -No presence
bruising, and of foul odor,
rashes lesions, and
bruises noted.
- temperature,
moisture, and
texture are within
normal limits.
Hair - Thick, silky and - Thick, silky, No significant
(Inspection) evenly distributed. and evenly manifestation was
distributed. No observed on the
- No infection or lesions in the hair.
infestation (such as scalp noted.
lice, nits or sores)
and dandruff in the
scalp and hair.
Nails - Pinkish nail bed - Capillary refill No significant
(Inspection and and has the shape time is less manifestation was
Palpation) of a convex curve. than 2 observed on the
seconds. skull.
- Capillary refill is - No nodules or
generally less than masses,
2 seconds. tenderness,
and
depressions
noted.
HEAD AND NECK
Skull - No nodules or The patient’s No significant
masses, skull was manifestation was
tenderness, and generally observed on the
depressions. round and skull.
there was no
tenderness
noted upon
palpation.
Head and Face - Head is - Symmetry in No significant
normocephalic. the features of manifestation was
the face and observed on the
-Face is head and with head and face.
symmetrical with no no involuntary
involuntary muscle muscle
movements. movements
noted. Can
move facial
muscles at will
and intact
cranial nerves
V and VII.
Neck - Straight and - Straight and No significant
(Inspection and symmetrical with no symmetrical no manifestation
palpation) visible mass or visible mass or observed on the
 lumps. No lesions lumps neck.
and cervical lymph
nodes were - Neck has
impalpable. The strength that
thyroid is non- allows
palpable as well as movements of
the nodules. Neck flexion,
has strength that extension,
allows movements bending and
of flexion, rotation.
extension, bending
and rotation.
EYES AND VISION (INSPECTION)
Eyebrows - Symmetrically - Black No manifestation of
aligned and equal colored, structural changes
in movement when symmetrically in the eye.
asked to raise and aligned and
lower eyebrows. evenly
distributed.

-Equal in
movement
observed when
asked to raise
and lower the
eyebrows
Eye lashes - Eyelashes should - Equally No manifestation of
be equally distributed and structural changes
distributed and curled outward in the eye.
curled slightly
outward.
Eyelids - Eyelids have no - There was no No manifestation of
presence of presence of structural changes
 discharges; no discharges and in eyelids of the
discoloration and discoloration patient.
lids close noted and lids
symmetrically with close
involuntary blinks. symmetrically
with
involuntary
blinks.
Lacrimal - No tenderness - No No manifestation of
apparatus and discoloration. tenderness structural changes
and in the lacrimal
discoloration apparatus.
noted.
Conjunctiva - Pink moist and - Pink moist No abnormalities
intact with no and intact with noted.
lesions or ulcers no present
present. lesions or
ulcers noted
Sclera - White and intact - White and Good sclera.
intact sclera
noted
Cornea - Transparent, - Transparent, No manifestation of
smooth and shiny. smooth and structural changes
There is a positive shiny and with in the cornea.
corneal reflex positive
corneal reflex.
Pupils - The pupils of the - PERRLA No manifestation of
eyes are black and structural changes
equal in size. The in the eye.
pupils are round.
PERRLA (pupils
equally round,
reactive to light,
 accommodation).
Visual Acuity - Able to see - Normal visual No manifestation of
(Inspection) pictures without acuity structural changes
visual problems or in the eye.
with the use of
glasses or contact
lenses.
EAR AND HEARING
Auricles - Aligned with the - Auricles are No manifestation of
outer canthus of the normal structural changes
eye. in the ears.

- When palpating
for the texture, the
auricles are mobile,
firm and not tender.

- Without redness
or swelling
External Ear - Clean with no - External ear No manifestation of
Canal presence of canal is clean structural changes
cerumen, and normal in ears.
discharges and
foreign bodies
Hearing Acuity - Rinne’s test: Air - Patient was No manifestation of
Test conduction is better able to hear structural changes
than bone the sound of in ears.
conduction. The the tuning fork
patient should be in both ears.
able to hear the
sound of the tuning
fork adjacent to
 their ear.
NOSE AND SINUSES
External Nose - Symmetric, center The patient’s No deformities in
(Inspection) and uniform in nose is the external nose
color. symmetric and noted.
uniform in
- No presence of color.
discharge or flaring
and deformities. - No presence
of discharge or
flaring and
deformities.
Nasal Cavity - Mucosa is pink, no -No tenderness No deformities in
tenderness and and lesions the nasal cavity
lesions. noted upon noted.
palpation
MOUTH
Lips - Lips should be Dry lips is The patient was still
(Inspection) uniformly pink; noted under NPO
moist, symmetric
and have a smooth
texture.
Teeth & Gums - There is no -No Aside from the
discoloration of the discoloration in missing teeth, there
enamels, no the teeth was no unusuality
retraction of gums, noted, no noted.
and they are retractions of
pinkish. gums and
pinkish.
- 32 teeth present.

-30 teeth noted

Tongue - Tongue should be - Patient’s No manifestation of
centrally positioned. tongue was structural changes
centrally in the tongue
- Tongue should be positioned,
pink in color, moist, pinkish in
and slightly rough. color, moist
and rough
Buccal/oral uniformly pinked, The patient’s No manifestation of
mucosa moist, and soft. buccal and oral structural changes
mucosa were in buccal and oral
uniformly pink, mucosa.
soft, and moist.
Uvula - Uvula should be The patient’s No manifestation of
positioned in the uvula was structural changes
midline of the soft positioned in in the patient's
palate. No lesions the midline of Uvula.
or swelling were the soft palate
noted. with no lesions
or swelling
noted
THORAX
Abdomen - No distention - No distention Normal
bulging, or bulging, or
discoloration of the discoloration of
umbilicus or flunks. the umbilicus
or flunks.

