Integrated Surgical Clinical Pathway for Patient for Appendectomy
-
Upload
allein-torres-antonio -
Category
Documents
-
view
100 -
download
0
Transcript of Integrated Surgical Clinical Pathway for Patient for Appendectomy
![Page 1: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/1.jpg)
INTEGRATED SURGICAL CLINICAL PATHWAY FOR
PATIENT FOR LapAROSCOPIC OR OPEN
APPENDECTOMYALNEIL ANTONIO RNLAURICE SARMIENTO
RN
![Page 2: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/2.jpg)
AppendEcTOMY
ois the surgical removal of the appendix when an infection has made it inflamed and swollenoappendicitis, is considered an emergency because it can be life threatening if untreated
![Page 3: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/3.jpg)
•most commonly performedemergency operation worldwide•Appendectomy is on the top 16 of the most common surgery in the Philippines according to Philhealth claims from January to September 2011•Top 12 with claims of 12, 847
![Page 4: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/4.jpg)
HEADING
NAME: SEX:AGE: BIRTHDAY:ATTENDING PHYSICIAN: HOSPITAL
NUMBER:ADMITTING DIAGNOSIS: HEIGHT:
cmWEIGHT: Kg
ADMISSION DATE & TIME: ALLERGIES(if any):
DISCHARGE DATE & TIME:
FINAL DIAGNOSIS:
ACTUAL LENGTH OF STAY: days EXPECTED LENGTH OF STAY: days PATIENT TO INCLUDE IN PATHWAY: Patients with a diagnosis of probable appendicitisPATIENT TO EXCLUDE IN PATHWAY: (1) Incidental Appendectomy (2)Patient with symptoms that require ICU level of care (3) Patient with complicating chronic conditionREMOVE FROM THE PATHWAY IF THE FF. OCCURS: (1) change in Diagnosis (2) Transfer to a higher level of care (3) Significant post-operative complication such as:- Bowel obstruction requiring a second operation or prolonged TPN
ADULT HEALTH CARE HOSPITAL
![Page 5: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/5.jpg)
PARTS OF THE PATHWAYPHASE OF CARE Phase i (emergency room/admission/ward)
ACTIVITY Specific Activities Health Care Team
Time & date
EVALUATIOn
ASsessment
ÿ Initial Vital Signs and Pain Assessment done
ÿ Observe Non verbal cues/ Pain behaviors
ÿ Verification of patient’s identity
ÿ Physical Examination
ÿ Medical History taken
ÿ Measure Height and Weight
RN:____
RN:____
MD:____
RN:____
MD:____
RN:____
MD:____
RN:____
ÿ Goal metÿ goal not met
![Page 6: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/6.jpg)
Inclusion criteria
Patients with a diagnosis of probable appendicitis• The most common symptom of appendicitis is abdominal pain on the
right lower side of the abdomen§ Pain is a symptom described by a patient; tenderness is the response to
being touched. Certain specific signs will help to diagnose appendicitis.§ McBurney's sign -§ Rebound tenderness § Guarding § Rovsing's sign
Other less commonly elicited signs that may indicate appendicitis include:
§ Aaron's sign § Psoas sign § Obturator sign § Blumberg's sign
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 7: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/7.jpg)
EXclusion criteria
(1) Incidental Appendectomy Surgical removal of the vermiform appendix, performed incidentally to another primary surgical procedure.
