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Discussion of the Problem

Appendicitis is an inflammation of the veniform appendix caused by an


obstruction of the intestinal lumen from infection, fecal mass, foreign body or tumor. It
starts when there is obstruction followed by edema, infection and ischemia.

The symptoms begin with acute abdominal pain (generalized or localized) which
comes in manes. In the beginning it maybe merely a discomfort that makes the patient
feel as though passing flatus or having bowel movement will give relief. The pain
typically starts in the epigastrium or periumbilical region and shifts to the right lower
quadrant as the inflammatory process spreads to involve the serosal layers of the bowel
and brings the inflammation into contact with the peritoneum. The pain now becomes
steady rather than intermittent, and the patient guards the area by lying still and drawing
the leg up to relieve tension on the abdominal muscle

Other symptoms include vomiting, which begins after the pain starts, loss of
appetite, a low grade fever, moderate malaise, coated tongue and bad breath. Usually
constipation occurs and diarrhea occasionally. Mild leukocytes are usually present with a
white blood cell count between 10,000 and 15,000. Rebound tenderness, generalized
abdominal rigidity also occurs.

Treatment is removal of the appendix (appendectomy) 24-48 hours of onset of the


symptoms. Delay usually causes rupture of the organ resulting to peritonitis.

I. Patients Profile
Name: Jomar Ba-a Lumabas
Age: 16 y/o
Sex: Male
Date of Birth: March 3, 1991
Place of Birth: Buguias
Religion: Roman Catholic
Nationality: Filipino
Civil Status: Single
Address: Natubleng, Nabalikong, Buguias
Occupation: Vegetable Delivery Boy
Educational Attainment: Elementary Graduate
Date and Time Admitted: 09/17/2007
Ward: Surgical Ward
Attending Physician: Dr. Pablo Candelario
Admitting Diagnosis: Acute Appendicitis
Operation Performed: E Appendectomy
II. Chief Complaint and Course of Confinement
The patient experienced fever for 2 days, and abdominal pain at the right
lower quadrant started on a Friday, 09/14/07. The following Saturday, 09/15/07,
he was confined at Atok District Hospital and was referred to Benguet General
Hospital.
III. Present Illness
At present, the patient is afebrile but feels pain on the right lower quadrant
of the abdomen.
IV. Past History
The patient had no major disease that needed medical hospitalization
except for flu, colds, cough, and fever, which was managed by over the counter
drugs
V. Family History
The patient has a family history of hypertension

13 Areas of Assessment
I. Psychological
Patient Lumabas, a pure Kankanaey, 16 years old, male, is from Natubleng
Nabalikong, Buguias. He was born on March 3, 1991. He works as a vegetable
delivery boy. Their main source of livelihood is farming and gardening. He is a
roman catholic while his parents Jehovas Witnesses. His parents refrain from
eating foods mixed with blood while the patient used to eat dinuguan. The patient
was admitted due to abdominal pain and fever. He stayed at the surgical ward,
which has cubicles that has a four bed capacity for patients. The patient was first
confined in Atok District Hospital and was referred to Benguet General Hospital.
He is the 6th child in the family. He lives together with his parents and
three siblings. He lives a simple life and used to work and play billiards in their
place prior to admission.
II. Mental and Emotional Status
The patient is conscious and coherent. He answers correctly with the
questions being asked. He feels pain when touched by sharp objects. He is well
oriented to time and place from where he is. He is an elementary graduate,
meaning he was able to finish up to grade 6. He knows how to read and write, is
very attentive and has the ability to understand the questions being asked. He
doesnt know what the cause of what he is feeling is but his mother believes that it
is because his son carries heavy sacks of vegetables as it is part of his job. The
patient, felt pain near the area of his umbilicus at first, which he thought could be
relieved by taking some rest and sleep but still, he felt the pain and thus went to
Atok District Hospital and was referred to Benguet General Hospital.
He appears weak and silent. He converses only when asked. He just wants
to lie in bed and rest but still feels pain on his right lower quadrant of his
abdomen. When he was still at home and felt the pain, he took is paracetamol
without any prescription of a doctor.
III. Environment Status
The patient has limited range of motion. He is assisted when walking
especially in going to the comfort room.
He described that their equipment for farming and gardening is well
organized as to prevent accidents. And sharp materials are kept.
At present, he has cough and colds. He is not taking medicine for his
cough and colds.
According to him, whenever theres a sick family member, like that of his
situation, the family usually isolates them in their house to prevent transfer of
pathogens
He can still tolerate noise coming from visitors of other patients but if too
loud, he becomes irritable. He prefers lying in bed and staring at people and
objects than to do other activities like reading magazines to divert sensations of
pain.
IV. Sensory Status
The patient has normal field of vision and has the ability to distinguish
objects at a specific distance. He doesnt use any corrective devices. He has
pinkish palpebral and white bulbar.
He has the ability to distinguish voices even if it is soft or loud at specified
distances, with clean, complete and symmetrical ears.

