INTRODUCTION

This care study is on Master P.G 38years old man who reported at korle-bu teaching

hospital on the 22/06/2019 at the Emergency Department (ED) with a diagnosis of Acute

Appendicitis after been examined by the Doctor Pecku. He was ambulant and was accompanied

by his uncle Mr

. M.T.

My interaction with Master P.G and his relative started on 22 nd June 2019 at about 2:30

pm when she was admitted to the surgical Ward by Dr. Pecku, the medical officer. In his case, he

was booked for surgery the next day which was 23rd June, 2019 at 12noon after which he had

appendectomy performed on him.

Master P.G complained of loss of appetite, elevation of temperature, vomiting, pain in the

abdomen. He was cared for from admission through hospitalization, discharge and follow up

home visit at his residence in Tema.

This care study gives a competency based Nursing care rendered to Master and family

from 22nd June, 2019 till Termination of care on 27 th June, 2019 the nursing process was

employed and the various stages are: Assessment, Analysis, Planning, Implementation and

Evaluation

i. Assessment: This deals with the process of data collection.

ii. Analysis: This is the phase of determining the competent parts of a patient’s health

problems.

iii. Planning: It deals with setting priority of eliminating the health problems of a patient.

iv. Implementation: This phase deals with carrying out the designed nursing

interventions and goals.

1i
 v. Evaluation; this stage involves a critical assessment and judgment of how far the

stated goals and objectives have been achieved.

1ii
 CHAPTER ONE

ASSESSMENT OF PATIENT AND FAMILY

Assessment forms a base which is used for analysis. It is also important for the planning

and provision of comprehensive nursing care to the patient and family.

It also serves as the basis of therapeutic nurse-patient relationship; hence it enables the

nurse to plan effectively towards the care given to the patient. The tools used for collecting the

information were observation, interview, physical examination and consultation and patient’s

particulars.

PATIENT’S PARTICULARS

Master P.G aged thirty-eight (38) years is a Ghanaian and hails from Amanakrom in the

Eastern region North Municipality of Ghana. He is a native of Amanakrom, he was born in

Accra police hospital and brought up in Tema. He was born to Mr. O.S and Mrs. C.L both alive

and staying at Amanakrom. Presently, Master P.G stays at Tema with his uncle. Master P.G is

the fourth born to his parents and they are five in all three girls and two boys. Master P.G

attended Suhum Angelican for his basic education and furthered his S.H.S at Suhum senior high

school. After he proceeded to University for Professional Studies (UPS), he works at cocoa

board as a security. Master P.G. is an Adventist by religion and speaks Twi, and English. He

weighed 86 kilogram (kg) on admission with a height of 158 centimeters (cm). He is dark in

complexion.
PATIENT/FAMILY MEDICAL AND SOCIO-ECONOMIC HISTORY

According to Master P.G, there is no known history of psychiatric disorders and

hereditary diseases such as Diabetes Mellitus, Asthma, or leprosy in the family. But the

hereditary disease is hypertension. However, other minor sicknesses like headache, diarrhea,

abdominal pains and fevers do occur but are usually treated with drugs bought from chemical

shops.

Master P.G said his late maternal grandfather suffered from appendicitis before his death.

Master P.G. is security personnel at cocoa Board, According to Master P.G, he has a sister called

J.N. who works at Kings Radio Station as secretary and also supports the family financially. The

patient resides in the house with his uncle, and sister. He is a registered member of the National

Health Insurance Scheme (NHIS).

PATIENT’S DEVELOPMENTAL HISTORY

Master P. G. was born on 19th March, 1981 at police hospital in the greater Accra region

Municipality at home through spontaneous vaginal delivery with the assistance of a midwife. He

was immunized against the childhood killer diseases and has Baccile Calmette Guerin (BCG)

scar at the right upper shoulder which gives evidence that he had his immunization. Master P.G.

could remember his uncle telling him that his development stages were normal. He could sit

alone at six-month, he started crawling at seven months, at eight months, he could use his fingers

to eat, and he could say “dada” and “mama” at ten months. At one and half years, he started

standing and walking and could also put words together.

His uncle said he did not practice exclusive breast feeding as he was taught at the

Antenatal clinic. According to him, this was because he did not get the understanding very well.

Master P.G is currently a worker at cocoa board.