Lungs and - Chest expansion Normal

thoracic region was bilaterally - Chest
symmetrical. expansion was
- No tenderness, bilaterally
lesions, masses or symmetrical.
crepitation. - No
 tenderness,
- Normal fremitus is lesions,
observed bilaterally. masses or
crepitation.
- No dullness or
flatness noted for
underlying lungs.
No adventitious
sounds upon
auscultation in both
symmetrical areas.

- Respiration should
be 12-20 cycles per
minute.
Heart Cardiac rate: - Pulse rate No manifestation of
Regular and strong reads 77bpm structural changes
normal range: 60- in the heart.
100bpm
Extremities (Inspection and Palpation)
Hands - Complete sets of - Complete No manifestation of
5 digits on each sets of 5 digits structural changes
hand. on each hand. in the hands.

- Can be able to - Can be able

flex, extend, to flex, extend,
hyperextend and hyperextend
rotate the hands and rotate the
and opposition on hands and
the fingers. opposition on
the fingers.
Arms - Presence of the - Presence of No manifestation of
ulnar and radial the ulnar and structural changes
 pulses noted. radial pulses in the arms noted.
noted.
- Able to move
arms in pronation, - Able to move
supination and arms in
rotation and flex pronation,
and extend both supination and
elbow and rotation and
shoulder. flex and extend
both elbow and
shoulder.
Lower - Complete sets of - Complete Normal
Extremities 5 digits on each sets of 5 digits
foot. on each foot.

- No presence of - No presence
scars and no of scars and no
lesions. lesions.

- Able to flex and - Able to flex

extend her legs and extend her
while lying down as legs while lying
well as dorsiflexion down as well
and plantar as dorsiflexion
movement of feet. and plantar
movement of
feet.
IX. ANATOMY AND PHYSIOLOGY

The appendix is a fingerlike pouch attached to the large intestine in the

lower right area of the abdomen, the area between the chest and hips. The
large intestine is part of the body’s gastrointestinal (GI) tract. The GI tract is a
series of hollow organs joined in a long, twisting tube from the mouth to the
anus. The movement of muscles in the GI tract, along with the release of
hormones and enzymes, helps digest food. The appendix does not appear to
have a specific function in the body and removing it does not seem to affect a
person’s health. The inside of the appendix is called the appendiceal lumen.
Normally, mucus created by the appendix travels through the appendiceal
lumen and empties into the large intestine. The large intestine absorbs water
from stool and changes it from a liquid to a solid form. The blood supply of the
appendix derives from the appendicular artery, which arises from the ileocolic
artery. It passes behind the terminal ileum to reach the appendix via the
appendicular mesentery. The appendix originates from the posteromedial
aspect of the cecum. It is supported by the mesoappendix, a fold of
mesentery which suspends the appendix from the terminal ileum.

The position of the free-end of the appendix is highly variable and can be
categorised into seven main locations depending on its relationship to the
ileum, caecum or pelvis. The most common position is retrocecal. They may
also be remembered by their relationship to a clock face:
 Pre-ileal – anterior to the terminal ileum – 1 or 2 o’clock.
 Post-ileal – posterior to the terminal ileum – 1 or 2 o’clock.
 Sub-ileal – parallel with the terminal ileum – 3 o’clock.
 Pelvic – descending over the pelvic brim – 5 o’clock.
 Subcecal – below the cecum – 6 o’clock.
 Paracecal – alongside the lateral border of the cecum – 10 o’clock.
 Retrocecal – behind the cecum – 11 o’clock.

Neurovascular Supply
The appendix is derived from the embryologic midgut. Therefore, the
vascular supply is via branches of the superior mesenteric vessels.
 Arterial supply is from the appendicular artery (derived from the ileocolic
artery, a branch of the superior mesenteric artery) and venous drainage is via
the corresponding appendicular vein. Both are contained within the
mesoappendix.

Sympathetic and parasympathetic branches of the autonomic nervous

system innervate the appendix. This is achieved by the ileocolic branch of the
superior mesenteric plexus. It accompanies the ileocolic artery to reach the
appendix.
X. ETIOLOGY AND SYMPTOMATOLOGY
ETIOLOGY
PREDISPOSING INDICATON JUSTIFICATION
FACTORS
Age Appendicitis can occur at Patient was a 21-year-old.
any age, but it is most Making her age one of the
common in people between predisposing factors for
the ages of 10 and 30, with a diagnosing the said
peak incidence in the late disease.
teens and early twenties.

