Polypectomy_CS
description
Transcript of Polypectomy_CS
LICEO DE CAGAYAN UNIVERSITY
COLLEGE OF NURSING
NCM501203
NCM501203
A Care Study
POLYPECTOMY
Submitted to:
AS PARTIAL FULFILLMENT OF THE COURSE REQUIREMENT
FOR NCM501203
Submitted by:
I. Introduction
Overview of the case
II. Health History
Profile of patient
III. Developmental Data
IV. Anatomy and Physiology
V. Pathophysiology
VI. Medical Management
VII. Laboratory Results
VIII. Drug Study
IX. Ideal Nursing Management
X. Actual Nursing Management
XI. Health Teachings
XII. Referrals and Follow up
XIII. Bibliography
I. INTRODUCTION
a. Overview of the Case
A polyp is an abnormal growth of tissue (tumor) projecting from a mucous
membrane. If it is attached to the surface by a narrow elongated stalk it is said to
be pedunculated. If no stalk is present it is said to be sessile. Polyps are
commonly found in the colon, stomach, nose, urinary bladder and uterus. They
may also occur elsewhere in the body where mucous membranes exist like the
cervix and small intestine.
Cervical polyps are fingerlike growths that start on the surface of the
cervix or endocervical canal. These small, fragile growths hang from a stalk
and push through the cervical opening.
The cause of cervical polyps is not completely understood. They may be
associated with chronic inflammation, an abnormal response to increased levels
of estrogen, or clogged cervical blood vessels.
Cervical polyps are relatively common, especially in women over
age 20 who have had children. Only a single polyp is present in most
cases, but sometimes two or three are found. They are rare in females
who have not started menstruating.
Abnormal vaginal bleeding is one of the manifestation in this kind of
condition, especially after intercourse, douching, menopause, and even
abnormal heavy periods (menorrhagia), white or yellow mucous discharge
(leukorrhea)
A pelvic examination reveals smooth, red or purple, fingerlike projections from
the cervical canal. A cervical biopsy typically reveals mildly atypical cells and
signs of infection. Polyps can be removed during a simple, outpatient procedure.
Gentle twisting of a cervical polyp may remove it, but normally a polyp is taken
out by tying a surgical string around the base and cutting it off. Removal of the
polyp's base is done by electrocautery or with a laser.
Because many polyps are infected, an antibiotic may be given after the
removal, even if there are no or few signs of infection. Although most cervical
polyps are non-cancerous (benign), the removed tissue should be sent to a
laboratory for further examination. Typically, polyps are benign and easily
removed. Regrowth of polyps is uncommon.
II. HEALTH HISTORY
a. Profile of Patient
Patient’s Name:
Birth Date:
Birthplace:
Age: 39 years old
Sex: Female
Status: Married
Religion:
Nationality: Filipino
Address:
Allergy: None
Date of Admission: May 17, 2007
Time of Admission: 8:30 am
Chief Complaints: Vaginal bleeding on and off
Diagnosis: Dysfunctional Uterine Bleeding
III. DEVELOPMENTAL TASK
ERIK ERICKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT
VI. MEDICAL MANAGEMENT
DOCTOR’S ORDER RATIONALE
May 17, 2007
Admit to Gynecology:
> Temperature every 4 hours
> Soft diet, NPO
> Labs: CBC stat., U/A, FBS,
Hgb, Ultrasound, Chest X-ray,
ECG, Alkaline phosphate.
> Intake and Output every shift
> D5LR I L @ KVO
> Meds:
> During this period of time, potentially fatal
complications may develop
> Serves as transition to the regular diet; is a
nutritionally adequate diet; is a modification of
normal diet in consistency and texture
> CBC- leukocytosis usually present, although
a low WBC counts may present in viral
infection.
> 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.
- ampicillin 1 IVT every 8° Anst
- famotidine 1 amp IVT every
12°
May 18, 2007
> for Evacuation and Curettage
and Polypectomy
>Meds:
>
>diazepam 5 grams IVT
> infuse 20 “u” oxytocin 1 IVF –
30
> methylosomets 1 amp DBP <
8°
> Abdominal massage
> Follow-up D5LR 1 L @ 30
gtts/min. oxytoxin 10 “u”
> Kills susceptible bacteria
> Decreases gastric acid levels and prevents
heartburn.
> for operation to remove cervical polyps.