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PATIENT’S LIFE STYLE/HOBBIES

According to Master P.G on weekdays he usually wakes up around 5:00 am, washes his

face and brushes his teeth with paste and toothbrush. He then empties his bowel and fetches

water for his bath; he takes his bath and goes to work around 6:00am. He takes his breakfast at

9:30am when he goes for the first break at work. He closes from work around 6:00 pm; changes

to his house dress and then takes his supper which is usually Banku and Okro stew. Afterwards,

He takes his bath visits one or two friends of his and later comes back to plan his schedules.

On his off days, he wakes up around 7:00am perform his personal hygiene he then takes

his breakfast and prepares to church around 8:00am he return from church round 12:30pm and

take some rest, around 2:00pm he goes Sabbath School at the church and closes around 5:30pm.

Afterwards, he takes his bath and supper around 6:00 pm. He then watches movies on his laptop.

On Sundays, he wakes up around 7:30 am and performs his personal hygiene he wash his dirty

clothes. He then takes his breakfast. He goes to market and buy food stuff to prepare his stew to

be used in the course of the week.

His favorite food is Banku and Okro stew and his hobbies are watching television,

movies and playing cards with friends. During his leisure times, he engages himself in the

reading of story books. He neither takes alcoholic beverages nor smoke. He normally goes to bed

around 9:30 pm after the day’s activities.

PATIENT’S PAST MEDICAL HISTORY

On interview, the uncle, Mr.L.p said her son has been admitted to konongo hospital with

a diagnosis of malaria when he was four (4) years old which was resolved. According to Mrs.

C.L, her son occasionally had headache and malaria for which he usually buys drugs from the

chemical shops for treatment.

13
Patient’s Present Medical History

According to Mrs. C.L, on 22nd June, 2019, Master P.G. returned from church in the evening

with complains of severe abdominal pains, fever, chills and dizziness. Her uncle gave him

magnesium Trinscilicate15 milliliter which he vomited immediately after taking it. The

following morning, Mr. L.P, the uncle also gave Mr. P.G. 15 milliliters of magnesium

Triscillicate before leaving for Kumasi. Not quite long after leaving for Kumasi, he visited a

nearby friend in the neighborhood, and the friend brought him back to the uncle at the house with

the same complaint.

Mr. L.P. took Master P.G to Tema General hospital and was later referred to Korle bu

Teaching Hospital, after several assessment made on him at Korle bu Teaching hospital. Upon

series of examinations and investigations by the doctor, he was diagnosed of an acute

appendicitis. He was then booked for appendectomy on, 23rd June, 2019

ADMISSION OF MASTER P.G

Master P.G. was admitted on Sunday, 22 nd June, 2019 at 2:30pm through the Emergency

department of korle bu Teaching hospital by Dr. Pecku to the surgical ward with the diagnosis of

acute appendicitis. Master P.G and his uncle arrived at the ward as an ambulant patient

accompanied by a nurse.

Master P.G, uncle and the accompanying nurse were warmly welcomed to the nurses’

station and offered seats. I introduced myself and the other staff on duty. The necessary

documents were collected from the accompanying nurse and the name on the folder was

mentioned to confirm the patient’s identity. They were reassured of good prognosis to allay their

fear and anxiety. His vital signs were checked and recorded as follows:

14
 Temperature - 36.6 degrees Celsius ( oc)

Pulse - 86 beats per minute (bpm)

Respiration - 23 cycles per minute (cpm)

Blood pressure - 135/70 millimeters of mercury (mm/Hg)

His weight and height were checked and recorded as 86 kilogram (kg) and 158

centimeters (cm) respectively. Laboratory investigations which were requested were:

1. Hemoglobin level estimation.

2. Sickling test.

3. White blood cell count.

4. Malaria parasites.

5. Urine for routine examination.

6. Blood for grouping and cross-matching

He was assisted to change into his gown and patients next to him were introduced to him

and the uncle. Extra cloths and articles that were not needed were given to the uncle to send

home while those that were needed were kept neatly in his bed side locker. Master P.G was

assisted to sign the consent form for treatment after a careful explanation has been given. The

National Health Insurance Scheme (NHIS) was explained to him and his uncle. Master P.G and

uncle were informed about the visiting hours which were, Morning 5:30am to 6:30am, Evening

5:30 to 6:30pm. Master P.G and his uncle were oriented to the ward, hospital and its

environments.

