GOVT.

COLLEGE OF NURSING,
SMS HOSPITAL, JAIPUR

CASE STUDY
ACUTE APPENDICITIS

SUBMITTED TO: SUBMITTED BY:

Mr. RAMESH JANGID CHAINA RAM
Dr. DAISEY CRISTOFER M.Sc.N (P)
Dr. MINAXI MESSEY GCON JAIPUR
Mr. SATYAPAL SINGH
Mr. SHRIKANT LATA
LECTURER, GCON JAIPUR

DATE OF SUBMISSION- NOV.20, 2023

 ACUTE APPENDICITIS

 BIOGRAPHICAL DATA

 Name : Kafi
 Age : 18 year
 Sex : female
 Father’s name : Arbaj
 Occupation of father : Private job.
 Education of child : 5th
 Religion : Muslim
 Address : Kanota, Jaipur
 Informant : Mother
 Date of admission : 26/10/2023
 Registration no. : 26102337708
 Ward : Surgical ICU
 Bed no. :5
 Diagnosis : Acute Appendicitis

 PATIENT’S REASON FOR SEEKING ADMISSION:-

 Patient is suffering pain abdomen , fever and vomiting .

 PRESENT MEDICAL/ SURGICAL HISTORY

 Pt admitted at JK Loan hospital with complain of pain abdomen, fever and vomiting
from previous three days. USG reveals gangrenous appendicitis .

 PAST HEALTH HISTORY

 No any identified medical complain except above mentioned , no any surgical
correction previously done.
 FAMILY HISTORY
 Family composition

S Name Age Sex Relationship Education Occupation Health

N with patient status
1 Arbaj 44 yr M Father 12th Private job Healthy
2 Fatma 42 yr F Mother 8th Housewife Healthy
3 Rehan 20 yr M Brother BA Nil Healthy
4 Kafi 18 yr F Self 12th NA sick
5 Rubika 16 yr F Sister 10th NA Healthy
6 Ashgar 14 yr M Brother 8th NA Healthy

 Family pedigree

M F 42
44

16
20 yr 18 yr 14 yr
yr

 LIFE STYLE AND HEALTH PRACTICES

a. Normal physical activity.
b. Diet- home made food, 3-4 times in a day
c. Sleep – adequate
d. Habit – not significant
e. Allergy – not known
f. Bowel pattern- constipation
g. Bladder pattern- normal
 ENVIRONMENTAL HISTORY
a. Environmental hygiene – not hygienic
b. Housing – semi Pkka
c. Source of drinking water – PHED water supply
d. Disposal of excreta- functional toilets available
e. Drainage system- not proper

 PHYSICAL EXAMINATION-
 Vital sign

Vitals Date- 27/10/23

Temperature (f) 100.4
HR (beat/mt) 90
Resp. (breath/mt.) 26
BP (mm Hg) 114/76

 General appearance
 Activity- in rest and comfort ,
 Level of consciousness- conscious

 Head to Toe examination

Skin and hair  No odour from skin

 Moist and smooth skin
 No any oedema
 Hair distributed on scalp- normal
Head and neck  Normal size of head
 No involuntary movements
 No any lump on scalp
 No Lymphadenopathy at neck
Eyes (vision)  Eyelids and eyelashes are normal
 Lid margins are normal
  No redness or discharge from eye
 Eye position normally in orbital socket
Ear (hearing)  Ear appears normally in size , shape and location
 Normal hearing ,
 No discharge from ears
Mouth , throat and  Lips are dry
nose  No visible defect

 Systemic examination –

Respiratory system  No nasal flaring or pursed lip breathing.

 SpO2 97 % on room air
 No breathing difficulty
 Sensation to touch and temperature is present
 Chest expansion symmetrically.
 Normal breathing sound, no any wheeze, rhonchi or
abnormal sound on auscultation
Cardiovascular  No distension in jugular vein
system  S1 & S2 normal , No murmur sound on auscultation
 Arms, hands and finger normal temp to touch
 No oedema on lower extremities
Gastro-intestinal  On abdominal inspection skin in pink in colour
system  Umbilicus normal , no omphocele
 Abdominal tenderness on palpation
 No vomiting
 Constipation
Musculo skeletal  Normal movement of body
system  No swelling or tenderness on extremities
 Both hand and legs are symmetrical
Neurological system  Comfortable
 Normal sensory and motor development.
 No unusual involuntary movements.
Sensory system  No nuchal rigidity but not movement in all ROM
 No. sensation to pain , touch and temperature on left
 side.
Genitourinary system  Normal urine frequency and output

 No history of blood with urine

 No any congenital abnormality seen
Anus and rectum  No fissure or ulceration on anus.
 No any abnormalities noticed.

