Acute Appendicitis_CS

8/9/2019 Acute Appendicitis_CS

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LICEODECAGAYANUNIVERSITYR.N.P. Blvd., Carmen, Cagayan de Oro City

C O L L E G E O F N U R S I N G

A Case Study

?

With

Submitted to:

?

Clinical Instructor

As Partial Requirement for NCM501202

Submitted by:

?

March 21, 2008

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I. Introduction

Overview of the Case

II. Health History

a. Profile of Patient

b. Family and Personal Health History

c. History of Present Illness

d. Chief Complain

III. Developmental Data

IV. Medical Management

a. Medical Orders and Rationale

b. Drug Study

V. Pathophysiology with Anatomy & Physiology

VI. Nursing Assessment (System Review & Nursing. Assessment II)

VII. Nursing Management

a. Ideal Nursing Management (NCP)

b. Actual Nursing Management (SOAPIE)

VIII. Health teachings

IX. Referrals & Follow-up

X. Prognosis

XI. Evaluation

XII. References

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INTRODUCTION

Overview of the Case

Any part of the lower gastro-intestinal tract is susceptible to acute

inflammation caused by bacterial, viral or fungal infection. Two such situations

are appendicitis and diverticulitis. Appendicitis is inflammation of the appendix. It

is thought that appendicitis begins when the opening from the appendix into the

cecum becomes blocked. The blockage may be due to a build-up of thick mucus

within the appendix or to stool that enters the appendix from the cecum. Themucus or stool hardens, becomes rock-like, and blocks the opening. This rock is

called a fecalith (literally, a rock of stool). At other times, the lymphatic tissue in

the appendix may swell and block the appendix. Bacteria which normally are

found within the appendix then begin to invade (infect) the wall of the appendix.

The body responds to the invasion by mounting an attack on the bacteria, an

attack called inflammation. (An alternative theory for the cause of appendicitis is

an initial rupture of the appendix followed by spread of bacteria outside the

appendix. The cause of such a rupture is unclear, but it may relate to changes

that occur in the lymphatic tissue that line the wall of the appendix.)

If the inflammation and infection spread through the wall of the appendix,

the appendix can rupture. After rupture, infection can spread throughout the

abdomen; however, it usually is confined to a small area surrounding the

appendix (forming a peri-appendiceal abscess).

Sometimes, the body is successful in containing ("healing") the appendicitis

without surgical treatment if the infection and accompanying inflammation do not

spread throughout the abdomen. The inflammation, pain and symptoms may

disappear. This is particularly true in elderly patients and when antibiotics are

used. The patients then may come to the doctor long after the episode of

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appendicitis with a lump or a mass in the right lower abdomen that is due to the

scarring that occurs during healing. This lump might raise the suspicion of

cancer. The main symptom of appendicitis is abdominal pain. The pain is at first

diffuse and poorly localized, that is, not confined to one spot. (Poorly localized

pain is typical whenever a problem is confined to the small intestine or colon,

including the appendix.) The pain is so difficult to pinpoint that when asked to

point to the area of the pain, most people indicate the location of the pain with a

circular motion of their hand around the central part of their abdomen.

As appendiceal inflammation increases, it extends through the appendix to

its outer covering and then to the lining of the abdomen, a thin membrane called

the peritoneum. Once the peritoneum becomes inflamed, the pain changes andthen can be localized clearly to one small area. Generally, this area is between

the front of the right hip bone and the belly button. The exact point is named after

Dr. Charles McBurney--McBurney's point. If the appendix ruptures and infection

spreads throughout the abdomen, the pain becomes diffuse again as the entire

lining of the abdomen becomes inflamed. Nausea and vomiting also occur in

appendicitis and may be due to intestinal obstruction.

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HEALTH HISTORY

a. Profile of Patient

Patients Name: ?

Birth Date: ?

Birthplace: ?

Age: 18

Sex: Male

Height: 55Weight: 58 kg.

Status: Single

Religion: Roman Catholic

Nationality: Filipino

Fathers Name: Deceased

Mothers Name: ?

Address: ?

Allergy: Foods & Drugs

Date of Admission: January 7, 2008

Time of Admission: 1:00 AM

Chief Complaints: Abdominal Pain

Admitting Diagnosis: Acute Appendicitis

Vital Signs:

Temperature: 38.9 C

Pulse Rate: 95 bpm

Respiratory Rate: 32 cpm

BP: 140/70 mmHg

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b. Family and Personal Health History

?, the youngest in the family who was diagnosed of having a Acute

Appendicitis admitted at Polymedic General Hospital lasts January 7, 2008.