BuzzRx
(https://www.buzzrx.com/blo
g/how-to-identify-the-signs-
of-appendicitis-in-kids)
Sex Historically, appendicitis was Patient was a 21-year-old,
thought to be more common female. Making her age
in males. However, recent and her gender one of the
studies have shown that the predisposing factors for
incidence is similar between diagnosing the said
males and females, although disease.
there may be variations in
presentation and outcomes.
 PMC(https://
www.ncbi.nlm.nih.gov/pmc/
articles/PMC1562475/)

PRECIPITATING INDICATION JUSTIFICATION

FACTORS
Diet Eating high-fat and high- Upon the assessment, the
cholesterol foods have also patient verbalized
been linked to an increased “ganahan jud kog mga
risk of appendicitis. High-fat sweets ug parat, ma’am.
foods such as cheese, butter, Ambot murag magluya
and fatty meats can cause kog di ko kakaon ug mga
digestive problems, leading ning-ana. Ganahan sad
to constipation and bowel kog processed foods kay
irregularities that can tapulan man gud ko
contribute to inflammation manghugas ug plato
and infection of the appendix. ma’am, hehe maong sa
processed food ko kay
ADVANCED COLORECTAL makakaon dayon ko.”
AND GENERAL SURGERY
(https://colorectalsurgery.com
.sg/food-cause-appendicitis/#
:~:text=Eating%20high
%2Dfat%20and%20high,and
%20infection%20of%20the
%20appendix.)
Lifestyle A healthy lifestyle plays a Upon the assessment, the
crucial role in promoting and patient verbalized, “Online
maintaining healthy seller ko maam, maka
peristalsis, which is the straight jud kog lingkod
coordinated muscle mga 4-6 hours labon nag
 contractions that propel food maga live ko.
through the digestive tract. Ginapugngan nako akong
ihi ug tae ma’am basta
Kinnu mag live ko, kay
(https://kinnu.xyz/kinnuverse/ ginahuman jud nako
science/human-physiology/th akong live ma’am. Tapos
e-digestive-system/) maong dili nako galuto kay
kapuyan ko ma’am maong
processed foods jud
akong madali-dali,
ma’am.” Making her
lifestyle one of the
precipitating factors of the
said disease.

SYMPTOMATOLOGY
SYMPTOMS INDICATION JUSTIFICATION
Abdominal Pain The most prominent Upon assessment, patient
(Present) symptom is often pain in the verbalizes abdominal pain,
lower right side of the “nagpacheck-up ko maam,
abdomen. The pain may start kay sakit akong tiyan, abi
around the navel and the nako ug U.T.I lang.” that’s
shift to the lower right why the patient has been
abdomen. hospitalized.

EverydayHealth
(https://www.everydayhealth.
com/appendicitis/guide/symp
toms/abdominal-pain/
#:~:text=Signs%20of
%20appendicitis%20include
%20pain,with%20movement
%20or%20jarring
 %20motions)
Nausea and Many individuals with Upon assessment, the
Vomiting appendicitis experience patient verbalized
(Present) nausea, which may be “nagsuka pud diay ko
followed by vomiting. It is the ma’am, color green man to
body’s responses to the siya.” Which is a great
irritation and inflammation in factor in adding
the abdominal area caused information in diagnosing
by the swollen appendix. the disease of the patient.

Cleveland Clinic
(https://my.clevelandclinic.or
g/health/diseases/8095-
appendicitis)
Loss of A reduced desire to eat or a Upon the assessment, the
Appetite complete loss of appetite is client verbalized “wala na
(Present) common in individuals with jud koy gana mukaon ato
acute appendicitis. It is a ma’am kay ginasuka man
normal reaction of the body gud gihapon nako tanan”.
to the inflammation in the Adding information for the
abdomen, signaling that diagnosis of the patient’s
something is wrong and disease.
needs attention.

Cleveland Clinic
(https://my.clevelandclinic.or
g/health/diseases/8095-
appendicitis)
Abdominal The abdomen can become Upon the assessment,
Tenderness sensitive to touch, especially patient verbalized “giduot-
(Present) in the area around the duot man to akong tiyan
appendix. Pressing on this ma’am katong naa pako
area may cause increased sa ER, tapos kana ganing
 pain. kuhaon na sa nurse iyang
kamot nag gikan niduot sa
Mount Sinai akong tiyan, paska gyud
(https://www.mountsinai.org/ nga pagkasakita. Mga
health-library/diseases- 10/10 jud.” Adding
conditions/appendicitis#:~:te information for the
xt=If%20you%20have diagnosis of the patient’s
%20appendicitis%2C disease.
%20your,right%20side%20of
%20your%20rectum.)
Flatulence When a person has acute Upon the assessment,
(Present) appendicitis, the appendix, a patient verbalized “akong
small pouch-like organ in the utot jud ma’am grabe, like
lower right side of the sige jud ko pangutot,
abdomen, can become dagko pajud, baho pa
inflamed or swollen. This gyud kaayo.” Adding
swelling can block the information to the
normal flow of fluids and diagnosis of the patient’s
gases in the appendix. As a disease.
result, the trapped gases
inside the appendix start to
build up.

