SYMPTOMATOLOGY.docx

8/12/2019 SYMPTOMATOLOGY.docx

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V. SYMPTOMATOLOGY

Signs andSymptoms

Present Absent Rationale

Urine becomes darkand cloudy /

Because of the protein and red blood cellsleaked into it.

Facial and

periorbital edema /

As the colloid osmotic pressure of the blood

drops and soduim and water are retained

BP is elavated/

Owing to increased renin secretion and decreasedGFR

Flank or back pain/

As the kidney tissue swells and stretches the

capsule

Sources(Pathophysiology for the health professions. Barbara E. Gould. Third edition)


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VI ETIOLOGY OF THE DISEASE

ETIOLOGY ACTUAL SYMPTOMS IMPLICATION

Viruses(RSV viral pathogen,

parainfluenza types 1,2 and 3 and

influenza A or B.

RSV infection occurs in the

witer and early spring.

Parainfluenza type 3

infection occurs in the

spring, and types 1 and 2

occur in the fall. Influenza

occurs in the winter.

Other viruses (adenovirus,

enterovirus,hMPV, rhinovirus, and

coronavirus)

herpesviruses (HSV, VZV, and CMV)

cause pneumonia less

frequently in infants and

young children (adenovirus,

enterovirus, rhinovirus, and

coronavirus). A recent

addition to this list is hMPV,

which causes an illness

similar to RSV and may be

responsible for one third to

one half of non-RSV

bronchiolitis. The


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herpesviruses (HSV, VZV,

and CMV) may rarely cause

pneumonia, particularly in

children with impaired

immune systems.

Baterial (S pneumoniae)

H influenzaetype B (HiB

S pyogenes,and S aureus.

S pneumoniae is by far the

most common bacterial

cause of pneumonia. H

influenzae type B (HiB)

(very uncommon in

immunized children), S

pyogenes,and S aureus.

Poor Diet Without the sufficient intake

of vitamins and minerals

that are present in the diet,

the defense mechanism of

the body is weakened;

making it susceptible to

infection and invasion of

possible microorganisms

that are present in the

environment.


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Place of residence his will make the client

susceptible for acquiring a

disease from someone

proximal to him; therefore, a

disease may or may not

develop depending on the

distance of the client from

an infected person and the

virulence of the disease.

Age factor in which the clients

immunity against possible

diseases is not that

developed in comparison to

adults.


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Sex factor in which the

occurrence of the said

disease in prevalent in

males more it is in females.

http://emedicine.medscape.com/article/967822-overview#aw2aab6b2b2date and

http://nurseslabs.com/pneumonia /February 24, 2013

ANATOMY AND

PHYSIOLOGY
http://nurseslabs.com/pneumonia/http://nurseslabs.com/pneumonia/http://nurseslabs.com/pneumonia/http://nurseslabs.com/pneumonia/


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The gastrointestinal tract(GIT) consists of a hollow muscular tube starting from

the oral cavity, where food enters the mouth, continuing through the pharynx,

esophagus, stomach and intestines to the rectum and anus, where food is expelled.

There are various accessory organsthat assist the tract by secreting enzymes to help

break down food into its component nutrients. Thus the salivary glands, liver, pancreas

and gall bladder have important functions in the digestive system. Food is propelled

along the length of the GIT by peristaltic movements of the muscular walls

The functions of the digestive system are:

Ingestion- eating food

Digestion- breakdown of the food

Absorption- extraction of nutrients from the food

Defecation- removal of waste products

The digestive system also builds and replaces cells and tissues that are constantlydying.

Digestive Organs

The digestive system is a group of organs (Buccal cavity (mouth), pharynx,

oesophagus, stomach, liver, gall bladder, jejunum, ileum and colon) that breakdown the


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chemical components of food, with digestive juices, into tiny nutrients which can be

absorbed to generate energy for the body.

The Buccal Cavity

Food enters the mouth and is chewed by the teeth, turned over and mixed with saliva by

the tongue. The sensations of smell and taste from the food sets up reflexes which

stimulate the salivary glands.

The Salivary glands

These glands increase their output of secretions through three pairs of ducts into the

oral cavity, and begin the process of digestion.

Saliva lubricates the food enabling it to be swallowed and contains the enzyme ptyalin

which serves to begin to break down starch.

The Pharynx

Situated at the back of the nose and oral cavity receives the softened food mass or

bolus by the tongue pushing it against the palate which initiates the swallowing action.

At the same time a small flap called the epiglottis moves over the trachea to prevent any

food particles getting into the windpipe.

From the pharynx onwards the alimentary canal is a simple tube starting with the

salivary glands.

The Oesophagus

The oesophagus travels through the neck and thorax, behind the trachea and in front of

the aorta. The food is moved by rhythmical muscular contractions known as peristalsis

(wave-like motions) caused by contractions in longitudinal and circular bands of muscle.

