Appendicitis

Hospital: Al-amiri

Ward:5

Room: 14

Bed:23

Client name: Zhen fda

Diagnosis: appendicitis

DevelopmentAge: 43 years

Sex: male Marital status : M

Children: 4 Significant others: Husain- his brother

SpiritualReligion: MuslimSocio culturalOccupation: driverEducation: high schoolNationality: India Languages: Arabic/English Living situation: flatHobbies : Readingsmoking :NO

Family history: NO Client history : No Allergic: NoDiet: normal diet.Dose client wearDentures: Noglasses: Yescontact lenses: NoDose client required help in ADL?Eating: nobathing: nodressing: nowalking: notoilet: no

PsychologicalDose client worry about any thing?

Anxiety about his disease.

How client does cope with the worry?

Follow of doctor order.

PhysiologicalWhy did the client come to hospital?

Sever abdominal pain.

Sleep pattern: 6- 8 hours comfortable

Elimination pattern: -urine: 5 time per day /yellow -stool: 1 time per day/ brown

List medications presently taking: -flgyl 250ml,IV

-zantac 150 mg po.

-rocephin 1g,IV

Observation and comments: pale skin, tired,

Extra personalInterpersonalIntrapersonalvariables

- Iv lock-Abdominal pain

Physiological

- Lack of support from his worker group

- Anxiety about his disease .Psychological

- Not comfortable from his job

-Socio-culture

Extra personalInterpersonalIntrapersonalvariables

Developmental

- he want go to mosque but he can not, because he is in hospital

Spiritual

The appendix is a closed-ended, narrow tube up to several inches in length that attaches to the cecum (the first part of the colon) like a worm.

The inner lining of the appendix produces a small amount of mucus that flows through the open center of the appendix and into the cecum

The wall of the appendix contains lymphatic tissue that is part of the immune system for making antibodies.

Appendicitis means inflammation of the appendix.

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.

The mucus or stool hardens, becomes rock-like, and blocks the opening.

After the blockage occurs, bacteria which normally are found within the appendix begin to invade (infect) the wall of the appendix.

Body responds to the invasion by mounting an attack on the bacteria, an attack called inflammation.

If the inflammation and infection spread through the wall of the appendix, the appendix can rupture.

After rupture, infection can spread throughout the abdomen.

rupture may happen as soon as 48 to 72 hours after symptoms begin.

A less common complication of appendicitis is blockage of the intestine.

Blockage occurs when the inflammation surrounding the appendix causes the intestinal muscle to stop working, and this prevents the intestinal contents from passing.

Nausea and vomiting may occur.

Pain

Nausea and sometimes vomiting

Loss of appetite

Appendix inflammation increase

Fever will be present

Consitipation

Inability to pass gas

Diarrhea

Abdominal swelling

In addition to a complete medical history and physical examination, diagnostic procedures for appendicitis may include the following:

Blood tests.

Urine tests (to rule out a urinary tract infection).

Imaging procedures (to determine if the appendix is inflamed), including the following:

1. Computer tomography scan

2. Ultrasound

3. Abdominal X-Ray

(medication) Antibiotics .

surgical removal of the appendix (appendectomy). People can live a normal life without their appendix and specific changes in diet, exercise, or other lifestyle factors may not be necessary

As inflammation spreads pain is localized and is noted with palpation of the right lower

quadrant. This is referred to as McBurney’s Point.

During an appendectomy, an incision two to three inches in length is made through the skin and the layers of the abdominal wall over the area of the appendix.

Surgeon enters the abdomen and looks for the appendix which usually is in the right lower abdomen.

After examining the area around the appendix to be certain that no additional problem is present, the appendix is removed. This is done by freeing the appendix from its mesenteric attachment to the abdomen and colon, cutting the appendix from the colon, and sewing over the hole in the colon. If an abscess is present, the pus can be drained with drains that pass from the abscess and out through the skin.

The abdominal incision then is closed.

Newer techniques for removing the appendix involve the use of the laparoscope. The laparoscope is a thin telescope attached to a video camera that allows the surgeon to inspect the inside of the abdomen through a small puncture wound (instead of a larger incision).

It is not clear if the appendix has an important role in the body in older children and adults. There are no major, long-term health problems resulting from removing the appendix although a slight increase in some diseases has been noted

Assessment

Subjective data.. Client said: "I feel pain in my abdomen"

"I'm tired"

" I'm feeling nausea "

''I'm worry from the surgery '‘

Objective data.. Vomiting

Tired

Fever 38.6c

Abdominal swelling

Nursing diagnosis

Anxiety related to outcome of surgery

Nursing goal

The client will verbalize knowledge of routines and care during and after surgery

Interventions

2)Assess level of anxiety.

Rationales

2)To identify level of anxiety and reduce that .

Interventions

3)Identify cause that leading to anxiety

Rationales3)To dissolve the problem that leading to

anxiety and give the client some suggest to reduce the anxiety

Interventions

4)give antianixety as prescribed.

Rationales

4) to decrease anxiety

Evaluation

Goal-met because the client reduced the anxiety to minimal level

Nursing diagnosis

Risk for infection related to invasion of organism in the site of surgery

Nursing goal

Client will be free from infection during and after intervention

Interventions

2) assess and monitor swelling redness near of the site of surgery

Rationales

2)That make easy treatment and prevent to develop the infection

Interventions

1) monitor v/s

Rationales

1)To maintain state of client and prevent to cause side effect

Interventions

3)regular dressing

Rationales

3)To prevent for develop infection and pathogens

Evaluation

Goal met because the client free from infection and pathogens

Interventions

2)Monitor input and output chart

Rationales

2)intake and output monitoring provides early detection of fluid imbalance

Ranitidine (zantac)

pre-operative

150mg

po

Indications

- use for treatment of duodenal ulcer and gastric ulcer

Contraindications

- with patient who have allergic with this drug.

Side effects.

- diarrhea or constipation

- headache, dizziness- blurred vision- jaundice

Nursing responsibilities

- assess for abdominal pain

- teach client what the side effect of drug

- teach client to avoid smoking

- given zantac one hour before antacid

Rocephin

pre-operative

1g

IV

Indications

- abdominal infection

- meningitis

- pelvic inflammatory disease

- bone infection

Nursing responsibilities

-watch and observe if the client have allergic or no

-teach client about what the side effect of drug

-if drug IM inject in deep and large muscle

Contraindications

- with patient who have allergic with this drug .

Side effects.

-diarrhea

- skin rash

-fever, headache

-phlebitis

Premosan10mg

Pre-operative

Po

Indications

-prevent nausea and vomiting

-gastrointestinal reflux

Contraindications

-seizures

- with gastrointestinal hemorrhage

- patient with phaeochromocytoma

Side effect

- drowsiness

- depression

Nursing responsibilities

- teach client to avoid alcohol

- teach client what the side effect

- check if any allergic

1) INFORMED CONSENT

Obtain a written permission from client or relatives.

2) NURSING ASSESSMENT

Vital signs Physical assessment drug history Weight and height

3) LEARNING NEEDS

leg exercises

Positioning

deep breathing

4)LABORATORY TESTS

nurses’ responsibility ensure that the doctors orders are completed

Regulation of I/V fluids

Monitor dressings

Monitor vital signs

If vomiting occurs hold client’s head or turn to one side to prevent aspiration

1)Web

www.healthteaching.com

www.rxlist.com

2)Book

Focus on nursing pharmacology

Nursing care plan and documentation

Abdullah Motir

Khaled Rasheed

Nasser Ali