Or Vega Villarta

ST.
PAUL UNIVERSITY DUMAGUETE

COLLEGE OFNURSING
DUMAGUETE CITY
2nd Semester, A.Y.2022 – 2023
IN PARTIAL FULFILLMENT OF THE REQUIREMENT

IN NCM 112 A RLE (RELATED LEARNING
EXPERIENCE)
Clinical Paper:
Case Study on a patient with
Acute Gangrenous
Appendicitis
SUBMITTED TO:
Ms. Nicole Ann Llamada RN,
SUBMITTED BY:
Vega, Sean Mevrick T.
Villarta, Melba Lu Veronica
G.
October 28,
2023 DATE
SUBMITTED
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ST. PAUL UNIVERSITY DUMAGUETE
COLLEGE OFNURSING
DUMAGUETE CITY
Table of Contents
ACKNOWLEDGEMENTS.................................................................................................................................4
Abstract....................................................................................................................................................5
Introduction...........................................................................................................................................5
Objective..................................................................................................................................................6
KNOWLEDGE:................................................................................................................................................6
SKILLS:.......................................................................................................................................................6
ATTITUDE:..................................................................................................................................................6
Scope...........................................................................................................................................................7
Limitation................................................................................................................................................7
CHAPTER II...............................................................................................................................................8
CASE DATA AND INFORMATION............................................................................................................8
Patient’s Biographical Data.......................................................................................................8
HEALTH HISTORY ASSESSMENT............................................................................................................8
PAST HEALTH HISTORY..........................................................................................................................9
Genogram..................................................................................................................................................11
Interpretation....................................................................................................................................11
Functional Health Patterns.......................................................................................................12
PHYSICAL ASSESSMENT........................................................................................................................21
LABORATORY EXAMINATIONS..............................................................................................................25
Interpretation:..........................................................................................................................26
Urinalysis [October 19, 2023]........................................................................................26
Interpretation:..........................................................................................................................27
DIAGNOSTIC IMAGING STUDIES.......................................................................................................28
Patient ID: 2200156159.........................................................................................................28
Parts and Type of Examination: Whole Abdomen....................................................28
CHAPTER III...........................................................................................................................................30
LITERATURE REVIEW............................................................................................................................30
Related Literature..........................................................................................................................30
Normal Anatomy and Physiology................................................................................................32
Figure 2. 1...........................................................................................................................................32
Overview of the Digestive System and their functions........................................32
Figure 2.2.............................................................................................................................................34
The Abdominal Regions...................................................................................................................34
Theoretical Background.................................................................................................................37
CHAPTER IV.............................................................................................................................................39
CASE ANALYSIS AND INTERVENTIONS...........................................................................................39
Pathophysiology..................................................................................................................................39
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MEDICAL-NURSING MANAGEMENT.......................................................................................................40
PHARMACOLOGY/ DRUG STUDY...........................................................................................................41
Progress Notes...................................................................................................................................45
NURSING CARE PLAN............................................................................................................................46
DISCHARGE PLAN....................................................................................................................................55
Chapter V:.............................................................................................................................................58
CONCLUSION AND RECOMMENDATION................................................................................................58
Recommendation............................................................................................................................59
References.............................................................................................................................................60
Anatomy, head and neck, oral cavity (mouth) - statpearls - NCBI
bookshelf. (n.d.). https://www.ncbi.nlm.nih.gov/books/NBK545271/...........60
Pharynx. Pharynx | SEER Training. (n.d.).
https://training.seer.cancer.gov/anatomy/respiratory/passages/pharynx.
html
.....................................................................................................................................................................
60
%20meatus..............................................................................................................................................60
Appendices.............................................................................................................................................62
Personal Background........................................................................................................................63
Educational Background................................................................................................................63
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ACKNOWLEDGEMENTS
The student nurses would like to convey their deep appreciation to all
the individuals who have significantly contributed to the successful
completion of their clinical rotation.
First and foremost, they express profound gratitude to the Divine for
granting them this incredible chance to engage in clinical duties and
expand their knowledge, particularly in the realm of pediatric
patients.
They extend their most sincere thanks to their exceptional clinical
instructor, Ms. Nicole Ann Llamada, RN, whose consistent guidance and
mentorship have accompanied them throughout the entire rotation. Her
wealth of knowledge and expertise have been invaluable in shaping
their skills and enabling them to carry out their responsibilities
with the utmost proficiency.
Furthermore, they would like to express their heartfelt appreciation

to the dedicated staff at the Negros Oriental Provincial Hospital
Operating Room Department. Their patience, unwavering support, and
steadfast dedication have fostered an environment in which the student
nurses have felt comfortable and empowered to learn and develop.
Last but certainly not least, they wish to convey their deep gratitude
to their patient and her significant other. Their cooperation,
patience, and understanding during the student nurses' interviews and
physical assessments have played an instrumental role in their growth
as healthcare professionals. Their trust in the student nurses and
their active participation in the learning process have indeed been
invaluable.
The student nurses are thankful for the efforts and contributions of
each individual involved, as they have played a pivotal role in
ensuring the success of their clinical rotation. Their dedication,
wealth of knowledge, and unwavering support have shaped the student
nurses' journey, and they feel privileged to have had the opportunity
to learn and develop under their guidance. Their collective efforts
have made this clinical rotation an extraordinary and transformative
experience.
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Abstract
One day prior to admission, onset of epigastric pain with one episode
of vomiting. Consult was done with labs ordered. Urinalysis and
Prothrombin Time done both result negative. CBC done showed increased
in white blood cells with neutrophilic predominance. Managed as non-
ulcerative dyspepsia initially. One night prior, patient had
recurrence of vomiting. Pain radiated at right lower quadrant with
mild rebound tenderness and onset of low-grade fever (38°C).
Ultrasound of whole abdomen with appendix requested. Morning prior,
patient was sent to Dumaguete City for ultrasound, and result showed
acute appendicitis. This prompted this referral. This case underscores
the significance of swift evaluation, the correct administration of
medications, and continuous observation in the management of
hypogastric pain and vomiting in pediatric patients. The goal is to
deliver efficient relief and guarantee the best possible care for the
patient.
Introduction
This case study presents the admission and initial management of a

patient known as M.F.J., who was admitted to Negros Provincial
Hospital due to acute gangrenous appendicitis.
Appendicitis is a medical condition characterized by the inflammation
of the appendix; a small pouch-like organ situated in the lower right
side of the abdomen. When the appendix becomes inflamed, it can lead
to severe abdominal pain, nausea, vomiting, and other symptoms. In
many cases, appendicitis requires surgical removal of the appendix, a
procedure called an appendectomy, to prevent the appendix from
rupturing, which can be a life-threatening complication. Prompt
diagnosis and treatment are essential to manage this condition
effectively.
The student nurses selected this case as they saw it as an opportunity
to enhance their knowledge and competencies, as well as to test their
abilities in a clinical environment. The primary objective of this
investigation was to present a comprehensive overview of the patient's
clinical symptoms, laboratory results, and the initial treatment
delivered upon admission. Grasping the patient's clinical indicators,
diagnostic assessments, and the correct therapeutic methods is
fundamental for ensuring the best patient care and achieving favorable
patient results. Through a thorough examination of the patient's case,
they hope to acquire insights into the assessment, intervention, and
interdisciplinary cooperation required for the effective treatment of
acute gangrenous appendicitis in patients. Furthermore, this case
study will illuminate the obstacles faced and the educational
opportunities encountered during their clinical journey as student
nurses.
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Objective
The primary goals of this case study regarding a patient with acute
gangrenous appendicitis are to foster a comprehensive comprehension of
the patient's clinical display, laboratory results, and the management
of acute gangrenous appendicitis in individuals. By delving into the
patient's state, symptoms, medical background, and therapy results,
nursing practitioners can gain beneficial insights into the most
effective approaches and actions for dealing with this particular
medical condition. The intention of this case study is to advance
nursing practitioners' understanding and capabilities, which are
necessary for evaluating, diagnosing, strategizing, implementing, and
assessing care for patients with acute gangrenous appendicitis. By
addressing the distinct complexities and considerations linked with
these situations, nursing experts can enrich their capacity to offer
patient-focused care, boost favorable results, and optimize the
overall wellness of the patient.
KNOWLEDGE:
To comprehensively record the patient's information, this entails the
thorough documentation of all pertinent particulars, observations,
appraisals, actions, and consequences associated with the management
of acute gangrenous appendicitis. Through the meticulous and organized
documentation of this case study, it functions as a valuable reference
for healthcare experts, researchers, and educators. It allows for an
intricate scrutiny of the patient's state, the approach to treatment,
and the reactions to medical procedures. Furthermore, exhaustive
documentation streamlines forthcoming research, initiatives to enhance
quality, and evidence-based practices. It empowers healthcare
providers to gain insights from the case, pinpoint recurring themes or
developments, and make informed decisions to enhance patient care.
Ultimately, the documentation of this case study contributes to the
cumulative knowledge within the realm of nursing and fosters the
delivery of first-rate, evidence-driven care to comparable patients in
the times ahead.
SKILLS:
Enhance their communication, critical thinking, collaboration, and
professional development. Through active engagement in discussions and
integration of feedback, student nurses have the opportunity to refine
their comprehension of the case study and bolster their analytical and
critical thinking abilities. They can explore different perspectives,
delve into alternative approaches, and deepen their grasp of the
subject matter. This collaborative process fosters a more
comprehensive and holistic case study that mirrors the combined wisdom
and proficiency of the nursing community. Additionally, participating
in constructive dialogues empowers student nurses to be proactive
contributors to the ongoing advancement of the nursing profession. By
sharing their insights, experiences, and reflections, they can
actively contribute to the continuous enhancement of nursing practice
and the provision of patient- centered care.
ATTITUDE:
Encouraging the cultivation of effective teamwork, seamless
cooperation, and robust collaboration within the team is vital for
nurturing a sense
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of camaraderie and achieving success during the case study.
Prioritizing these elements allows student nurses to establish a
united and efficient team environment. This, in turn, empowers them to
collaborate synergistically, leverage the unique strengths of each
team member, and ultimately deliver the highest quality of care for
the patient with acute gangrenous appendicitis.
Scope
This clinical research paper delves into the case of a patient who was
admitted to Negros Oriental Provincial Hospital on account of acute
gangrenous appendicitis. The investigation encompasses vital data such
as the patient's personal history, chief complaints, medical and
familial background (obtained through a genogram), clinical
indications, and results from laboratory tests. Furthermore, this
study closely examines the patient's current status, scrutinizing
their lab outcomes, pharmacological therapies, and the three foremost
nursing diagnoses as identified by the student nurses. All the
discoveries and particulars derived from this clinical investigation
are thoroughly documented within this paper.
Limitation
This case study revolves around a pediatric patient who presented with
acute gangrenous appendicitis. The student nurses were involved in
providing care for a single day, specifically on October 19, 2023, and
as a result, any data beyond this date is not incorporated in the
study. Nonetheless, the data pertaining to these aspects was sourced
from the patient's mother. The key sources of information utilized for
this clinical paper encompassed the patient's medical records, direct
interactions, and an interview with the patient and the mother.
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CHAPTER II
CASE DATA AND INFORMATION
Patient’s Biographical Data
Client’s Name:M.F.J
Age: 17 years old
Sex: Female
Address: Cangabo,La Libertad,Negros Oriental
Date of Birth: January 27, 2006
Place of birth: La Libertad, Negros Oriental
Citizenship: Filipino
Race/Ethnicity: Asian
Civil Status: Child
Religion: Protestant
Educational Attainment: Senior High
Date of Admission: October 19, 2023
Time of Admission: 12:30 PM
Healthcare Financing: None
Source of Income: Student
Usual Source of Medical Care: Holy Child Hospital, Negros Oriental
Physician: Dr. A.J.U
Admitting Diagnosis: Raptured Appendicitis
HEALTH HISTORY ASSESSMENT
ADMITTING DIAGNOSIS: Nephrolithiasis
SOURCE OF INFORMATION:
PATIENT – 60%
Significant other – 20%
Medical Records – 20%
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REASONS OF SEEKING/ CHIEF COMPLAINT: “Nikalit ra gud ug sakit ang
akong kilid sa tuo. Sa ubos dapit unya giingnan nako dayon si mama,”
as verbalized by the patient.
HISTORY OF PRESENT ILLNESS