Cleveland Clinic
(https://my.clevelandclinic.or
g/health/diseases/8095-
appendicitis)
Fever A low-grade fever may be Upon the assessment, the
(Present) present, and the body patient verbalized "oo,
temperature may rise as the ma'am gikalintura sad ko
Temp.: 38°C inflammation progresses. ato maong niadto najud
Date: February mig hospital". Adding
14, 2024 NIH information for the
Time: 11:59 pm (https://www.ncbi.nlm.nih.gov diagnosis of the said
(Upon admission /books/NBK562334/) disease.
XI. PATHOPHYSIOLOGY

PREDISPOSING PRECIPITATING
FACTORS FACTORS
- Age (21yo) - Diet (Processed Foods
and High in Sugar Foods)
- Gender - Lifestyle (Sedentary)

Luminal Obstruction

Increased Intraluminal Pressure

Bacterial Overgrowth and

Infection

Inflammation

Loss of Appetite
Abdominal Pain

Abdominal Tenderness Acute Appendicitis Nausea/Vomiting

Flatulence Fever
 Perforation
If treated:
Diagnostic Exam:
 Physical Exam, Hematology, Urinalysis, and
Ultrasound
Medications:
 Antibiotics
 Analgesics If treated:
Diagnostic Exam: If not treated:
 Antiemetic  Physical Exam, Hematology, Complications:
Medical Management: Urinalysis, and Ultrasound  Abscess Leakage
 Appendectomy (Surgery) Medications:  Peritonitis
 Antibiotics  Intra-Abdominal
Nursing Management:  Analgesics
 Conduct thorough assessments of the patient's Adhesions
 Antiemetic
Medical Management:  Sepsis
symptoms to monitor for changes and
 Ruptured Appendectomy (Surgery)
complications. Nursing Management:
 Administer medications as prescribed.  Monitor Vital Signs and Symptoms.
 Monitor patient for NPO.  Administer Antibiotics as Prescribed
 Provide Pain Management
 Prepare the patient for surgery.  Maintain NPO (Nothing by Mouth)
 Monitor the patient closely postoperatively for Status.
signs of complications.  Promote Wound Care and Infection
Prevention Poor Prognosis (Death)

Good Prognosis Good Prognosis

XII. DOCTOR’S ORDER
Date Doctor’s Order Rationale Remarks
2/14/2024 Admit under Dr. To be able to give the patient Done
Tolentino with precise treatment required
Secure consent To safeguard the patient’s Done
right to healthcare choice.
Patient has the right to refuse
unwanted medical treatment
by signing wavers.
Vsq6 In order for the patient to be Done
assessed, evaluated, and
managed properly.
NPO For safety precaution and to Done
avoid aspiration of gastric
contents during induction of
anaesthesia.
IVF D5LR 1L @ To maintain body fluid and Done
120 cc/hr avoid dehydration.
Labs:
Complete Blood It is used to look at overall Done
Count (CBC) health and a wide range of
conditions such as infection.
Urinalysis (UA) It is used to look for the Done
presence of bacteria in the
urine that indicates infection.
Meds:
Metoclopramide 1 To relieve nausea and Done
amp IVTT then q8 vomiting.
now
Refer This may create a Done
collaborative treatment among
 the client and health providers;
thus it also makes a good
coordination in the treatment
of the client.
Tramadol 50 mg It is used for the short relief of Done
IVTT now moderate to severe pain.
Then refer to Dr. This may create a Done
Tolentino collaborative treatment among
the client and health providers;
thus it also makes a good
coordination in the treatment
of the client.
12/15/2024 POST_OP
ORDERS
To PACU To monitor patient progress. Done
NPO To avoid aspiration and Done
complication.
Continuous VS To assess the clinical status of Done
monitoring x10 the patient.
IVF to @ 120 cc/hr To maintain body fluid and Done
avoid dehydration.
Send specimen to To diagnose disease. Done
lab for histopath
D/C Cefazolin It is only given before surgery. Done
Silgram 1.5 gm q8 Treatment for infections Done
IV AWST
Paracetamol 600 g To treat mild to severe pain. Done
IV q6 RTC
Tramadol 50g IV q6 It is used for the short relief of Done
PRN for moderate to severe pain.
breakthrough pain
Ketorolac 30g q6 IV It is used in the treatment of Done
 RTC moderate to severe acute
onset pain.

XIII. DIAGNOSTIC EXAM

MISCELLANEOUS RESULT (02/15/2024, 12:45AM)

Specimen
SERUM
Result
NEGATIVE

HEMATOLOGY (02/15/2024, 12:48AM)

TEST NORMAL RESULTS IMPLICATION
VALUES

HEMOGLOBIN 12.0-16.0 g/dl 14.5g/dl Normal

LEUKOCYTES X10 9/L F:4-10 18.45 High: Also known

as leukocytosis,
can indicate
various
underlying
condition such as
infection ang
inflammation
ERYTHROCYTES X10 12/L F: 4.0- 4.96 Normal
5.4
NEUTROPHILS 0.40-0.60% 0.84 High: High
neutrophil levels,
also known as
 neutrophilia may
indicate
inflammation,
infection, or other
medical condition
LYMPHOCYTES 0.25-0.40% 0.11 Low: At higher
risk of infection
MONOCYTES 0.01-0.12% 0.5 Normal
PACK CELL F:37-43% 44.2 High: Also known
VOLUME(Hct) as polycythemia,
indicate several
potential health
issues including
dehydration.
THROMBOCYTES X10 9/L F:150- 379 Normal
400
MCV 80-100fl 89.2 Normal
MCH 27-34pg 29.2 Normal
MCHC 32-36g/dl 32.8 Normal

URINALYSIS (02/15/2024, 12:51AM)

