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TABLE OF CONTENTS

I.
Time table
II.
Objectives
a. General
b. Specific
III.
Introduction
IV.
Anatomy and physiology
V.
Pathophysiology
VI.
Assessment
VII.
Nursing care plan
VIII.
Drug study
IX.
Diagnostic examination
X.
Medical intervention
XI.
Nursing management
XII.
Health teachings
XIII.
Prognosis
XIV.
Evaluation

II.
OBJECTIVES
A. GENERAL OBJECTIVE

Within our groups 2- hour long case presentation, we will be able to study out what are the causes and

treatment for appendicitis and by doing so, allowing us to gain more knowledge and learn new skills. We will also be

able to improve our way of caring for clients having same disease condition thereby developing therapeutic use of self.

B. Specific objectives
Within our groups 2- hour long case presentation, we will be able to:
1.I dentify patients health care needs.
2.Impart necessary health teachings.
3. Discuss the anatomy and physiology.

4. Explain the underlying cause of the d isease condition.

5. Enumerate medical management needed.

6.I dentify nursing interventions.

7. Formulate e ffective nursing care plan.

8. Know the prognosis of the patient. 9.I dentify risk factors of the d isease. 10. Enumerate nursing interventions
III.
INTRODUCTION
ACUTE APPENDICITIS
Acute- severe, sharp, having a sudden onset and short duration
Appendicitis- an inflammation of the appendix
In this casepresentation wewi l l discuss some important points about the diseasecondition of
our patient like what is appendicitis and what causes appendicitis.
What is appendicitis?
Appendicitis is an inflammation of the appendix.It is a common ad urgent surgical illness with protean
manifistations, generous overlap with other clinical syndromes and significant morbidity, which
increases withdiagnosticdelay. No single sign, symptom ordiagnostic test actually confirms the
diagnosis of appendecial inflammation in all cases.
Acute appendicitis is a rapidly progressing inflammation of a small part of the large intestine called the
appendix.Acute appendicitis is amedicalemergency that generally requires prompt removal of the
appendix to prevent life-threatening complications, such as ruptured appendix and peritonitis.
What causes appendicitis?

Obstruction of the appendiceal lumen causes appendicitis. Mucus backs up in the appendiceal lumen, causing bacteria
that normally live inside the appendix to multiply.As a result, the appendix swells and becomes infected. Sources of
obstruction include

feces, parasites, or growths that clog the appendiceal lumen


y

enlarged lymph tissue in the wall of theappendix, caused by infection in theg astroi ntestinal
tract orelsewhere in the body
y

inflammatory boweldisease, including Crohnsdisease and ulcerative colitis


y

trauma to the abdomen


An inflamed appendix will likely burst if not removed. Bursting spreads infection throughout the
abdomena potentiallydangerous condition called peritonitis.
Anyone can get appendicitis, but it is more common among people 10 to 30 years old. Appendicitis leads
to more e mergency abdominal surgeries than any other cause.

IV.
ANATOMY AND PHYSIOLOGY
Human Digestive System
The humandigestive system is a complex series of organs and glands that processes food.In order to
use the food we e at, our body has to break the food d own into smaller molecules that it can process; it
also has toexcrete waste.

Most of the d igestive organs (like the stomach and intestines) are tube-like and contain the food as it
makes its way through the body.The d igestive system isessentially a long, twisting tube that runs from
the mouth to the anus, plus a few other organs (like the liver and pancreas) that produce or store

digestivechemicals.
The Digestive Process:
The start of the process - the mouth:The d igestive process begins in the mouth. Food is partly broken
down by thepro cess of chewing and by thec hemical action of salivary enzymes (these enzymes are
produced by the salivary glands and breakdown starches into smaller molecules).
On the way to the stomach: the esophagus -After being chewed and swallowed, the food e nters the
esophagus.The esophagus is a long tube that runs from the mouth to thes tom ach. It uses rhythmic,
wave-like muscle movements (called peristalsis) to force food from the throat into the stomach.This
muscle movement gives us the ability toeat ordrinkeven when we're upside-down.
In the stomach -The stomach is a large, sack-like organ that churns the food and bathes it in a very
strong acid (gastric acid). Food in the stomach that is partlydigested and mixed with stomach acids is
called chyme.
In the small intestine -After being in the stomach, food e nters the d uodenum, the first part of the small
intestine.It thenenters the jejunum and then the ileum (the final part of the small intestine).In the
small intestine, bile (produced in the liver and stored in the gall bladder), pancreaticenzymes, and other
digestive enzymes produced by thei nner wall of the small intestinehelp in thebreakdown of food.
In the large intestine -After passing through the small intestine, food passes into the large intestine.In