Two days prior to admission, the patient had onset of epigastric pain
radiating to the right. The patient tolerated the condition. One day
prior to admission, the patient had onset of 8 vomiting episodes,
sought consult again and referred to Polymedic Hospital to have an
ultrasound which then showed appendicitis.
PAST HEALTH HISTORY
SERIOUS CHILDHOOD ILLNESSES
The patient had a history of chickenpox in her early years.
HOSPITALIZATIONS
No past admissions.
PSYCHOLOGICAL PROBLEMS
The patient has no psychological problems.
SURGERIES
No past surgeries.
SERIOUS INJURIES
The patient has an experience of a serious injury when she was in the
first grade. She crashed against a cement block causing an injury in
the chin and had stitches.
SERIOUS/CHRONIC ILLNESS
The patient has a history of chickenpox, past colds, and fever.
IMMUNIZATION
The patient has undergone immunization such as Janssen Pfizer with
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booster for COVID-19.
ALLERGIES
The patient has no known allergies.
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Genogram
Interpretation
On the patient's maternal side, both grandparents are alive and well,
however her grandmother has hypertension. The patient's mother has
four siblings and all are healthy. On the paternal side, both
grandparents are also alive and well and are free of disease. The
patient's father died due to electrocution on the year 2018. Siblings
are all alive and well. There are no hereditary factors that led up to
the patient's disease. Lifestyle and other predisposing factors
contribute to her illness.
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Functional Health Patterns
Functional Prior to During Justification

Health Admission Hospitalization
Pattern
Health
Perception Before being The patient was While the
and Health admitted, the admitted to address patient had no
Management patient has her severe prior
Pattern previously abdominal pain, hospitalizations
been prompting a series , she does have
hospitalized of diagnostic tests a degree
in 2022 for to pinpoint the of
the same exact cause of her familiarity with
abdominal discomfort. The the healthcare
complaint, initial diagnosis system, which
indicating before the surgery has equipped her
familiarity was uncomplicated with an
with the acute appendicitis, understanding of
hospitalization but after the the importance
process. The appendectomy, the of promptly
patient does post-operative addressing her
not take any diagnosis revealed current health
medications at acute gangrenous concerns. This
home but appendicitis. The acquaintance
regularly patient possesses a with the
consumes clear understanding healthcare
Celine of her condition system is a
(Chewable) as and the reason for crucial
a vitamin C her hospital stay. component of
supplement. She acknowledges health
For the two the urgency perception,
days leading of seeking prompt shaping her
up to medical care due to subjective
admission, the the intensity of assessment of
patient has her pain, her own well-
been recognizing its being. It enables
experiencing pivotal role in her her to better
intense pain path to better comprehend her
in the lower health. health status
abdomen, rated and recognize
at 8 out of 10 the significance
on a pain of
scale, and has seeking medical
also vomited. care to enhance
Drinking warm her present
water and condition. This
resting experience is
provides some likely to
relief for the provide her
pain. with
additional
knowledge that
will influence
her behavior and
expectations
during her
recent
hospitalization,
ultimately
making her
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better
prepared and more
cooperative in
her care plan.
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Nutrition Before The patient This commitment
and hospitalization follows the to following the
Metabolism , the patient prescribed prescribed diet
adheres to a diet as is essential for
consistent tolerated the patient's
daily meal plan well-being, as
schedule, recommended by it ensures that
enjoying the doctor. she receives
breakfast at 7 While at the the
a.m., lunch at hospital, the necessary
12 p.m. patient nutrients and
followed by typically sustenance to
afternoon finishes the aid in her
snacks, and nutritious healing process.
dinner at 7 meals provided Moreover, the
p.m., typically to her. support and
prepared by the However, the involvement of
patient’s patient also the patient's
mother. The consumes mother in
meals often snacks and providing
consist of drinks additional
convenient brought by the snacks and drinks
options like patient’s demonstrate the
canned goods mother. All in importance of
and instant all, she has a familial support
noodles, with balanced and the role it
dining out diet meal plays in
reserved for plan complementing
special during her the hospital's
occasions. The hospitalizatio efforts in
patient’s n which aides delivering well-
breakfast is in her faster rounded care to
typically at recovery. the patient.
home, and the This
patient’s collaboration
mother prepares between
a healthcare
packed lunch to professionals
take to school. and the
For snacks, the patient's
patient family enhances
frequently her overall
indulges in experience and
junk food contributes to a
accompanied by more successful
carbonated recovery.
beverages and
maintains a
daily water
intake of 2 to
3 glasses. The
patient does
not have any
known food
allergies and
is generally
flexible with
dietary choices
but doesn’t
usually like to
eat vegetables.
In summary, the
patient does
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not experience
any
notable feeding-
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related
problems.
Elimination The patient The patient's Typically,
Pattern maintains bowel elimination the presence
regular bowel pattern appears to of an
habits, be normal, without intravenous
typically any noticeable fluid (IVF)
having 2-3 irregularities or can alter
bowel abnormalities. the
movements per Despite the frequency of
day. In terms presence of an urination as
of urination, intravenous fluid the
she voids up (IVF), the additional
to 2-3 times patient's usual fluid is
daily. pattern of continuously
There are no urination remains infusedinto
indications of unaffected. The the body.
excessive administration of However, in
sweating or the IVF does not the case of
perspiration. cause any this patient,
These normal significant her regular
patterns of changes or pattern of
bowel disruptions to the elimination
movements, patient's urinary and urination
urination, habits or frequency
and absence frequency of remains
of excessive urination. This unaffected
sweating suggests that the despite the
suggest a IVF does not administration
healthy interfere with the of theIVF.
functioning patient's natural This suggests
of the urinary patterns. that the
patient's patient's body
digestive is efficiently
andurinary processing and
systems. balancing the
additional
fluid,
allowing her
to maintain
her normal
urination
routine
without any
significant
changes.
Sleep-Rest The patient The patient adheres To ensure the

