CASE STUDY : PATIENT WITH APPENDICITIS

Submitted by : Farzaneh Yeganeh

Submitted to : Ms. Amara Sabri
 WHAT IS APPENDICITIS ?
 Appendicitis is an inflammation of the appendix, a
finger-shaped pouch that projects from your colon on the
lower right side of your abdomen.
 Appendicitis causes pain in your lower right abdomen.
However, in most people, pain begins around the navel
and then moves. As inflammation worsens, appendicitis
pain typically increases and eventually becomes severe.
 Although anyone can develop appendicitis, most often it
occurs in people between the ages of 10 and 30. Standard
treatment is surgical removal of the appendix.
WHAT IS APPENDICITIS ?
 SYMPTOMS:
 Sudden pain that begins on the right side of the lower
abdomen
 Sudden pain that begins around your navel and often
shifts to your lower right abdomen
 Pain that worsens if you cough, walk or make other
jarring movements
 Nausea and vomiting

 Loss of appetite

 Low-grade fever that may worsen as the illness progresses

 Constipation or diarrhea

 Abdominal bloating

 Flatulence
 COMPLICATIONS:
 A ruptured appendix. A rupture spreads infection
throughout your abdomen (peritonitis). Possibly life-
threatening, this condition requires immediate surgery to
remove the appendix and clean your abdominal cavity.
 A pocket of pus that forms in the abdomen. If your
appendix bursts, you may develop a pocket of infection
(abscess). In most cases, a surgeon drains the abscess by
placing a tube through your abdominal wall into the
abscess. The tube is left in place for about two weeks, and
you're given antibiotics to clear the infection.
 Once the infection is clear, you'll have surgery to remove
the appendix. In some cases, the abscess is drained, and
the appendix is removed immediately.
 CASE STUDY:
 Mr. x is 21 years old, single.
 Mohammad admitted to ER complains from abdominal pain
since 2 days in 6-5-2021 at 10 am.
 At ER Iv cannula inserted; serum mixture 1L , blood test done;
CRP: 364.8 , normal volume: <5 , WBC: 14700 , normal
volume: 4000-11000, CT abd pelvis done that shows appendicitis
so planned for OR.
 Patient admitted to MS floor through ER ,conscious, oriented,
cooperative , on room air ventilation , regular pulse , skin warm
and pink , ambulant , normal bowel movement , urine voided
freely , vital signs;
BP:11/7cm/hg , HR:73 b/m , SPO2: 98% , T: 37ċ.
CASE STUDY:
 After surgery patient admitted to floor under spinal
anesthesia, complains from pain ,score:3 conscious,
oriented, cooperative , on room air ventilation , regular
pulse , skin warm and pink , dressing at abdomen clean
and dry, drain at left side of abdomen 30cc bloody , NPO
for 24h, no flatus, urine voided freely , need assist, vital
signs; BP:12/8cm/hg , HR:75 b/m , SPO2: 99% , T: 37ċ.
 MEDICATIONS:
 Rocephin (2g/IV/Q:24h): for Injection is a cephalosporin
antibiotic used to treat many kinds of bacterial infections,
including severe or life-threatening forms such as meningitis.

 Risek (40mg/IV/Q:24h): Treatment of symptomatic

gastroesophageal disease (GERD) without esophagitis; healing
of erosive esophagitis; maintenance of healed erosive
esophagitis; gastric and duodenal ulcer.

 Flagyl (500mg/IV/Q:8h): used to treat serious bacterial

infections in different areas of the body. It is also used to prevent
infections in the bowels before and after surgery for some
patients.
 DIAGNOSIS:
 Pain related to abdominal surgical incision as evidenced by verbal
report of pt.
 Impaired skin integrity related to surgery as evidenced by suture at
the abdomen area.
 Impaired physical mobility related to pain as evidenced by pt.

 Anxiety related to hospitalization as evidenced by pt.

 Self-care deficient related to physical limitation secondary to

surgical site as evidenced by inability to walk, toiletting,get
dressed.
 Knowledge deficient miss information as evidenced by verbal
report of patient and family.
 Risk for infection related to post surgical.

 Risk for infection related to use of medical equipment.

 Risk for fall related to use of medical equipment.

