BATANGAS REGIONAL HOSPITAL Appendicitis CASE STUDY In partial Fulfillment of the

Requirements In Nursing Care Management 102 Presented to: Mrs. Annabelle Iturra
lde RN. MAN Presented by: BSN III - 5 Group C Edmalyn Gozar
I. Introduction
Acute appendicitis is the inflammation of the appendix often cause by obstructio
n to its narrow opening, fallowed by swelling and bacterial infection. Acute app
endicitis can lead to rupture of the organ, formation of an abscess or peritonit
is. Symptoms include abdominal pain (usually in RL abdomen) nausea, vomiting and
fever. Early surgical removal of the appendix is essential; any abscess require
s drainage of pus and delayed removal. Appendicitis is the most common abdominal
emergency found in children and young adults. One person in 15 develops appendi
citis in his or her lifetime. The incidence is highest among males aged 10 to 14
. And among females aged 15 to 19. More males than females develop appendicitis
between puberty and aged 25. It is rare in infants and children under the
the aged of two. In the United States, appendicitis occur in four out of 1000 ch
ildren. It occurs in 5 to 6% of its population. I chose this case because I want
to understand and have more information about appendicitis. I am very much curi
ous on how an acute appendicitis developed and what are the signs and symptoms a
ccompanied it.
II. Objectives General Objectives At the end of the study I will be able to acqu
ire knowledge, skills and attitude regarding my patient’s case. Specific Objecti
ves My specific objectives are to: -Give an overview about the disease appendici
tis. -Know the personal data of the client -Perform the Physical Assessment -Fam
iliarize with different laboratory test and its significance to the disease -Ana
lyze the system that is being affected of this disorder -Know the factors that l
ead to appendicitis -Apply interventions that may help client’s condition -Know
the drugs that the client is taking -Know the improvement of clients’ condition
III. Patient’s Profile
Name: Mrs. X Age: 39years old Sex: Female Birthday: September 13,1969 Civil Stat
us: Female Address: Quilo, Ibaan Batangas Nationality: Filipino Religion: Iglesi
a ni Cristo Date of Admission: Dec. 9,2008 Physician’s Name: Dr. Reyes Chief Com
plaint: Two days prior to admission the client experienced RLQ pain,vomiting fev
er and loss of appetite Admitting Diagnosis: Acute Appendicitis Final Diagnosis:
Periappendecial abscess
IV. Clinical Appraisal On December 9, 2008, Mrs. X, a 39 years old was admitted
in Batangas Regional Hospital due to Acute Appendicitis. A. Past Health History
According to Mrs. X, she completed her childhood immunization. She has no allerg
ies to drugs, foods animals or any insects bites. Mrs. X didn’t experience any a
ccident or injury. According to her husband, she had history of Pulmonary Tuberc
ulosis treated for six months. Mrs. X experienced common illnesses like fever, c
ough and cold. She used over the counter drugs like Paracetamol for fever, Solmu
x for cough and neosep for cold.
B. Family History Mrs. X has 9 siblings and twin sister. She was blessed with 5
children which are all boys. According to her she and her relatives has low bloo
d pressure. Her family has no history of diabetes, hypertension, heart diseases
and asthma. C. Personal History Mrs. X was not choosy in her meal, she eat fish,
meat specially vegetables and fruits because it is available in the farm. Mrs.
X daily activities was cleaning the house, washing clothes and manage their smal
l sari-sari store. She had enough sleep and resting hours. D. Social History Mrs
. X and her family is living in a rural area. She finish elementary and her husb
and finished high school. Mrs. X is responsible in managing the house and their
small
sari-sari store, while Mr. X her husband is a farmer. Mrs. X has a belief not to
take a bath during her menstrual period. According to her, before she was admit
ted to the hospital she has a menstruation for 5 days and she didn’t take a bath
for the said days. There is a health center available in their community. She c
onsulted first to their health center before her husband decided to brought her
to BRH. E. Psychological History According to Mrs. X, Her major stressor s their
financial status. It was very difficult for her to budget their monthly income
to support all their needs. To cope with this problem she keeps on praying and a
sking God for more blessings and assistance.
