OBJECTIVES

General After our clinical exposure, we should be able to assess and diagnose patients current status and to plan, implement and evaluate our nursing procedures towards phases.

Specific
1. To be able to establish rapport with the patient and folks. 2. To be able to obtain a nursing health history, conduct physical assessment, review records, organize and validate data. 3. To be able to formulate nursing diagnoses and collaborative problem statements. 4. To be able to set priorities and goals/outcomes in collaboration with the client. 5. To be able to select nursing strategies/intervention. 6. To be able to perform planned nursing interventions. 7. To be able to document care and client responses to care and give verbal reports if necessary. 8. To be able to collaborate with client and collect data desired outcomes. 9. To be able to document achievement of outcomes and modification of the care plan.

Introduction
Definition of the Disease
The appendix is a small, finger-shaped sac that is attached to the large intestine. Experts do not know what the appendix does, but most of the time it does not cause problems. Appendicitis means your appendix is infected, and you will need to have it taken out. If you do not have an infected appendix removed, it can break open (rupture) and spill infection into your belly. This can be deadly if it is not treated right away. It is not always clear why people get appendicitis. In many cases a small object, such as a hard piece of stool or a piece of food, blocks the opening to the appendix. Then bacteria grow in the appendix and cause an infection. The main symptom of appendicitis is belly pain. You first may feel pain near your belly button. Then it moves to the lower right side of your belly. The pain gets worse if you move, walk, or cough. You also may have a fever, feel like you are going to throw up, or not want to eat. If you have these symptoms, call your doctor right away. In many cases, appendicitis does not cause the symptoms listed above. If you have any belly pain that does not go away and you have a fever, call your doctor right away.

St. Anthony College of Roxas City College of Nursing San Roque St., Roxas City

Vital Information
Name Age Sex Address Civil Status Religion Date and Time admitted Ward Chief Complaint Diagnosis : Ms. H. B. : 47 years old : Female : Bolo, Roxas City : Single : Protestant : February 7, 2007 at 10:45 PM : FSW : Acute abdominal pain : Acute appendicitis ruptured appendicitis with localized abscess

Clinical History
A. Nursing History 1. History of present illness One week before admission, patient had experienced abdominal pain that worsens with movement, deep breathing, walking or being touched. She had experienced it for many days already but she didnt mind it until last February 7, 2007, she was admitted because of continuous pain. She was complaining of her abdomen, daw ginahiwa akon ang tiyan as verbalized by the patient. When the problem occurred she said that gabarikutot lang ko. In order to alleviate pain she tried to apply efficascent oil in the area, drinking lukewarm water and taking Loperamide but it doesnt help her 2. Past Health Problem/Status Last January 9, 2007, patient got accident at Tanza Gua, Roxas City when one tricycle hit the other tricycle where she was in. She got abrasion and bruises on her body, but they didnt go to the hospital for they knew that it was only a minor accident. No allergies or past hospitalization.

3. Patterns of functioning b. breathing patterns fast shallow breathing, 27 breaths/minutes c. circulation BP= 120/90 mmHg, PR= 82 bpm ; CR= 84 bpm d. sleeping patterns The patient usually wakes up at four in the morning and sleeps at nine in the evening. She doesnt have time to take a nap for she is teaching her students for the whole day. She uses two pillows and covers her body with a blanket. She lies comfortably in a side-lying position. e. Drinking pattern She usually drinks three to five glasses of water a day. f. Eating pattern Breakfast Moreishi coffee Lunch rice, fish and vegetables Dinner rice and vegetables g. Elimination Pattern Bowel movement twice a day Urination twice a day h. Personal Hygiene She takes a bath once a day and brushes her teeth twice a day. i. Recreation and exercise During her free times, she usually reads books and listens to music. Exercise includes walking around the school. 4. Brief Social, Cultural and religious background i. educational background ELEM- Bolo Elem. School HIGH SCHOOL FCC ECONOMIC FCC ii. Religious practices Patient is a protestant. She goes to church on Sundays. iii. Economic status Elementary teacher B. CLINICAL INSPECTION