 INVESTIGATION

Test Value in patient Normal range

1.Hematology
 RBC 4.34 million/ mm3 3.80- 6.0 million/ mm3
 Hb 10.4 gm/dl 11.5 – 17.0 gm/dl
 Platelets 2.58 lakh/ mm3 150 -400 lakh/ mm3
 WBC 21.70 thousand / mm3 3- 10 thousand / mm3
 DLC
o Neutrophils 85.0 % 50-70%
o Lymphocytes 10.0 % 20-40%
o Monocytes 02.0 % 5-10%
o Eosinophils 03.0 % 1-4%
o Basophils 00.0 % 0-1%
 PT 11.4 Sec 11-13.5 sec
 INR 1 0.8-1.1
2. Biochemistry
 Random blood sugar 68.0 mg/dl 80-120 mg/dl
 Serum creatinine 0.20 mg/dl 0.6-1.5 mg/dl
 Blood urea 21.0 mg/dl 10-50 mg/dl
 Serum sodium 148.6 mEq/l 135-145 mEq/l
 Serum potassium 4.50 mEq/l 3.5-5.5 mEq/l
 Serum chloride 101.0 mEq/l 95-110 mEq/l
 Serum bilirubin 0.60 mg/dl 0.1-1.0 mg/dl
 SGOT 42.0 IU/L 0-35 IU/L
 SGPT 48.0 IU/L 0-40 IU/L
3. Viral marker
 HBsAg Negative -
 HIV Negative -
 CoV-19 Negative -
 MEDICATIONS

S Name/dose/ Actions Indications Contra- Side effect Nurses

N Route/time indication Respo.
1 Inj. Antibiotic Severe Hyper- Dizziness, Monitor
Piperacillin infection sensitivity increased HR vitals,
+ & RR assess for
tazobactam side effects.
4.5 gm TDS

2. Inj. Antibiotic Gram Hyper- Ototoxicity Monitor

Amikacin negative sensitivity nephrotoxicity vitals,
500 mg BD infections assess for
side effects.

3 Inj. Analgesic To control Hyper- Headache, Timely

Tramadol pain sensitivity insomnia, administer,
100 mg BD nausea monitor
side effects.
4 Inj. Antipyretic To control Hyper- Fatigue Monitor
Paracetamol fever sensitivity Liver and body temp.
100 ml SOS kidney at regular
interval.
damage.
3. Inj. H2- Gastritis , Hyper- Cramps in Monitor
Pantoprazol receptor Peptic ulcer sensitivity abdomen, side effects,
e 40 mg OD antagonist watery Follow 7R
diarrhoea
 CASE IN DETAIL

 ANATOMY – The appendix extends from the

lower end of the cecum, a pouch-like structure in the
large intestine. The diameter of the appendix usually
ranges from 7 to 8 mm and its length ranges between
2 and 20 cm, with an average length of 9 cm. The
appendix is usually located at the lower right side of
the abdomen

 DEFINITION - Acute appendicitis is the most common sudden abdominal event ,

which also occurs at any age. If acute appendicitis is suspected, the patient should always
be thoroughly examined and the diagnosis not delayed. Later diagnoses can lead to
various complications and serious, life-threatening consequences.
 AETIOLOGY –

 Intestinal contents and the formation of coprolite,

 Wedging of a foreign body in the appendix,
 Appendix length,
 parasitic diseases,
 Scar suppression from the outside,
 Imbalance of the intestinal flora.

 CLINICAL MANIFESTATION

Text book picture Patient picture

 Pain abdomen ( mc burny’s point)  Pain abdomen ( mc burny’s point)

 Tenderness  Tenderness
 Rovsing’s sign  Rovsing’s sign
 Nausea  Nausea
  Vomiting  Vomiting
 Fever  Fever
 Constipation

 DIAGNOSTIC EVALUATION

Book picture Patient picture

 General physical exam.  General physical exam.
 CT SCAN  CECT
 Sonography  Sonography
 Haematology  Haematology
 Biochemistry  Biochemistry

 MANAGEMENT

Book picture Patient picture

 Medical management.  Medical management
 Appendectomy  Appendectomy

 NURSING MANAGEMENT
 Preoperative
 Explain the condition and procedure to parents of child.
 Take informed consent
 Collect all investigation reports
 Give pre-medications as ordered.
 Keep the baby NBM for 6-8 hours from midnight
 Prepare the part for surgery
 Shift the patient to OT with BHT.