F. History of Present Illness Mrs. X brought to Batangas Regional Hospital last
December 9, 2008 because of experiencing abdominal pain, fever, vomiting and los
s of appetite for 2 days. She was diagnosed of having acute appendicitis and sch
eduled for emergency appendectomy.
V. Physical Assessment Done: December 9, 2008; 7:35pm General Appearance Status
Mrs. X is a newly admitted client. She is on supine position showing anxiety, bo
dy weakness, and pain felt on the RLQ of her abdomen. Vital Signs: Temperature:
38.1°C Pulse Rate: 72 Beats per minute Respiratory Rate: 26 Breaths per minute B
lood Pressure: 100/60 mmHg
Body Parts Skin
Method >Inspection

Palpation
Findings >Varies from light to deep brown >Good skin turgor >Not tender
Analysis >Normal
>Normal >Normal
Hair

Inspection
>Short and black with normal distribution
>Normal
Body Parts Scalp
Method >Inspection
Findings >Absence of seborrhea
Analysis >Normal
>No abrasion >Normal Head >Inspection >rounded, smooth skull contour >Absence of
masses or nodules >Normal
>Palpation
>Normal
Body Parts Face
Method >Inspection
Findings Analysis >facial features >Normal & facial movements are symmetrical
Neck
>no enlargement of >Inspection & lymph nodes >Normal Palpation >no enlargement o
f thyroid gland
Thyroid Gland >Inspection & Palpation
>Normal
Body Parts Eyes >Eyebrow
Methods >Inspection
Findings
Analysis
>symmetrically >Normal aligned >hair evenly >Normal distributed >normal distribu
tion >Pink palpebral conjunctiva >Normal >Normal
>Eyelashes >Conjunctiva
>Inspection >Inspection
Ears
>Inspection
>Auricles are firm & not tender >Normal
Body Parts
Methods
Findings >symmetrically aligned >no discharges >color of the auricle is the same
as the face
Analysis >Normal >Normal >Normal
Nose
>Inspection
>Palpation
>no discharges >Normal >symmetrically aligned >Normal >color is the same as the
rest >Normal of the face >not tender >Normal
Body Parts Sinuses
Method >Palpation
Findings Analysis >Frontal & >Normal maxillary sinuses are not tender
Mouth >Lips
>Inspection
>uniform pink color, smooth texture
>Normal
>Tongue
>Inspection
>Uvula
>Inspection
>moves freely & >Normal at the midline >at the midline >Normal
Body Parts Chest and Lungs
Method Findings >Inspection and >Equal chest Auscultation expansion >Quiet, rhyt
hmic & effortless respiration >Tachypnic 26 bpm >Auscultation >65 beats per minu
te >no murmur
Analysis >Normal >Normal
Heart
>May be normal response to fever and anxiety >Normal >Normal
Body parts Abdomen
Method Findings Analysis >Inspection >Uniform color >Normal >Auscultation >audib
le bowel >Normal sound, absence of arterial bruit >Percussion >Tympanic sound he
ard >Normal
>Palpation
>Flat and not >Normal tender >Tenderness on >Abnormal. Due RLQ noted to inflamma
tion of the appendix.
Body Parts
Upper extremities >Hands
Method
Findings
Analysis
>Inspection >Pulse >Nails >Palpation >Inspection
>Presence of IV fluid
Lower extremities >Inspection & Palpation
>Abnormal. Fluids are regulated to prevent >distal pulses are dehydration and to
provide access for palpable administration of medication. >Normal >Abnormal. Du
e to >Pink in color poor hygiene. >Long dirty nails > Normal >No edema
Summary of Physical Assessment She is a newly admitted client. Physical Assessme
nt was done by inspection, palpation, percussion and auscultation. This will ser
ve as a baseline guide for her progress. As I assessed her general appearance I
noticed her weak appearance, feeling anxious and pain felt on her abdomen. Her t
emperature was above normal due to the inflammation of the appendix. Her respira
tory rate was increase it was a normal response to fever and anxiety. Upon inspe
cting I noticed her dirty long nails which indicates poor hygiene. She was tachy
pniec, it was a normal response to fever and anxiety.