Pattern maintains a to a steady sleep patient’s proper
regular sleep schedule, retiring recovery, the
pattern, to bed at 9 p.m. medical team has
usually However, the recommended that
retiring to bed patient’s sleep is the patient
occasionally
between 9 to 10 observes bed
disrupted due to
p.m. and rising rest throughout
the discomfort
at 5 a.m. in the the
the morning. patient experiences hospitalization.
This consistent from the surgical While
sleep routine incision in the the
is a interruptions in
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positive sign, abdomen. This is a the patient’s
as it indicates common occurrence sleep can be
a degree of following abdominal frustrating, the
sleep hygiene surgery, as theprescribed bed
and can pain and tenderness rest is
contribute to around the incision essential for
site can make
overall well- the healing and
finding a
being. recuperation
comfortable
Furthermore, sleeping positionprocess. During
there no challenging. this period, the
incident of the body has the
patient having opportunity to
nightmares or focus on tissue
suddenly waking repair and
up during the recovery, aiding
patient’s hours in a swifter and
of sleep. more efficient
recovery from
the surgery.
It's
important that
healthcare
providers manage
the patient's
pain adequately
to minimize
disruptions in
sleep and ensure
the patient gets
the rest
necessary for
overall well-
being and
healing.
Activity- The patient The patient depends The patient's
Exercise follows a on the mother's ongoing medical
Pattern regular daily support and condition and
routine that oversight for hospital stay
involves various daily markedly affect
attending activities such as the capacity to
school during independently
eating, washing,
the day and perform daily
grooming, personal
returning home activities.
in the hygiene, and using Consequently,
afternoon. the toilet. The the patient
During the patient’s depends on the
patient’s free functional self- mother's
time, the care assessment assistance and
patient uses indicates a level supervision to
cellphone for 2, signifying that fulfill these
entertainment. the patient needs tasks. The
The patient help and constraints
helps in the supervision to posed by the
household accomplish these health
chores as well condition
tasks. This
as in their necessitate the
reliance on
sari-sari presence of the
assistance is mother, who
directly connected plays
a crucial role in
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store. The to the patient’s supporting
patient existing medical various aspects
maintains good condition, which of the patient's
habits of body hampers the daily routine.
and oral capacity to In essence,
hygiene, autonomously manage the
demonstrating a patient’s
these activities.
high level of illness has
In
self-care. resulted in a
Based on the essence, the reliance
relevant patient’s illness on
assessment has rendered external
code, she reliant on external assistance for
displays full support for these these essential
self-care at fundamental aspects everyday
level 0, of daily living, tasks,
indicating her emphasizing the underscoring the
ability to impact of her profound
independently health condition on influence of the
meet her day-to- day life. health status on
personal care the patient’s
needs without self-
assistance. sufficiency.
Cognitive The patient The patient's The patient's
Pattern doesn’t have cognitive current health
any development have condition does
complications shown no signs of not affect the
with regards to decline or development of
hearing, disruption the cognitive
vision, or throughout the abilities.
learning hospitalization.
difficulties.
Self- The patient The patient noticed The patient's
Perception generally a decline in weight observation of
- Self experiences a as the symptoms weight loss
Concept sense of well- began to appear. aligns with
Pattern being and The patient’s loss common
satisfaction of appetite during experiences when
with the this period facing health
patient’s contributed to this issues. In this
overall weight change. The case, the loss
physical patient has also of appetite due
condition. become reliant on to the symptoms
However, the the mother for likely
patient does assistance with contributed to
have moments of daily activities as this weight
annoyance, the condition has change, which is
particularly limited a common
when the independence. occurrence when
patient feels However, despite individuals are
that the person these challenges, unwell.
the the patient Furthermore, the
patient is maintains a hopeful patient’s
communicating and optimistic increasing
with isn't outlook on the reliance on the
actively situation. mother for help
listening, with daily
which can then activities
escalate to highlights the
frustration. impact of the
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condition on the
ability to
maintain
independence.
This illustrates
the critical
role the mother
plays in the
daily life during
the
illness.
However, the
patient's
ability to stay
hopeful and
optimistic is a
valuable
asset. Such
a positive
outlook can have
a profound
influence on the
coping
mechanisms and
overall well-
being. It can be
a source of
strength
during the
journey to
recovery and can
significantly
impact on the
quality of life.
Roles- The patient The patient's The patient's
Relationshi resides solely mother conveyed her mother's
pPattern with the mother feelings of sadness emotional state
following the about her child reflects a mix
passing of the needing an of concern
father. Despite operation, although and sadness
dealing with she recognizes the as she grapples
the challenges necessity of the with her child's
of the procedure for the need for
patient’s patient's health surgery. Despite
current medical improvement. With the emotional
condition, the the patient challenge, she
education currently in the is well aware of
remains a hospital, she the essential
significant cannot socialize nature of the
part of life, with procedure for
and reports friends until her child's
that the discharge. health and,
patient is Fortunately, the therefore,
doing well in family's income is supports it. The
school. adequate to support patient's
Additionally, both the mother and hospitalization
the patient the patient, has temporarily
enjoys a robust covering the disrupted the
social life, expenses related to patient's usual
with close hospitalization, social
friends both at thanks to the activities, such
school and assistance provided as spending time
within their by their health with friends, as
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local insurance. she needs to
neighborhood. focus on her
These recovery.
friendships
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likely provide However, the
emotional family's
support, financial
particularly situation is
during the reassuring, as
patient’s their income is
illness, and sufficient to
contribute to cover their
the overall living expenses
well-being. and the costs
associated with
the patient's
hospitalization.
Notably, the
burden of these
medical expenses
is lightened by
their health
insurance, which
plays a crucial
role in ensuring
that the patient
receives the
necessary care
without straining
the family's
finances. This
overall situation
demonstrates the
importance of
both emotional
and financial
support in
helping the
patient and her
family navigate
this challenging
period of medical
treatment.
Sexuality- The patient had The patient's sexual The patient's
Reproductiv her first and reproductive sexual and
e Pattern menstruation at concerns remain reproductive
the age of 12, unaffected by her well-being have
and since then, hospitalization and remained
she has current health consistent and
maintained a condition. Her unaltered despite
consistent admission to the her current
menstrual cycle. hospital has not led hospitalization
During her to any issues or and health
menstruation, dysfunction in her condition. This
she typically reproductive organs means that her
uses two or sexual health. ability to engage
menstrual pads in sexual
per day for a activity and her
duration of one reproductive
week. Her most system's
recent menstrual functionality
period occurred have not been
in the third negatively
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week of impacted by her
September. hospital stay or
medical
condition. In
other words, she
can still
maintain
her
sexual health
and reproductive
capabilities as
she did before
being admitted
to the hospital.
This is an
important aspect
to consider when
evaluating the
overall impact
of her medical
condition and
treatment.
Coping- The patient's The patient's During the
Stress life has been mother's presence patient's
Tolerance relatively and attentive care hospitalization,
Pattern stable over the are instrumental in her mother's
past year, with providing the constant
no major emotional support presence and
upheavals or needed during her
dedicated
significant hospitalization.
care play a
changes. The The patient derives
patient comfort from crucial role in
generally engaging in offering the
maintains a activities such as emotional
calm and relaxed using her phone or support
demeanor in her talking with essential for
day-to-day her family, which her well-being.
life. When the serve as effective The
patient coping mechanisms emotional
experiences in dealing support provided
discomfort, she with by
typically the challenges and family members,
manages it with uncertainties of
particularly
over-the- her hospital stay.
during a
counter pain These activities
relievers like act as valuable hospital stay,
paracetamol, distractions and can
indicating a sources of significantly
self-reliant relaxation, impact a
approach to assisting the patient's
minor health patient in experience and
issues. navigating her recovery. In
Additionally, current situation this case, the
when challenges and promoting a patient's mother
or problems sense of comfort serves as a
arise, the and normalcy within pillar of
patient seeks the hospital emotional
support and environment.
support,
advice from her
mother or close offering
friends. These reassurance and
comfort in an
otherwise
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unfamiliar and
sometimes
stressful
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support environment.
networks play a Additionally,
crucial role the patient
in engages in
addressing activities
issues, such as using
although they
her phone and
might take some
talking with her
time to
resolve, the family as
patient and her coping
support system mechanisms.
have been These activities
successful in serve as a
finding source of
solutions. distraction and
relaxation,
allowing the
patient to
temporarily
shift her focus
away from
the
challenges and
uncertainties
associated with
her
hospitalization.
Distraction and
relaxation play
an important
role in helping
the patient
navigate her
situation,
manage stress,
and maintain a
sense of
normalcy and
comfort
within the
hospital
setting. These
activities
provide a sense
of control and
familiarity,
contributing to
the patient's
overall
emotional well-
being during her
hospital
stay.
Value- In the Due to her This dedication
Belief patient's future hospitalization, is a testament
Pattern plans, the patient is to the patient's
she aspires to unable to attend unwavering
pursue a career Mass on Sundays. faith, even in
as a teacher. However, this the face of
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Religion holds situation does not health
a significant diminish her faith challenges and
place in or devotion to the disruptions to
her her usual
life, serving as
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a source of Lord. She remains routines. For
strength that committed to her many
keeps her in a daily prayers, individuals,
positive frame finding solace and attending
of mind. strength through religious
Together with her ongoing services is an
her mother, the religious essential part
patient engages practices. of their faith
in daily and spiritual
prayer, and connection.
they make it a Despite her
practice to inability to be
attend church physically
regularly, present at
particularly on church, the
Sundays, to patient's
partake in the continued daily
Mass. prayers are a
means of
maintaining her
spiritual bond
and
demonstrating
her resilience
in upholding
her
faith during
challenging
times. Her
commitment to
prayer reflects
the strength of
her religious
convictions and
the importance
of spirituality
in her life,
even in
the hospital
setting.
PHYSICAL ASSESSMENT
1. General appearance and Mental Status:
- The patient’s body type is petite and appropriate for her age.
- not very well-groomed when assessed
- affect is weak and tries her best to respond to questions being asked
- The patient is conscious and alert to surroundings, people, and
situations.
A. Vital Sign Measurement:
VITAL SIGNS MEASUREMENT

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October 19, 2023 October 20,2023
Pre- Intra- Post- 7 A.M
operative
operative operative
Temperature 36.1 36.4 36.1 36.1
Pulse Rate 114 bpm 117 bpm 103 bpm 93 bpm
Respiratory 26 cpm 22 cpm 20 cpm 20 cpm
Rate
Blood 90/60 126/80 157/87 mmhg 119/58 mmhg
pressure mmhg mmhg
SPO2 100% 100% 99% 100%
B. Height/Weight – 156cm/46.5kg.
C. Discomforts – Abdominal area particularly in the right

lower quadrant
2. Integumentary System (Skin, Hair, and Nails):
The patient’s skin is smooth and has no signs of dehydration.

Skin temperature is warm and equal bilaterally on arms and legs. Her
skin tone is light brown, and there is no other abnormal
pigmentation. There is no cyanosis, erythema noted. The skin is
intact, however has lesions in her chin and knee because of
accidents. There is also good skin turgor; skin goes back in less
than 2 seconds when pinched. Patient has untrimmed and long nails.
Patient’s hair is short, thin and evenly distributed.
3. Head, Face, and Neck
The patient’s head is round and is symmetric upon observation.

Scalp is observably moist. During palpation of the skull, there are
no masses felt. Patient’s neck does not have any lesions observed.
Face is observably fatigued and slightly pale. Facial movements are
symmetrical.
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4. Eyes, Ears, Nose, Mouth, and Throat
The patient’s eyelids are symmetric, sclera is white and

conjunctiva appears pink. Color is consistent with the patient’s
complexion. Pupils are equal, round, reactive to light stimulation,
and eyeballs are slightly sunken. The patient’s outer ears are
intact, symmetric, and slightly aligned with the eyes. There are no
noted lesions and drainage. For the inner ear, the eardrums are
intact and no noted lesions. The patient’s nose is symmetrical, and
no deviation of septum noted. There are also no signs of tenderness
or deformities and nares are patent for proper breathing. Nose isn't
flaring, mucosa is slightly dry, and sinuses are non-tender. The
patient’s lips are slightly dry however no lesions noted. The
patient’s gingiva is slightly pale, intact, there are no signs of
bleeding, edema and lesions. Teeth are incomplete, dental caries are
observed. The patient’s throat has no signs of lesion, and the
trachea is at
midline.
5. Respiratory System (Thorax and lungs)
The patient’s neck is symmetric, no noted masses and the skin

is intact. Her thyroid is non-palpable and non-tender. Also, his
lymph nodes are non-palpable and non-tender when assessed.
The patient has eupnea at a rate of 20 cycles per minute upon

vital signs taken. Also, there are no abnormal breath sounds on both
lungs, no crackles noted upon auscultation.
6. Cardiovascular System
The patient’s chest is symmetrical anteriorly and posteriorly

during excursion. It is also symmetrical during inhalation and
exhalation of air. There are no lesions and masses noted. Also, the
cardiac pattern of the patient is regular. There are no noted
abnormal cardiac sounds upon auscultation.
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7. Peripheral-Vascular and Lymphatic System
The patient’s lymph nodes are non-palpable, non-tender upon

palpation.
8. Breast and Axillae
The patient’s breasts are symmetrical upon observation. There

are no signs of lesions and masses. The nipples are light brown and
round. No lymph nodes palpable in the upper arm or axillae, no
swelling, no asymmetry, no discoloration; no increased temperature
over lymph node locations, and no pain reported by the patient.
9. Abdomen Assessment
Incision site is dry and the wound is closed. There is moderate

pain as the patient rates it as “6” out of 10. No pus or blood
oozing, no fever and soreness in the incision site. Hypoactive and
soft abdomen upon palpation.
10. Genitourinary System
There are no masses, lesions, pain and discomfort noted on the

patient’s genitalia upon interview. She also noted that there is no
pain when voiding and there are no lesions, masses and tenderness
noted on her rectum as well.
11. Motor-Musculoskeletal System