The patient’s name, sex, age, occupation of both parents (mother and father), address,

date and time of admission were recorded in the admission and discharge book as well as the

daily ward state. Master P.G. was put on the following medications on admission:

15
 1. Intravenous ciprofloxacin 400mg 12hourly

2. Intravenous flagyl 500mg eight hourly

3. Intravenous dextrose saline 500mg 2litres

4. Intravenous ringers Lactate 500mg 1litre

5. Diclofenac 75mg 12hourly

PATIENTS/FAMILY CONCEPT OF HIS ILLNESS

According to Master P.G, his condition was not as a result of any evil forces and that he

believes in the divine healing of the Most High God and with the efficient management of the

health personnel, he will recover soon with no complications.

The uncle also said he is a Christian and believed that his nephew’s illness would be healed by

the Almighty God.

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LITERATURE REVIEW ON THE DISEASE CONDITION (APPENDICITIS)

According to Suzanne and Brenda, 2006 Appendicitis is inflammation of the vermiform

appendix attached to the base of the caecum near the ileocecal valve. It is a small finger like

appendage of about 13cm long.

According to Frances Donovan Monahan 2007, the vermiform appendix is a small,

fingerlike projection attached to the caecum just below the ileocecal valve. The appendix is

approximately 10cm (4 inches) long.

INCIDENCE

Appendicitis may occur at any age. It is more common among males and females of pre-

school age, adolescents and young adults. About 7% of the population will have appendicitis at

some time in their lives. Males are more affected than females. The disease is more prevalent in

countries in which people consume a diet low in fibers and high in refined carbohydrate.

AETIOLOGY

Obstruction of the intestinal lumen by a faecolith or stricture of the lumen is the main

cause of appendicitis. The inflammatory process can lead to thrombosis, necrosis and

perforation. It may be brought about by the following factors:

Kinking of the appendix which may impaired circulation and lower resistance to organisms

within the body such as colon bacilli or streptococci.

i. Blood born infection associated with history of sore throat, measles can result in appendicitis.

It can also be as a result of stasis in the appendix that is stagnation of fluid in the appendix.

ii. Scar tissue in the wall of the appendix

iii. Stricture

17
PATHOPHYSIOLOGY

The appendix becomes inflamed and oedematous because of either kinking or an

occlusion, possibly caused by faecolith (hardened mass of stool), tumour or foreign body. It can

also be compared to a closed loop obstruction which occurs first and inflammation and infection

follows. An abscess may develop in the appendiceal wall or in the surrounding tissue. The

appendix may rupture to cause peritonitis.

In chronic appendicitis, the lumen of the appendix is obstructed, hypoxia develops, the

mucosa ulcerates and bacteria invade the wall. The obstruction is brought about as a result of;

a. Hardened faecolith

b. Kinking of appendix

c. Oedema of the lymphoid tissue (inguinal node)

The appendix is usually fibrosed or surrounded by adhesions.

TYPES

Appendicitis may be classified as

i. Simple appendicitis

ii. Gangrenous appendicitis

iii. Perforated appendicitis

i. Simple appendicitis involves an inflamed and intact appendix.

ii. In gangrenous appendicitis, the appendix may have faecal or extensive necrosis

with microscopic perforation.

iii. In perforated appendicitis, there is gross disruption of the appendix wall.

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CLINICAL FEATURES

There may be colicky pain when there is associated obstruction and increased peristalsis

to overcome it, or there may be dull arched in an ordinary inflammation. Typically, the pain

commence as a central per-umbilical colic which shift to the right iliac fossa or to the site of the

inflamed appendix.

The patient often guards the area by lying still and drawing the legs up to relieve tension

on the abdominal muscles. Nausea and vomiting are usually present and follows the onset of

pain. The pain results into increased peristaltic movement. Abdominal tenderness, Anorexia

occurs as a result of pain and due to toxins, constipation, fever, thus the temperature and pulse

are raised due to infections.

Restlessness due to pain which comes about as a result of the inflammation. The

respiration may be shallow and rapid as a result of ventilatory interference by extreme abdominal

distention.

COMPLICATIONS OF APPENDICITIS

i. Appendicular mass: This arise in case the blood supply is cut off resulting in gangrene

ii. Shock: The patient may fall into shock because of severe pain and generalized infection.

iii. General Peritonitis: Infection of faecal matter and pus spilling into the Peritoneal cavity.

iv. Perforation: the appendix may perforate leading to spontaneous faecal fistula.

19
COMPLICATIONS OF APPENDECTOMY

i. Incisional hernia: This may occur after operation from pulmonary infection given

rise to coughing which predisposes to the occurrence of wound adhesion.

ii. Intra abdominal infection

iii. Wound infection

iv. Recurrence due to incomplete resection of the appendix.

v. Acute intestinal obstruction in paramedian incision due to effect of the pus in the

peritoneum with associate fibrous adhesions.