(2) Patient with symptoms that require ICU level of care
(3) Patient with complicating chronic condition
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 8: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/8.jpg)
REMOVE FROM THE PATHWAY
(1) Change in Diagnosis (2) Transfer to a higher level of care (3) Significant post-operative complication such as:
Bowel obstruction requiring a second operation or prolonged TPN
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 9: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/9.jpg)
PHASES OF CARE
q Phase i (emergency room/admission-ward)q PHASE II (FROM WARD-Perioperative)q PHASE III(POST ANESTHESIA CARE UNIT) q PHASE IV(DAY 1 WARD)q PHASE V (DAY 2 WARD-DISCHARGE)
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 10: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/10.jpg)
Phase I (emergency room/admission-
ward)
![Page 11: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/11.jpg)
Phase i (emergency room/admission-ward)
q Assessmentq LABORATORY & DIAGNOSTIC EXAMq COMFORT AND SAFETYq CONSULTq IV LINEq DIETq Medicationsq Ambulationq HEALTH TEACHINGq Discharge planningq ENDORSE
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 12: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/12.jpg)
Assessment
•Initial Vital Signs and Pain Assessment done•Observe Non verbal cues/ Pain behaviors•Verification of patient’s identity•Physical Examination•Medical History taken•Measure Height and Weight
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 13: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/13.jpg)
LABORATORY & DIAGNOSTIC EXAM
•CBC with differential•PT/PTT•Electrolytes•BUN, Creatinine•Blood sugar•Urinalysis•Pregnancy Test for female•Abdominal CT Scan•Abdominal Xray•ECG
•Other____
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 14: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/14.jpg)
COMFORT AND SAFETY
•Always put the side rails up•Assisted the patient in knee-chest position to relieve pain•Provided instructions on pain relieving measures such as purse lip breathing and deep breathing exercises
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 15: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/15.jpg)
CONSULT
Surgical Consult: Abdominal Pain, Ruled out Appendicitis
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 16: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/16.jpg)
INTRAVENOUS LINE
•D5LRS1L x ____ gtts/min•PNSS1L x ____ gtts/min•Others:•_________
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 17: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/17.jpg)
DIET
•NPO
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 18: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/18.jpg)
ACTIVITIES
•Complete Bed Rest•Complete Bed Rest with BRP’s•Other______
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 19: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/19.jpg)
HEALTH TEACHINGs
•Encouraged Deep Breathing Exercises and purse lip breathing•Instruct not to give any pain medication until the diagnosis is confirmed•Instruct the patient not to provide hot or cold compress•Instruct the patient not to eat anything•Encourage verbalization of feelings about pain•Others:__________________
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 20: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/20.jpg)
Discharge planning
qAssess living conditions and Nature of workqLifestyle Modification
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 21: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/21.jpg)
PHASE II (FROM WARD-PERIOPERATIVE)
![Page 22: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/22.jpg)
PHASE II (FROM WARD-PERIOPERATIVE)
q Assessmentq COMFORT AND SAFETYq proceduresq IV LINEq DIETq SKIN PREPARATIONq Medicationsq HEALTH TEACHINGSq ENDORSE
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 23: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/23.jpg)
Assessment
•Obtain Vital Signs Monitoring/ Pain Assessment Monitoring•Secure Surgical Consent/OR Schedule •OR Pre-Operative Evaluation/ Anesthesia Checklist Done•Ensure Cardio-Pulmonary Clearance Done
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 24: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/24.jpg)
COMFORT AND SAFETY
•Ensure the safety from ward to Operating Room•Secure safety straps and arm boards•Ensure all instruments, sponges and sharps are counted complete
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 25: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/25.jpg)
procedures
•Foley Catheter•Cardiac Monitor•Oxygen Therapy•O2 via NC@__LPM•O2 via FM@__LPM
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 26: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/26.jpg)
INTRAVENOUS LINE
•D5LRS1L x ____ gtts/min•PNSS1L x ____ gtts/min•Others:•_________
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 27: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/27.jpg)
INTRAVENOUS LINE
•D5LRS1L x ____ gtts/min•PNSS1L x ____ gtts/min•Others:•_________
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 28: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/28.jpg)
DIET
•NPO
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 29: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/29.jpg)
SKIN PREPARATION
•Skin Preparation and Removal of Hair at ward•Skin Prepping and Surgical Draping Done
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 30: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/30.jpg)
