DIPOLOG MEDICAL CENTER COLLEGE FOUNDATION INC.

College of Nursing

A
CASE STUDY
OF
APPENDICITIS

Submitted by:
SHARMAINE S. CAGANG
BSN III - KING

Submitted to:
MR. HAROLD S. NABOR, USRN
INSTRUCTOR
 CONTENTS

A. Introduction

B. Terminologies

C. Anatomy and Physiology

D. Pathophysiology

E. Nursing Care Plan

F. Discharge Instructions (Methods) Style

G. Drug Study

H. Readings r/t Digestive cases / Articles Summary and Reaction

I. General Evaluation including Laboratory / Diagnostic Tests

 A. INTRODUCTION

Description
 The appendix is a small, finger-like appendage about 10 cm (4 in) long that is
attached to the cecum just below the ileocecal valve. The appendix fills with
food and empties regularly into the cecum. Because it empties inefficiently and
its lumen is small, the appendix is prone to obstruction and is particularly
vulnerable to infection.
 Appendicitis is inflammation of the appendix.
 When the appendix becomes inflamed or infected, rupture may occur within a
matter of hours, leading to peritonitis and sepsis.

Risk Factors

 Obstruction by fecalith or foreign bodies, bacteria or toxins.

 Low-fiber diet
 High intake of refined carbohydrates

Signs and Symptoms

 Pain in the periumbilical area that descends to the right lower quadrant.
 Abdominal pain that is most intense at McBurney’s point
 Rebound tenderness and abdominal rigidity
 Low-grade fever
 Elevated white blood cell count
 Anorexia, nausea, and vomiting
 Client in side-lying position, with abdominal guarding and legs flexed
 Constipation or diarrhea
 B. TERMINOLOGIES

Appendectomy - surgical removal of the appendix.

Appendicitis - is inflammation of the appendix.

Fecalith - A hard stony mass of feces in the intestinal tract.

McBurney’s point - defined as a point that lies one-third of the distance laterally on a

line drawn from the umbilicus to the right anterior superior iliac spine. Classically, it
corresponds to the location of the base of the appendix.

Perforation - a hole that develops through the wall of a body organ. 

 C. ANATOMY AND PHYSIOLOGY

APPENDIX

 formally vermiform appendix, in anatomy, a vestigial hollow tube that is closed

at one end and is attached at the other end to the cecum, a pouch-like
beginning of the large intestine into which the small intestine empties its
contents. 
 Researchers deduce that the appendix is designed to protect good bacteria in
the gut. That way, when the gut is affected by a bout of diarrhea or other illness
that cleans out the intestines, the good bacteria in the appendix can repopulate
the digestive system and keep you healthy.
 D. PATHOPHYSIOLOGY

Obstruction of the appendiceal lumen (inside the appendix)