the large intestine, some of the water and e lectrolytes (chemicals like sodium) are removed from the
food. Many microbes (bacteria like Bacteroides, Lactobacillus acidophilus, Escherichia coli, andKlebsiella)
in the large intestine help in the d igestion process.The first part of the large intestine is called the
cecum (the appendix is connected to the cecum). Food then travels upward in the ascending colon.The
food travels across the abdomen in the transverse colon, goes backdown the other side of the body in
the descending colon, and then through the sigmoid colon.

The end of the process - Solid waste is then stored in the rectum until it isexcreted via the anus.

THE APPENDIX
In human anatomy, the appendix( or vermiform appendix; also cecal (or caecal) appendix; also vermix)

is a blind-ended tube connected to the cecum (or caecum), from which itdevelopsembryologically.The

cecum is a pouchlike structure of the colon.The appendix is located near the junction of the small

intestine and the large intestine.

The term "vermiform" comes from Latin and means "worm-shaped".The appendix averages 10 cm in

length, but can range from 2 to 20 cm.The d iameter of the appendix is usually between 7 and 8 mm.The

appendix is usually located in the right iliac region, just below the ileocecal valve (designated

McBurney's point) and can be found at the midpoint of a straight line d rawn from the umbilicus to the

right anterior iliac crest.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. During the first few years of life, the appendix functions as a part of the immune system, it helps make

immunogobulins. But after this time period, the appendix stops functioning. However, immunoglobulins are made in

many parts of the body, thus, removing the appendixdoes not seem to result in problems with the immune system.

Like the rest of the colon, the wall of the appendix also contains a layer of muscle, but the
muscle is poorlydeveloped
VI.
ASSESSMENT
Patients name:Camomot, Petrolino

Age: 52 years old

Sex: P-1 Pikaluwag, Sultan Naga Dimaporo, LDN.

Chief Complaint: 1day PTA, Pt noted RLQ pain severe.

Attending Diagosis: Acute Appendicitis

Religion:C athol i c

Date And Time admitted: July 03, 2010 1:10pm

Physician: Dr. Dennis Ybanez

PRESENT ILLNESS:
Pt. Comomot has admitted last July 3,2010 at 1:10pm of acute appendicitis, 1day PTA, pt. noted severe
pain at his RLQ and was admitted in MHARS RTI.
PREVIOUS:
According to Mr. Comomot , he was not admitted before.It was his first time to be admitted in the
because he d ont have anyexperience with a serious illness ad ifever he got sick, he just stay at home
and have a self medication.
REACTIONS TO AND EXPECTATIONS ABOUT HOSPITALIZATION

Patient Petrolino Camomot was admitted because of acute appendicitis. He already felt the pain at his RLQ before his

admission but he d idnt mind it. During his admission, he understand about his illness and follows the d octors

orders and advices.Though he d oesnt like to be hospitalized, but he has to, because of his condition.According to

him, he feels more sick when he stays in the hospital. His illness has affected his life, because he cantdo strenuous

work inevery activity.

REACTION ABOUT TX AND DIAGOSTIC PROCEDURE


He has gone to treatments and d iagnostic before.

Competences
Physical

- Patient isquite malnourished. He is 52 y. o.. he has a weight of 0 kg.. Skin isdry and brow.The

texture is poor. Patients nails were d irty and uncut, both hands and feet. He cannotdo any

straneous work and cantdo heavyexercise.