Movements are limited. Patient is stiff in bed, however is able to
be in a semi-fowler’s position when being fed. Pain and discomfort
noted during movement. Muscle strength is diminished and weakness
noted. Patient needs assistance and dependent on daily tasks like
feeding and grooming herself.
12. Sensory-Neurologic System
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The patient is awake, conscious and aware of time, place,

people, and surroundings. She is observably weak and is poorly-
groomed as evidenced by the unbrushed hair and unchanged gown. There
are no signs of disorientation. The patient shows full participation,
maintains eye contact and has good attention span when being
interviewed.
LABORATORY EXAMINATIONS
Blood Count (Complete Blood Count) [October 19, 2023 @ 4:40 pm]
Blood tests are used to measure or examine cells, chemicals, proteins,
or other substances in the blood. Blood testing, also known as blood
work, is one of the most common types of lab tests. Blood work is
often included as part of a regular checkup.Complete blood count (CBC)
measures different parts of your blood, including red and white blood
cells, platelets, and hemoglobin. A CBC is often included as part of a
regular checkup.
The test is done on the patient to assess for any abnormalities of

blood. If one component of the result has abnormalities, it can be
corrected immediately.
EXAMINATION RESULT NORMAL VALUES
CBC
Hematocrit 33.20 L 37.0-47.0 %
Hemoglobin 10.50 L 12-14 g/dl
RBC 3.58 L 3.8-5.8 x10^6/mm3
WBC 16.20 H 4.0-11.0 10^3/mm3
DIFFERENTIAL COUNT
Neutrophil 82.00 H 40-75 %
Eosinophil 0.60 0-6 %
Basophil 0.70 0-1 %
Monocyte 7.30 0-10 %
Lymphocyte 9.40 L 20-45 %
Platelet 306.00 150-450 x 10^3 /

mm3
Cell Indices 476 150-450 x 10^9 /
L
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MCV 93.00 76-96 um63
MCH 29.50 27-32 pg
MCHC 31.80 30-35 g/dL
MPV 8.30 8.0-12.0 um^3
RDW 14.00 %
Interpretation:
Patient has levels of hematocrit, hemoglobin, RBC and lymphocyte that

are below the normal range in her CBC result. High levels of WBC and
neutrophil are seen in her differential count. Patient is anemic with
the low levels of H&H and RBC and high level of platelet count.
Possible signs of infection can be determined with the high level of
neutrophil and low levels of lymphocytes.
Urinalysis [October 19, 2023]
A urinalysis also known as a urine test is a test that examines the

visual, chemical, and microscopic aspects of your urine. It can
include a variety of tests that detect and measure various
compoundsthat pass through your urine using a single sample of urine.
This is routinely ordered to detect whether there is an occurrence of

infection within the patient's body system.
TEST RESULT Norma

l
Value
s
PHYSICAL
CHARACTERISTICS
Color Orange Amber
Appearance Clear Clear
CHEMICAL
REACTIONS
Glucose Negative
Bilirubin Negative
Ketone Negative
Specific Gravity 1.030
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Blood Negative
PH 5.0
Protein Positive
Urobilinogen Negative 0.2 EU/DL
Nitrite Negative
Leukocyte Negative
MICROSCOPIC
EXAM
Amorphous Urates Few
Pus Cells 0.2
Epithelial cells Moderate 0-5
RBC 0.1 0-5
WBC <4 0-9
Bacteria Occasional 0-130
Others: Mucus Threads
Interpretation:
Patient’s examination shows no possible sign of infection in her

urinary system as the results are within normal range.
Prothrombin Time
The prothrombin time, sometimes referred to as PT or pro time, test is

a test to evaluate blood clotting.
Protime- 17.9 seconds
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DIAGNOSTIC IMAGING STUDIES
Date Taken: October 19, 2023 (10:48 a.m.)
Patient ID: 2200156159
Parts and Type of Examination: Whole Abdomen
ABDOMEN ULTRASOUND
REMARKS:
The liver is normal in size, with a midhepatic length od 12 cm. It has

homogenous parenchymal echotexture and smooth contour. No discrete
focal mass lesion observed. The intrahepatic bile ducts are not
dilated. The main portal vein is normal in caliber.
The gall bladder is normal in volume and configuration and measures

5.6 x 2.8 cm. Its wall is not thickened, measuring 0.1 cm. A 0.4 cm
polyp is seen. The visualized proximal common bile duct is not
dilated.
The pancreas is normal in size and parenchymal echo pattern with no

discrete focal masses or calcifications. The main pancreatic duct is
not dilated.
The spleen is not enlarged, with a length of 8.2 cm. No focal lesions
are detected.
Gallbladder polyp.
Sonographically unremarkable liver, pancreas, spleen, kidneys, urinary

bladder and uterus.
Both kidneys are normal in size and position, with good

corticomedullary differentiation as well as intact cortical thickness
and echogenicity. The right kidney measures 9.1 x 3.8 x 3.4 cm with
cortical thickness of
1.3 cm. The central echo complexes in both sides are intact with out
evident hydronephrosis. No masses or lithiasis are detected.
The urinary bladder is normal in volume, configuration and wall
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thickness. No mass or lithiasis identified.
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The uterus is not enlarged, measuring 6.4 x 2.8 x 2.4 cm. The
endometrium is not thickened. No mass seen. Adnexae are unremarkable.
A noncompressible tubular structure with surrounding hypoechogenicity

and an extraluminal diameter of 0.8 cm is noted in the right quadrant
region.
Minimal ascites is present
Impression:
- Acute appendicitis
- Minimal ascites
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CHAPTER III
LITERATURE
REVIEW
Related Literature
Acute appendicitis (AA) is the most common surgical emergency in

childhood. It occurs in almost all age-groups and is particularly
difficult to diagnose in its early stage in infants and toddlers. The
lifetime risk of developing appendicitis is approximately 9% in males
and 7% in females. Approximately 30-75% of children present with
perforation, especially in younger children (<5 years). The risk of
rupture is negligible within the first 24 h, climbing to 6% after 36 h
from the onset of symptoms and remains steady at approximately 5% for
each ensuring 12-hour period, establishing a 36-hour period from the
onset of symptoms to surgery as a low-risk period for appendiceal
perforation. The diagnosis of AA is challenging specially in the
pediatric population, due to potential atypical clinical presentation
in this age group, non-specific clinical symptoms and also a wide
range of differential diagnoses. The initial misdiagnosis rate for
appendicitis ranges from 28% to 57% for older children and may reach
up to 100% for those 2 years or younger, despite clinical history,
physical examination and diagnostic armamentarium including total
leucocytes count (TLC), C-reactive protein (CRP), ultrasound, computed
axial tomography scan and magnetic resonance imaging. The early
diagnosis is vital for the successful outcome because the delay in
diagnosis can lead to gangrene or perforation with increased morbidity
including wound infection, abscess formation, prolonged
hospitalization, and mortality with an increased risk of malpractice
litigation. Because of difficulty in accurate diagnosis of AA a
significant number of children still are being managed when it is
already perforated. There is always a need to make an early diagnosis
of AA and to find out the risk factors associated with development of
complication in this condition. The present study was done to
determine the risk factors for complications in AA in pediatric
patients (Singh, Mahavir, et al.,2020).
Classically, appendicitis is described as a dynamic disease process
that comprises five stages occurring over a 24–36-hour period. The
inciting event is the obstruction of the appendiceal lumen, which is
unable to drain and, as a result, distends. The etiology is
multifactorial, but fecaliths, lymphoid hyperplasia, foreign bodies,
malignancy, and parasites have all been described. During the second
stage, stimulation of the 8th-10th visceral afferent thoracic nerves
cause a mild to moderate peri-umbilical pain that typically lasts from
4 h to 6 h. As intraluminal pressure increases, appendiceal wall
perfusion decreases due to arterial insufficiency. This third stage
results in tissue ischemia and mucosal compromise. Bacteria are then
able to invade the luminal wall, leading to transmural inflammation-
the fourth stage. As transmural inflammation extends beyond the
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appendix, the parietal peritoneum and adjacent structures also become
inflamed. This final stage causes a shift in pain perception from the
periumbilical region to the
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right lower quadrant of the abdomen. At this stage, the pain is

typically more severe, continuous, and often associated with
constitutional symptoms, such as anorexia, fever, nausea, and
vomiting. If untreated, appendicitis rarely resolves spontaneously,
and usually progresses to perforation. Studies have suggested that a
delay of >48 h in the diagnosis or in the treatment of appendicitis
results in perforation and complication rates >60%. Bacterial
peritonitis can subsequently arise, which may result in overwhelming
sepsis and death (Dogra, BharatBhushan, 2020).
Laparoscopic appendectomy has been widely practiced for
uncomplicated appendicitis; various reports demonstrated its merits in
assisting diagnosis, reducing postoperative
pain, analgesic requirement, and incidence of wound infection. The
role of laparoscopy in management of complicated appendicitis, ie,
gangrenous, perforated appendicitis and appendiceal abscess, remains
undefined. Currently, the choice of operative approach is mostly at
the surgeons’ discretion. A retrospective study was conducted in our
institution to review the feasibility, safety, and efficacy of
laparoscopic appendectomy for patients with complicated appendicitis.
From January 1999 to January 2004, records of patients older than 14
years of age with diagnosis of appendicitis were retrieved from
computer database for analysis. All patients underwent diagnostic
laparoscopy to confirm diagnosis of complicated appendicitis, and
patients subsequently underwent either laparoscopic or open
appendectomies. Patients’ demographics data and perioperative outcomes
from the two groups were compared. During the study period, 1,133
patients with acute appendicitis underwent operations in our
institution. Two hundred forty- four patients (21.5%) with complicated
appendicitis were identified by laparoscopy, of which 175 underwent
laparoscopic appendectomy (LA) and
69 had open appendectomy (OA). Both groups of patients were comparable
in demographics. Mean operative time was 55 minutes for LA group and
70 minutes for the OA group (p < 0.001). Mean hospital stay was 5 days
and
6 days for LA and OA group respectively (p < 0.001). There was one
conversion patient (0.6%) in the LA group who suffered from wound
infection, and there were seven (10%) wound infections in the OA group
(p = 0.001). There were 10 cases (5.7%) of intraabdominal collection
in the LA group and 3 (4.3%) in the OA group (p = 0.473). There was no
mortality in the current series. Laparoscopic appendectomy for
complicated appendicitis is feasible and safe. It is associated with a
significantly shorter operative time, lower incidence of wound
infection, and reduced length of hospital stay when compared with
patients who had open appendectomy (Yau, Kwok Kay, et al., 2007).
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Normal Anatomy and Physiology