>
> Relieves anxiety, muscle spasms and
seizures; promotes calmness and sleep.
Causes potent and selective stimulation of
uterine and mammary gland smooth muscle.
>
> To relax the abdomen.
> > Fluids are required to replace losses, to
prevent patient dehydration. It aids also for
mobilization of secretion.
Name of drug Date
Ordered
Classification Dosage/
Frequency
Route
Mechanism of
Action
Specific
Indication
Contraindications Side Effects Nursing
Implication
Paracetamol
(Biogesec)
Cefuroxime
(Zinacef)
May6,2007
May6,2007
Antipyretic,
analgesic
Antibiotic
1 tab, P.O.
(prn)
400 g every
8 hours.
Chemical Effect:
May produce
analgesic effect
by blocking pain
impulses, by
inhibiting
prostaglandin.
Therapeutic
Effect:: Relieves
pain and reduces
fever.
Chemical effect:
Inhibits cell-wall
synthesis,
promoting
osmotic
instability.
Therapeutic
effect: Kills
susceptible
bacteria
Reduces fever
Hinders or
kills
susceptible
bacteria.
- Contraindicated
in patients
hypersensitive to
drug.
- Use cautiously
in patients with
history of chronic
alcohol abuse.
- Contraindicated
in patients
hypersensitive to
drug or other
cephalosporins.
- Use cautiously
in patients with
history of
sensitivity to
penicillin.
Hematologic:
hemolytic
anemia,leucopenia
Hepatic: liver
damage, jaundice.
Metabolic:
hypoglycemia
Skin: rash, urticaria
CNS: headache,
malaise, dizziness.
GI: nausea,
anorexia, vomiting,
diarrhea, glossitis,
abdominal cramps.
Respiratory: dyspnea
Skin: rashes,
urticaria.
- Assess patient’s pain or temperature before and dring therapy.- Assess patient’s drug history.- Be alert for adverse reactions and drug interactions.
- Assess patient’s infection before therapy.- Ask patient about previous reactions to cephalosporin- Be alert for adverse reactions and drug
interactions.
VIII. DRUG STUDY
Name of
drug
Date
Ordered
Classification Dosage/
Frequency
Route
Mechanism of
Action
Specific
Indication
Contraindications Side Effects Nursing Implication
Tramadol May6,2007 Pharmacologic
class: opioid
agonist
Therapeutic
class:
analgesic
300 g IVTT
every 8
hours.
Chemical
effect:
Centrally acting
synthetic
analgesic
compound
thought to bind
opioid
receptorsand
inhibit reuptake
of
norepinephrine
and serotonin.
Therapeutic
effect: Relieves
pain.
Relieves
pain.
- Contraindicated in
patients
hypersensitive to drug
or any of its
component.
- Use cautiously in
patients at risk for
seizures or respiratory
depression.
CNS:
dizziness,
vertigo,
headache
CV:
vasodilation
EENT: visual
disturbances.
GI: nausea,
constipation,
vomiting,
diarrhea
- Assess patient’s
pain before starting
the therapy.
- Monitor CV and
respiratory status.
- Monitor patient for
drug dependence.
Be alert for adverse
reaction.
Name of
drug
Date
Ordered
Classification Dosage/
Frequency
Route
Mechanism of
Action
Specific
Indication
Contraindications Side Effects Nursing Implication
Ketorolac
(Toradol)
Ranitidine
(Zantac)
May7,2007
May7,2007
Pharmacologic
class: NSAID
Therapeutic:
analgesic,
anti-
inflammatory.
Antiulcerative
30 mg IV
every 6
hours.
300g IVTT
every 8
hours.
Chemical
effect: May
inhibit
prostaglandins
synthesis.
Therapeutic
effect:
Relieves pain
and
inflammation.
Chem. Effect:
Competitively
inhibits action
of H2 at
receptor site.
-Relieves GI
discomfort.
Relieves
pain and
inflammation.
Relieves GI
discomfort.
- Contraindicated in
patients
hypersensitive to
drug or any of its
components.
- Not recommend for
intrathecal or epidural
administration
because of its alcohol
content.
- Use cautiously in
patients in the
perioperative period.
- Contraindicated in patients hypersensitive to drug or any of its components.Use cautiously in patients with impaired kidney function.
CNS:
drowsiness,
insomnia,
dizziness,
headache.