TEST RESULTS INTERPRETATION IMPLICATION
MACROSCOPIC
Color Yellow Normal Slightly
dehydrated or
taking
more vitamins
than your
body needs
Transparency Slightly Cloudy Slightly Cloudy Dehydrated and
lack of fluids, the
urine becomes
 more
concentrated
leading to
cloudiness.
Albumin Trace Early signs of
kidney damage or
dysfunction.
When the kidneys
are not
functioning
properly, small
amounts of
protein, such as
albumin, can leak
into the urine.
Reaction 7.5 Normal It is within normal
range, so it may
simply reflect the
normal
fluctuations of
urine in acidity or
alkalinity.
Glucose Negative Normal Normal blood
glucose
Specific Gravity 1.010 Normal Kidneys are
functioning
Normally
MICROSCOPIC
Pus Cells 2-3 Normal Normal red blood
cells levels.
RBC Cells 2-5
Epithelial Cells ++ High May indicate a
urinary tract
 infection, kidney
disease or other
serious medical
condition
Mucus Thread ++ High May be a sign of
urinary tract
infection or other
medical condition
XIV. SURGICAL PROCEDURE
An appendectomy is a surgical procedure to remove the appendix, a
small, finger-shaped pouch of tissue attached to the large intestine. It is most
commonly performed as an emergency surgery to treat appendicitis, which is
an inflammation of the appendix. If left untreated, appendicitis can rupture and
cause serious complications, such as peritonitis, a life-threatening infection of
the abdominal lining.

Date/Time Procedure
February 15, 2024
11:00 am

XV. NURSING THEORIES

Nursing theories provide a framework for nurses to understand and care
for patients in various clinical scenarios. When caring patients with Acute
Appendicitis, nurses can apply various nursing theories and concepts to
provide holistic care and promote patient well-being. Here are some nursing
theories and concepts that can be related to patients with acute appendicitis:

Comfort Theory of Katharine Kolcaba

Comfort theory focuses on the holistic comfort of the patient, which
includes physical, psych spiritual, and sociocultural aspects. After an
Appendectomy, patients may experience physical discomfort due to surgical
incisions and digestive changes. Nurses can use this theory to assess and
address the patient's comfort needs, such as pain management, anxiety
reduction, and education about dietary adjustments (Sharma 2021).

Self-Care Deficit Nursing Theory of Dorothea Orem

Orem's self-care theory emphasizes the patient's ability to perform self-
care activities to maintain health and recover from illness. Appendectomy
patients need to learn how to manage their diet and lifestyle to prevent
complications. Nurses can assess the patient's self-care abilities and provide
education and support to enhance their self-care skills. Also, appendectomy
patients may have limitations in self-care abilities due to postoperative pain
and restricted mobility. Nurses can use Orem's theory to assess the patient's
self-care deficits and provide assistance with activities of daily living (ADLs)
until the patient can regain independence (Rosman 2022).

Health Promotion Model by Nola Pender

Pender's health promotion model focuses on motivating individuals to
engage in health-promoting behaviors. After appendectomy, it's essential to
promote the patient's health and prevent complications. Nurses can apply
Pender's Health Promotion Model to assess the patient's health beliefs and
motivation for self-care. They can then develop strategies to encourage the
patient to adopt a healthy lifestyle and adhere to dietary recommendations
(Cardoso 2021)

Caring Theory by Jean Watson

Watson's Caring Theory emphasizes the importance of a therapeutic
nurse-patient relationship and the nurse's role in providing compassionate
care. When caring for post-appendectomy patients, nurses can apply this
theory by building a trusting and supportive relationship, actively listening to
the patient's concerns, and providing emotional support during their recovery
process (Watson 2021).

Adaptation Model by Sister Callista Roy

Sister Roy's adaptation model explores how individuals adapt to changes
in their health status. Appendectomy patients undergo physiological and
psychological changes. Nurses can utilize Roy's Adaptation Model to assess
how patients are adapting to these changes and intervene as needed to
facilitate the patient's adaptation process (Morrow 2022).

Environmental Theory by Florence Nightingale

According to Gilbert 2020, Florence Nightingale's Environmental Theory
emphasizes creating a healing environment that promotes the patient's
physical and emotional well-being. For a post-appendectomy patient, this
means maintaining cleanliness, proper ventilation, noise control, appropriate
lighting, nutrition, hydration, social interaction, personal hygiene, and
education to facilitate a smooth and successful recovery process. This theory
can be applied to a patient who has undergone and appendectomy (surgical
removal of the appendix) as follows:
1. Cleanliness and Sanitation: Nightingale believed that maintaining a
clean and sanitary environment was essential for healing. For a post-
appendectomy patient, it's crucial to ensure that the patient's room is
clean and free from any potential sources of infection. Proper hand
hygiene and strict aseptic techniques should be observed to prevent
surgical site infections.

2. Proper Ventilation: Adequate ventilation is essential to provide fresh

air and maintain a comfortable temperature in the patient's room. Good
ventilation helps in reducing the risk of respiratory complications and
promotes overall well-being.

3. Noise Control: Nightingale emphasized the importance of minimizing

noise in the patient's environment. Excessive noise can be stressful and
disruptive to patients' rest and recovery. In the case of a post-
appendectomy patient, a quiet and peaceful environment is especially
important, as it promotes rest and helps in managing post-operative pain.

4. Lighting: Appropriate lighting is crucial for patients. Nightingale

advocated for natural light whenever possible. Adequate lighting helps
with the patient's orientation, mood, and overall sense of well-being. For
post-appendectomy patients, proper lighting can assist with monitoring
and early detection of any complications.

5. Nutrition and Hydration: Nightingale recognized the significance of

proper nutrition and hydration in the healing process. For post-
appendectomy patients, ensuring they receive appropriate nutrition and
hydration is vital for recovery. The nursing staff should monitor the
patient's dietary needs, fluid intake, and any signs of gastrointestinal
complications.