Buildup of mucus in the appendix

Increase intraluminal pressure

Ulceration of the appendix mucosal lining

Hypoxia

Decreased blood flow to the appendix

Promotes microbe invasion

Inflammation and swelling of the appendix

APPENDICITIS

Appendicitis is inflammation of the vermiform appendix caused by an obstruction

attributable to infection, structure, fecal mass, foreign body, or tumor. Appendicitis is the
most common disease requiring surgery. If left untreated, appendicitis may progress to
abscess, perforation, subsequent peritonitis, and death.
 E. NURSING CARE PLAN
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Independent: Independent:
Subjective: Acute pain After 1 hour of 1. Assess pain, noting 1. Useful in monitoring After 1 hour of nursing
may be nursing location, characteristics effectiveness of interventions, the goal
“Sumasakit ang related to interventions, the and severity (0-10 medications and was met. The patient
sugat ng opera distention of patient will report scale). Investigate and progression of healing. was able to report
ko.” As intestinal relieved or report changes in pain, Changes in characteristic relieved or controlled
verbalized by the tissue by controlled pain as appropriate. of pain may indicate pain and the patient
patient. inflammation and the patient 2. Provide accurate, developing abscess or appeared to be relaxed
and presence will appear to be honest information to peritonitis, requiring prompt and was able to sleep
Objective: patient and significant medical evaluation and
of surgical relaxed, able to and rest appropriately.
others. intervention.
incision. sleep and rest
-guarding 3. Keep patient at rest in 2. Being informed about
appropriately.
behavior in the semi-fowlers position. progress of situation
abdomen. 4. Provide diversional provides emotional
activities support, helping to
-facial mask of
5. Place ice bag on decrease anxiety
pain
abdomen periodically 3. To lessen the pain.
-distraction Gravity localizes
during initial 24–48 hr,
behaviors as appropriate. inflammatory exudate into
6. Watch closely for lower abdomen or pelvis,
V/S taken as possible surgical relieving abdominal
follows: complications. tension, which is
7. Keep NPO and accentuated
Temp: 36.8°C maintain NG suction by supine position.
PR: 83 initially. 4. Refocuses attention,
RR: 17 8. Encourage early promotes relaxation, and
BP: 110/80 ambulation. may enhance coping
mmHg Dependent: abilities.
9. Administer analgesics 5.  Soothes and relieves
as indicated. pain through
desensitization of nerve
endings. Note: Do not use
heat, because it may cause
tissue congestion.
6. Continuing pain
and fever may signal an
abscess.
7. Decreases discomfort of
early intestinal peristalsis,
gastric irritation
and vomiting.
8. Promotes normalization
of organ
function (stimulates peristal
sis and passing of flatus,
reducing abdominal
discomfort).
Dependent:
9. Relief of pain facilitates
cooperation with other
therapeutic interventions
(ambulation, pulmonary
toilet).
 F. DISCHARGE INSTRUCTIONS (METHODS) STYLE

M     Antibiotics for infection

       Analgesic agent (morphine) can be given for pain after the surgery

E    Within 12 hours of surgery you may get up and move around. 
You can usually return to normal activities in 2-3 weeks after laparoscopic
surgery.

T    Pretreatment of foods with lactase preparations (e.g. lactacid drops)

before ingestion can reduce symptoms.
Ingestion of lactase enzyme tablets with the first bite of food can reduce
symptoms.

H     To care wound perform dressing changes and irrigations as prescribe

avoid taking laxative or applying heat to abdomen when abdominal pain of
unknown cause is experienced.
Reinforce need for follow-up appointment with the surgeon
Call your physician for increased pain at the incision site

O     Document bowel sounds and the passing of flatus or bowel movements
(these are signs of the return of peristalsis)
Watch for surgical complications such as continuing pain or fever, which
indicate an abscess or wound dehiscence
Stitches removed between fifth and seventh day (usually in physician’s
office)

D   Liquid or soft diet until the infection subsides

      Soft diet is low in fiber and easily breaks down in the gastrointestinal tract
 G. DRUG STUDY