He can discriminate odors but cant smell a lot at present because of the
presence of colds that could obstruct or hinder his sense of smell.
He feels sharp and dull, light and firm touch. He responds usually with
sharp objects because he feels pain from it. He also feels cold when the weathers
cold and feels hot when the weathers warm. He can differentiate hot and cold
sensations.
He speaks softly but clearly. He doesnt initiate conversations.
V. Motor Status
The patient had undergone a procedure last Sept. 17, 2007 which was an
appendectomy. He has limited range of motion because of pain on his operative
site. He has tissue trauma due to post operative surgical incision. All extremities
are intact, without any lesions but is with impaired skin integrity on the operative
site. He is still on bed rest. He can ambulate at a minimal distance due to the fresh
incision site of his post operative surgery. These changes happen to a person who
has undergone surgical procedures and is seen normally in them. These are still
validated again on our duty last September 18, 2007 at the 3-11 shift.
VI. Nutritional Status
The patient eats three times a day with good appetite prior to admission.
But upon hospitalization, he eats small amounts of food, and usually consumes at
least - of it. He doesnt appear thin and is not that fat. Their mother is
responsible for preparing food at home.
According to him, foods are very much important especially that he works
as a delivery boy and so he eats a lot. He eats all that he likes. He has no religious
dietary restrictions.
He has the ability to swallow despite having incomplete teeth. He is
missing a tooth, the primary mandibular incisor. He doesnt use dentures.
According to him, he bowel movement of at least 3-4 times a week. He is
not taking any laxatives.
VII. Elimination Status
The patient defecates at least 3-4 times a week. He doesnt use any
laxatives that could aid in elimination.
Upon urinating, he feels pain. He has light yellow, clear, with some
epithelial cells, few bacteria, many mucus threads, with WBC of 0-2/HPF and
RBC of 1-2/HPF. These laboratory test result was taken last September 15,2007.
VIII. Fluid and Electrolyte Status
The patient consumes at least 4-5 glasses of water a day. He perspires
whenever he works or plays billiards.
Upon hospitalization, he was given an IVF of D5LRS 1Lx8hours prior to
the procedure, which was an appendectomy.
He has a skin turgor of 1-2 sec. Due to health problems, theres a decrease
in his intake and output.
IX. Circulatory Status
The patient has a pulse rate of 84 bpm, tready and irregular. This was
taken before the surgical procedure.
He has a blood pressure of 140/80 mmHg. He has a family history of
hypertension.

With regards to his haemoglobin mass taken last September.17,2007 he


has 150g/L still normal because the normal range is 135-180g/L
X. Temperature Status
The patients body temperature is 37.3oC taken from the axilla prior to
surgical procedure.
Upon admission, hes not having fever but he had fever for two days
which started last September 14,2007, Friday. He took in paracetamol, an over the
counter drug.
XI. Integumentary Status
The patient has brown skin color. No lesions to any part of the body
except for the operative site done last September 17,2007 at 8:00 in the evening.
Characteristics of the operative site are to be assessed. Also, the wound dressings
and exudates, and wound drains are to be assessed on our duty day last September
18,2007 at 3-11 shift.
He has a good condition of nail, well, trimmed and clean. He has also
black shiny hair.
XII. Comfort and Rest
The patient has normal sleep pattern before hospitalization. He sleeps at
least 6-8 hours a day.
Due to health problems, he is still to be supervised if he will still have
normal sleep pattern in the hospital.
Upon seeing and conversing with the patient, he is calm and silent while
taking rest. He still feels pain on his RLQ abdomen. But still cooperates with the
nursing interventions given.
XIII. Respiratory Status
The patient has a respiratory rate of 20bpm, regular and slightly deep. He
has colds and cough which is non-productive, but is still to be assessed because
upon conversation with him, he doesnt have any tissue paper or handkerchief that
he may use for excretion of sputum. He doesnt use any 02 therapy.
He is not smoking and does not drink alcohol. He has normal shape of
nails
He also possesses good posture.

Problem Prioritization

Prioritizations of the Problems are According to


Maslows Hierarchy of Needs

1. Altered Thermoregulatory Status: Hyperthermia related to Inflammatory


Process
2. Pain related to Tissue Trauma secondary to Appendectomy
3. Altered Physical Mobility related to Pain
4. Impaired Skin Integrity related to Surgical Incision
5. Risk for Infection related to Surgical Incision secondary to Appendectomy

Altered Thermoregulatory Status as the problem because an increase


in temperature can lead to a more severe condition such as convulsion and
dehydration.

Pain related to Tissue Trauma secondary to Appendectomy is the


second prioritized problem. The perception of pain in a patient can affect the
treatment process.

Altered Physical Mobility related to Pain is the third prioritized


problem, because of pain, patient will suffer discomfort that will cause him to
have slow and careful movements.

Impaired Skin Integrity related to Surgical Incision is the fourth


prioritized problem because any opening to the skin can lead to infection and
can affect skin barriers.

Risk for Infection related to Surgical Incision secondary to


Appendectomy is the last prioritized problem because any infection can lead
to more serious infections and complications.