According to my interview with him it was his first time to be admitted at the

hospital.

c. History of Present Illness

My patient was ?, he was admitted at Polymedic General Hospital on

January 7, 2008 at 1:00 a.m. and his condition started a day prior to admissionas onset of acute appendicitis with abdominal pain.

d. Chief Complaint

A case of my patient, ?, was due to abdominal pain.

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DEVELOPMENTAL TASK

ERIK ERICKSONS THEORY OF PSYCHOSOCIAL DEVELOPMENT

Adolescence:

Intimacy vs. Isolation

Intimate relationship with another person

Commitment to work and relationships

Impersonal relationships avoidance of relationship, career, or lifestyle

commitments

JEAN PIAGETS THEORY OF COGNITIVE DEVELOPMENT

Piaget's Cognitive Development:

Formal Operations Phase

Uses rational thinking

Reasoning is deductive and futuristic

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MEDICAL MANAGEMENT

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DOCTORS ORDER RATIONALE

January 9, 2008

> Temperature every 2 hours

> NPO

> Intake and Output every 4

hours

> IVF follow up #3 D5LR I L @

30 gtts/min

> Transfer IV site to Left Arm

> Continue medications

> Ambulate

January 10, 2008

> Temperature every 2 hours

> Diet As Tolerated

> To monitor patients condition if there is an

improvement or if there is a change to prevent

further complications. During this period of time,

potentially fatal complications may develop.

> Maintained as ordered.

> To know if the patient has a normal fluid

intake and output. To know for normal kidney

functioning and for laboratory purposes.

> Fluids are required to replace losses, to

prevent patient dehydration. It aids also for

mobilization of secretion.

> To change the swelling site because of back

flow of blood.

> Compliance of medications gives early

recovery.

> Early ambulation helps the patient from faster

recovery.

> To monitor patients condition if there is an

improvement or if there is a change to prevent

further complications. During this period of time,

potentially fatal complications may develop.

> Serves as transition to the regular diet; is a

nutritionall ade uate diet is a modification of

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Name of

drug

Date

Ordered

Classificatio

n

Dosage/

Frequenc

y

Route

Mechanism of

Action

Specific

IndicationContraindications

Side Effects/Toxic

Effects

Nursing

Precautio

Paracetamol

(Biogesec)

January

7, 2008

Antipyretic,

Analgesic

1 tab,

P.O.

(prn)

Chemical

Effect: May

produce

analgesic

effect by

blocking pain

impulses, by

inhibiting

prostaglandin.

Therapeutic

Effect:Relieves pain

and reduces

fever.

Fever - Contraindicated

in patients

hypersensitive to

drug.

- Use cautiously

in patients with

history of chronic

alcohol abuse.

Hematologic:

hemolytic

anemia,leucopeni

a

Hepatic: liver

damage, jaundice.

Metabolic:

hypoglycemia

Skin: rash,

urticaria.

- Assess

patients

pain or

temperatu

before and

dring

therapy.

- Assess

patients

drug

history.

- Be alert

for advers

reactions

and drug

interaction

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Laboratory Results

January 7, 2008

Complete Blood Count

Result Expected Values

ame of

drug

Date

Ordere

d

Classificati

on

Dosage/

Frequen

cy

Route

Mechanis

m of

Action

Specific

Indicatio

n

Contraindicati

ons

Side

Effects/Toxi

c Effects

Nur

Preca

furoxim

e

nacef)

Januar

y 7,

2008

Antibiotic 400 g

every 8

hours

Chemical

Effect:

Inhibits

cell-wall

synthesis,

promoting

osmotic

instability.

Therapeuti

c effect:

Kills

susceptibl

e bacteria

Hinders

or kills

suscepti

ble

bacteria.

-

Contraindicat

ed in patients

hypersensitiv

e to drug or

other

cephalosporin

s.

- Use

cautiously in

patients with

history of

sensitivity to

penicillin.

CNS:

headache,

malaise,

dizziness.

GI: nausea,

anorexia,

vomiting,

diarrhea,

glossitis,

abdominal

cramps.

Respiratory:

dyspnea

Skin:

rashes,

urticaria.

- Ass

patien

infect

befor

thera

- Ask

patien

about

previo

reacti

to

cepha

orin

- Be a

for ad

reacti

and d

intera

s.