CV: edema,
hypertension,
palpitations.
GI: nausea,
GI pain,
diarrhea.
Skin:
sweating.
CNS: vertigo,
malaise.
EENT:
blurred vision
Hepatic:
Jaundice.
- Assess patient’s infection before therapy.- Ask patient about previous reactions to cephalosporin- Be alert for adverse reactions and drug interactions.
-Assess patient’s GI
condition before
starting therapy.
- Be alert for adverse
reactions of drug
interactions.
VII. LABORATORY RESULTS
DIAGNOSTIC TESTS
URINALYSIS
May 6, 2007
Specimen: Random Sample
Color: Yellow
Appearance: Hazy
Glucose: negative
Protein: negative
Reaction: 6.0 pH
Specific gravity: 1.030
Microscopic
WBC: 0-2
RBC: 0-3
Epithelial Cells: plenty
Pus Cells: 3-7 hpf
Mucus Threads: none seen
Urates: moderate
CHEMISTRY:
Alkaline 160 mg/dl
Creatinine G 0.6 u/l
Glucose- G 79 mg/dl
HEMATOLOGY
May 17, 2007
CBC
Total WBC 9.7
Hemoglobin 13.0
Hematocrit 37.7
MCV 81.4
MCH 26.8
Platelet Count 265
Differential Count
Lymphocytes 42
Segmenters 58
Basophils 13.5
HBsAg – non reactive
ULTRASOUND
Cervix 3.0 x 2.90 cm
Endometrium 0.77cm
Uterus 5.3 x 5.2 x 4.1 cm
Right ovary 2.3 x 1.50 cm
Left ovary 2.67 x 1.50 cm
CHEST X-RAY
Finding:
There is no evidence of active parenchyma infiltrates.
Heart is not enlarged.
Aorta, trachea, diaphragm and sinuses are unremarkable.
IV. ANATOMY AND PHYSIOLOGY
The cervix (from Latin "neck") is the lower, narrow portion of the uterus
where it joins with the top end of the vagina. It is cylindrical or conical in shape
and protrudes through the upper anterior vaginal wall. Approximately half its
length is visible with appropriate medical equipment; the remainder lies above
the vagina beyond view. It is occasionally called "cervix uteri", or "neck of the
uterus".
Ectocervix
The portion projecting into the vagina is referred to as the portio vaginalis
or ectocervix. On average, the ectocervix is 3 cm long and 2.5 cm wide. It has a
convex, elliptical surface and is divided into anterior and posterior lips.
External Os
The ectocervix's opening is called the external os. The size and shape of the
external os and the ectocervix varies widely with age, hormonal state, and
whether the woman has had a vaginal birth. In women who have not had a
vaginal birth the external os appears as a small, circular opening. In women who
have had a vaginal birth, the ectocervix appears bulkier and the external os
appears wider, more slit-like and gaping.
Endocervical canal
The passageway between the external os and the uterine cavity is referred to as
the endocervical canal. It varies widely in length and width, along with the cervix
overall. Flattened anterior to posterior, the endocervical canal measures 7 to 8
mm at its widest in reproductive-aged women.
Internal Os
The endocervical canal terminates at the internal os which is the opening of the
cervix inside the uterine cavity.
Cervical crypts
There are pockets in the lining of the cervix known as cervical crypts. They
function to produce cervical fluid.[1]
Histology
The epithelium of the cervix is nonkeratinized stratified squamous epithelium at
the ectocervix, and simple columnar epithelium at the cervix proper.[2][3] At certain
times of life, the columnar epithelium is replaced by metaplastic squamous
epithelium, and is then known as the transformation zone.
Nabothian cysts are often found in the cervix.
Functionality
During menstruation the cervix stretches open slightly to allow the endometrium
to be shed. This stretching is believed to be part of the cramping pain that many
women experience. Evidence for this is given by the fact that some women's
cramps subside or disappear after their first vaginal birth because the cervical
opening has widened.
During childbirth, contractions of the uterus will dilate the cervix up to 10 cm in
diameter to allow the child to pass through.
During orgasm, the cervix convulses and the external os dilates. Dr. R. Robin
Baker and Dr. Mark A. Bellis, both at the University of Manchester, first proposed
that this behavior worked in such a way as to draw any semen in the vagina into
the uterus, increasing the likelihood of conception. Later researchers, most
notably Elisabeth A. Lloyd, have questioned the logic of this theory and the
quality of the experimental data used to back it.