Medications
Pain MedicationPre-Operative Medication given Anesthesia given: Spinal AnesthesiaGeneral AnesthesiaOthers:
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 31: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/31.jpg)
Health TEACHINGS
•Explain the procedure to the patient•Instruct the client to void before the procedure•Instruct the client to remove dentures and accessories prior to transfer to OR
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 32: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/32.jpg)
POST OPERATIVE CARE
•Surgical Dressings on incision site•Ensure patients care after the procedure•Assess the wound and drainage•Clean the surgical site•Ensure patients safety from OR to RR•Ensure that all records are accomplish
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 33: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/33.jpg)
PHASE III(POST ANESTHESIA CARE
UNIT)
![Page 34: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/34.jpg)
PHASE III(POST ANESTHESIA CARE UNIT)
q Assessmentq COMFORT AND SAFETYq PROCEDURESq IV LINEq DIETq SURGICAL INCISION and DRESSINGq Medicationsq ACTIVITIESq DRAINAGEq HEALTH TEACHINGq ENDORSE
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 35: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/35.jpg)
Assessment
•Obtain Vital Signs Monitoring q 15 •Assess for Post-Op Pain and Complications•Assess the incision site, dressing and drainage•Assess for urine output
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 36: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/36.jpg)
COMFORT AND SAFETY
•Ensure the safety in PACU and transfer from PACU to ward•Keep the siderails up at all times and keep the bed in low position•Provide thermoregulation via:•Thermal Blanket/ Warmer •Drop Light
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 37: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/37.jpg)
PROCEDURES
•Hooked to Cardiac MonitorOxygen Therapy•O2 via NC@__LPM•O2 via FM@__LPM
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 38: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/38.jpg)
DIET
•NPO
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 39: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/39.jpg)
IV LINE
•D5LRS1L x ___gtts/min•PNSS1L x __gtts/min•Others:•_____________
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 40: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/40.jpg)
SURGICAL INCISION and DRESSING
•Assess and change the surgical dressing if soaked with blood•Drain the drainage container(if any) before transfer to room
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 41: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/41.jpg)
Medications
•Ketorolac ___/IV q__hrs x ___doses•Nubain __/SIVP PRN for severe pain•Demerol __mg/IV PRN for chills•Tramadol___mg/IV q___hrs x __doses•Ranitidine 60mg/IV q__ x __doses•Others:
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 42: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/42.jpg)
ACTIVITIES
•Keep the patient flat on bed•Moderate to High Back Rest•Assisted patient on needs
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 43: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/43.jpg)
DRAINAGE
•JP Drain•Penrose Drain•Hemovac
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 44: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/44.jpg)
HEALTH TEACHING
•Inform the relative regarding the result of operation/complications, risk and stability of the patient• Inform the patient & relative after transfer to room diet, activities and
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 45: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/45.jpg)
PHASE IV(DAY 1 WARD)
![Page 46: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/46.jpg)
PHASE IV(DAY 1 POST OPERATIVE AT WARD)
q Assessmentq COMFORT AND SAFETYq Woundq IV LINEq DIETq ELIMINATIONq Medicationsq ACTIVITIESq DRAINAGEq HEALTH TEACHINGq ENDORSE
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 47: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/47.jpg)
Assessment
•Monitor Vital Signs•Assess for Post-Op Pain and Complications•Assess the incision site and drainage•Assess for urine output, bowel sounds
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 48: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/48.jpg)
COMFORT AND SAFETY
•Keep the side rails up at all times•Keep the bed at the possible lowest position•Assisted on needs
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 49: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/49.jpg)
wound
•Assess and Record the amount of drainage •Assess the wound for any absess or sings of inlammation•Clean the wound with Normal Saline Solution and Hydrogen peroxide and Anti Septic
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 50: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/50.jpg)
DIET
•NPO•Clear Liquid Diet•Soft Diet•Regular Diet
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 51: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/51.jpg)
IV LINE
•D5LRS1L x ___gtts/min•PNSS1L x __gtts/min•Others:•_____________
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 52: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/52.jpg)
ELIMINATION
•Removes the indwelling urinary catheter. Record urinary output.•Check bowel sounds. Note stool consistency