 Postoperative

 Need identified for nursing care

 Acute pain abdomen
 Fever
 NBM

 Nursing diagnosis
a. Acute Pain related to surgical incision and tissue trauma.
b. Altered body temperature more then normal related to infection.
c. Risk for deficient fluid volume related to preoperative vomiting, postoperative
restrictions.
d. Anxiety of parents related to surgical experience, hospitalization, and
postoperative care.
e. Deficient Knowledge related to the post operative care.
 NURSING CARE PLAN
Assessment Nursing Objective Intervention Rationale Implementation Evaluation
diagnosis
 pain intensity, a. Acute Pain  To reduce  Assess  To identify level of  Pain level Pain
location, and related to pain the patient's pain pain assessed by pain controlled.
characteristics surgical level using a pain  Medication help to scale.
by using pain incision and scale and bind receptors and  Analgesic
scale tissue trauma. document their control it. administered.
pain intensity  Positioning and other  Position changed.
regularly. non- pharmacological  Distraction and
 Administer technique distract his diversion therapy
prescribed attention on pain applied.
analgesic
medications as
scheduled or as
needed.
 Implement
non-
pharmacological
pain management
techniques such
as positioning,
distraction

 Assess body b. Altered body  To regulate  Keep the patient  Well ventilation and  Keep the unit Fever reduced
temp. temperature body unit room cool cool room temp help temp cool and and temp.
 more then temperature and ventilated, to maintain surface ventilated become
normal related  Switch on the fan body temp.  Switch on the fan normal.
to infection.  Remove extra  Extra cloths  Extra clothes
cloths removing help in removed
 Remove wet loss of temp.  Paracetamol
cloths  Antipyretics helps to administered as
 Antipyretics as reduce fever. prescribed .
prescribed.
 Asses hydration  To correct  Check vitals  Vitals and intake  Vitals monitored Fluid volume
c. Risk
status. fluid volume  Maintain intake output chart indicate  IO chart maintained .
for deficient
 Assess skin deficit. and output the hydration level. maintained.
fluid
turgor  Check level of  Iv therapy will  IV fluid
volume relate
 Asses vomiting hydration correct fluid volume administered as
d to
amount and regularly. deficit. prescribed.
preoperative
colour .  Parental fluid
vomiting,
therapy to replace
postoperative
volume.
restrictions.

 Pt. verbalize d. Anxiety  To reduce  Assess the  Assessment help to  Make IPR with Pt feel
about prognosis of patient the anxiety emotional status identification the cause attendants. relaxed and
of baby. related to of attendants and anxiety.  Communicate
stress free.
surgical provide with them and
experience, psychological identify the
hospitalization support. fears.

 Ques of e. Deficient  To improve  Educate the family  Education about  Educate the Knowledge of
attendant Knowledge the about the surgical procedure parents of child family
 about related to the knowledge condition, surgical and wound healing regarding member
recovery of condition, of parents. procedure, and make them relax. surgical improved.
pt. surgical postoperative care.  Instruction regarding correction.
 Ques of father procedure,  Provide wound care and  Inform parents
about and instructions on Medication and about care at home
discharge & postoperative wound care, prevent the risk of  Follow up
treatment care. Medication infection. schedule
plan. administration,  Follow up to informed.
and signs complete the  Involve
of treatment attendant in
complications. regimen. discharge
 Schedule  Involvement of planning.
follow- up parents in Discharge  Train attendants to
appointments planning make them care at home
 Collaborate with informed about
the health care team discharge and care
to develop a at home
comprehensive
discharge plan
 HEALTH EDUCATION-

Health education given to pt and attendants following issues.

a. Maintain personal hygiene.
b. Support the pt. psychologically.
c. Complete the treatment regimen according to order.
d. Follow up as advised by doctors and complete the treatment regimen.

 REFERENCES

a) K sembulingam, premasembulingam, essential of medical physiology, fourth edition,

Jaypee publication, anatomy and physiology, page no.:439-441
b) Joyce M Black, medical surgical nursing, 8th edition, Elsevier publication