Nursing
Drug Mechanism of Action Indications Contraindications Side effects
considerations
Generic Name: Inhibits the action of Pre-operative Contraindicated to CNS: Headache,  10 drug
histamine at the patients under patients malaise, dizziness administration rights
Ranitidine
histamine-sensitive H2 NPO. hypersensitive to CV: bradycardia  Use cautiously in
Brand Name: receptor sites of the drug. GI: nausea and patients with hepatic
parietal cells in the constipation dysfunction
Zantac
stomach; thus SKIN: rash  Avoid administration
Classification: contraindicates acidity. LOCAL: burning of antacids at the
and itching same time as
H2 receptor
sensations at ranitidine.
antagonist injection site.  Avoid foods and
factors that may
increase gastric acid
secretion.
Generic Name: Interfering with bacterial Prophylaxis for Contraindicated to CNS: Headache,  10 drug
cell wall synthesis pre-operative patients malaise, administration
Cefuroxime
thereby altering the patients hypersensitive to paresthesia, and rights
Sodium osmotic stability of the drug. dizziness  Contraindicated in
actively growing bacterial GI: nausea and hypersensitivity to
Brand Name:
cell and resulting in its constipation, other
Zinacef death. nausea, anorexia, cephalosporin.
vomiting, diarrhea  Use cautiously in
Classification:
and abdominal patients with renal
Cephalosporin cramps impairment.
SKIN:  With large doses or
erythematous prolonged therapy,
rashes, urticaria monitor for
LOCAL: at superinfection,
injection site pain, especially in high
temperature risk patients.
 elevation,
phlebitis, and
thrombophlebitis
with I.V injection
Other:
hypersensitivity
and dyspnea
Generic Name: A direct acting Prevention of Contraindicated to CNS: vertigo,  10 drug
trichomonaside and postoperative patients headache, administration rights
Metronidazole
amebicide that works at infection in hypersensitive to confusion,  The IV form should
Brand Name: both intestinal and contaminated or drug. irritability, be administered by
extraintestinal sites. potentially depression, slow infusion only.
Flagyl
contaminated restlessness, Don’t give IV push.
Classification: colorectal weakness, fatigue,  Don’t refrigerate
surgery. drowsiness, Flagyl IV RTU
Antiparasitic
insomnia  Flagyl IV RTU may
GI: cramping, cause sodium
nausea, vomiting, retention
anorexia, diarrhea,  Observe carefully
dry mouth for edema
Skin: pruritus,  Drug may cause
flushing darkening of the
GU: darkened urine
urine  Monitor client for
LOCAL: development of
thrombophlebitis neurological
after IV infusion. symptoms.
Generic Name: Replaces and maintains Hypokalemia CNS: paresthesia  10 drug
potassium level. of the extremities, administration rights
Potassium
mental confusion,  Contraindicated to
Chloride weakness or patients with severe
heaviness of renal impairment
Brand Name:
limbs, flaccid  Potassium should
 - paralysis. not be given during
CV: peripheral immediate
Classification:
vascular collapse postoperative period
Electrolyte with fall in blood until urine flow is
pressure, cardiac established.
arrhythmias, heart  Parenteral
block, possible potassium is given
cardiac arrest. by infusion only;
GI: nausea, never IV push or IM.
vomiting,
abdominal pain,
diarrhea, GI
ulcerations
GU: oliguria
Skin: cold skin,
gray pallor
LOCAL: post-
infusion phlebitis

Generic Name: An NSAID that acts by Short term Contraindicated to CNS: drowsiness,  10 drug
inhibiting the synthesis of management of patients dizziness, administration rights
KEROTOLAC
prostaglandins. pain hypersensitive to headache,  Use caution with
TROMETHAMINE drug. sweating patients who has
CV: edema hepatic or renal
Brand Name:
GI: nausea, impairment
Toradol dyspepsia, GI  This drug is
pain, diarrhea intended only for
Classification:
LOCAL: pain in short term
NSAID the injection site management of
pain. The rate and
severity of adverse
reactions should be
less than that
observed in patients
taking NSAIDS on a
chronic basis.
H. READINGS R/T DIGESTIVE CASES / ARTICLES SUMMARY AND
REACTIONS
 I. GENERAL EVALUATION INCLUDING LABORATORY OR DIAGNOSTIC
TESTS

Appendicitis tests usually include a physical exam of your abdomen and one or more of
the following:

 Blood test to check for signs of infection. A high white blood cell count is a sign
of an infection, including, but not limited to, appendicitis.
 Urine test to rule out a urinary tract infection.
 Imaging tests, such as an abdominal ultrasound or CT scan, to view the inside
of your abdomen. Imaging tests are often used to help confirm a diagnosis, if a
physical exam and/or blood test show possible appendicitis.

 During a blood test, a health care professional will take a blood sample from a
vein in your arm, using a small needle. After the needle is inserted, a small
amount of blood will be collected into a test tube or vial. You may feel a little sting
when the needle goes in or out. This usually takes less than five minutes.
 For a urine test, you will need to provide a sample of your urine.
 An abdominal ultrasound uses sound waves to view the inside of your
abdomen.
 A CT scan uses a computer that's linked to an x-ray machine to create a series
of pictures of the inside of your body. Before the scan, you may need to take in a
substance called contrast dye. Contrast dye helps the images show up better in
the x-ray. You may get contrast dye through an intravenous line or by drinking it.

Diagnosis is based on results of a complete physical examination and on laboratory

and x-ray findings. The complete blood cell count demonstrates an elevated white blood
cell count. The leukocyte count may exceed 10,000 cells/mm3, and the neutrophil count
may exceed 75%. Abdominal x-ray films, ultrasound studies, and CT scans may reveal
a right lower quadrant density or localized distention of the bowel.