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White Cell Count - 17,500 5,000 10,000

Red Cell Count - 5.20 4.20 5.40 million

Hemoglobin - 15.7 12.0 16.0 gm/dl

Hematocrit - 45.4 37.0 47.0 vol. %

MCV 87.3 82.0 98.0 fL

MCH 30.2 27.0 31.0 pg

MCHC 34.6 31.5 35.0 g/dl

RDW LV 12.7 12.0 17.0 %

PDW 10.0 9.0 16.0 fL

MPV 8.9 8.0 12.0 fL

Differential Count

Lymphocytes - 13.6 17.4 48.2 %

Neutrophil - 74.6 43.4 76.2 %

Monocyte - 10.7 4.5 10.5 %

Eosonophil - 1.0 0 7.0 %

Basophils - 0.1 0.0 2.0 %

Platelet Count - 240,000 150,000 400,000 mm

Urinalysis

Color - yellow

Clarity - hazy

pH - 7.5

Specific Gravity - 1.010

Protein - negative

Glucose - negative

PATHOPHYSIOLOGY WITH ANATOMY& PHYSIOLOGY

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Anatomy & Physiology

The appendix is a small finger-like projection that comes off the cecum of

the large intestine and has no apparent function in the human. When the

opening in the sac is blocked, it leads to an inflammation of the appendix

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called appendicitis. This condition occurs most commonly in the young,

between childhood and young adulthood.

Appendicitis is an emergency condition and requires urgent surgicalremoval of the appendix. The appendix is a narrow, muscular tube. One end

is attached to the first part of the large intestine, while the other end is closed.

The position of the appendix in the body can vary from person to person. An

average adult appendix is about 4 inches (10cm) long. However, it can vary in

length from as less as an inch to 8 inches. Its diameter is usually about about 6

to 7 mm.

The function of the appendix is unknown. Foods that have not been digested

tend to move into the appendix and are forced out again by the contractions of

appendix. In herbivorous animals like cow and goat, the appendix can function.

In man, this has become what is called as a vestigial organ (an organ that is no

more required). The vermifom appendix or appendix in short, is a small part of

the bowel or intestine. It is situated on the right side of the abdomen at the

junction of the small and large intestines. It is a small narrow sac approximately

10 cm long and 1 cm wide. The appendix is a vestigial organ, that is, it serves

no useful purpose.

The appendix is a small projection that develops from a portion of the

large intestine called the cecum. As the appendix develops it lengthens

and the tip can be found in almost any position about the cecum.

Pathophysiology

Predisposing factors:

Age

Gender

Lifestyle

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Precipitating factors:

Infections

Appendicitis

Obstruction of the narrow appendiceal lumen

Obstruction has many sources, including fecaliths, lymphoid hyperplasia (related

to viral illnesses such as upper respiratory infections, mononucleosis, or

Gastroenteritisgastrointestinal parasites, foreign bodies, and Crohn's disease

Continued secretion of mucus from within the obstructed appendix results in

elevated intraluminal pressure,

Leading to tissue ischemia, over-growth of bacteria, transmural inflammation,

appendiceal infarction, and possible perforation

Inflammation may then quickly extend into the parietal peritoneum and

adjacent structures

s/s: epigastric pain, vomiting, anorexia, fever

Complications: wound infections, intra-abdominal abscess, intestinal

obstruction, and prolonged ileus

NURSING SYSTEMS REVIEW CHART

Name: X Date: 01-08-08

Vital Signs:

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Pulse: 95 bpm Bp: 140/70 mmHg RR: 32 cpm Temp: 38.9 CHeight: 55 Weight: 58 kg.

EENT[ ] impaired vision [ ] blind

[ ] pain redden [ ] drainage[ ] gums [ ] hard of hearing [ ] deaf[ ] burning [ ] edema [ ] lesion [ ] teeth[ ] assess eyes ears nose[ ] throat for abnormality [x] no problem fast breathingRESP:[ ] asymmetric [x] tachypnea [ ] barrel chest[ ] apnea [ ] rales [ ] cough pain at the surgical site[ ] bradypnea [ ] shallow [ ] rhonchi[ ] sputum [ ] diminished [ ] dyspnea[ ] orthopnea [ ] labored [ ] wheezing[ ] pain [ ] cyanoticAssess resp. rate, rhythm, pulse bloodbreath sounds, comfort [x] no problemCARDIOVASCULAR:

[ ] arrhythmia [ ] tachycardia [ ] numbness[ ] diminished pulses [ ] edema [ ] fatigue[ ] irregular [ ] bradycardia [ ] murmur[ ] tingling [ ] absent pulses [ ] painAssess heart sounds, rate rhythm, pulse, bloodpressure, circ., fluid retention, comfort[x] No problemGASTROINTESTINAL TRACT:[ ] obese [ ] distention [ ] mass[ ] dysphagia [ ] rigidity [x] painassess abdomen, bowel habits, swallowing,bowel sounds, comfort [x] no problemGENITO URINARY AND GYNE[ ] pain [ ] urine [ ] color [ ] vaginal bleeding[ ] hematuria [ ] discharge [ ] nucturia

Assess urine frequency, control, color, odor,[ ] gyne bleeding [ ] discharge [x] no problemNEURO:[ ] paralysis [ ] stuporus [ ] unsteady [ ] seizure[ ] lethargic [ ] comatose [ ] vertigo [ ] tremors[ ] confused [ ] vision [ ] gripAssess motor, function, sensation, LOC,grip, gait, coordination, speech [x] no problemMUSCULOSKELETAL and SKIN:[ ] appliance [ ] stiffness [ ] itching [ ] petechiae[ ] rashes [ ] drainage [ ] prosthesis [ ] swelling[ ] lesion [ ] poor turgor [ ] cool [ ] flushed[ ] atrophy [ ] pain [ ] ecchymosis [ ] diaphoreticAssess mobility, motion gait, alignment, skin color,texture, turgor, integrity [x] no problem

NURSING MANAGEMENT

Ideal Nursing Management (NCP)

NURSING DIAGNOSIS: Sleep Pattern Disturbances

Risk factors may include

Internal factors: illness, psychologic stress, inactivity

External factors: environmental changes, facility routines

Changes in activity pattern

Possibly evidenced by

Reports of difficulty in falling asleep/not feeling well-rested

Interrupted sleep, awakening earlier than desired

Change in behavior/performance, increasing irritability

DESIRED OUTCOMES/EVALUATION CRITERIAADULT WILL:

Sleep (NOC)

Report improvement in sleep/rest pattern.

Verbalize increased sense of well-being and feeling rested.

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ACTIONS/INTERVENTIONS

Sleep Enhancement (NIC)

Independent

Provide comfortable bedding and

some of own possessions; e.g., pillow,

afghan.

Establish new sleep routine

incorporating old pattern and new

environment.

Match with roommate who has similar

sleep patterns and nocturnal needs.

Encourage some light physical

activity during the day. Make

sure client stops activity several

hours before bedtime as

individually appropriate.

Promote bedtime comfort regimens;

e.g., warm bath and massage, a glass

of warm milk, wine/brandy at bedtime.

Instruct in relaxation measures.

Reduce noise and light.

Encourage position of comfort, assist

in turning.

Lower bed and osition one side

RATIONALE

Increases comfort for sleep and

physiologic/psychologic support.

When new routine contains as

many aspects of old habits as

possible, stress and related anxiety

may be reduced, enhancing sleep.

Decreases likelihood that night owl

roommate may delay clients falling

asleep or create interruptions that

cause awakening.

Daytime activity can help client

expend energy and be ready for

nighttime sleep; however,

continuation of activity close to

bedtime may act as stimulant,delaying sleep.

Promotes a relaxing, soothing

effect.

Helps induce sleep.

Provides atmosphere conductive to

sleep.

Repositioning alters areas of

pressure and promotes rest.

May heave fear of falling because of

chan e in size and hei ht of bed.

NURSING DIAGNOSIS: Risk for Imbalanced Body Temperature


Exposure to cool environment

Use of medications, anesthetic agents

Extremes of age, weight; dehydration


[Not applicable; presence of signs and symptoms establishes an act

diagnosis]

DESIRED OUTCOMES/EVALUATION CRITERIACHILD WILL:

Thermoregulation (NOC)

Maintain body temperature within normal range.

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Temperature Regulation (NIC)

Independent

Assess environmental temperature

and modify as needed; e.g., providewarming blankets, increase room

temperature.

Provide cooling measures for client

with preoperative or postoperative

temperature elevations.

Increase ambient room

temperature (e.g., to 78F or

80F) at conclusion of procedure.

Collaborative

RATIONALE

Manipulating ambient air around client

will prevent heat loss.

Cool irrigations, exposure of skin

surfaces to air, cooling blanket may

be required to decrease

temperature.