The organs that take in food and liquids and break them down into
substances that the body can use for energy, growth, and tissue
repair. Waste products the body cannot use leave the body through
bowel movements. The digestive system includes the mouth, pharynx
(throat), esophagus, stomach, small intestine, large intestine,
rectum, and anus. It also includes the salivary glands, liver,
gallbladder, and pancreas, which make digestive juices and enzymesthat
help the body digest food and liquids. Also called gastrointestinal
system.
The abdominal region is an important area of the body that contains

several vital organs, including the stomach, liver, intestines,
kidneys, and reproductive organs. When experiencing pain in the
stomach or abdominal area, understanding the anatomy and potential
causes in this region becomes crucial for proper diagnosis and
treatment.
The normal anatomy and physiology of the Digestive system and

Abdominal Pain Region and its parts affected by Abdominal Pain are
asfollows:
Figure 2. 1
Overview of the Digestive System and their

functions
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Oral Cavity - More commonly known as the mouth or buccal cavity,serves

as the first portion of the digestive system.
Tongue - Is principally involved in digestion, taste perception, and

speech but also plays an important role in breathing.
Pharynx - Is commonly called the throat, is a passageway that extends

from the base of the skull to the level of the sixth cervical
vertebra.
Salivary Glands - Are exocrine glands that make, modify and secrete
saliva into the oral cavity.
Parotid - Is the largest major salivary gland and secretes a

serous saliva.
Sublingual - Is the smallest of the three major salivary glands,

it is a seromucous polystomatic exocrine gland.
Submandibular - Is the second largest salivary gland, this is a

paired major salivary gland that lies in the submandibular triangle.
Esophagus - Is a primary delivery route of food to the stomach.
Liver - Is the storage location for fat-soluble vitamins and handles

cholesterol homeostasis. The liver plays a role in heme breakdown into
unconjugated bilirubin and conjugates it.
Gallbladder - Is located right underneath the liver. It stores and

concentrates bile from the liver. The bile is then released into the
first section of the small intestine (the duodenum), where it helps
your body to break down and absorb fats from food.
Stomach - Is a muscular hollow organ. It takes in food from the

esophagus (gullet or food pipe), mixes it, breaks it down, and then
passes it on to the small intestine in small portions.
Pancreas - Is a glandular organ located in the abdomen. It makes

pancreatic juices, which contain enzymes that aid in digestion, and it
produces several hormones, including insulin.
Large Intestine - Is approximately 5 feet long, responsible for

processing indigestible food material (chyme) after most nutrients are
absorbed in the small intestine.
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Small Intestine - Is a crucial component of the digestive system that

allows for the breakdown and absorption of important nutrients that
permits the body to function at its peak performance.
Appendix - Is a small, fingerlike pouch that is attached to the end of

the colon (large intestine).
Rectum - Is the last several inches of the large intestine closest to

the anus.
Anus - Is the opening at the lower end of the alimentary canal,through

which the solid refuse of digestion is excreted.
Figure 2.2
The Abdominal Regions
Right Hypochondriac - Contains the right portion of the liver, the

gallbladder, the right kidney, and parts of the small intestine.
Right Lumbar - Consists of the gallbladder, the right kidney, part of

the liver, and the ascending colon.
Right Iliac - Contains the appendix, cecum, and the right iliac fossa.
It is also commonly referred to as the right inguinal region. Pain in
this area is generally associated with appendicitis.
Epigastric Region - Contains the majority of the stomach, part of the

liver, part of the pancreas, part of the duodenum, part of the spleen,
and the adrenal glands. This region pushes out when the diaphragm
contracts during breathing.
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Umbilical Region - Contains the umbilicus (navel), and many parts of

the small intestine, such as part of the duodenum, the jejunum, and
the ileum. It also contains the transverse colon (the section between
the ascending and descending colons) and the bottom portions of both
the left and right kidney.
Hypogastric Region - Contains the organs around the pubic bone. These
include bladder, part of the sigmoid colon, the anus, and many
organsof the reproductive system, such as the uterus and ovaries in
femalesand the prostate in males.
Left Hypochondriac - Contains part of the spleen, the left kidney,part

of the stomach, the pancreas, and parts of the colon.
Left Lumbar - Consists of the descending colon, the left kidney, and
part of the spleen.
Left Iliac - Contains part of the descending colon, the sigmoid colon,
and the left iliac fossa. It is also commonly called the left inguinal
region.
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The appendix is a small, finger-shaped organ that branches off the

cecum. The cecum is a pouch situated at the junction of the
small intestine and large intestine whose main role is to absorb
fluids and salts that remain after the completion of intestinal
digestion.
The average size of an appendix is 3.5 inches, although some can be as
small as 2 inches or as large as 14 inches. The appendix is usually
located in the lower right side of the abdomen, near the right hip
bone.
In recent years, those beliefs have shifted. Many scientists say that
the appendix plays a significant role in our immune and digestive
health.
Among some of the recent theories, the appendix is thought to:
 Maintain gut flora: The digestive tract is filled with "good" bacteria
and yeast that help keep "bad" bacteria and yeast in check. Some
scientists believe that the appendix serves as a haven for
useful bacteria when diarrheal diseases like dysentery or cholera
flush the intestines or when antibiotic drugs kill "good" bacteria
along with the "bad."
 Support the immune defense: The tissues of the appendix contain a
higher number of immune cells called B-cell lymphocytes (commonly made
in bone marrow) and T-cell lymphocytes (commonly made in the thymus
gland). It is theorized that the appendix may play a role in
preventing early diseases in the large intestine.
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Theoretical Background
Acute Gangrenous Appendicitis
Definition - Acute gangrenous appendicitis is a medical condition

characterized by severe inflammation, infection, and tissue death
(necrosis) in the appendix, a small pouch-like organ located in the
lower right abdomen. It is considered a more advanced and severe form
of appendicitis.
Clinical Manifestation:
Severe Abdominal Pain: Typically, patients experience sharp, intense
pain that starts around the navel and migrates to the lower right
abdomen (McBurney's point). This pain may worsen with movement and
coughing.
Fever: Patients often develop a fever as a response to the infection.
Nausea and Vomiting: Individuals with this condition may experience
nausea and vomiting.
Loss of Appetite: There's a significant reduction in appetite due to
the abdominal discomfort.
Abdominal Tenderness: The abdomen becomes tender and painful to touch,
especially in the right lower quadrant.
Elevated White Blood Cell Count: Blood tests may reveal an increased
white blood cell count, indicating an inflammatory response.
Etiology - The etiology, or cause, of acute gangrenous appendicitis is

typically associated with:
Obstruction: Most often, the condition is caused by a blockage in the
appendix, which can occur due to the accumulation of fecal matter,
enlarged lymph nodes, or sometimes even a small foreign body.
Infection: Bacterial infection can lead to inflammation and further
exacerbate the condition.
Reduced Blood Supply: The inflammation in the appendix can restrict
blood flow to the organ, causing tissue death (gangrene).
Rupture: If not promptly treated, acute gangrenous appendicitis can
result in the rupture of the appendix, spilling its contents and
potentially causing widespread abdominal infection (peritonitis).
Medical Management
The medical management of acute gangrenous appendicitis usually

involves:
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Intravenous Antibiotics: To combat the infection and reduce

inflammation.
Emerging evidence suggests that antibiotic therapy may be considered a

first-line and possibly sole therapy in selected patients with
uncomplicated appendicitis. A meta-analysis of five randomized
controlled trials compared various antibiotic treatments with
appendectomy in 980 adults who had uncomplicated
appendicitis. 31 Antibiotic treatment resulted in a decreased rate of
complications (odds ratio = 0.54; 95% confidence interval [CI], 0.37
to 0.78), less sick leave or disability (standard mean difference =
−0.19; 95% CI, −0.33 to −0.06), and less need for pain medication
(standard mean difference = −1.55; 95% CI, −1.96 to −1.14). However,
40% of patients in the antibiotic group required appendectomy in the
following year, compared with 8.5% of those in the appendectomy group
who required a second surgery (Snyder, Matthew J., et al., 2018).
Fluid Resuscitation: To maintain hydration and address any fluid
imbalances.
Surgical Management - Surgical intervention is the primary treatment

for acute gangrenous appendicitis. Surgical management includes:
Appendectomy: This involves the removal of the inflamed and necrotic
appendix. It can be performed using open surgery or laparoscopic
techniques.
Exploration and Peritoneal Lavage: If there's any evidence of
perforation or peritonitis, the surgeon may explore the abdominal
cavity to remove any contaminated material and irrigate the area.
Drain Placement: In some cases, drains may be placed to manage any
abscesses or collections of infected fluid.
Early intervention and surgery are crucial to prevent complications
and serious infection.
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CHAPTER IV
CASE ANALYSIS AND INTERVENTIONS
Pathophysiology
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MEDICAL-NURSING MANAGEMENT
Medical Management
Medical Management involves close monitoring of blood pressure,

temperature, respirations, pulse rate, and oxygen saturation.
Laboratory examinations, including complete blood count, differential
count, and urinalysis are also monitored. The patient also underwent
an ultrasound of the whole abdomen to help diagnose the cause of
unexplained abdominal pain, discomfort, or bloating. It can reveal
issues like appendicitis, gallstones, or kidney stones. Patients with
suspected appendicitis are often advised to abstain from eating or
drinking to prevent further irritation of the inflamed appendix.
Intravenous fluid specifically 1 liter of Lactated Ringer’s Solution
at 30 drops per minute are administered to maintain hydration and
electrolyte balance while the patient is on NPO. Antibiotics are
administered to combat the infection and reduce inflammation.
Prescribed antibiotics include Cefuroxime 750 mg IVTT and
Metronidazole
500 mg IVTT. Pain relief medications, such as Tramadol and Ketorolac
are given to manage pain and discomfort. The patient should be
advised to rest and avoid strenuous activity and follow-up
appointments to monitor her condition and manage any ongoing
complications.
Nursing Management
Nursing management entails careful observation of the patient's vital