Upon palpation tenderness on the RLQ was noted. It was abnormal because it indic
ates inflammation of the appendix. Upon inspecting her hand I noticed that there
is a presence of IV fluid on her right hand. It is abnormal because IV fluid ar
e regulated to prevent dehydration and provide access for administration of medi
cation.
Laboratory and Diagnostic Test Urinalysis Done: Dec. 9, 2008 Color: dark yellow
Sugar: negative Albumin: Plus 2 (++) Pus Cells: 4-6/hpf Reaction: 6– acidic RBC:
too numerous to count Sp. Gravity: 1.015 character: slightly turbid
Blood Chemistry Description Erythroctes Hgb Hct Leukocyte Neutrophils Eosinophil
s Basophils Lymphocytes Monocyte
Done: Dec. 9, 2008 Ref. Value Result M:4.6-6.28x10/L 2.24 F:4.2-5.4 M:140-180g/d
l 127.2 F:120-140 M:0.40-0.54 0.377 F:0.38-0.47 4.5-11x10/L 26.00 45-65% 1-3% 0-
1% 25-40% 3-7% 0.869 0.012 0.007 .052 .060 Analysis decrease. It indicates anemi
a or dietary deficiency normal normal increase. It indicates infection or inflam
mation increase. It indicates inflammation. decrease. It indicates increase adre
nosteroid production. decrease in acute phase of infection. decrease. Indicate l
eukemia decrease may be due to drug therapy
Thrombocyte MCH MCV MCHC RDW
150-400x10/L 27-31 pg 80-96 f1 .32-.36 11.5-14.5
348 29.99 88.80 .34 10%
normal normal normal normal normal normal decrease. It indicates hypokalemia. in
crease. It indicates hypernatremia. normal
Dec. 10, 2008 Sodium 135-148mmol/L 140.3 Potassium 3.5-5.5mmol/L 2.96 Dec. 12, 2
008 Sodium Potassium 135-148mmol/L 3.5-5.5mmol/L 150.2 4.28
Summary of Diagnostic and Laboratory Result As the laboratory result has been re
leased it shows some abnormalities in the blood. The erythrocyte is decreased wh
ich indicates anemia and dietary deficiency. The patients hematocrit and hemoglo
bin are normal. The leukocytes is elevated because it fight infection and defend
the body by the process called phagocytosis. The neutrophils which is the most
numerous and important type of leukocytes in the body s reaction to inflammation
such as appendicitis was elevated. Decrease circulating eosinophil is usually c
ause by increase adrenal steroid production that accompanies most conditions of
bodily stress and is associated with Acute bacterial infection with a marked shi
ft to the left. Basophils is decrease in acute phase of infection and may indica
te hyperthyroidism. Lymphocyte is decrease which indicate leukemia.
The other blood component are normal. The dark yellow urine may indicate bilirub
in in the urine. Slight turbid may indicate UTI. The Potassium was decrease whic
h indicate electrolyte imbalance such as hypokalemia. The sodium was increase wh
ich indicate hypernatremia.
VII. Anatomy and Physiology
The appendix (or vermiform appendix; also cecal (or caecal) appendix; also vermi
x) is a blind ended tube connected to the cecum (or caecum), from which it devel
ops embryologicallly. The cecum is a pouch-like structure of the colon. The appe
ndix is near the junction of the small intestine and the large intestine.The ter
m "vermiform" comes from Latin and means "worm-like in appearance". The appendix
averages 10 cm in length, but can range from 2 to 20 cm. The diameter of the ap
pendix is usually between 7 and 8 mm. The longest appendix ever removed measured
26 cm in Zagreb, Croatia. The appendix is located in the lower right quadrant o
f the abdomen, or more specifically, the right iliac fossa. Its position within
the abdomen corresponds to a point on the surface known as McBurney s point. Whi
le the base of the appendix is at a fairly constant location, 2 cm below the ile
ocaecal valve,
the location of the tip of the appendix can vary from being retrocaecal (74%) to
being in the pelvis to being extra peritoneal. In rare individuals with situs i
nversus, the appendix may be located in the lower left side.