1. Vital Signs: T = 36.6 C BP= 120/90 mmHg PR= 82 bpm CR= 84 bpm 2. Height = 5 Weight = 45kg 3. Physical Assessment a. General Appearance b. Skin Hair Nails c. Head Face d. Eyes Ears Mouth and Throat e. thorax and lungs f. heart g. Abdomen rebound in h. lower extremities 4. General Appraisal a. Speech clear, understandable and coherent b. Hearing listens attentively c. Mental Status alert, oriented to time, place and person. Patient answer questions accurately and precisely. : slouching posture, weak : pallor, dry, warm to touch : black long hair with average texture, no lice : clean and short : (+) dizziness : untidy face :With glasses, pupils are round , react t light and accommodation : no earrings on both sides, no earache : dry mouth, coated tongue, no bleeding gums : symmetrical chest expansion, no rales, wheezes or rhonchi : (-) murmur : flat, no bowel sounds heard, it is firm and broadlike with increase tenderness, guarding and the right midquadrant. : no edema

d. Emotional Status expresses boredom and staying in bed

Textbook Discussion
APPENDICITIS Definition: Appendicitis is inflammation of the vermiform appendix caused by an obstruction of the intestinal lumen from infection, stricture, fecal mass, foreign body, or tumor. Signs and Symptoms: MANIFESTED BY PATIENT

TEXTBOOK Nausea Vomiting Pain in the upper abdomen Pain around the navel Tenderness in the right lower abdomen Fever Rebound Tenderness in the right lower abdomen Loss of appetite Constipation Diarrhea Inability to pass gas Frequent urination Abdominal swelling

SCHEMATIC DIAGRAM OF APPENDICITIS

Obstruction of Lumen Edema, Infection and Ischema Continuous Mucosal Secretion Intraluminal Pressure Appendix becomes hypoxic Mucosa blood flow

Ulceration of the mucusa

Inflammation of Appendix

PATHOPHYSIOLOGY The exact mechanism of the cause of appendicitis is controversial. Obstruction of the lumen with stool, tumors, or foreign bodies with consequent bacterial infection is the most common theory. The obstruction is followed by edema, infection and ischemia. The obstructed lumen does not allow drainage of the appendix, and as mucosal secretion continues, Intraluminal pressure increases. The increased pressure decreases mucosa blood flow, and the appendix becomes hypoxic. The mucosa ulcerates, promoting bacterial or other microbial invasion with further inflammation and edema. Inflammation may

involve the distal or entire appendix. Gangrene develops from thrombosis of the luminal blood vessels, followed by perforation.

Anatomy
The appendix is a slender projection opening from the pouch like portion of the large intestine called the cecum. Located near the point where the ileum, or lower portion of the small intestine, empties into the large intestine, it is called the vermiform appendix, from the Latin vermiform meaning wormlike, which describes its shape. It is 2-20cm (1-8 in) long, about as thick as a pencil, and hollow; the free end is closed. The appendix may have some immune function, but it isnt an essential organ. When the appendix is inflamed the condition is referred to as appendicitis. It is the most common cause of sudden, severe abdominal pain and abdominal surgery. It is most common between the ages 10 and 30. the cause of appendicitis isnt fully understood. In most cases, a blockage inside the appendix becomes inflamed and infected. If inflammation continues without treatment, the appendix can rupture. A rupture appendix spills bacteria-laden intestinal contents into the abdomen, causing peritonitis, which may result in life-threatening infection. A rupture also may cause an abscess to form. In a woman, the ovaries and fallopian tubes may become infected, and the resulting blockage of the tubes may cause infertility. A rupture appendix also may allow bacteria to infect the bloodstreama life-threatening condition call septicemia.