appendectomy_cs

8/9/2019 Appendectomy_CS

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LICEO DE CAGAYAN UNIVERSITY

COLLEGE OF NURSING

NCM501X

NCM501X

A Care Study

APPENDECTOMY

X

Submitted to:

X, RN

AS PARTIAL FULFILLMENT OF THE COURSE REQUIREMENT

FOR NCM501X

Submitted by:

X


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I. Introduction

Overview of the case

II. Health History

Profile of patient

III. Developmental Data

IV. Anatomy and Physiology

V. Pathophysiology

VI. Medical Management

VII. Laboratory Results

VIII. Drug Study

IX. Ideal Nursing Management

X. Actual Nursing Management

XI. Health Teachings

XII. Referrals and Follow up

XIII. Bibliography


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I. INTRODUCTION

a. Overview of the Case

Any part of the lower gastro-intestinal tract is susceptible to acuteinflammation caused by bacterial, viral or fungal infection. Two such situations

are appendicitis and diverticulitis. Appendicitis is inflammation of the appendix. It

is thought that appendicitis begins when the 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. This rock is

called a fecalith (literally, a rock of stool). At other times, the lymphatic tissue in

the appendix may swell and block the appendix. Bacteria which normally are

found within the appendix then begin to invade (infect) the wall of the appendix.

The body responds to the invasion by mounting an attack on the bacteria, an

attack called inflammation. (An alternative theory for the cause of appendicitis is

an initial rupture of the appendix followed by spread of bacteria outside the

appendix.. The cause of such a rupture is unclear, but it may relate to changes

that occur in the lymphatic tissue that line the wall of the appendix.)

If the inflammation and infection spread through the wall of the appendix, the

appendix can rupture. After rupture, infection can spread throughout the

abdomen; however, it usually is confined to a small area surrounding the

appendix (forming a peri-appendiceal abscess).

Sometimes, the body is successful in containing ("healing") the appendicitis

without surgical treatment if the infection and accompanying inflammation do not

spread throughout the abdomen. The inflammation, pain and symptoms may

disappear. This is particularly true in elderly patients and when antibiotics are

used. The patients then may come to the doctor long after the episode of

appendicitis with a lump or a mass in the right lower abdomen that is due to the

scarring that occurs during healing. This lump might raise the suspicion of
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cancer. The main symptom of appendicitis is abdominal pain. The pain is at first

diffuse and poorly localized, that is, not confined to one spot. (Poorly localized

pain is typical whenever a problem is confined to the small intestine or colon,

including the appendix.) The pain is so difficult to pinpoint that when asked to

point to the area of the pain, most people indicate the location of the pain with a

circular motion of their hand around the central part of their abdomen.

As appendiceal inflammation increases, it extends through the appendix to its

outer covering and then to the lining of the abdomen, a thin membrane called the

peritoneum. Once the peritoneum becomes inflamed, the pain changes and then

can be localized clearly to one small area. Generally, this area is between the

front of the right hip bone and the belly button. The exact point is named after Dr.Charles McBurney--McBurney's point. If the appendix ruptures and infection

spreads throughout the abdomen, the pain becomes diffuse again as the entire

lining of the abdomen becomes inflamed. Nausea and vomiting also occur in

appendicitis and may be due to intestinal obstruction.
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II. HEALTH HISTORY

a. Profile of Patient

Patients Name: X

Birth Date: X

Birthplace: X

Age: X

Sex: Female

Status: Single (child)

Religion: Roman Catholic

Nationality: Filipino

Fathers Name: X

Mothers Name: X

Address: B X

Allergy: None

Date of Admission: May 5, 2007

Time of Admission: 11:30 amChief Complaints: Epigastric pain, vomiting and fever

Admitting Diagnosis: Acute Appendicitis


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III. DEVELOPMENTAL TASK

ERIK ERICKSONS THEORY OF PSYCHOSOCIAL DEVELOPMENT

Grade School:

Stage 4 - Industry vs. Inferiority To bring a productive situation to completion is an aim which gradually

supersedes the whims and wishes of play.

The fundamentals of technology are developed

To lose the hope of such "industrious" association may pull the child back

to the more isolated, less conscious familial rivalry of the Oedipal time

The child can become a conformist and thoughtless slave whom others

exploit.

JEAN PIAGETS THEORY OF COGNITIVE DEVELOPMENT

Piaget's Cognitive Development:

Concrete operations (ages 7-11)--As physical experience accumulates,

the child starts to conceptualize, creating logical structures that explain his

or her physical experiences. Abstract problem solving is also possible at

this stage. For example, arithmetic equations can be solved with numbers,

not just with objects.

Formal operations (beginning at ages 11-15)--By this point, the child's

cognitive structures are like those of an adult and include conceptual

reasoning.


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VI. MEDICAL MANAGEMENT


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DOCTORS ORDER RATIONALEMay 6, 2007

> Temperature every 4 hours

> Diet As Tolerated

> Labs: CBC stat., U/A, S/E

>Meds:

Paracetamol 10mL every 4

hours PRN

> Intake and Output every shift

> IVF follow up D5LR I L

May 7, 2007

> During this period of time, potentially fatal

complications may develop

> Serves as transition to the regular diet; is a

nutritionally adequate diet; is a modification of

normal diet in consistency and texture

> CBC- leukocytosis usually present, although

a low WBC counts may present in viral

infection.