VIII. Pathophysiology
Non Modifiable Factor Age Gender ACUTE APPENDICITIS Modifiable Diet
Obstruction of the lumen Obstruction of the outflow of the secretion Increase mu
cosal secretions Increase intraluminal pressure
Distention of the appendix Inflammation of the appendix Localized Peritonitis Pe
riappendiceal Abscess
Abdominal pain Tenderness on RLQ Fever, vomiting Loss of appetite
Summary of Pathophysiology Appendicitis is the most common cause emergency, abdo
minal surgery. It develops when the lumen of the appendix becomes obstructed, us
ually by fecalith, foreign body or tumors. The obstructed lumen does not allow d
rainage of the appendix and the mucosal secretions continues, intraluminal press
ure increases. The resultant increase pressure decreases mucosal blood flow and
the appendix becomes hypoxic. The obstructed appendix become distended because o
f continued secretion of mucus by the lining cell. Typically acute appendicitis
progresses from obstruction of the lumen and distention of the appendix to sprea
d
Of the inflammation beyond the appendix. The inflammatory process increases intr
aluminal pressure, initiating a progressively severe generalized or upper abdomi
nal pain which within a few hours becomes localized in the RLQ of the abdomen. T
he pain is usually accompanied by a low grade fever, nausea and often vomiting.
Local tenderness is noted when pressure is applied and loss of appetite is commo
n. Initially there is a localized peritonitis confined to the area of the append
ix. If unrecognized and untreated, this may lead to rupture and abscess.
IX. Nursing Care Process
Assessment
Nursing Diagnosis
S> ”Parang nahihiwa ang tyan Acute pain related to surgical ko ” incision. O>fac
ial grimace connotes pain. >weak appearance >pain scale 6/10 >provokes pain when
moving >dull pain >RLQ of the abdomen >intermittent
Scientific Explanation
Planning
Usually a recent onset associates a After 2 hours of nursing specific injury, ac
ute pain indicates that intervention the client level cause pain may heal sponta
neously or of pain from 6/10 will be may require treatment. The system minimized
into tolerable involved in the perception of pain is level. referred to as noci
ceptal system. The sensitivity of this system component can be affected by sever
al factors and may differ among individuals. A stimulus may result on pain at on
e time but not in another. Pain receptors are free nerve endings in the skin tha
t respond only to intense potentially damaging stimuli. A number of algogenic su
bstances that affect the sensitivity of nociceptors are released into the extra
cellular tissue as a result of tissue damage. (Medical Surgical Nursing Smeltzer
et. al pp. 264)
Nursing Interventions > V/s taken and recorded.
Rationale > To establish baseline data.
(NANDA, Doenges et. Al)
> Noted location of surgical procedure. >Used pain rating scale for aged/cogniti
on. (6/10)
>This can influence the amount of postoperative pain experienced. (NANDA Doenges
et. Al) >It assist the patients perception of pain.
(NANDA Doenges et al)
> Pain is subjective and cannot >Accepted client description be felt by others.
( NANDA Doenges et al) of pain. (dull)
Nursing Interventions Rationale Provided comfort measures >Promotes relaxation
and may such as therapeutic touch enhance patients coping abilities and repositi
oning. by refocusing attention. ( NCP 6’th
edition Doenges et al)
Administered pain medication as ordered. Kotorolac Tromethamine 30 mg IV q8. Ad
minisred IV fluid as ordered.

>Reduce metabolic rate and intestinal irritation from circulating/ local toxins,
which aids in pain relief and promotes healing.
(NANDA Doenges et al)
>Maintain Hydration and provides
access for administration of medications. (Delmar s Critical Care NCP
Sheree Comer)
Nursing Interventions
Rationale
> placed the patient in high >This position reduces the fowler position. tension
on the incision and abdominal organs helping to reduce pain. (Medical Surgical
Nursing Smeltzer et al)
Evaluation The clients level of pain was minimized as evidence by pain scale of
4/10.