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 53: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/53.jpg)
Medications
•Ketorolac ___/IV q__hrs x ___doses•Nubain __/SIVP PRN for severe pain•Demerol __mg/IV PRN for chills•Tramadol___mg/IV q___hrs x __doses•Ranitidine 60mg/IV q__ x __doses•Others:
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 54: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/54.jpg)
ACTIVITIES
•Keep the patient flat on bed•Moderate to High Back Rest•Assisted patient on needs•May move from side to side but with assistance
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 55: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/55.jpg)
HEALTH TEACHING
•Encouraged deep breathing and purselip exercises•Instruct not to lift heavy weights•Provided instructions on wound cleaning and change of dressings•
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 56: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/56.jpg)
Discharge planning
•Stressed out the compliance in taking medications•Provided instructions on appropriate exercises and not to lift heavy objects•Instructed to follow the treatment regimen and health teachings given•Stressed out the importance of diet in patients condition•Instructed on follow up check up
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 57: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/57.jpg)
PHASE V (DAY 2 WARD-DISCHARGE)
![Page 58: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/58.jpg)
PHASE V (DAY 2 WARD-DISCHARGE)
q Assessmentq COMFORT AND SAFETYq Woundq IV LINEq DIETq ELIMINATIONq Medicationsq ACTIVITIESq DRAINAGEq HEALTH TEACHINGq ENDORSE
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 59: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/59.jpg)
Assessment
•Monitor Vital Signs•Assess for Post-Op Pain and Complications•Assess the incision site and drainage•Assess for urine output, bowel sounds
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 60: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/60.jpg)
COMFORT AND SAFETY
•Keep the side rails up at all times•Keep the bed at the possible lowest position•Assisted on needs
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 61: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/61.jpg)
wound
•Assess and Record the amount of drainage •Assess the wound for any absess or sings of inlammation•Clean the wound with Normal Saline Solution and Hydrogen peroxide and Anti Septic•Remove the drainage
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 62: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/62.jpg)
DIET
•NPO•Clear Liquid Diet•Soft Diet•Regular Diet
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 63: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/63.jpg)
IV LINE
•D5LRS1L x ___gtts/min•PNSS1L x __gtts/min•Others:•_____________
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 64: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/64.jpg)
ELIMINATION
•Removes the indwelling urinary catheter. Record urinary output.•Check bowel sounds. Note stool consistency
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 65: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/65.jpg)
Medications
•Ketorolac ___/IV q__hrs x ___doses•Nubain __/SIVP PRN for severe pain•Demerol __mg/IV PRN for chills•Tramadol___mg/IV q___hrs x __doses•Ranitidine 60mg/IV q__ x __doses•Others:
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 66: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/66.jpg)
ACTIVITIES
•Keep the patient flat on bed•Moderate to High Back Rest•Assisted patient on needs•May move from side to side but with assistance
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 67: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/67.jpg)
HEALTH TEACHING
•Encouraged deep breathing and purselip exercises•Instruct not to lift heavy weights•Provided instructions on wound cleaning and change of dressings•
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 68: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/68.jpg)
Discharge planning
•Stressed out the compliance in taking medications•Provided instructions on appropriate exercises and not to lift heavy objects•Instructed to follow the treatment regimen and health teachings given•Stressed out the importance of diet in patients condition•Instructed on follow up check up
http://www.medindia.net/patients/patientinfo/Appendicitis_symptoms.htm
![Page 69: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/69.jpg)
DateTime
Type of VarianceDescription of Variance
Occurrence(Include what happened, why
it happened and what was done about it)
RN’s Name & Signature
Date Time Type of Variance Description of Variance Occurrence
(Include what happened, why it happened and what was done about it)
RN’s Name & Signature
VARIANCE RECORD SHEET
![Page 70: Integrated Surgical Clinical Pathway for Patient for Appendectomy](https://reader034.fdocuments.in/reader034/viewer/2022042521/55401278550346c4778b4a25/html5/thumbnails/70.jpg)
Variance code
A. PATIENT/ FAMILY
B. HEALTH CARE PROVIDER
C. HOSPITAL/ INSTITUTION
SYSTEM
D. OUTSIDE HOSPITAL/INSTI
TUTION
1.PATIENT’S MEDICAL CONDITION
1.MEDICAL ORDER 1. RESULTS/DATA UNAVAILABILITY
1. CONDITION/TRANSPORTATION
2.PATIENT’S/FAMILY DECISION
2. PROVIDER’S DECISION
2. SUPPLIES/EQUIPMENT RELATED
2.HOME CARE AVAILABILITY
3.PATIENT/FAMILY AVAILABILITY\
3.PROVIDER’S RESPONSE
3.APPOINTMENT/AVAILABILITY
3.OTHER REASONS
4.NO FUNDS 4.OTHER REASONS 4.WEEKEND/HOLIDAY
5.OTHERS 5.OTHER REASONS