 OBJECTIVES AND INTERVENTIONS:
Pain related to abdominal surgical incision as evidenced by verbal
report of pt.
Objective : Within the 8 hours of duty, the patient should be able
to: Report pain is relieved or controlled.
Pain intensity will Decrease 3 from 0 to 10 pain scale.
Interventions : 1-assess pain scale
2-monitor v/s.
3-provide a quiet environment
4-assisst pt during activities
5-provide relaxation technique
6-administer analgesic if indicate
7-emphasize importance rest period after every activity.
 OBJECTIVES AND INTERVENTIONS:
Impaired skin integrity related to surgery as evidenced by suture
at the abdomen area.
Objective: By the end of the shift, the client will develop and
maintain optimal conditions for wound healing.
Interventions:
1.Note skin color, texture, and turgor.
2. Palpate skin lesions for size, shape, consistency, texture,
temperature, and hydration.
3. Determine degree or depth of injury or damage to skin.
4. Measure length, width, depth of wound.
5. Inspect surrounding skin for erythema, indurations, and
maceration.
6. Note odors emitted from the wound.
 OBJECTIVES AND INTERVENTIONS:
 Impaired physical mobility related to pain as evidenced by pt.
Objective: after 7 days of nursing interventions, the patient will
increase strength and function of affected body part.
Interventions:1-maintain bed rest or chair rest when indicated.
2-Assist with active or passive range of motion exercises.
3-Encourage patient to maintain upright and erect posture when
sitting , standing and walking.
4-Discuss and provide safety needs.
5-Reposition patient frequently.
 OBJECTIVES AND INTERVENTIONS:
Anxiety related to hospitalization as evidenced by pt.
Objective: After nursing intervention the client will appear relax and
report anxiety is reduced to a manageable level.
Interventions: 1-Identify client’s perception of the threat represented by
the situation.
2-Monitor vital signs To assist client to identify feelings and begin to
deal with problems.
3- Clarify meaning of feelings/ actions by providing feedback and
checking meaning with the client.
4- Acknowledge anxiety/fear. Do not deny or reassure client that
everything will be alright.
5- Provide accurate information about the situation.
To promote wellness:
a.) Encourage client to develop an exercise/activity program
b.) Assist in developing skills.
 OBJECTIVES AND INTERVENTIONS:
Self-care deficient related to physical limitation secondary to surgical site as
evidenced by inability to walk, toileting ,get dressed.
Objective: the patient will be able to demonstrate self care .
Interventions:
1.Support and instruct client in incisional support when turning, coughing,
deep breathing, and ambulating
2. Observe incisions periodically, noting approximation of wound edges,
hematoma formation and resolution, and presence of bleeding and
drainage.
3. Provide routine incisional care, being careful to keep dressing dry and
sterile. Assess and maintain patency of drains.
4. Encourage frequent positional change, inspect pressure points, and
massage gently, as indicated. Apply transparent skin barrier to elbows and
heels, if indicated.
5. Provide meticulous skin care, pay particular attention to skin folds
common in the very obese client.
6. Provide foam, water, or air mattress, as indicated.
 OBJECTIVES AND INTERVENTIONS:
Knowledge deficient miss information as evidenced by verbal report
of patient and family.
Objective: After nursing intervention the patient will be able to
participate in learning process.
Interventions:
1-Ascertain level of knowledge, including anticipatory needs.
2-Provide positive reinforcement.
3-Determine clients most urgent need from both clients and nurse
viewpoint State objectives clearly in learner’s terms
4-Determine client’s method of accessing information
5-Provide mutual goal setting and learning contacts.
6-Provide access information for contact person.
7-Provide access information about additional learning resources.
 OBJECTIVES AND INTERVENTIONS:
 Risk for infection related to use of medical equipment.
Objective: After nursing intervention, the patient will:
Short term:
Identify the risk factors that are present
Have partial understanding about infection control
Long term:
Client’s full knowledge in identifying the risk factors of the infection
Be free from any signs and symptoms of related to infection
Interventions: 1.Note risk factors for
occurrence of infection in the incision
2. observed for localized sign of infection at insertion sites of
invasive lines, surgical incisions or wounds.
3. Make health teachings especially in identification of
environmental risk factors that could add up on infection
 OBJECTIVES AND INTERVENTIONS:
Risk for fall related to use of medical equipment.
Objective: prevention of fall.
Interventions:
1.initiate fall interventions as per hospital policy.
2.Keep the for side rails up.
3.Lock the bed brakes.
4.Assess high risk patients every 2hours.
5.Provide adequate nighttime lighting.
6.Lower the bed to its lowest position at all times when not
providing care.
7.Provide toilet assistance.
8.Keep the call button within patient’s reach at all times.
EVALUATION

 Relieved pain.
 Prevented fluid volume deficit.

 Reduced anxiety.

 Eliminated infection due to the potential or actual

disruption of the GI tract.
 Maintained skin integrity.

 Attained optimal nutrition.