Assessment S> “Kinakabahan ako dahil operasyon ko na mamaya.” O>voice quivering
>anxious >restless >poor eye contact >increase respiration
Nursing Diagnosis Anxiety related to preoperative procedure.
Scientific Explanation
Planning
Vague uneasy feeling of After an hour of nursing discomfort or dried interventio
n the clients anxiety accompanied by an will be lessened in a tolerable autonomi
c response (the level. source often non specific or unknown to the individual);
a feeling of apprehension caused by anticipation of danger. It is an altering si
gnal that warns of impending danger and enables the individual to take measures
to deal with treat. (NANDA Doenges et al)
Nursing Interventions V/s taken and recorded.
Rationale To identify physical responses associated with both physical and emot
ional conditions. (NANDA Doenges et al) Helps client to identify what is reality
based. (NANDA Doenges et

Provided accurate information about the situation. al)

Observed behaviors.
Can point the client level of consciousness. (NANDA Doenges

et al)
Nursing Interventions
Rationale
>Stayed with client, > To decrease anxiety and maintaining a calm, confident pro
vide comfort. (NANDA Doenges et al) manner. > Provided preoperative education. D
iscuss routine procedures that frightened the patient. >Can provide reassurance
and alleviate patients anxiety as well as provide information for formulating in
traoperative care.
(NANDA Doenges et al)
Evaluation The clients anxiety was lessened as evidenced by being able to commun
icate her feeling to her significant others.
Assessment O>T: 38.1 C >warm to touch >weak >teary eyed
Nursing Diagnosis Elevated body temperature related to inflammation of the appen
dix.
Scientific Explanation
Planning
Inflammation is a local and After 2 hour of nursing non specific defensive inter
vention the clients body response of the tissues to an temperature will decrease
to injurious or an infectious normal range. agent. It is an adaptive mechanisms
that destroys or dilutes a injurious agent, prevents further spread of the inju
ry, and promotes the repair of damage tissue. The inflammatory process causes el
evation of the body temperature to fight infection. (Fundamentals of Nursing, Ko
zier et al page 634)
.
Nursing Interventions >Monitored the client temperature. >Provided tepid sponge
bath.
Rationale >provide information about the effectiveness of care. (NANDA
Doenges et al)
>To increase heat loss through conduction. (Fundamentals of
Nursing 8’th edition Kozier et al)
> Monitored use of Hypothermia Doenges et al) blanket and wrap extremities with
bath towels.
>To minimize shivering. (NANDA
Nursing Interventions >Reduced physical activity.
Rationale >To limit heat production.
(Fundamentals of nursing 8th edition Kozier et al)
>Maintained and regulated IV fluid as ordered. D5 LR 1L@30 gtts/min
>To met the increase metabolic demand and prevent dehydration. (Fundamentals of
nursing 8th edition Kozier et al)
>Administered antipyretic medicine as ordered. Paracetamol 300 mg IV q6.
> May relieve fever through central action to the hypothalamic regulating center
. (Nursing 2008 Drug Handbook
Williams and Wilkins)
Evaluation The clients body temperature back to normal range.
X. Drug Study Drug Name Generic Name: Cefoxitine Sodium Dose: 1g Route: Through
IV Frequency: q8 Classification and Mechanism of Action Anti-infective Drugs Sec
ond generation cephalosporins that inhibits cell wall synthesis, promoting osmot
ic instability: usually bactericidal.
Indication Adverse Reaction >Perioperative prevention. CNS: fever CV: hypotentio
n GI: nausea and vomoting Hematologic: Thrombocytopenia, transient neutropenia,
eosinophilia, hymolitic anemia, anemia Respiratory: Dyspnea
Contraindication >Contraindicated in patients hypersensitive to drugs and other
cephalosporin s. >Use cautiously in patients hypersensitive to penicillin becaus
e of possibility od cross sensitivity to with other beta lactam antibiotics.