6. Social Interaction: Nightingale also stressed the importance of social

interaction and mental stimulation for patients. For post-appendectomy
patients, social support from family, friends, and healthcare providers can
help reduce anxiety and improve the patient's overall emotional well-being
during the recovery process.
 7. Personal Hygiene: Maintaining the patient's personal hygiene is
another aspect of Nightingale's theory. Post-appendectomy patients may
have incisions and drains that need to be kept clean and dry to prevent
infection. Proper hygiene measures should be followed to ensure the
patient's safety and comfort.

In summary, nursing theories offer valuable frameworks for providing

patient-centered care to individuals who have undergone an appendectomy.
By applying these theories, nurses can address the physical, emotional, and
educational needs of post-appendectomy patients and help them achieve
optimal recovery and well-being.
 XVI. NURSING CARE PLAN
NURSING CARE PLAN - 1

Patient’s Name: Ms. IHO Hospital no.: 000000000

Diagnosis: Acute Appendicitis
Date: January 15, 2024 Attending physician: Dr. Magallanes, Dr. Prudencio,
Dr. Tolentino, and Dr. Maranan
NSG. DIAGNOSIS
CUES NEED W/ SCIENTIFIC BASIS OBJECTIVE OF NSG. ACTION EVALUATION
CARE
S: “Sakit kaayo P Acute Pain Related to Within 8 hours of Independent:
akong tiyan, H Inflammation as nursing 1. Assess the client’s vital Goal Met
ma’am” as Y evidenced by Pain intervention, the signs.
verbalized by the S Scale of 7/10 (acute). patient will: Within 8 hours of
patient . I 2. Monitor the client’s vital nursing intervention,
O Scientific Basis:  Report a pain signs for changes in patient was able to:
L Acute abdominal pain score of 0/10 temperature or heart rate.  Report pain is
O:
O associated with acute by discharge. - Fever and tachycardia relieved 0/10
 Restlessness
G appendicitis is  Display signs can both indicate infection pain scale.
 Moaning
I scientifically linked to of comfort as or inflammation.  Have a stable
 7/10 pain scale
C inflammation, as evidenced by pulse rate 80-
 VS taken as A evidenced by the resting with 3. Keep NPO. 100 bpm.
follows: L sudden onset of pain eyes closed - Instruct the patient that  Display signs of
RR: 20 cpm Needs by resulting from the and vital not eating or drinking is comfort and
PR: 110 bpm Maslow’s inflammatory response signs within important to prevent resume normal
BP: 90/60 mmHg Hierarchy in the appendix. normal limits. further gastric irritation sleeping pattern.
Temp:37.1 C of Needs  Display and vomiting and as a  Demonstrate
SPO2: 96% improvement safety measure in understanding of
in mood, preparation for potential self-care
coping. surgery. measures and
compliance with
4. Perform a the treatment
comprehensive plan.
assessment of pain.
Determine the location,
characteristics, onset,
duration, frequency,
quality, and severity of
pain via assessment.
- The patient experiencing
pain is the most reliable
source of information
about their pain. Their
self-report on pain is the
gold standard in pain
assessment as they can
describe the location,
intensity, and duration.

5. Offer distraction.
- Until pain relief occurs or
surgery takes place the
patient may need
distractive measures to
refocus their attention and
promote relaxation.

6. Provide accurate and

honest information to the
client and significant
others.
- Being informed about
the progress of the
situation provides
emotional support,
helping to decrease
anxiety.

7. Place the client in a

semi-Fowler’s position.
- Gravity localizes
inflammatory exudate into
the lower abdomen or
pelvis, relieving
abdominal tension, which
is accentuated by the
supine position .

Dependent:
1. Administer analgesics
 as prescribed.
- Relief of pain facilitates
cooperation with other
therapeutic interventions,
such as early ambulation.

Collaborative:
1. Discuss with the
surgeon to confirm
specific post-op
ambulation orders and
any restrictions.
- Understanding surgical
considerations ensures
safe initiation of
ambulation and supports
wound healing.

NURSING CARE PLAN - 2

 Patient’s Name: Ms. IHO Hospital no.: 000000000
Diagnosis: Acute Appendicitis Attending physician: Dr. Magallanes, Dr. Prudencio,
Dr. Tolentino and Dr. Maranan
NSG. DIAGNOSIS
CUES NEED W/ SCIENTIFIC BASIS OBJECTIVE NSG. ACTION EVALUATION
OF CARE
S: N/A P Risk for Infection related to surgical Within 8 hours Independent:
H incision of nursing 1. Assess the client’s vital Goal Met
Y intervention, signs, especially the
S the patient will; temperature. Within 8 hours of
O:
I R: Monitor the client’s pulse nursing
- Surgical
O  Remain rate and temperature for intervention, the
incision Scientific Basis:
L free of signs of infection. An patient was able to;
-VS taken Regardless of the surgical technique
O infection. elevated temperature and  Remain free of
as (laparoscopic or open surgery),
G  Display pulse rate are suggestive of infection.
follows: appendectomy remains a skeptical
I appropriat the presence of infection,  Display
RR: 20 surgical intervention associated with
C e healing developing sepsis, appropriate
cpm a substantial risk of surgical site
A of surgical abscess, and peritonitis. healing of
PR: 110 infections (SSIs). SSIs after
incision. surgical incision
bpm L appendectomy are postoperative as evidenced
BP:90/60 Needs by nosocomial infections affecting the 2. Assess surgical incision by an absence
mmHg Maslow’s incision site, deep tissues, and site regularly of redness,
Temp: Hierarchy organs at the operative site within 30 R: Close monitoring of the warmth, or
37.1 °C of Needs days after the surgical procedure. incision site allows for early drainage.
SPO2: Healthcare-associated infections are detection of signs and
96% acquired by clients when receiving symptoms of infection such
care and are the most frequent as redness, swelling,
adverse event affecting client safety warmth, or discharge.
worldwide.
3. Maintain strict hand
hygiene.
R: Proper hand hygiene
reduces the risk of
introducing pathogens to
the incision site, preventing
potential infections.