PROGNOSIS

Good, after surgery is done to remove the obstructed appendix.

DIAGNOSTIC INVESTIGATIONS

Appendicitis can be diagnosed by the following investigations:

i. Abdominal x-ray, this indicates the appearance of faecolith in the right iliac region.

ii. Intravenous pyelography. This is done to differentiate appendicitis from suspected

urinary tract infection.

iii. Palpation: Palpation of the abdomen and differential determination. On physical

examination, there is slightly muscular rigidity, normal bowel sounds and rebound

tenderness around the umbilical and middle epigastrum. As the condition progresses pain

shifts to the lower right quadrant.

iv. Percussion. If the patient coughs or the abdomen is percussed, pain is enhanced.

v. The history of the patient may confirm the condition.

vi. Blood analysis may reveal increase white blood cell count indicating infection.

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vii. Urinalysis: This indicates small amount of erythrocytes and leucocytes.

viii. Peritoneal fluid analysis: This shows the presence of bacteria.

ix. Ultrasonography may show the appearance of faecolith on inflamed appendix.

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DIFFERENTIAL DIAGNOSIS

i. Acute mesenteric adenitis.

ii. Acute gastro enteritis.

iii. Urinary tract infection

iv. Meckel’s diverticulitis

v. Intussusceptions

vi. Regional enteritis

vii. Primary peritonitis

viii. Perforated peptic ulcer

ix. Intestinal obstruction

SPECIFIC MEDICAL/ SURGICAL TREATMENT

The treatment of appendicitis could be either conservative or surgical.

CONSERVATIVE TREATMENT

If a mass is present, conservative treatment is given. The patient is not to take anything

orally. Intravenous infusion is administered to replace fluid loss. If the patient responds to

antibiotics, the mass reduces in size; oral fluids may then be introduced over the next few days.

Metronidazole (flagyl) is used to control bactericides and some other bacteria that cause the

infection. It could be given in the form of tablet, orally or through intravenous route. Drugs in the

cephalosporin group such as cefuroxine (zenacef) 250-500mgs intramuscularly or intravenously

could be used to kill the bacterial and prevent septicemia.

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 Broad spectrum antibiotics like Ampicillin may be used. When the patient has peritonitis,

intravenous fluid is administered and he is put on nil per os whiles the stomach is kept empty by

the passage of gastric tube to drain its contents.

Adequate rest is ensured until bowel sounds returns, the patient is not allowed to take anything

by mouth.

SURGICAL TREATMENT

When conservation treatment fails, surgical intervention is done. Appendectomy is done

to remove the vermiform appendix. Appendectomy is usually done through an incision in the

right lower quadrant of the abdomen.

Drainage tubes are used when an abscess is discovered. From the two forms of treatment

discussed, the surgical intervention is the best since it enhances faster recovery and prevents

recurrence of the condition and complications.

POST-OPERATIVE COMPLICATIONS

i. Hemorrhage

ii. Wound infection

iii. Intra abdominal infection

iv. Faecal fistula

v. Intestinal obstruction

vi. Pelvic abscess

vii. Recurrence due to incomplete resection of the appendix.

viii. Sub phrenic abscess

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NURSING MANAGEMENT

Bed rest and Comfort:

1. The patient should be given complete bed rest and made comfortable in bed.

2. Nursing activities should be organized in order not to interfere with sleeping time.

3. Patient should be nursed in a quiet environment.

4. Change linen when dirty or soiled

5. Administer analgesic for pain killers

Observation:

1. Monitor vital signs 4 hourly which are temperature, pulse, respiration and blood pressure.

2. Observe for side effects of drugs that are rashes, urticaria, pruritis and others.

3. Observe patients mental status.

4. Observe urine for blood and amount.

5. Patient body weight must be checked daily.

Nutrition

1. The client must be given a balanced diet with high calories and protein.

2. Liberal fluids must be encouraged.

3. Plan diet with patient and family.

4. Serve food in a nice and attractive way.

5. Encouraged intake of fruits after meal.

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Personal hygiene

1. Patient must be given bed bath and tepid sponging to reduce temperature and to make

him / her neat.