Antiperistalsis, where the contractions travel upwards, is the reflex action of vomiting

and is usually aided by the contraction of the abdominal muscles and diaphragm.

The Stomach


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The stomach lies below the diaphragm and to the left of the liver. It is the widest part of

the alimentary canal and acts as a reservoir for the food where it may remain for

between 2 and 6 hours. Here the food is churned over and mixed with various

hormones, enzymes including pepsinogen which begins the digestion of protein,

hydrochloric acid, and other chemicals; all of which are also secreted further down the

digestive tract.

The stomach has an average capacity of 1 litre, varies in shape, and is capable of

considerable distension. When expanding this sends stimuli to the hypothalamus which

is the part of the brain and nervous system controlling hunger and the desire to eat.

The wall of the stomach is impermeable to most substances, although does absorb

some water, electrolytes, certain drugs, and alcohol. At regular intervals a circular

muscle at the lower end of the stomach, the pylorus opens allowing small amounts of

food, now known as chyme to enter the small intestine.

Small Intestine

The small intestine measures about 7m in an average adult and consists of the

duodenum, jejunum, and ileum. Both the bile and pancreatic ducts open into the

duodenum together. The small intestine, because of its structure, provides a vast lining

through which further absorption takes place. There is a large lymph and blood supply

to this area, ready to transport nutrients to the rest of the body. Digestion in the small

intestine relies on its own secretions plus those from the pancreas, liver, and gall

bladder.

The Pancreas

The Pancreas is connected to the duodenum via two ducts and has two main functions:

1. To produce enzymes to aid the process of digestion

2. To release insulin directly into the blood stream for the purpose of controlling

blood sugar levels

Enzymes suspended in the very alkaline pancreatic juices include amylase for breaking

down starch into sugar, and lipase which, when activated by bile salts, helps to break

down fat. The hormone insulin is produced by specialised cells, the islets of


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Langerhans, and plays an important role in controlling the level of sugar in the blood

and how much is allowed to pass to the cells.

The Liver

The liver, which acts as a large reservoir and filter for blood, occupies the upper right

portion of abdomen and has several important functions:

1. Secretion of bile to the gall bladder

2. Carbohydrate, protein and fat metabolism

3. The storage of glycogen ready for conversion into glucose when energy is

required.

4. Storage of vitamins

5. Phagocytosis - ingestion of worn out red and white blood cells, and some

bacteria

The Gall Bladder

The gall bladder stores and concentrates bile which emulsifies fats making them easier

to break down by the pancreatic juices.

The Large Intestine

The large intestine averages about 1.5m long and comprises the caecum, appendix,

colon, and rectum. After food is passed into the caecum a reflex action in response to

the pressure causes the contraction of the ileo-colic valve preventing any food returning

to the ileum. Here most of the water is absorbed, much of which was not ingested, but

secreted by digestive glands further up the digestive tract. The colon is divided into the

ascending, transverse and descending colons, before reaching the anal canal where the

indigestible foods are expelled from the body.

ANATOMY OF THE APPENDIX


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The appendix is a wormlike extension of the cecum and, for this reason, has

been called the vermiform appendix. The average length of the appendix is 8-10 cm

(ranging from 2-20 cm). The appendix appears during the fifth month of gestation, and

several lymphoid follicles are scattered in its mucosa. Such follicles increase in number

when individuals are aged 8-20 years.

The appendix is contained within the visceral peritoneum that forms the serosa,

and its exterior layer is longitudinal and derived from the taenia coli; the deeper, interior

muscle layer is circular. Beneath these layers lies the submucosal layer, which contains

lymphoepithelial tissue. The mucosa consists of columnar epithelium with few glandular

elements and neuroendocrine argentaffin cells.

Taenia coli converge on the posteromedial area of the cecum, which is the site of

the appendiceal base. The appendix runs into a serosal sheet of the peritoneum calledthe mesoappendix, within which courses the appendicular artery, which is derived from

the ileocolic artery. Sometimes, an accessory appendicular artery (deriving from the

posterior cecal artery) may be found.

Appendiceal vasculature


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The vasculature of the appendix must be addressed to avoid intraoperative

hemorrhages. The appendicular artery is contained within the mesenteric fold that

arises from a peritoneal extension from the terminal ileum to the medial aspect of the

cecum and appendix; it is a terminal branch of the ileocolic artery and runs adjacent to

the appendicular wall. Venous drainage is via the ileocolic veins and the right colic vein

into the portal vein; lymphatic drainage occurs via the ileocolic nodes along the course

of the superior mesenteric artery to the celiac nodes and cisterna chyli.