4. Ensure sterile technique

during dressing changes.
R: Sterile technique
prevents contamination of
the wound, reducing the
risk of infection.

5. Educate patient on signs

and symptoms of infection.
R: Patient education
empowers individuals to
recognize signs of infection
early, facilitating timely
intervention and preventing
complications.

6. Promote adequate
nutrition and hydration.
R: Proper nutrition and
hydration support the
body's immune response,
aiding in wound healing and
reducing the risk of
infection.

7. Ensure adequate pain

management.
R: Effective pain
management promotes
patient comfort and
mobility, facilitating early
ambulation and respiratory
function, which are
essential for preventing
complications and
promoting wound healing.

8 Maintain a clean and

comfortable environment.
R: A clean environment
reduces the risk of
introducing pathogens to
the surgical site, minimizing
the risk of infection.

Dependent:
1. Administer antibiotic as
ordered.
R: Antibiotics given before
appendectomy are primarily
for prophylaxis of wound
infection and are not
usually continued
postoperatively.
Therapeutic antibiotics are
administered if the
appendix is ruptured or
abscessed, or peritonitis
has developed.
 NURSING CARE PLAN- 3

Patient’s Name: Ms. IHO Hospital no.: 000000000

Diagnosis: Acute Appendicitis Attending physician: Dr. Magallanes, Dr. Prudencio,
Dr. Tolentino and Dr. Maranan
NSG. DIAGNOSIS
CUES NEED W/ SCIENTIFIC BASIS OBJECTIVE OF NSG. ACTION EVALUATION
CARE
S: “Dli kaayo ko P Impaired Mobility Within 8 hrs of Independent:
maka lihok kay H Related to Surgical nursing 1. Encourage and assist
Goal Met
sakit akong tahi”, Y Procedure as Evidenced intervention the the patient in early
as verbalized by S by Limited Ability to patient will: ambulation as soon as
Within 8 hrs of
the patient I Change Positions feasible postoperatively.
nursing intervention
O Independently  Patient will R: Early ambulation helps
the patient was able
L participate in their prevent complications
to:
O activities of daily such as atelectasis, deep
O:  Demonstrate an
G life (ADLs) and vein thrombosis, and
- Limited ability Scientific Basis: improvement in
I prescribed constipation. It also
to change Acute appendicitis can physical mobility,
C therapies. promotes circulation and
positions cause impaired mobility such as being
 Patient will aids in the recovery of
independently A independently due to display normal mobility. able to move and
- Expressions of L localized inflammation improvement in change positions
discomfort or Needs by and pain, triggering physical mobility. 2. Assist the patient in independently.
pain upon Maslow’s protective muscle  Will display changing positions  Participate in
movement Hierarchy guarding and limiting signs of comfort regularly, utilizing proper ADLs.
-VS taken as of Needs movement to minimize as evidenced by body mechanics.  Report display
follows: discomfort and prevent resting eyes R: This prevents joint signs of comfort
RR: 20 cpm further irritation. closed and vital stiffness, minimizes and normal
PR: 101 bpm signs within discomfort, and aids in sleeping pattern.
BP:140/90 normal limits. preventing complications  Display normal
mmHg like pressure ulcers. vital signs.
Temp: 36.4 °C  Demonstrate
SPO2: 98% 3. Provide education to the understanding of
patient on techniques to self care
improve mobility, including measures and
proper body mechanics, compliance with
using assistive devices, the treatment
and the importance of plan.
gradual movement.
R: Empowering the patient
with knowledge enhances
their ability to actively
participate in their
recovery.

4. Regularly assess for

signs of complications
such as infection,
increased pain, or changes
in mobility.
R: Early detection and
management of
complications are crucial
for preventing further
impairment and promoting
a smooth recovery.

5. Promote proper
nutrition and hydration.
R: Malnourishment
prevents recovery and
contributes to a higher risk
of functional disability.
Adequate caloric intake is
required for energy with
high-protein foods
supporting muscle mass
and strength.

6. Provide positive
reinforcement.
- A patient who is making
an effort, no matter how
small, will be more inclined
to continue when their
accomplishments are
noticed and praised..

7. Provide positive
reinforcement.
R: A patient who is making
an effort, no matter how
small, will be more inclined
to continue when their
accomplishments are
noticed and praised.

Dependent:
1. Administer prescribed
pain medications.
R: Adequate pain control is
essential for promoting
mobility.
XVII. DISCHARGE PLAN (METHODS)
A carefully planned and executed discharge process contributes to patient
satisfaction. When patients feel well-informed, supported, and prepared for
their postoperative care, they are more likely to have a positive experience
and better outcomes.