2. The perineum will be cared for after every defecation and micturition.

3. Care of the mouth will be given at least twice daily.

4. Clothes will be changed if soiled.

5. Hands and feet will be taken care of.

6. Hands will be washed after every defecation and micturition to prevent further infections.

Medication:

1. Administer antibiotics and other drugs as ordered and at the appropriate time.

2. Administer antipyretics and analgesics as ordered and at the right time.

Health Promotion:

1. Teach patient and family proper treatment of water before use such as boiling to kill parasites.

2. Encourage patient and family to take in balanced diet to boost the immune system.

3. Encourage patient and family to adhere to treatment and follow up visit to nearby hospital

Psychological Care:

1. Reassure patient and family of speedy recovery and competent staff.

2. Educate patient and family on the causes, signs and symptoms and complications of the

disease.

3. Explain all routine procedures before commencing.

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4. Introduce patient and family to people who have recovered successfully from acute

appendicitis.

5. Allow patient and family to express his outburst since it may be as a result of his/her

condition.

Protection:

1. Nurse patient on a low bed.

2. Floor should be mopped of all spillages.

3. Nurse patient in a well-lighted room.

4. All sharps and injurious equipment should be placed in a safe place.

5. All personal properties should be placed within the reach of patient.

VALIDATION OF DATA

This is the act of confirming or verifying the data collected from patients and their relatives

to ensure that it is free from bias, errors and misinterpretation. The data on Master P.G. was

collected from the patient himself, the uncle and other relatives. It was then confirmed by

laboratory investigations and the Doctors and Nurses. Assessment and observation was also

found to be valid.

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 CHAPTER TWO

ANALYSIS OF DATA

Analysis of data is the systematic examination of all the data collected during assessment. It is

the second step in the nursing process.

Analysis of data involves:

a. Comparison of data with standards.

b. Patient /family strengths

c. Health problems.

d. Nursing diagnosis.

COMPARISON OF DATA WITH STANDARDS DIAGNOSTIC INVESTIGATION

The following investigations were ordered and carried out on Master P.G

i. Haemoglobin level estimation

ii. White Blood Cell count

iii. Sickling test

iv. Malaria parasites

v. Urine for routine examination

vi. Blood for grouping and cross-matching

Details of the above investigations are found in table 1.

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Table 1: Diagnostic Investigations Carried Out on Master P.G

DATE SPECIMEN INVESTIGATION RESULTS NORMAL INTERPRETATION REMARKS

/TEST VALUES

23/06/19 Blood Hemoglobin level 15.1g/dl 11.5 to Haemoglobin level was No treatment given.

Estimation 16.5 g/100ml Within the normal

Range

23/06/19 Blood Sickling test Negative Negative normal Normal No treatment given.

no abnormal biconcave disc

shape shape RBC

of RBC

23/06/19 Blood White Blood 15.1 x 109/L 4X109/L Indication for infection Antibiotics ordered

Cell count to and administered

11x109/L

23/06/19 Blood Malaria Parasite Negative Negative Absence of malaria No treatment given.

parasite

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 in blood

23/06/19 Urine Urine for routine

Examination

PH 6.5 4.5-8.0

Glucose Negative Negative

Protein Negative Negative

Nitrite Negative Negative No indication for urine No treatment required

Ketones Negative Negative infection.

Bilirubin Negative Negative

Blood Negative Negative

Leukocytes Negative Negative

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23/06/19 Blood Grouping and Cross O RhD Blood group A, B, Normal blood group No treatment given.

Matching Positive ‘O’ with rhesus compactible with blood

positive or negative group ‘O’ rhesus

positive.

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CAUSES

With reference to the textbook causes as seen in the literature review, Master P.G’s condition

might have occurred as a result of inflammation of the mucosa of the appendix because there

were secretions collected in the tube causing distention which resulted in pressure on the blood

vessels.

SIGNS AND SYMPTOMS

Table 2: Comparison of Signs and Symptoms Manifested By Master P.G. With Standard

CLINICAL FEATURES OUTLINED THOSE PRESENTED BY MASTER P.G

UNDER THE LITERATURE REVIEW

1. Abdominal pains Patient experienced Abdominal Pains

2. Vomiting Patient experienced vomiting

3. Nausea Patient experienced Nausea

4. Loss of appetite Patient experienced loss of appetite

5. Insomnia Patient experienced Insomnia

6. Increased pulse rate Patient experienced increase pulse rate

7. Pyrexia Patient did not experienced pyrexia

8. Halitosis Patient did not experienced Halitosis

9. constipation Patient did not experienced constipation

10. Restlessness Patient experienced Restlessness

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TREATMENT/PHARMACOLOGY OF DRUGS

MEDICAL TREATMENT GIVEN TO MASTER P.G

In the case of Master P.G, surgical intervention, appendectomy was carried out. The following

were the drugs prescribed for him pre and post operatively.