Nursing Responsibilities >Tell the patient to report adverse reactions and s/s o
f super infection. >Instructed the patient to report discomfort at IV site. >Adv
ise patient to notify prescriber about loose stools or diarrhea.
Monitoring Parameters >May increase alkaline phosphate, ALT, AST,bilirubin and L
DH levels. May decrease hemoglobin level. > May increase eosiniphil count. May d
ecrease neutrophil and platelet count.
Drug Name
Classification & Mechanism of action
Generic Name: Acetaminophen (APAP Paracetamol) Dose: 300mg Route: IV Frequency:
q6
Nonophioid Analgesics and antipyretics Thought to produce analgesia by blocking
pain impulses by inhibiting synthesis of prostaglandin in the CNS or of other su
bstances that synthesize pain receptors to stimulation. The drug may relieve fev
er through central action in the hypothalamic regulatory center.
Indication >Mild pain or fever
Adverse Reaction Hematologic: hymolitic anemia, leukopenia, pancytophenia. Hepat
ic: jaundice Metabolic: hypoglycemia
Contraindication >Contraindicated to patients hypersensitive to drugs. >Use caut
iously in patient with long term alcohol use because therapeutic dose can cause
hepatotoxicity in these patients.
Nursing Responsibilities
Monitoring Parameters
> Advice patient and >May decrease glucose and caregiver that many OTC hgb level
s and hct. products contain >May decrease nuetrophils, acetaminophen and should
WBC, RBC, and platelet count. be counted when calculating total daily dose. > Te
ll patient not to used for marked fever (temperature higher than 103 F. >Warn pa
tient that high doses or unsupervised long term used can cause liver damage. Exc
essive alcohol used may increase the risk of liver damage.
Drug Name Generic Name: Ketorolac Dose: 30mg Route: Through IV Frequency: q8
Classification & Mechanism of action Nonsteroidal Inflammatory Drugs (NSAIDs) Ma
y inhibit prostaglandin synthesis, to produce antiinflammatory, analgesics and a
nti pyretic effects.
Indication
Side Effects
Short term management of CNS: headache, dizziness, moderately severe, acute drow
siness, sedation pain for single dose treatment CV: arrythmias, edema, hypertens
ion, palpitations GI: dyspepsia, GI pain, nausea, constipation, diarrhea, flatul
ence, peptic ulceration, vomiting, stomatitis Skin: rash, pruritis, diaphoresis
Hematologic: decreased platelet adhesion, prolonged bleeding time, purpura Other
: pain in the injection site
Contraindication
Nursing Responsibilities
Contraindicated in patients Correct hypovolemia hypersensitive to drugs and befo
re giving in those with active peptic Don’t give epidurally ulcer disease and re
cent GI because of alcohol content bleeding NSAIDs may mask sign Contraindicated
as and symptoms of infection prophylactic analgesic before because of their ant
ipyretic major surgery of and anti inflammatory intraoperatively when actions he
mostasis is critical Serious GI toxicity Use cautiously in patients including bl
eeding and peptic who are elderly or have ulcers, can occur in patients hepatic
or renal impairment taking NSAIDs, despite lack of symptoms
Contraindication
Nursing Responsibilities
Carefully observe patients Contraindicated to children younger than age of two a
nd with coagulopathies and those taking anticoagulants in patients with history
of peptic ulcer disease, past allergic reactions to aspirin and during labor and
delivery or breastfeeding
Monitoring Parameters May increase ALT and AST level May increase bleeding time
XI. Prognosis
After four days of confinement at Batangas Regional Hospital the client prognosi
s is good because the patient was recovering well after the surgery. According t
o the doctor the patient will be discharge after three more days.
XII. Discharge Planning
M- Instructed the significant others to continue giving the patients medications
as ordered. 1. Paracetamol 30 mg as necessary for fever. 2. Ketorolac 30 mg thr
ee times a day 3. Metronidazole 500 mg three times a day E- Advised the client t
o exercise in moderation with a gradual build up in intensity. Explained to the
client that her normal activity can be resumed after 2 to 4 weeks. T-Instructed
the significant others to cleanse and change the dressing of the client wound re
gularly. H-Instructed the significant others to always bath the patient but avoi
d soaking the wound in the water.