IX. NURSING MANAGEMENT
a. Ideal Nursing Management (NCP)
NURSING DIAGNOSIS: Nutrition: imbalanced, risk for less than body
requirements
Risk factors may include
Inability to ingest or digest food or absorb nutrients because of biological,
psychological, or economic factors
Increased metabolic demands
Possibly evidenced by
[Not applicable, presence of signs and symptoms establishes an actual
diagnosis.]
DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL:
Nutritional Status (NOC)
Ingest nutritionally adequate diet for age, activity level, and metabolic
demands.
Demonstrate stable weight/progressive weight gain toward goal.
ACTIONS/INTERVENTIONS
Nutrition Management (NIC)
Independent
Identify children at risk for malnutrition (e.g.,
intestinal surgery, hypermetabolic states,
restricted intake, prior nutritional
deficiencies).
Determine ability to chew, swallow, taste;
presence of mechanical barriers; or
conditions such as lactose intolerance,
cystic fibrosis, diabetes, inflammatory bowel
diseases.
Determine child’s current nutritional status
using age-appropriate measurements,
including weight and body build, strength,
activity level, sleep/rest cycles.
Elicit information from child/parent of
younger child regarding typical daily food
intake, determining foods and beverages
RATIONALE
Provides opportunity for early
intervention.
These factors can affect ingestion
and/or digestion of nutrients, and
specific dietary choices.
Identifies individual nutritional
needs and provides comparative
baseline.
Baseline information to determine
adequacy of intake. Knowledge of
child’s specific likes/dislikes may
normally consumed. Note types of snacks.
Discuss eating habits and food preferences
(likes and dislikes).
Determine psychological factors, cultural or
religious desires/influences on dietary
choices.
Determine whether infant is breastfed or
formula-fed and typical pattern of feedings
during a 24-hr period. Note type and
amounts of solid foods an infant/young
toddler eats.
Auscultate bowel sounds. Note
characteristics of stool (color, amount,
frequency, and so on).
Discuss with parent what types of candy,
other sweets, snacks, and sodas child
eats/drinks.
Emphasize importance of well-balanced,
nutritious intake. Provide information
regarding individual nutritional needs and
ways to meet these needs within financial
constraints. Avoid arguing over food intake.
be helpful in meeting child’s
nutritional needs during a time
when appetite is suppressed or
child has no interest in food.
Dietary beliefs, such as
vegetarianism, can affect
nutritional intake. Ethnic food
choices can improve a child’s
intake when appetite is poor.
Providing usual and typical
feedings is important to infant well-
being and early growth.
Provides information about
digestion/bowel function and may
affect choice/timing of feeding.
Identifies what child eats in a
typical day. Provides opportunity
for identifying and providing
healthy snacks.
Although nutritious intake is
important, arguing over food is
counterproductive. Providing age-
appropriate guidelines to children
as well as to parents/care provider
Provide food without comment.
Review drug regimen, side effects, and
potential interactions with other
medications/over-the-counter drugs.
Clarify family/caregiver access to/use of
resources such as food stamps, budget
counseling, WIC, community food bank,
and/or other appropriate assistance
programs.
Collaborative
Establish a nutritional plan that meets
individual needs incorporating specific food
restrictions, special dietary needs.
Consult dietitian/nutritional team as
indicated.
Review indicated laboratory data (e.g.,
serum albumin/prealbumin, transferring,
amino acid profile, iron, blood urea nitrogen
[BUN], nitrogen balance studies, glucose,
liver function, electrolytes, total lymphocyte
count, indirect calorimetry).
may help them in making healthy
choices.
Timing of medication doses,
interaction with certain foods can
alter effect of medication or
digestion/absorption of nutrients.
May be necessary to improve
child’s intake and/or availability of
food to meet nutritional needs.
Corrects/controls underlying
causative factors (e.g., diabetes,
cancer, malabsorption syndrome,
and anorexia).
Useful in determining individual
nutritional needs and therapeutic
diet.
Indicators of nutritional health and
effects of nutrients in organ
function.
NURSING DIAGNOSIS: Fluid volume, risk for imbalance
Risk factors may include
Lack of adequate intake, increase in fluid needs, e.g. fever
Rapid/sustained loss, e.g., hemorrhage, burns, vomiting, diarrhea, fistulas
Rapid/excessive fluid replacement
Possibly evidenced by
[Not applicable; presence of signs and symptoms establishes an actual
diagnosis.]
DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL:
Hydration (NOC)
Demonstrate adequate fluid balance as evidenced by stable vital signs,
palpable pulses/good quality, normal skin turgor, moist mucous
membranes; individual appropriate urinary output; lack of excessive
weight fluctuation (loss/gain), and absence of edema.
PARENT/CAREGIVER WILL:
Verbalize understanding of child’s fluid needs.
Promote adequate age-appropriate fluid intake.
ACTIONS/INTERVENTIONS
Fluid Management (NIC)
Independent
Note potential sources of fluid loss/intake,
presence of conditions such as diabetes,
burns, use of total parenteral nutrition
(TPN), etc.
RATIONALE
Causative/contributing factors for
fluid imbalances.
Note child’s age, size, weight, and
cognitive abilities.
Monitor vital signs, mucous membranes,
weight, skin turgor, breath sounds, urinary
and gastric output, amount of blood
draws, hemodynamic measurements.
Review child’s intake of fluids.
Determine child’s normal pattern of
elimination, and whether child is toilet
trained.
Determine whether child has problems
with urination, such as urine retention,
bed-wetting, burning, holding.
Note uses of drainage devices such as
nasogastric tube, wound drain; use of
laxatives, enemas, and suppositories.
Collaborative
Administer IV fluids via control
device/pump.
Affects ability to tolerate fluctuations
in fluid level and ability to respond to
fluid needs.
Indicators of hydration status. Note:
Hypotension indicative of developing
shock may not be readily observed
in pediatric patients until very late in
the clinical course.
Children often do not take in enough
oral fluids to meet hydration needs.
Provides information for baseline
and comparison. If child is in
diapers, output may be determined
by weighing diapers.
Evaluation of these issues is
important for determining cause and
treatment of underlying problem.
May increase fluid and electrolyte
losses.
Because smaller volumes are
administered, close monitoring and
regulation is required to prevent fluid
overload while correcting fluid
balance.
Replace electrolytes as indicated by oral
route whenever possible.
Monitor laboratory results, e.g.,
hemoglobin/hematocrit (Hb/Hct), BUN,
urine osmolality/specific gravity.
Arrange with laboratory to combine
common tests and draw smallest amount
of blood that is necessary to perform
required tests.
Oral replacement solutions
formulated for children are often
safer and better tolerated when
given orally if time/condition allows.
Indicators of adequacy of
hydration/therapeutic interventions.
Excessive/repetitive blood draws
may markedly reduce Hb/Hct levels
in pediatric patients.
NURSING DIAGNOSIS: Infection, risk for (septicemia)
Risk factors may include
Inadequate primary defenses (broken skin, traumatized tissue, altered
peristalsis)
Inadequate secondary defenses (immunosuppression)
Invasive procedures
Possibly evidenced by
[Not applicable; presence of signs and symptoms establishes an actual
diagnosis.]
DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:
Infection Status (NOC)
Achieve timely healing; be free of purulent drainage or erythema; be afebrile.
Risk Control (NOC)
Verbalize understanding of the individual causative/risk factor(s).
ACTIONS/INTERVENTIONS
Infection Control (NIC)
Independent
Assess vital signs frequently, noting
unresolved or
progressing hypotension, decreased
pulse pressure,
tachycardia, fever, tachypnea.
Note changes in mental status (e.g.,
confusion, stupor).
Note skin color, temperature, moisture.
Monitor urine output.
Perform/model good handwashing
technique. Monitor staff/patient
compliance.
Monitor/restrict visitors and staff as
appropriate. Provide protective
isolation if indicated.
RATIONALE
Signs of impending septic shock.
Circulating endotoxins eventually
produce vasodilation, shift of fluid from
circulation, and a low cardiac output
state.
Hypoxemia, hypotension, and acidosis
can cause
deteriorating mental status.
Warm, flushed, dry skin is early sign of
septicemia. Later manifestations
include cool, clammy, pale skin and
cyanosis as shock becomes refractory.
Reduces risk of
cross-contamination/spread of
infection.
Reduces risk of exposure to/acquisition
of secondary infection in
immunosuppressed patient.
Collaborative
Obtain specimens/monitor results of
serial blood, urine,
wound cultures.