Mental
- He can understand ad speak visayan language and can hardly understand English language.
He is a high school graduate and he knows how to read and write. He is responsive.
Emotional
-
Well as far as he know, he thinks that being sad is not good especially in his condition.
Spiritual
- He attends massevery Sunday. He is a Roman Catholic.
Environmental
-
Their house is one storey building. He sleeps in his bedroom. Their neighbors are q uite close
from their house and some of them are his relatives.They live near the church and school but
far from the market.

VIII. DRUG STUDY

Generic name: ranitidine

Brand name: zantac

Classification: anti- ulcerants

Dosage: 50 mgIVTTq 6 hrs. x 6doses

Action:
Competitively inhibits action of histamine on the H2 at receptor.
Indications:
- Duodenal and gastric ulcer (short treatment) pathologic hyper secretory conditions such as
Zollinger- Ellison syndrome
- Maintenance therapy forduodenal or gastric ulcer

- Gastroesophageal refluxdisease

- Erosive e sophagitis

- Heart burn

Contraindication:

- contraindicated in patients with hypersensitivity todrug and those with acute porphyria

- use cautiously in patients with hepaticdysfunction.Adjustdosage in patients with impaired

renal functions
Adversereactions:

CNS- vertigo, malaise, headache

EENT- blurred vision


HEPATIC- jaundice

Other- burning and itching at injection site, anaphylaxis, angioedema

Nursing considerations:

1.Assess pt. for abdominal pain. Note for presence of blood inemesis, stool, or gastric aspirate.

2. Ranitidine may be added to total parenteral nutrition.

Generic name: cefuroxime

Brand name: aeruginox

Classification: cephalosporin

Dosage: 250 mgIVTTq 8 hrs.

Action:
Second generation cephalosporin that inhibits cell wall synthesis, promoting osmotic instability,
usually bactericidal
Indications:
- Serious lower respiratory tract infections, UTI, minor skin structure infection, bone or joint
infection, septicemia, meningitis, gonorrhea
- Pre- operative prevention
- Bacterialexacerbation or chronic bronchitis or secondary bacterial infection of acute bronchitis
-
Acute bacterial and maxillary sinusitis

- Pharyngitis and tonsillitis

- Otitis media

- Uncomplicated skin and skin structure infection

Contraindication:
- Contraindicated in the pts. Hypersensitive todrug or other cephalosporin
- Use cautiously in pts. Hypersensitive to penicillin because of the possibility of cross- sensitivity
with other beta- lactrum antibiotics
- Use cautiously in breast feeding woman ad in pts.With history of colitis or renal insufficiency
Adversereactions:
CV- PHLEBITIS,TROMBOPHLEBITIS

GI- Diarrhea, pseudomembranous colitis, nausea, anorexia, vomiting

HEM- hemolytic anemia, thrombocytopenia, transient neutropenia,eosinophilia

Nursing considerations:
1. Monitor liver function test results carefully inelderly pts
2. Give oral form with meals
3. Observe pt fore dema
4. Record character of stoo

Generic name: metronidazole

Brand name: flagyl

Classification: anti- amoebic/ antiprotozoans

Dosage:500 mgIVTTq 8 hrs anst ( )

Action:

Direct acting trichomonocide and amoebicide that works inside and out the intestines.Its

thought toenter the cells of microorganism that contain metroreductors, forming unstable compounds

that bind to DNA and inhibit synthesis causing celldeath.

Indications:
-
Amebic liver abscess
-Intestinal amoebiasis
-
Trichomoniasis
- Refractory infections caused by anaerobic microorganisms
-
To prevent post- operative infection in contaminated of potentially contaminated colorectal
surgery
Contraindication:
- Contraindicated in pts hypersensitive todrug or other metronidazole derivatives
- Use cautiously in pts with history of blood d yscrasia, CNSdirsorders, and retinal or visual field
changes
- Use cautiously in pts who take hepatotoxicdrugs or have hepaticdisease or alcoholism
Adversereactions:
CNS- fever, vertigo, headache,dizziness, ataxia, syncope, irritability,depression, weakness,
insomniaCV- flattenedT wave,e dema, flushing, thrombophlebitis
EENT- rhinitis, sinusitis, pharyngitis
GI- abdominal cramping, polyuria,dysuria, cystitis,dyspareunia,dryness of vagina and vulva.
Nursing considerations:
1. Monitor liver function
2. Give oral form for meals
V.
PATHOPHSIOLOGY
A.DESCRIPTION
The pathophysiology of appendicitis is the constellation of processes that leads to the development of