Advised the patient to always cut the nails. Instructed the significant others t
o provide clean and safe environment for the clients early recovery. O- Instruct
ed the patient to have a follow up check up to Dr. Reyes after one week for the
removal of the sutures. D- Instructed to eat foods rich in protein and Vit. C. S
- Advised the client to strengthen her faith in GOD. Because Jesus is the only s
ource of healing. S- Provided health teaching of sexual responsibility.
Acknowledgement I would like to extend my deepest and heartfelt gratitude to all
those people who helped and supported me while I’m doing this study. First of a
ll to our Almighty God for the strength ,knowledge and wisdom He gave me while I
’ doing this study. To my parents who always there for me and supported me emoti
onally and financially. To my dear clinical instructor, Mrs. Annabelle Iturralde
for sharing us her knowledge and guiding us in the clinical area. To the staff
of the IMC, for allowing me to
borrow books and use their internet.
To all my friends, classmates, and group mates for all the ideas and advices you
shared to me. To all of you THANK YOU SO MUCH AND GODBLESS.
Bibliography Delmar s Critical Care NCP Sheree Comer Essentials Anatomy and Phys
iology by Seeley, Tate & Stephens Fundamentals of Nursing, Kozier et al Laborato
ry and Diagnostic Test with Nursing Implication; 7th edition by Joyce Lefever Le
e Medical Surgical Nursing 7th edition by Joyce Black & Jane Hokanson Medical Su
rgical Nursing 8th edition by Brunner & Suddarths Medical Surgical Nursing Smelt
zer et. al NCP 6’th edition Doenges et al MIMS17th edition2005 NANDA Doenges et
al Nursing Care Plan 7th edition by Marilynn Doenges et.al Nursing Drug Handbook
28th edition Nursing 2008 Drug Handbook Williams and Wilkins Electronic Referen
ces www.yahoo.com
Nurse Patient Interaction
Therapeutic Communication
>it promotes understanding and helped establish a constructive relationship betw
een the nurse and the client. >Unlike the social relationship, where there may n
ot be a specific purpose or direction, the therapeutic helping relationship is c
lient and goal oriented.
Therapeutic communications technique
1.Using silence – Accepting pauses or silences that may extend for several secon
ds or minutes without interjecting any verbal response. Ex. Sitting quietly and
waiting attentively until the client is able to put thoughts and feelings into w
ords. 2.Providing general leads – Using statements or questions that encourage t
he person to verbalize , choose a topic of conversation and facilitate continued
verbalization. Ex. “Can you tell me how it is for you?” “Perhaps you would like
to talk about…” “And then what….” 3.Being specific and tentative – Making state
ments that are specific rather than general and tentative rather than absolute.
Ex. Rate your pain on a scale of 0-10. (specific statements) Are you in pain? (g
eneral statements)
4.Using open ended question – asking broad questions that lead or invite the cli
ent to explore thoughts and feelings. Ex. “I’d like to hear more about that.” “T
ell me about…” “How have you been feeling lately?” 5.Using touch – providing app
ropriate form of touch to reinforce caring feelings. Ex. “Putting an arm over th
e clients shoulder. Putting your hand over the clients hand.” 6.Restating or par
aphrasing – Actively listening to the client’s basic message and then repeating
those thoughts or feeling in similar words. Ex. “Client: I couldn t manage to ea
t any dinner last night – not even the dessert. “Nurse: You had difficulty eatin
g yesterday. 7. Seeking clarification – A method of making a clients broad overa
ll meaning of the message more understandable. Ex. “I’m puzzled”. “I’m not sure
I understand that.”