signs, including fluid intake and output as well as blood pressure,
temperature, pulse rate, respiration rate, and oxygen saturation. The
patient has to rest and sleep enough. Her activity should be
restricted to prevent additional problems like overexertion-related
tiredness. A comprehensive nursing examination is conducted to learn
about the patient's health history, allergies, current medications,
and any particular illnesses or worries that could compromise the
treatment or anesthesia. Pre-operative preparation is covered in
detail, including food restrictions, fasting requirements, and
medications that must be taken or avoided before to the procedure.
Added emotional support and assurance to assist reduce worry and
anxiety related to the impending treatment.
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Surgical Management:
The standard treatment for appendicitis involves surgically removing
the inflamed appendix. It is done through an open surgical procedure
making an incision in the abdominal wall. Open appendectomy is the
type of surgery done. Incision of 2 to 4 inches was made in the lower
right side of the abdomen to accomplish this. The incision is used to
remove the appendix. The patient was diagnosed with Acute Gangrenous
Appendicitis post-operatively. Acute gangrenous appendicitis is
characterized by inflammation that has advanced to the point that the
appendix's blood supply is either impaired or entirely cut off.
Gangrene (tissue death) can result from this lack of blood flow in
the appendix.
PHARMACOLOGY/ DRUG STUDY

 Paracetamol
Brand Name: Calpol, Panadol, Tempra, Alvedon, Biogesic,

Alaxan, Saridon
Classification: Analgesic, Antipyretic
Indications: Paracetamol is a commonly used medicine that

can help treat pain and reduce a high temperature (fever).
It's typically used to relieve mild or moderate pain, such
as headaches, toothache or sprains, and reduce fevers
caused by illnesses such as colds and flu.
Dosage:
- 600mg IV q 6hrs x 8 doses
Drug Action: Paracetamol works by blocking the production of

chemicals, known as prostaglandins, which are involved in
pain transmission.
Adverse effects: Common adverse effects occur when taking
this drug includes an allergic reaction which can cause rash
and swelling, flushing, low blood pressure, and a fast
heartbeat.
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Nursing Responsibilities:
 Inspect injection sites for inflammation. Rotate sites.

 Watch for and report signs of petechiae, epistaxis,
or any unexplained bleeding.
 Check for fever if diarrhea occurs.
 Tramadol
Brand Name: Gesitram, TDL, Tramalin, Tramadin, Ultram,

Zydol
Classification: Analgesic, Narcotic Agonist
Indications: Management of moderate to moderately severe
pain.
Dosage: 50 mg IVTT q6H x 8 doses
Drug Action: Centrally acting opiate receptor agonist that

inhibits the uptake of norepinephrine and serotonin,
suggesting both opioid and nonopioid mechanisms of pain
relief. May produce opioid-like effects, but causes less
respiratory depression than morphine.
Side and Adverse effects: Drowsiness, dizziness, vertigo,
fatigue, headache, restlessness, euphoria, confusion,
anxiety, coordination disturbance, sleep disturbances,
seizures.
 Assess for level of pain relief and administer prn dose as
needed but not to exceed the recommended total daily dose.
 Monitor vital signs and assess for orthostatic hypotension
or signs of CNS depression.
 Discontinue drug and notify physician if S&S of
hypersensitivity occur.
 Ketorolac
Brand Name: Ketomed, Marolac, Toradol, Acular, Acular LS

Classification: NSAID,Analgesic, Antipyretic
Indications: Short-term management of pain; ocular itching
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due to seasonal allergic conjunctivitis, reduction of

post-operative pain
Drug Action: It inhibits synthesis of prostaglandins and is a

peripherally acting analgesic. Ketorolac does not have any
known effects on opiate receptors.
Side and Adverse effects: Drowsiness, dizziness,
headache, Nausea, dyspepsia, GI pain, hemorrhage, Edema,
sweating, pain at injection site
 Correct hypovolemia prior to administration of ketorolac.

 Lab tests: Periodic serum electrolytes and liver functions;
urinalysis (for hematuria and proteinuria) with long-term use.
 Monitor for S&S of GI distress or bleeding including nausea, GI
pain, diarrhea, melena, or hematemesis. GI ulceration with
perforation can occur anytime during treatment. Drug decreases
platelet aggregation and thus may prolong bleeding time.
 Celecoxib
Brand Name: Celcoxx, Celebrex, Celetor-200, Coxbitor

200/Coxbitor 400, Coxid, Coxidia, Euroflam, Flamacox
Classification: Analgesic, Narcotic Agonist

Indications: It is used to manage symptoms of various
types of arthritis pain and in familial adenomatous
polyposis (FAP) to reduce precancerous polyps in the colon
Dosage: 20 mg, 1 in A.M, 1 in noon BID x 3 doses
Drug Action: Celecoxib blocks the enzyme that makes

prostaglandins (cyclooxygenase 2), resulting in lower
concentrations of prostaglandins. As a consequence,
inflammation and its accompanying pain, fever, swelling, and
tenderness are reduced. Celecoxib differs from other NSAIDs
in that it causes less inflammation and ulceration of the
stomach and intestine (at least with short-term use) and does
not interfere with the clotting of blood.
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Side and Adverse effects: Headache, Abdominal pain,

Indigestion (dyspepsia), Diarrhea, Nausea, Flatulence (gas),
Insomnia, serious stomach and intestinal ulcers
 Assess range of motion, degree of swelling, and pain in affected

joints before and periodically during therapy.
 Assess patient for allergy to sulfonamides, aspirin, or NSAIDs.
Patients with these allergies should not receive celecoxib.
 Assess patient for skin rash frequently during therapy.
 Ranitidine
Brand Name: Ranirex, Zantol, Raxide, Zantac, Ranipen

Classification: Gastrointestinal Agent, Antisecretory
Indications: Treatment of gastroesophageal reflux disease;
short-term treatment of active, benign gastric ulcer;
treatment of pathologic GI hypersecretory conditions
Drug Action: Potent anti-ulcer drug that competitively and

reversibly inhibits histamine action at H2-receptor sites on
parietal cells, thus blocking gastric acid secretion.
Indirectly reduces pepsin secretion but appears to have
minimal effect on fasting and postprandial serum gastrin
concentrations or secretion of gastric intrinsic factor or
mucus.
Side and Adverse effects: Headache, malaise, dizziness,
somnolence, insomnia, vertigo, mental confusion, agitation,
depression, Bradycardia (with rapid IV push), Constipation,
nausea, abdominal pain, diarrhea, Rash
 Potential toxicity results from decreased clearance (elimination)

and therefore prolonged action.
 Lab tests: Periodic liver functions. Monitor creatinine clearance
if renal dysfunction is present or suspected. When clearance is
<50 mL/min, manufacturer recommends reduction of the dose to 150
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mg once q24h with cautious and gradual reduction of the interval

to q12h or less, if necessary.
 Be alert for early signs of hepatotoxicity (though low and
thought to be a hypersensitivity reaction): jaundice (dark urine,
pruritus, yellow sclera and skin), elevated transaminases
(especially ALT) and LDH.
Progress Notes
DATE PROBLEM MEDICAL/SURGICAL NURSING OUTCOME

INTERVENTION INTERVENTION
10/19/2023 Subjective - Medications: - needs - pain

Complaints: attended relief by
1. Cefuroxime
Right lower the effect
750mg IVTT - IV
quadrant of the
regulated @
tenderness 2. Omeprazole 40 medication
30 gtts/min
mg IVTT
Objective: -
- vital
3. Hyoscine-N- prevention
BP- 90/60 signs
butylbromide of
monitoring
T- 36.1 (HNBB)1 ampule electrolyte
post
HR- 114 bpm - CBC, Blood imbalance
operatively
typing, by the
RR- 26 cpm
Ultrasound of intravenous
Urinary the Whole fluid
Output- 156 Abdomen
ml
- Tenderness
upon deep
palpation
with
rebound
tenderness
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NURSING CARE PLAN
Patient’s Name (Initials): M.F.J Age: 17 Sex: Female Room No: 209
Admitting Diagnosis/Medical Diagnosis/CC: Ruptured
Appendicitis Physician (Initials): Dr. A.J.U Diet: DAT
SUBJECTIVE OBJECTIVE
“Sakit akong tahi ug mo gimok ko,” as - Facial grimace
verbalized by the patient.”
- Weakness noted
- Guarding behavior in the
abdomen
- Rated pain as “6” out of
10
NURSING
DIAGNOSIS
Acute pain related to presence of surgical incision, as evidenced by
self-report of intensity using standardized pain scale (6/10) and
guarding behavior
Definition: Unpleasant sensory and emotional experience associated

with actual or potential tissue damage, or described in terms of such
damage (International Association for the Study of Pain); sudden or
slow onset of any intensity from mild to severe and with a duration
of less than 3 months.
Reference: NANDA
SCIENTIFIC
ANALYSIS
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Appendectomy is the removal of the inflamed appendix. In an open,

conventional, and uncomplicated appendectomy, the surgeon removes the
appendix through an incision approximately 3 inches long in the right
lower quadrant. The incision is larger if the appendix is in a typical
position or if peritonitis is present.
Reference: John Hopkins Medicine. (2019). Appendectomy. John Hopkins
Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-
and-therapies/appendectomy
PLANNING
Short-term goal: Patient will be able to report a relief of pain and
achieve effective pain control using presented pain medications.
Long-term goal: Patient will report a pain score of 0/10 by discharge
and will verbalize an understanding of their prescribed pharmacologic
regimen to control pain.
INTERVENTIONS RATIONALE
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- Independent:
1. Determine pain characteristics 1. Establishes baseline for
through client’s description. assessing
improvement/changes.
2. Administer Ketorolac 30 mg IVTT q8H
x 6 doses and document 2. Provides relief of
effectiveness. discomfort when
3. Encourage adequate rest periods. unrelieved by other
- Dependent: measures.
1. Collaborate with medical providers
in pain assessment, including 3. To promote wellness and
neurological and psychological prevent fatigue.
factors as appropriate when pain
1. Medical providers
exists.
can help diagnose
the underlying
causes of pain,
which is crucial
for effective
treatment. Their
expertise can
distinguish between
various types of
pain (e.g.,
neuropathic,
nociceptive) and
their potential
sources.
EXPECTED OUTCOMES EVALUATION
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- Patient will display signs of comfort Short-term: Report pain is