acute appendicitis from a normal appendix.The main thrust ofevents leading to the development of acute appendicitis lies

in the appendixdeveloping a compromised blood supplydue to obstruction of its lumen and becoming very vulnerable to

invasion by bacteria found in the gut normally.

B. RISK FACTORS
1.SEX
The incidence of appendicitis is approximately 1.4 times greater in men than in women. The incidence of
primary appendectomy is approximatelyequal in both sexes.
2.AGE
y

Incidence of appendicitis gradually rises from birth, peaks in thel ateteen y ears, andg radually
declines in thegeriatric years.Themedian age at appendectomy is 22 years.
y

The e mergencydepartment clinician must maintain a high index of suspicion in all age groups.
3. CULTURE/ DIET
Incidence of appendicitis is lower in cultures with a higher intakeof dietary fiber. Dietary fiber is thought
todecrease the viscosity of feces,decrease bowel transit time, and d iscourage formation of fecaliths,
which predispose individuals to obstructions of the appendiceal lumen.
People whose d iet is low in fiber and rich in refined carbohydrates have an increased risk of getting
appendicitis.
4. HEREDITARY
A particular position of the appendix, which predisposes it to infection, runs in certain families. Having a
family history of appendicitis may increase a child's risk for the illness.
5.SEASONAL VARIATION
Most cases of appendicitis occur in the winter months - between the months of October and May.
6.INFECTIONS
Gastrointestinal infections such asAmebiasis, Bacterial Gastroenteritis, Mumps, Coxsackievirus B and
Adenovirus can predispose an individual to Appendicitis.

C. COMMON SIGNS AND SYMPTOMS


1. abdominal pain usually
y

occurs suddenly, often causing a person to wake up at night


y

occurs before other symptoms


y

begins near the belly button and then moves lower and to the right
y

is new and unlike any pain felt before


y

gets worse in a matter of hours


y

gets worse when moving around, takingde ep breaths, coughing, or sneezing


2.SIGNS UPONPHYSICAL EXAM THAT MAYINDICATEA P PENDICITIS
y

Guarding. Guarding occurs when a person subconsciously tenses the abdominal musclesduring
anexamination. Voluntary guarding occurs the moment the d octors hand touches the
abdomen.Involuntary guarding occurs before the d octor actually makes contact.
y

Rebound tenderness.A doctor tests for reboundtenderness by applying handpressure to a


patients abdomen and then letting go. Pain felt upon the release of the pressure indicates
rebound tenderness.A person may alsoexperience rebound tenderness as pain when the
abdomen is jarredforexample, when a person bumps into something or goes over a bump in a
car.

Rovsings sign.A doctor tests for Rovsings sign by applying handpressure to thel ower l eft side
of the abdomen. Pain felt on the lower right side of the abdomen upon the release of pressure
on the left side indicates the presence of Rovsings sign.
y

Psoas sign.The right psoas muscle runs over the pelvis near the appendix. Flexing this muscle
will cause abdominal pain if the appendix is inflamed.A doctor can check for the psoas sign by
applying resistance to the right knee as the patient tries to lift the right thigh while lyingdown.
y

Obturator sign. The right obturator muscle also runs near the appendix. Adoctor tests for the

obturator sign by asking the patient to lie d own with the right leg bent at the knee. Moving the bent knee left and right
requires flexing the obturator muscle and will cause abdominal pain if the appendix is inflamed.

3. Other symptoms of appendicitis may include


y

loss of appetite
y

nausea
y

vomiting
y

constipation ordiarrhea
y

inability to pass gas


y

a low-grade fever that follows other symptoms


y

abdominal swelling
y

the feeling that passing stool will relieve d iscomfort