Presentation 2‏1‏ appendicitis

1. Appendicitis Case presentation

2. Hospital : Al- amiri Ward: 5 Room: 14 Bed: 23 Client name: Zhen fda Diagnosis: appendicitis Development Age: 43 years Sex: male Marital status : M Children: 4 Significant others: Husain- his brother Nursing history

3. Spiritual Religion: Muslim Socio cultural Occupation: driver Education: high school Nationality: India Languages: Arabic/English Living situation: flat Hobbies : Reading smoking : NO

4. Family history: NO Client history : No Allergic: No Diet: normal diet. Dose client wear Dentures: No glasses: Yes contact lenses: No Dose client required help in ADL? Eating: no bathing: no dressing: no walking: no toilet: no

5. Psychological Dose client worry about any thing? Anxiety about his disease. How client does cope with the worry? Follow of doctor order. Physiological Why did the client come to hospital? Sever abdominal pain.

6. 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,

7. Stressor Extra personal Interpersonal Intrapersonal variables - Iv lock Abdominal pain Physiological - Lack of support from his worker group - Anxiety about his disease . Psychological - Not comfortable from his job - Socio-culture

8. Extra personal Interpersonal Intrapersonal variables Developmental - he want go to mosque but he can not, because he is in hospital Spiritual

9. What is the appendix? 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

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

11. 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. What is appendicitis and what causes appendicitis?

12. 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. What is appendicitis and what causes appendicitis?

13. 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. What is appendicitis and what causes appendicitis?

14. 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. What are the complications of appendicitis?

15. Pain Nausea and sometimes vomiting Loss of appetite Appendix inflammation increase Fever will be present Consitipation Inability to pass gas Diarrhea Abdominal swelling What are the symptoms of appendicitis?

16. 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). How is appendicitis diagnosed?

17. Imaging procedures (to determine if the appendix is inflamed), including the following: Computer tomography scan Ultrasound Abdominal X-Ray How is appendicitis diagnosed?

18. (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 How is appendicitis treated?

19. As inflammation spreads pain is localized and is noted with palpation of the right lower quadrant. This is referred to as McBurney’s Point.

20. How is an appendectomy done? 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.

21. How is an appendectomy done? 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.

22. How is an appendectomy done? The abdominal incision then is closed.

23. 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).

24. 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 Are there long-term consequences of appendectomy?

25. 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 care plane

26. Nursing diagnosis Anxiety related to outcome of surgery Nursing goal The client will verbalize knowledge of routines and care during and after surgery

27. Interventions 2)Assess level of anxiety. Rationales 2)To identify level of anxiety and reduce that .

28. Interventions 3)Identify cause that leading to anxiety Rationales 3)To dissolve the problem that leading to anxiety and give the client some suggest to reduce the anxiety

29. Interventions 4)give antianixety as prescribed. Rationales 4) to decrease anxiety

30. Evaluation Goal-met because the client reduced the anxiety to minimal level

31. 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

32. 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

33. Interventions 1) monitor v/s Rationales 1)To maintain state of client and prevent to cause side effect

34. Interventions 3)regular dressing Rationales 3)To prevent for develop infection and pathogens

35. Evaluation Goal met because the client free from infection and pathogens

36. Interventions 2)Monitor input and output chart Rationales 2)intake and output monitoring provides early detection of fluid imbalance

37. Ranitidine (zantac) pre-operative 150mg po Indications - use for treatment of duodenal ulcer and gastric ulcer Drugs

38. Contraindications - with patient who have allergic with this drug. Side effects. - diarrhea or constipation - headache, dizziness - blurred vision - jaundice

39. 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

40. Rocephin pre-operative 1g IV Indications - abdominal infection - meningitis - pelvic inflammatory disease - bone infection Drugs

41. 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

42. Contraindications - with patient who have allergic with this drug . Side effects. -diarrhea - skin rash -fever, headache -phlebitis

43. Premosan 10mg Pre-operative Po Indications -prevent nausea and vomiting -gastrointestinal reflux Drugs

44. Contraindications -seizures - with gastrointestinal hemorrhage - patient with phaeochromocytoma Side effect - drowsiness - depression

45. Nursing responsibilities - teach client to avoid alcohol - teach client what the side effect - check if any allergic

46. INFORMED CONSENT Obtain a written permission from client or relatives . 2) NURSING ASSESSMENT Vital signs Physical assessment drug history Weight and height Some nursing responsibility before client going to surgery

47. 3) LEARNING NEEDS leg exercises Positioning deep breathing 4)LABORATORY TESTS nurses’ responsibility ensure that the doctors orders are completed Some nursing responsibility before client going to surgery

48. 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 Some nursing responsibility after client doing surgery

49. 1)Web www.healthteaching.com www.rxlist.com 2)Book Focus on nursing pharmacology Nursing care plan and documentation Reference

50. Abdullah Motir Khaled Rasheed Nasser Ali Student Name