A Case of Appendectomy, Ms. IHO is a 21-year-old woman, who came

into the emergency room with a chief complaint of abdominal pain is receiving
continuous care from her admission up until her discharge.
 Reaffirm the importance of adhering to a medication
M – Medicine
regimen for continuity of treatment and prevention in order
to achieve the best possible recovery.
 Inform the patient to take their medication at the precise
time and in the recommended amount.
 Inform the patient about the potential side effects of
medications. Keep an eye out for allergies. Consult a
doctor if such symptoms persist. Also, warn the patient not
to take any medications that have not been recommended
by a doctor.
- Continue taking medicine by the doctor’s prescription until
blood pressure drops to normal, stop on doctor’s advice only
home monitoring of BP.
=

E - Exercise  Recommend reduced physical activity, but not strict bed

rest.
 Encourage the patient in maintaining a clean and safe
environment, as well as engaging in friendly and safe
activity for a faster recovery.

T – Treatment  Recommend that the patient attend the clinic for post-
operative check-ups and to monitor blood pressure and
possible complications.
  Advise the patient to take medications exactly as
prescribed by the doctor to avoid the risk of infections and
complications.
 Perform proper handwashing and good oral hygiene to
avoid infections.

H– Health  Encourage the patient to consume appropriate hydration

Education and balanced nutritional nutrients, such as vegetables and
fruits.
 Daily wound care after bath to avoid infections.
 Instruct the patient to rest and don’t do heavy housework
and heavy exercise.
 Maintain compliance to drug therapy.
 Advise her to seek help (or come back to see you) if she is
not feeling well or if she has any difficulties or concerns
with her wound.

O – Outpatient  Remind the patient and her family that follow up check-ups
Referral after 1 week is necessary to improve her health status, and
maintain a healthy balance of well-being.
(Check-up)

D - Diet  Advise the patient to lessen the intake of sugary and

unhealthy foods.
 Encourage the consumption of Soft or Low-Fiber Diet as
the patient's tolerance improves and bowel function begins
to return to normal, a soft or low-fiber diet is introduced.
This may include well-cooked vegetables, lean proteins,
and easily digestible grains
 Instruct the patient to increase her oral fluid intake. The
body needs a lot of fluid at about 6-10 glasses a day.
Drink mostly water, milk and fruit juice.

 Motivate the patient and all of the patient's family members

S- Spiritual
to put God first in all of their decisions and to have faith in
 all facets of their lives.

XVIII. RECOMMENDATION
MEDICATION. Instruct the parents to take the prescribed prescriptions until
they are finished, even if the patient starts to feel better, and to not miss any
doses or calculate the drug's amount incorrectly. Keep taking the medications
as directed by the doctor. Give precise directions on the amount to take, how
often, and any potential adverse effects for each drug. Keep in mind that
without a prescription or consent from their doctor, the patient will not be given
any medications.

TREATMENT. Emphasize the importance of keeping a pharmacological

treatment for continuity of care and prevention to offer the greatest potential
for recovery. Ensure that the family is aware of the patient's prescribed
medication dosages, administration guidelines, and possible side effects. Give
the patient-specific instructions regarding the time and dosage at which to
provide the patient’s medication. Additionally, caution the family against
utilizing medications that were not prescribed by a physician.

HEALTH TEACHING. Once you leave the hospital's walls and enter the
outside world, your medical treatment doesn't end. You will still need to have
appointments with the healthcare professional to track your progress and
improvement. In addition to this, the following interventions can be carried out
at home: Tell the patient's family how important it is to take their meds exactly
as directed. Emphasize the importance of a kidney-friendly diet, which
typically includes limiting sodium, phosphorus, and potassium intake.
Encourage regular, moderate exercise tailored to the patient's abilities.
Encourage lifestyle modifications, including a low-sodium diet, regular
exercise, and stress management. Physical activity can help control weight,
blood pressure, and overall well-being.

DIET. To speed up the healing process, the patient's diet is advised to include
a range of healthful meals such as fruits, vegetables, and fluids. Limit your
intake of processed and sugary meals, acidic foods, alcohol, carbonated
drinks, coffee, fatty foods, fried foods, fruit juices, pickled foods and spicy
foods which might impair recovery by compromising the immune system. To
ensure that the patient obtains appropriate nutrition without feeling
overwhelmed, serve smaller, more frequent meals and snacks.
XIX. REFERENCES/BIBLIOGRAPHY
Jones, M. W. (2023, April 24). Appendicitis. StatPearls - NCBI Bookshelf.
https://www.ncbi.nlm.nih.gov/books/NBK493193/#:~:text=Appendicitis%20is
%20the%20inflammation%20of,to%20the%20right%20lower%20quadrant.
Philippines: leading diseases in Davao | Statista. (2024, January 3). Statista.
https://www.statista.com/statistics/1119741/philippines-leading-cause-
morbidity-davao-region-by-disease/

The Editors of Encyclopaedia Britannica. (2024b, February 2). Appendix |

Definition, Location, Function, & Facts. Encyclopedia Britannica.
https://www.britannica.com/science/appendix
Weledji, E. P. (2022). Appendicitis: Epidemiology, evaluation, and controversy
in management. IntechOpen. https://doi.org/10.5772/intechopen.1000841

Walter, K. (2021). Acute appendicitis. JAMA, 326(22), 2339.

https://doi.org/10.1001/jama.2021.20410