Appendiceal location

The appendix has no fixed position. It originates 1.7-2.5 cm below the terminal ileum,

either in a dorsomedial location (most common) from the cecal fundus, directly beside

the ileal orifice, or as a funnel-shaped opening (2-3% of patients). The appendix has a

retroperitoneal location in 65% of patients and may descend into the iliac fossa in 31%.

In fact, many individuals may have an appendix located in the retroperitoneal space; in

the pelvis; or behind the terminal ileum, cecum, ascending colon, or liver. Thus, the

course of the appendix, the position of its tip, and the difference in appendiceal position

considerably changes clinical findings, accounting for the nonspecific signs and

symptoms of appendicitis.

Physiology of Appendix

The lumen of the appendix communicates with the cecum 3cm (about 1 inch)

before the ileoccal valve, thus making it an accessory organ of the digestive system. Its

functions are not certain, but some biologists believe that the appendix serves as a sort

of breeding groundfor some of the nonpathogenic intestinal bacteria thought to aid in

the digestion or absorption of nutrients.

Follicles of lymphoid tissue appear in the wall of the appendix shortly a few birth,

become more prominent during the first 10 years of life and then progressively

disappear. The defense or immune system function of lymphatic tissue present in the

appendix of young children is not fully understood.


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PATHOPHYSIOLOGY

Predisposing Factor Precipitating Factor

Age (23 y/o) Bowel movement: 3times a week.

Sedentary Lifestyle Low Fiber Diet

Obstruction to lumen ofthe appendix.

Occlusion/kinking of thelumen.

Inflammation of the

serosa of the appendix.

Signs and Symptoms:Acute RLQ Pain ofthe AbdomenFeverMcBurneys SignNauseaConstipation

Intraluminalpressure.

Muscle Spasm


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Pus Formation asevidenced by increased

White Blood Cell.

Rupture of the Appendix

If treated: If not treated:

Medications: RanitidineAmpicillin Flagyl

Metronidazole

Surgical Procedure:Appendectomy

Metastasize to theblood stream and

throughout the organ

Shock

Septicemia

Wellness

Death


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PATHOPHYSIOLOGY NARRATIVE

The client was diagnosed of acute appendicitis; she had a

predisposing factor; her age (23 y/o), which is according to research adult

age has the higher risk of incidence. Her gender didnt serve as a factor

because males are more prone to the disease rather than in females.

Prior to admission, she experienced irregularity in her bowel habit;

she only defecates three times a week. Her diet which is low in fiber, high

in cholesterol and protein and her sedentary lifestyle attributed to her

illness.

The two factors: precipitating and predisposing, led to the

obstruction of the lumen of the appendix. As the obstruction was

lengthened, it resulted in the kinking of the lumen, causing her pain. The

occlusion caused an inflammation of the serosa of the appendix which

produced an intraluminal pressure, causing muscle spasm on the client.

The inflammation of the serosa of the appendix was characterized by

signs and symptoms of fever, acute pain in the right lower quadrant of her

abdomen, McBurneys sign, nausea andconstipation which causes increase

in the intraluminal pressure thus resulting to muscle spasm.


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As there is presence of inflammation, it resulted in presence of pus

formation evidenced by increased in white blood cells to fight against

infection.

Furthermore, if inflammation will not be cured it can result to a

rupture of the appendix. If rupture is to be treated, the client will need

surgery (appendectomy) and medications. If treatment will be successful, it

will lead to wellness of life.

If the rupture is not treated, it would metastasize to the blood stream

and throughout the organ and further complicate to septicemia leading to

shock, which may result to DEATH.


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COMPLICATION OF APPENDICITIS

The most frequent complication of appendicitis is perforation. Perforation

of the appendix can lead to a periappendiceal abscess (a collection of

infected pus) or diffuse peritonitis (infection of the entire lining of the

abdomen and the pelvis). The major reason for appendiceal perforation is

delay in diagnosis and treatment. In general, the longer the delay between

diagnosis and surgery, the more likely is perforation. The risk of

perforation 36 hours after the onset of symptoms is at least 15%.

Therefore, once appendicitis is diagnosed, surgery should be done without

unnecessary delay.

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

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

contents from passing. If the intestine above the blockage begins to fill

with liquid and gas, the abdomen distends and nauseaand vomiting may

occur. It then may be necessary to drain the contents of the intestine

through a tube passed through the nose and esophagus and into the

stomach and intestine.

A feared complication of appendicitis is sepsis, a condition in which

infecting bacteria enter the blood and travel to other parts of the body.

This is a very serious, even life-threatening complication. Fortunately, it

occurs infrequently.

CLINICAL MANIFESTATION OF APPENDICITIS
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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. A second, common, early symptom of

appendicitis is loss of appetite which may progress to nausea and even

vomiting. Nausea and vomiting also may occur later due to intestinal

obstruction.

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 and then 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.
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