8.Perception checking or seeking conceptual validation – A method similar to cla
rifying that verifies the meaning of specific words rather than the overall mean
ing of the message. Ex. Client: “My husband never gives me any present” Nurse: “
You mean he has never given you a present for your birthday or Christmas?” 9.Off
ering Self – Suggesting ones presence, interest or wish to understand the client
without making any demands or attaching conditions that the client must comply
with to receive the nurses attention. Ex. “I’ll stay with you until your daughte
rs arrives.” “I’ll helped you to dress to go home if you like.” 10.Giving Inform
ation – Providing in a simple and direct manner , specific factual information t
he client may or may not request. Ex. “Your surgery is scheduled for 11 am tomor
row.” 11.Acknowledging –Giving recognition , in a non judgmental way, of a chang
e of behavior, an effort the client has made, or a contribution to a communicati
on. Ex. “You trimmed your beard and mustache and washed your hair.”
12. Clarifying time or sequence – Helping the client clarify an event, situation
or happening in relationship to time. Ex. Client: “I vomited this morning.” Nur
se: ”Was that after breakfast?” 13. Presenting Reality – Helping the client to d
ifferentiate the real from the unreal. Ex. ”The telephone ring came from the tel
evision.” 14Focusing – Helping the client expand on and develop a topic of impor
tance. Ex. Client: “My wife says she will look after me, but I don’t think she c
an, what with the children to take care of, and they’re always after her about s
omething- clothes, homework, what’s for dinner that night. Nurse: “Sounds like y
ou are worried how she can manage.”
15. Reflecting – Directing ideas, feelings, questions, or content back to client
s to enable them to explore their own ideas and feelings about the situation. EX
. Client: “What can I do?” Nurse: “What do you think would be helpful?” 16. Summ
arizing and planning – Stating the main points of a discussion to clarify the re
levant points discussed. EX. “During the past half hour we have talk about……” “T
omorrow afternoon we will explore this further.”
Attentive listening
It is listening actively using all the senses, as opposed to listening passively
with just the ear. It is probably the most important technique in nursing and i
s basic to all other techniques. Attentive listening is an active process that r
equires energy and concentration. It involves paying attention to the total mess
age, both verbal and nonverbal, and noting whether this communication is congrue
nt . Attentive listening means absorbing both the content and the feeling the pe
rson is conveying, without selectivity.
The Helping Relationship
Nurse-client relationship are referred to by some as interpersonal relationships
, by others as therapeutic relationships,
The Helping Relationship
Nurse-client relationship are referred to by some as interpersonal relationships
, by others as therapeutic relationships, and by still others as Helping relatio
nships. Helping is a growth facilitating process that strive to achieve to basic
goals. 1.Helps client manage their problems in living more effectively and deve
lop unused or underused opportunities more fully. 2.Helps client become better a
t helping themselves in their everyday lives. The key to the helping relationshi
p are: a. the development of trust and acceptance between the nurse and the clie
nt. b. an underlying belief that the nurse caresabout and wants to help the clie
nt.
Phases of helping relationship 1. Preinteraction phase >it is similar to the pla
nning stage before the interview. >the nurse has information about the client be
fore the first face to face meeting. Such information may include, the clients n
ame, address, age, medical history and social history. 2.Inroductory Phase >also
referred to as the orientation phase or the prehelping phase. >it is important
because it sets tone to the relationship. >the client and the nurse closely obse
rved each other and form judgments about the others behavior. >getting to know e
ach other and developing a degree of trust.
3. Working Phase >the nurse and the client begin to view each other as unique in
dividuals, they begin to appreciate this uniqueness and care about each other .
Caring is sharing deep and genuine concern about the welfare of another person.
4. Termination Phase >often expected to be difficult and filled with ambivalence
. >the client generally has a positive outlook and feels able to handle problems
independently. >it is natural to expect some feeling of loss, and each person n
eeds to developed a way of saying goodbye.
Developing a Helping Relationship
1.Listen actively. 2.Help to identify what the person is feeling. 3.Put yourself
in the other persons shoes. 4.Be honest. 5.Be genuine and credible. 6.Use your
ingenuity. 7.Be aware of cultural differences that may affect meaning and unders
tanding. 8.Maintain client confidentiality. 9.Know your roles and your limitatio
ns.