and vital signs within normal limits. minimized within 1 hour of
- Patient will verbalize
analgesic administration
nonpharmacological methods that
(ongoing.
provide relief.
Long-term: Report absence or
control of pain by discharge.
“Wala pa na limpyohan ang akong tahi - incised skin at right
karong buntag ma’am,” as verbalized by lower quadrant
the patient. - Incision pain
NURSING
DIAGNOSIS
Risk for surgical site infection related to perforation of appendix
secondary to appendectomy.
Definition:
Vulnerable to invasion and multiplication of pathogenic organisms,
which may compromise health.
Reference:
NANDA
SCIENTIFIC
ANALYSIS
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The creation of surgical incision during appendectomy disrupts the

skin integrity of the skin and its protective function. Exposure of
deep body tissues to the pathogens in the environment places the
patient at risk for infection of the surgical site, a potentially
threatening complication. Factors related to the surgical procedure
include the method of preoperative skin preparation, surgical attire
of the team, method of sterile draping, duration of surgery and
length of procedure.
Reference:
Hinkle J.L. Cheever K.H.(2017) Brunner an Suddath’s textbook of
Medical Surgical Nursing, Wolters Kluwer, New York. US
PLANNIN
G
Short Term:
Within 8 hours of nursing intervention, the patient will be able to
verbalize and understand the causative/risk factor for the infection.
Long Term: Within the shift of adequate nursing care, the patient
will be able to achieve timely wound healing and free of purulent
drain
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- Monitor vital signs, onset of fever - Fever and pain indicate

with chills, and pain. inflammatory responses,
- Note risk factors for occurrence of which contribute to
infection infection.
- Strict compliance to hospital control - To evaluate presence of
sterilization and aseptic policies. infection.
- Instruct good handwashing and aseptic - To establish mechanism to
wound care. prevent occurrence of
- Inspect incision site. Note infection.
characteristics of drainage from - Reduces the risk for
wound. infection or cross
- Change wound dressing as indicated, contamination of
using proper technique for changing/ bacteria.
disposing of contaminated materials. - Provides early detection
of infection process, and
presence of discharges
may help to identify
whether there is an
infection.
- To reduce existing risk
factors.
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-Patient surgical site is free of Short Term:

signs of infection by discharge date. The goal was met, within8
- Vital signs are in normal range and hours of nursing
indicate no signs of infection by intervention, the patient was
discharge date. able to verbalize and
understand the causative and
risk factor for the
infection.
Long-term: Patient
understands how to properly
care for surgical site &
minimize risk of infection
prior to being discharged.
“Sige kog kaon ug junkfoods ug paresan - Frequently eating
ug coke, dayon among sigeg kan-on kay processed food or poor-
canned goods ug instant noodles”, as quality food
verbalized by the patient. - Dehydration
NURSING
DIAGNOSI
S
Ineffective eating dynamics related to poor food choices as
evidenced by diagnosis of acute appendicitis
Definition:
Altered eating attitudes and behaviors resulting in over-or under-
eating patterns that compromise nutritional health.
Reference:
NANDA
SCIENTIF
I C
ANALYSIS
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Ineffective adolescent eating dynamics is not only a major issue in

the field of nursing, but it has also become increasingly
increasingly relevant to improve individuals’ overall quality of
life and health. Eating dynamics among adolescents is particularly
unique from other age cohorts and thus require specialized care,
support and assessment.
Reference:
WHO Collaborating Centre for Leadership in Nursing Development
Commission on Higher Education (CHED) Center for Excellence
CASE STUDY #4-CARE OF THE SCHOOL-AGE CHILD. (n.d.). Retrieved
October 28, 2023, from
https://vle.upm.edu.ph/pluginfile.php/173866/mod_forum/attachme
nt/75224/RamosKristine_HealthCarePlan_SchoolAgeChildren.pdf?for
cedownload=1#:~:text=Ineffective%20child%2Deating%20dynamics
PLANNIN
G
Short- term: Patient will follow a healthy food choice regimen.
Long-term: Assess the potential long-term health consequences of
ineffective eating dynamics, such as the risk of malnourished,
gastrointestinal disease, and other health issues.
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• Develop an individual nutrition plan  An individualized

and monitor adherence nutrition plan can
help manage or prevent
• Identify viable and achievable chronic diseases,
nutrition goals maintain a healthy
weight, and optimize
nutrient intake.
• Monitor physical health indicators  It helps patients
such as body weight, vital signs, and understand what they
laboratory results. want to achieve and
why they are making
• Asses knowledge of nutrition and dietary changes.
dietary habits.
 It helps in adjusting
treatment plans and
• Implement dietary modifications
medications as needed.
 Assessing dietary
habits and nutritional
knowledge can help
assess an individual's
risk factors for
certain nutritional
deficiencies.
 Dietary modifications
can aid in the
recovery process and
minimize the risk of
complications.
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- Patient will make nutritionally Short-term: The patient

adequate choices of food/liquids. will verbalize understanding
- Assume control over mealtime. of nutritional needs.
Long-term; The patient will

establish a dietary pattern
limiting the intake of
processed foods and
softdrinks.
DISCHARGE PLAN
Medications
Prescribed medications, their purpose, and potential side effects are

reviewed and ensured that the patient understands how to take the
medications as directed. Post-operative medications administered are
the following: Paracetamol 600 mg IVTT every 6 hours x 6 doses for
pain reliever and is often recommended for mild to moderate post-
operative pain. Tramadol 50 mg IVTT every 6 hours x 8 doses also
indicated for pain; Ketorolac 30 mg IVTT every 8 hours x 6 doses is a
nonsteroidal anti-inflammatory drug (NSAID) that is used for pain
management after the surgical procedure.It can be effective in
reducing pain and inflammation. Celecoxib 20 mg twice a day x 3 doses
also indicated for control of pain and inflammation. Ranitidine 50 mg
IVTT every 8 hours x
6 doses. After abdominal surgery, particularly if there are risk
factors for gastric ulcers, prescribe ranitidine is prescribed to
reduce stomach acid production and prevent the development of ulcers
during the recovery period.
Environment/ Exercise
Provide guidelines for activity and rest. The patient needs to limit
physical activity for a period. Clear instructions should be given
regarding any restrictions or modifications to daily activities.
Emphasize the importance of good hygiene practices, including
handwashing, to prevent infection. Within a few days to a week, regular
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activity can normally be resumed. For the first 4-6 weeks, the patient
should refrain from any intense activities and heavy lifting, unless
the doctor specifies otherwise. Small, frequent walks should be
promoted.
Treatment
Ensure that the patient is comfortable and has appropriate pain relief
medications if needed. Discuss the proper use of pain medications and
any potential side effects. Schedule and explain the importance of
follow-up appointments with the treating physician. Make sure the
patient is well informed about the need to finish all medications and
to take them with a meal if stomach upset happens.
Health Teaching
Ensure that the patient and their family or caregivers fully

understand the condition, treatment, and ongoing self-management.
Provide contact information for healthcare providers and emphasize
open communication. Instructed patient not to drive or handle
machinery while taking any painkillers, such as opioids, and to take a
stool softener to prevent constipation.
Outpatient
The patient will be advised to attend regular follow-up appointments

with their healthcare provider within the first week or two after
discharge. These appointments will serve the purpose of closely
monitoring the patient's recovery progress, including factors such as
body temperature, digestive symptoms, and general well-being.
Additionally, the healthcare provider will evaluate the effectiveness
of the prescribed medications, ensure the absence of complications,
and provide any necessary adjustments to the treatment plan.
Maintaining a close connection with the healthcare provider during the
outpatient phase of typhoid fever recovery is essential for ensuring a
successful and complete recuperation.
Diet
Advised the patient on dietary recommendations. Initially, a clear

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liquid
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diet may be recommended before gradually transitioning to regular

foods. Suggest avoiding foods that may cause digestive discomfort.
Make sure to incorporate sources of lean protein into your diet to aid
in healing. These can include skinless poultry, fish, tofu, and low-
fat dairy products.
Staying hydrated is crucial for recovery. Drink plenty of water
throughout the day. Avoid caffeinated and carbonated beverages if they
irritate your stomach. Consume smaller, more frequent meals to reduce
the strain on your digestive system. This can help prevent overloading
your stomach. Steer clear of spicy, greasy, and heavily processed
foods, as they can be harder to digest and may irritate your digestive
tract.
Spiritual
Initiate spiritual healing and coordinate with significant others to

encourage patient to participate in activities that promote relaxation
and stress management. Address any emotional or psychological concerns
and provide information about available resources or support groups if
needed.
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Chapter V:
CONCLUSION AND RECOMMENDATION

Conclusion
This clinical paper has been extremely beneficial in helping us,
student nurses, to comprehend acute gangrenous appendicitis in
patients and its associating factors. By examining the findings and
insights presented in the paper, student nurses can acquire a deeper
comprehension of the various causes, symptoms, and assessment
techniques related to acute gangrenous appendicitis. This knowledge is
essential for accurate and timely diagnosis, effective management,
andappropriate care planning for patients presenting with acute
gangrenous appendicitis. The paper serves as a valuable resource for
student nurses, providing them with evidence- based information and
helping them develop the necessary skills to provide comprehensive and
compassionate care patients with acute gangrenous appendicitis.
As we approach the conclusion of this case study about acute
gangrenous appendicitis, it is important to summarize the key findings
and implications of the study. This includes analyzing the patient's
presenting symptoms, medical history, diagnostic tests, and treatment
interventions.
By reviewing the patient's case, we can gain a deeper understanding of
the assessment and management of acute gangrenous appendicitis in
patients. They can identify common causes of acute gangrenous
appendicitis, such as gastrointestinal disorders, infections, or
structural abnormalities, and learn about the appropriate nursing
interventions and treatments for each condition.
Additionally, we should reflect on the challenges and complexities
involved in caring for patients with acute gangrenous appendicitis.
They can evaluate the importance of effective communication, patient
education, and the involvement of the healthcare team in providing
comprehensive care.
Furthermore, it is essential for us to consider the holistic aspectsof
patient care. This includes recognizing the emotional and
psychological impact of abdominal pain on the patient and their
family, and implementing strategies to address their needs and
concerns.
This case study serves as an opportunity for student nurses to
consolidate their knowledge, enhance their critical thinking
skills,and apply evidence-based practices in the care of patients with
acute gangrenous appendicitis. By continually seeking to expand their
understanding and skills in this area, student nurses can become
competent and compassionate caregivers in the field of nursing.
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Recommendation
After conducting a comprehensive research study on a patient with