Administer amoebecides e.g.,
Metronidazole.
Identifies causative microorganisms
and helps in
assessing effectiveness of
antimicrobial regimen.
Therapy is directed at anaerobic
bacteria.
X. Actual Nursing Management (SOAPIE)
S SUBJECTIVE: “ Sakit akong tiyan diri dapit sa akong kilid ” as verbalized by the patient.
O - Facial grimace - Guarding - Restlessness
A Alteration in comfort pain related to Distension of intestinal tissues by inflammation
P 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).- Helps evaluate degree of discomfort.
Provide accurate, honest information to patient/SO. Keep at rest in semi-Fowler’s position. - 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.- Reduces pain
Provide comfort measures e.g. back rub, repositioning the patient.- Promotes relaxation and may enhance coping abilities.
DEPENDENT:
Administer medications as indicated e.g. narcotics, analgesics.- Relieves pain enhances comfort and promotes rest.
E At the end of 30 minutes of rendering nursing intervention the patient was able to verbalized relief/ control of pain.
S SUBJECTIVE:
O - Facial grimace - Guarding - Restlessness
A Knowledge, deficient regarding condition, prognosis, treatment, self-care, and discharge needs related to Lack of exposure/recall; information misinterpretation
P At the end of 30 minutes of rendering nursing intervention the patient
will be able to verbalize understanding of disease process and potential complications.
I Identify symptoms requiring medical evaluation, e.g., increasing pain; edema/erythema of wound; presence of drainage, fever. - Prompt intervention reduces risk of serious complications, e.g., delayed wound healing, peritonitis.
Encourage progressive activities as tolerated with periodic rest periods. - Understanding promotes cooperation with therapeutic regimen, enhancing healing and recovery process.
Discuss care of incision, including dressing changes, bathing restrictions, and return to physician for suture/staple removal. - Understanding promotes cooperation with therapeutic regimen, enhancing healing and recovery process.
E At the end of 30 minutes of rendering nursing intervention the patient was able to verbalized understanding of disease process and potential complications.
S SUBJECTIVE: “
O Poor appetite when eating.
A Nutrition: Imbalances, less than body requirements related to poor appetite.
P At the end of 1 hour, patient will be able to demonstrate good appetite and verbalized her feelings concerning resumption of diet.
I Encouraged bed rest and limited activity.
- Decreasing metabolic needs aids in preventing caloric depletion and conserves energy.
Intake and output recorded.
- Useful in identifying specific deficiencies and determining GI response to foods.
Recommended rest before meals.
-Quiets peristalsis and increase available energy or eating.
Encouraged patient to verbalize feelings concerning resumption of diet.
- Hesitation to eat may result of fear that food will cause exacerbation o symptoms.
E At the end of 1 hour, patient was able to demonstrate good appetite and already spoken about her feelings concerning resumption of diet
XI. HEALTH TEACHINGS
Name of Patient: Judy Ann Roque
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.
TREATMENT Maintain clear surroundings.
OUT-PATIENT
(Check-up)
Advised the parents to visit the
nearest hospital for further
check-up for their child.
DIET Diet as to age.
Increase fluid intake.
XII. REFERRALS AND FOLLOW-UP
To allow continuous monitoring of the patient’s 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.
XIII. BIBLIOGRAPHY
Black, Joyce M. 1993. Medical-Surgical Nursing- A Psychologic Approach. 4th ed.
W.B Saunders Company: Philadelphia, Pennsylvania,USA.
Smeltzer, Suzanne C.et al.2004. Medical Surgical Nursing. - 10th ed.Lippincott
Williams and Wilkins: Philadelphia
Price, Sylvia A. 1997. Pathophysiology: Clinical Concepts of Disease Processes.
5th ed. Mosby Year Book, Inc: United States of America
Carpenito, Lynda Juall.2000. Nursing Diagnosis: Application to Clinical Practice.
8th ed. Lyndal Juall Carpenito: United States of America.
Pillitteri, Adele. 2003. Maternal and Child Health Nursing.4rth ed.Wolter Kluwer
Company: Hong Kong.
Doenges, Marilynn E.2006.Nurse’s Pocket Guide.F.ADavis Company:
Philadelphia.
www.yahoo.com
V. PATHOPHYSIOLOGY
Predisposing factors:
Age Gender Lifestyle
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
gastroenteritis gastrointestinal 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