Minimizes client heat loss when

drapes are removed and client is

prepared for transfer.

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Monitor temperature throughout

intraoperative phase.

Malignant HyperthermiaPrecautions (NIC)

Respond promptly to symptoms of

malignant hyperthermia (MH); i.e.,

rapid temperature elevation/persistenthigh fever:

Provide iced saline to all body

surfaces and orifices;

Obtain dantrolene (Dantrium) for IV

administration per protocol.

Continuous warm/cool humidified

inhalation anesthetics are used to

main humidity and temperature

balance within the tracheolbronchial

tree.

Prompt recognition and immediate

action to control temperature is

necessary to prevent seriouscomplications/death.

Iced solution lavage of body

surfaces and cavities will reduce

body temperature.

Immediate action to control

temperature is necessary to prevent

intense catabolic process

associated with malignant

hyperthermia.NURSING DIAGNOSIS: Acute Pain


Distention of intestinal tissues by inflammation

Presence of surgical incision


Reports of pain

Facial grimacing, muscle guarding; distraction behaviors

Autonomic responses

DESIRED OUTCOMES/EVALUATION CRITERIACHILD WILL:

Pain Level (NOC)

Report pain relieved/controlled.

Appear relaxed, able to rest/sleep appropriately.

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Pain Management (NIC)

Independent

Assess pain, noting location,

characteristics, severity (0-10 scale).

Investigate and report changes in pain

as appropriate.

Provide accurate, honest information

to client.

Keep at rest in semi-Fowlers position.

RATIONALE

Useful in monitoring effectiveness of

medication, progression of healing.

Being informed about progress of

situation provides emotional

support, helping to decrease

anxiety.

Gravity localizes inflammatory

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Encourage early ambulation.

Provide diversional activities.

Collaborative

Keep NPO/maintain NG suction

initially.

Administer analgesics as indicated

Place ice bag on abdomen

periodically during initial 24-48 hour as

appropriate.

exudates into lower abdomen or

pelvis, relieving abdominal tension,

which is accentuated by supine

position.

Promotes normalization of organ

function; e.g., stimulates peristalsis

and passing of flatus, reducing

abdominal discomfort.

Refocuses attention, promotes

relaxation, and may enhance coping

abilities.

Prompt recognition and immediate

action to control temperature is

necessary to prevent serious

complications/death.

Relief of pain facilitates cooperation

with other therapeutic interventions;

e.g., ambulation, pulmonary toilet.

Soothes and relieves pain through

desensitization of nerve endings.

Actual Nursing Management (SOAPIE)

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HEALTH TEACHINGSS Sakit akong tiyan diri dapit sa akong kilid as verbalized by the patient.

O

Facial grimace

Guarding

Restlessness

AAlteration in comfort pain related to distension of intestinal tissues by

inflammation

P

Long term: At the end of an hour, the patient will be able to response to

interventions/teaching and action performed.

Short term:At the end of 30 minutes of rendering nursing intervention, the

patient will be able to verbalize relief/control of pain.

I

Assess pain noting location, characteristics and intensity. (0-10 scale).

o Helps evaluate degree of discomfort.

Provide accurate, honest information to patient/SO. Keep at rest in

semi-Fowlers position.

o Being informed about progress of situation provides emotional

support, helping to decrease anxiety. Gravity localizes

inflammatory exudate into lower abdomen or pelvis, relieving

abdominal tension, which is accentuated by supine position.

Apply hot or cold compress when indicated.

o Reduces pain.

Provide comfort measures e.g. back rub, repositioning the patient.

o Promotes relaxation and may enhance coping abilities.

EAfter rendering nursing intervention, the patient was able to verbalized

relief/control of pain.

SDili ko katulog kaayo, lisod ko og katulog as verbalized by the patient.

O Sleep maintenance insomnia

Dark circles under eyes

Restlessness

A Sleep pattern disturbance related to fatigue and body temperature

PLong term: At the end of 24 hours, the patient will be able to report

improvement in sleep/rest pattern.

Short term: At the end of 8 hours of rendering nursing intervention, the

patient will be able to verbalize increase sense of well-being and feeling

rested.

I

Provide comfortable bedding and some of own possessions; e.g.,

pillow, afghan.

o Increases comfort for sleep and physiologic/psychologic

support.

Establish new sleep routine incorporating old pattern and new

environment.

o When new routine contains as many aspects of old habits as

possible, stress and related anxiety may be reduced, enhancing

sleep.