acute gangrenous appendicitis, several recommendations have been
developed to provide guidance for the patient's care during the
treatment period. These recommendations are based on the findings
andoutcomes obtained from the study and aim to optimize the patient's
treatment and overall well-being. By implementing these
recommendations.
To the nursing staff, adhering to evidence-based guidelines, nursing
staff can effectively manage the symptoms of acute gangrenous
appendicitis through appropriate interventions and medications. Close
monitoring of the patient's fluid and electrolyte balance is crucial
to prevent dehydration and electrolyte imbalances. Furthermore,
addressing the underlying cause of acute gangrenous appendicitis, such
as iron deficiency, is vital. Nursing staff should collaborate with
the healthcare team to ensure the patient receives appropriate
diagnostic tests, such as blood tests, and implement interventions to
address the acute gangrenous appendicitis, such as iron
supplementation and dietary modifications. Additionally, providing
education and support to the patient and their family is essential.
Nursing staff can offer guidance on dietary changes, medication
administration, and lifestyle modifications to manage and prevent
future episodes of acute gangrenous appendicitis. By empowering the
patient and their family with knowledge, they can actively participate
in their care and make informed decisions.
To the nursing administration, prioritize the availability of

necessary equipment and resources for accurate and timely monitoring.
Ensuring that nursing staff have access to up-to-date protocols and
guidelines for managing acute gangrenous appendicitis is crucial. This
includes implementing appropriate interventions and medications to
alleviate symptoms. Monitoring the patient's fluid and electrolyte
balance closely is essential to prevent complications associated with
dehydration and electrolyte imbalances. The nursing administration
should ensure that nursing staff receive continuous education and
training in managing anemia, staying updated with the latest research
and evidence-based practices. The nursing staff should be equipped
with the knowledge and tools to identify and address the underlying
causes, particularly iron deficiency. This may involve coordinating
with the healthcare team to perform necessary diagnostic tests and
implementing interventions such as iron supplementation and dietary
modifications.
For nursing educators, who play a vital role in enhancing the

understanding of acute gangrenous appendicitis among nursing students.
By incorporating comprehensive and evidence-based education on these
conditions into the curriculum, nursing educators can ensure that
students are well-prepared to provide competent and effective care to
patients. Nursing educators are crucial in encouraging and supporting
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students' involvement in research endeavors related to acute
gangrenous appendicitis. By fostering a research-minded culture and
providing
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mentorship and guidance, nursing educators can empower students to

contribute to the advancement of knowledge in these areas. This can
lead to a more comprehensive understanding of the conditions and help
identify novel approaches to prevention, management, and treatment.
For nursing students, expand their knowledge and understanding of
acute gangrenous appendicitis. They have the opportunity to delve
deeper into the pathophysiology, etiology, and clinical manifestations
of these conditions. Through literature reviews, data analysis, and
discussions with experienced researchers, student nurses can gain a
comprehensive understanding of the subject matter. Moreover,
involvement in research studies helps student nurses develop essential
research skills. They learn about research methodologies, data
collection techniques, and data analysis methods. This hands-on
experience allows them to become proficient in critical appraisal of
evidence and enhances their ability to interpret and apply research
findings in their clinical practice.
For significant others/parents, of a patient with acute gangrenous
appendicitis, their role in providing support and understanding is
crucial. This challenging time can be overwhelming for both the
patient and their loved ones, but with proper support, the patient's
journey towards recovery can be more manageable. They can actively
participate in the patient's care by ensuring that the patient
receives appropriate medical attention. This includes scheduling and
attending medical appointments, asking questions to healthcare
providers, and seeking clarification about treatment plans. By being
involved and informed, significant others can help ensure that the
patient's needs are met and that they receive the best possible care.
References
Anatomy, head and neck, oral cavity (mouth) - statpearls - NCBI

bookshelf. (n.d.). https://www.ncbi.nlm.nih.gov/books/NBK545271/
Anatomy, head and neck, tongue - statpearls - NCBI bookshelf. (n.d.-

b). https://www.ncbi.nlm.nih.gov/books/NBK507782/
Pharynx. Pharynx | SEER Training. (n.d.).

https://training.seer.cancer.gov/anatomy/respiratory/passages/pha
rynx.html
Parotid gland. Parotid Gland - an overview | ScienceDirect Topics.

(n.d.). https://www.sciencedirect.com/topics/agricultural-and-
biological-sciences/parotid- gland#:~:text=The%20parotid%20gland
%20is%20the,to%20the%20externa l%20acoustic
%20meatus.
Anatomy, head and neck, submandibular gland - statpearls - NCBI

bookshelf. (n.d.-b). https://www.ncbi.nlm.nih.gov/books/NBK542272/
69
COLLEGE OFNURSING
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Singh, Mahavir, et al. “Complicated Appendicitis: Analysis of Risk
Factors in Children.” African Journal of Paediatric Surgery, vol.
11, no. 2, 1 Apr. 2014, p. 109,
www.afrjpaedsurg.org/text.asp?2014/11/2/109/132796,
https://doi.org/10.4103/0189-6725.132796. Accessed 20 Sept. 2020.
Dogra, BharatBhushan. “Acute Appendicitis: Common Surgical Emergency.”
Medical Journal of Dr. D.Y. Patil University, vol. 7, no. 6, 2014,
p. 749, https://doi.org/10.4103/0975-2870.144866. Accessed 1 Mar.
2020.
Yau, Kwok Kay, et al. “Laparoscopic versus Open Appendectomy for
Complicated Appendicitis.” Journal of the American College of
Surgeons, vol. 205, no. 1, 1 July 2007, pp. 60–65,
www.sciencedirect.com/science/article/abs/pii/S107275150700453X,
https://doi.org/10.1016/j.jamcollsurg.2007.03.017.
Snyder, Matthew J., et al. “Acute Appendicitis: Efficient Diagnosis
and Management.” American Family Physician, vol. 98, no. 1, 1
July 2018, pp. 25–33,
www.aafp.org/pubs/afp/issues/2018/0701/p25.html.
What Food Can Cause Appendicitis? 5 Food Groups to Limit [as of 2023].
colorectalsurgery.com.sg/food-cause- appendicitis/#:~:text=Eating
%20high%2Dfat%20and%20high.
“What Is Gangrenous Appendicitis?” Www.icliniq.com, 25 Sept. 2023,
www.icliniq.com/articles/infectious-diseases/gangrenous-
appendicitis. Accessed 28 Oct. 2023.
Jones, M. W., Lopez, R. A., Deppen, J. G., & Kendall, B. A. (2021).

Appendicitis (Nursing). PubMed; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK568712/
DrugBank. (n.d.). Celecoxib. Go.drugbank.com
. https://go.drugbank.com/drugs/DB00482
70
COLLEGE OFNURSING
DUMAGUETE CITY
John Hopkins Medicine. (2019). Appendectomy. John Hopkins Medicine.

https://www.hopkinsmedicine.org/health/treatment-tests-and-
therapies/appendectomy
Hinkle J.L. Cheever K.H.(2017) Brunner an Suddath’s textbook of
Medical Surgical Nursing, Wolters Kluwer, New York. US
Appendices
APPENDICES
SEAN MEVRICK T. VEGA
Brgy. Basac, Larena, Siquijor
09278111715
Email address: vseanmevrick@gmail.com
Personal Background
Date of Birth: March 22, 2002

Place of Birth: Siquijor Provincial Hospital
Age: 21
Status: Single
Gender: Male
Citizenship: Filipino
Father: Mervin B. Vega
Mother: Susan T. Vega
Educational Background
Senior High School: Siquijor State College
71
COLLEGE OFNURSING
DUMAGUETE CITY
Junior High School: Siquijor State College
Grade School: Basac Elementary School
Melba Lu Veronica G. Villarta
Lower Camanjac, Dumaguete City, Negros
Oriental
09201748598
Email address: villartamelba@gmail.com
Personal Background
Date of Birth : November 28, 2001
Place of Birth : Dumaguete City, Negros Oriental
Age : 21 Status : Single
Gender : Female
Citizenship : Filipino
Father : Alvin Villarta (Deceased)
Mother : Vanessa Gonzalez-Navaja
Educational Background
Senior High School: Ramon Teves Pastor Memorial-Dumaguete
Science High School
Junior High School: Ramon Teves Pastor Memorial-Dumaguete
72
COLLEGE OFNURSING
DUMAGUETE CITY
Science High School
Grade School: West City Science Elementary School
73

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ST.

PAUL UNIVERSITY DUMAGUETE

2nd Semester, A.Y.2022 – 2023

IN PARTIAL FULFILLMENT OF THE REQUIREMENT

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

Furthermore, they would like to express their heartfelt appreciation

2nd Semester, A.Y.2022 – 2023

This case study presents the admission and initial management of a

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

CASE DATA AND INFORMATION

Patient’s Biographical Data

HEALTH HISTORY ASSESSMENT

ADMITTING DIAGNOSIS: Nephrolithiasis

Significant other – 20%

Medical Records – 20%

2nd Semester, A.Y.2022 – 2023

HISTORY OF PRESENT ILLNESS

PAST HEALTH HISTORY

SERIOUS CHILDHOOD ILLNESSES

The patient had a history of chickenpox in her early years.

The patient has no psychological problems.

The patient has a history of chickenpox, past colds, and fever.

The patient has undergone immunization such as Janssen Pfizer with

2nd Semester, A.Y.2022 – 2023

The patient has no known allergies.

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

Functional Prior to During Justification

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

Sleep-Rest The patient The patient adheres To ensure the

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

2nd Semester, A.Y.2022 – 2023

1. General appearance and Mental Status:

A. Vital Sign Measurement:

VITAL SIGNS MEASUREMENT

2nd Semester, A.Y.2022 – 2023

C. Discomforts – Abdominal area particularly in the right

2. Integumentary System (Skin, Hair, and Nails):

The patient’s skin is smooth and has no signs of dehydration.

3. Head, Face, and Neck

The patient’s head is round and is symmetric upon observation.

2nd Semester, A.Y.2022 – 2023

The patient’s eyelids are symmetric, sclera is white and

5. Respiratory System (Thorax and lungs)

The patient’s neck is symmetric, no noted masses and the skin

The patient has eupnea at a rate of 20 cycles per minute upon

The patient’s chest is symmetrical anteriorly and posteriorly

2nd Semester, A.Y.2022 – 2023