Pre Operative Treatment

i. Intravenous Dextrose saline 500 mg four hourly for four days.

ii. Intravenous Ringers Lactate 500 mg four hourly for four days

iii. Intravenous ciprofloxacin 400 mg bd for two days.

iv. Intravenous flagyl 500 mg eight hourly for two days.

Post Operative Treatment

i. Intravenous Dextrose Saline 500 mg four hourly for three days.

ii. Intravenous Ringers Lactate 500 mg four hourly for four days

iii. Intravenous ciprofloxacin 400 mg twelve hourly for three days.

iv. Intravenous flagyl 500 mg eight hourly for two days.

v. Diclofenac 75mg 12hourly for two days

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Details of the above can be found on table 3.

123
Table 3; Pharmacology of Drugs Used for Master P.G

DATE DRUG DOSAGE/ROUTE CLASSIFICATION DESIRED ACTUAL SIDE

OF EFFECTS ACTION EFFECTS/

ADMNISTRATION. OBSERVED REMARKS

22/06/19 5% Dextrose in 500mls 4 hourly Infusion nutrition. 1.To replace 1. Patient was Pulmonary

0.9% normal for 4days glucose fluidloss rehydrated. oedema,glucos

saline intravenously (carbohydrate) 2.To provide 2. He got energy uria,heart

energy 3.He regained her failure,

strength osmotic

diuresis,

confusion

None was

observed

22/06/19 Ciprofloxacin 400mg bd for 2 Antibacterial and Bactericidal 1. No infection Dizziness,

days intravenously antibiotic agent action against was observed rash, nausea,

gram-positive

124
 organism vomiting,

staphylococcu depression.

s epidermides None of the

above was

observed

22/06/19 Metronidazole 500mg 8 hourly for Antibacterial and It No infection was Nausea,

(flagyl) 2days intravenously antiprotozoal agent inhibitsamoeb observed vomiting,

iasis and gastro

giadiasis and intestinal

also bacterial disturbance,

infection unpleasant

metallic taste.

None was

observed

125
22/06/19 Diclofenac 75mg 12 hourly Non-steroidal anti- To relieve 1. Swollen of Headache,

(Naklofen) for 2 days inflammatory pains, incision site was edema and

intramuscular drug(NSAID) inflammation reduced. rashes.

and swelling 2.Patient was None was

relieved of pain observed.

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COMPLICATIONS

With reference to the complications listed under the literature review, none of the complications

was developed by Master P.G during the period of hospitalization.

PATIENT/FAMILY STRENGTHS IDENTIFIED

A patient strength is those resources and abilities that can help him cope with the stress.

During the analysis, the following strengths were identified on Master P.G.

1. He was educated and could speak English and understand his disease condition easily.

2. He had no known allergies to food or drugs

3. He had support from the family and significant others.

4. The patient and his family were co-operative.

5. His family and relatives as well as the church members supported him during his care by

paying him regular visits at the hospital.

6. His family was supportive and financially sound.

HEALTH PROBLEMS IDENTIFIED

A health problem is any physical, social or psychological stress on a patient that can cause a

change to his health. The following were the health problems identified on Master P.G. during

his hospitalization.

1. Risk of airway obstruction during the immediate post-operative period.

2. Pain at incision site

3. Anxiety/fear

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4. Master P.G. lacks knowledge regarding his condition.

5. Risk for dehydration as a result of nil per os

6. Patient could not attend to his hygienic needs normally

7. Inability to sleep.

8. Wound at incision site.

9. Bleeding at site of incision

NURSING DIAGNOSES

From the health problems identified during the analysis of Master P.G the following Nursing

diagnoses were made which were based on prioritization:

1. Risk for airway obstruction related to effect of general anaesthetic agents.

2. Alteration in comfort(pain) related to disease condition(acute appendicitis)

3. Anxiety related to impending operation

4. Knowledge deficit related to lack of exposure to the causes, manifestation and treatment

regimen of the disease condition.

5. Potential for fluid volume deficit related to nil per os.

6. Self-care deficit (partial) related to intravenous infusion, catheter and nasogastric tube

insitu.

7. Disturbance in sleeping pattern related to change of sleeping place from home to the

hospital ward.

8. Impaired skin integrity related to surgical wound.

128