Instruct in relaxation measures.

o

Helps induce sleep.

Encourage position of comfort, assist in turning.

o Repositioning alters areas of pressure and promotes rest.

E After rendering nursing intervention, the patient was able to verbalized

increase sense of well-being and feeling rested.

S Baho na kaayo ko, gusto nako maligo as verbalized by the patient.

O Body odor

Dryness of hair & scalp

Foul odor of the mouth

A Self-care deficit: bathing/hygiene related to pain discomfort

PLong term: At the end of the shift, the patient will be able to perform self-care

activities within level of own ability.

Short term:At the end of 30 minutes of rendering nursing intervention, the

patient will be able to demonstrate techniques/lifestyle changes to meet own

needs.

I

Involve client in formulation of plan of care at level of ability.

o Enhances sense of control and aids in cooperation and

maintenance of independence.

Provide and promote privacy, including during bathing/showering.

o Modesty may lead to reluctance to participate in care or perform

activities in the presence of others.

Shampoo/style hair as needed. Provide/assist with manicure.

o Aids in maintaining appearance. Shampooing may be required

more/less frequently than bathing schedule.

Encourage/assist with routine mouth/teeth care daily.

o Reduces risk of gum disease/tooth loss, enhances oral health,

and promotes proper fitting and use of dentures.

E After rendering nursing intervention, the patient was able demonstrated

techniques/lifestyle changes to meet own needs.

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MEDICATIONS > Advised and encouraged patient or family

to give the patient paracetamol when she

has fever.

> Do not give patient more than 5 doses in

24 hours unless prescribed by physician.

EXERCISE > Take some rest to prevent stress and

other complications.

> Instruct the patient to do frequent

ambulation, do ROM exercises and deep

breathing exercises to promote blood

circulation and fast healing.

TREATMENT > Instruct the patient to continue for

compliance of medication regimen.

> Instruct the patient to increased fluid

intake to promote regain of fluid and

electrolyte balance.

OUT-PATIENT

(Check-up)

> Advised the patient to visit to the nearest

hospital for further check-up.

> Instruct the patient to call his physician if

he will experience any unusualities.

DIET > Encourage the patient to eat rich in high

protein such as meat, fish, and eggs for

early wound healing

REFERRALS & FOLLOW-UP

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To allow continuous monitoring of the patients healing progress, patient

was encouraged to consult her doctor 2 weeks after discharge for follow-up

check up of her general condition. This will ensure thorough follow up of her

condition and prevention of potential complications. Apart from this, patient

was advised to increase fluid intake, make sure that proper hand washing is

practiced before and after eating.

PROGNOSIS

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Patients with acute appendicitis usually progress especially when it is not

yet to its mere complication. The rate of progression depends on the underlying

diagnosis, on the successful implementation of secondary preventative

measures, and on the individual patient. If the patient is untreated the prognosis

becomes worst and poor.

In the case of my patient, as he undergone tough treatment at Polymedic

General Hospital, his prognosis is considered as good. As evidenced by

tolerating slowly lessen the abdominal pain and maintaining increase of fluid

and electrolyte balance.

EVALUATION

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At the end of my hospital duty, I as a student nurse was able to render care

to my patient to help him resolve his problem regarding health. Through

observing the patients status, I was able to identify some problems during my

assessment. Because of a couple of interventions or health teachings applied

and imparted to the patient, I was able to render his needs on his problem;

alleviated pains felt by the patient due to the effects of the abdominal pain or

appendicitis; and even have improved his sleeping/resting pattern.

Patient was willing to pursue his medical therapy just to promote health and

wellness for the betterment of his condition. During the treatment, the patient was

able to develop or enhance health awareness on his disease and with this

knowledge instilled to his mind, he was then aware on how the disease was

transmitted and what are the proper ways or interventions done just to minimize

or prevent this disease from getting worst.

I have also made the patient realize the importance of completing the

course of therapy by taking the medicines prescribed or ordered to him by his

physician. In addition, eating healthy or nutritious foods that were prescribed to

him by the health providers was further been explained to him especially the

benefits he will gain in eating these nutritious foods.

In general, the patient was very cooperative to what health measures

administered to him by the health providers.

Moreover, these several interventions given to the patient made his body

functions different than as before.

Reference

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Black, Joyce M. 1993. Medical-Surgical Nursing. - A Psychologic

Approach. 4th Edition. W.B Saunders Company: Philadelphia, Pennsylvania,USA.

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