> Paracetamol is for fever reduction.

> To know if the patient has a normal fluid

intake and output. To know for normal kidney

functioning and for laboratory purposes.

> Fluids are required to replace losses, to

prevent patient dehydration. It aids also for

mobilization of secretion.

Name of drug Date

Ordered

Classification Dosage/

Frequency

Route

Mechanism of

Action

Specific

Indication

Contraindications Side Effects Nursing

Implicati

Paracetamol

(Biogesec)

Cefuroxime

(Zinacef)

May6,2007

May6,2007

Antipyretic,

analgesic

Antibiotic

1 tab, P.O.

(prn)

400 g every

8 hours.

Chemical Effect:

May produce

analgesic effect

by blocking pain

impulses, by

inhibiting

prostaglandin.

Therapeutic

Effect:: Relieves

pain and reduces

fever.

Chemical effect:

Inhibits cell-wall

synthesis,

promoting

osmoticinstability.

Therapeutic

effect: Kills

susceptible

bacteria

Reduces fever

Hinders or

kills

susceptible

bacteria.

- Contraindicated

in patients

hypersensitive to

drug.

- Use cautiously

in patients with

history of chronic

alcohol abuse.

- Contraindicated

in patients

hypersensitive to

drug or other

cephalosporins.- Use cautiously

in patients with

history of

sensitivity to

penicillin.

Hematologic:

hemolytic

anemia,leucopenia

Hepatic: liver

damage, jaundice.

Metabolic:

hypoglycemia

Skin: rash, urticaria

CNS: headache,

malaise, dizziness.

GI: nausea,

anorexia, vomiting,

diarrhea, glossitis,abdominal cramps.

Respiratory: dyspnea

Skin: rashes,

urticaria.

- Assesspatients portemperatubefore anddring thera- Assess

patients dhistory.- Be alert fadversereactions adruginteraction

- Assesspatientsinfectionbeforetherapy.- Ask patie

aboutpreviousreactions tcephalosp- Be alert fadversereactions adruginteraction


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VIII. DRUG STUDY

Name of

drug

Date

Ordered


Frequency

Route

Mechanism of

Action

Specific

Indication

Contraindications Side Effects Nursing Implication

Tramadol May6,2007 Pharmacologic

class: opioidagonist

Therapeutic

class:

analgesic

300 g IVTT

every 8hours.

Chemical

effect:Centrally acting

synthetic

analgesic

compound

thought to bind

opioid

receptorsand

inhibit reuptake

of

norepinephrine

and serotonin.

Therapeutic

effect: Relieves

pain.

Relieves

pain.

- Contraindicated in

patientshypersensitive to drug

or any of its

component.

- Use cautiously in

patients at risk for

seizures or respiratory

depression.

CNS:

dizziness,vertigo,

headache

CV:

vasodilation

EENT: visual

disturbances.

GI: nausea,

constipation,

vomiting,

diarrhea

- Assess patients pai

before starting ththerapy.

- Monitor CV an

respiratory status.

- Monitor patient fo

drug dependence.

Be alert for advers

reaction.


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Name of

drug

Date

Ordered


Frequency

Route

Mechanism of

Action

Specific

Indication

Contraindications Side Effects Nursing Implication

Ketorolac

(Toradol)

Ranitidine

(Zantac)

May7,2007

May7,2007

Pharmacologic

class: NSAID

Therapeutic:

analgesic,

anti-

inflammatory.

Antiulcerative

30 mg IV

every 6

hours.

300g IVTT

every 8

hours.

Chemical

effect: May

inhibit

prostaglandins

synthesis.

Therapeutic

effect:

Relieves pain

and

inflammation.

Chem. Effect:

Competitively

inhibits action

of H2 at

receptor site.

-Relieves GI

discomfort.

Relieves

pain and

inflammation.

Relieves GI

discomfort.

- Contraindicated in

patients

hypersensitive to

drug or any of its

components.

- Not recommend for

intrathecal or epidural

administration

because of its alcohol

content.

- Use cautiously in

patients in the

perioperative period.

- Contraindicated inpatientshypersensitive todrug or any of itscomponents.Use cautiously inpatients withimpaired kidneyfunction.

CNS:

drowsiness,

insomnia,

dizziness,

headache.

CV: edema,

hypertension,

palpitations.

GI: nausea,

GI pain,

diarrhea.

Skin:

sweating.

CNS: vertigo,

malaise.

EENT:

blurred vision

Hepatic:

Jaundice.

- Assess patientsinfection beforetherapy.- Ask patient aboutprevious reactions tocephalosporin- Be alert for adversereactions and druginteractions.

-Assess patients G

condit ion befor

starting therapy.

- Be alert for advers

reactions of dru

interactions.


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VII. LABORATORY RESULTS

DIAGNOSTIC TESTS

URINALYSIS

May 6, 2007

Specimen: Random Sample

Color: Yellow

Appearance: Clear

Glucose: negative

Protein: negative

Reaction: 6.0 pH

Specific gravity: 1.030

Microscopic

WBC: 0-2

RBC: 0-1

Epithelial Cells: 4-5

Pus Cells: 2-4 hpf Mucus Threads: none seen

Urates: none seen

Bacteria: none seen

CHEMISTRY:

Sodium 141.00 mmol/L

Potassium 4.0 mmol/L

Glucose-RBS L 2.6

Creatinine L 44.70mmol/L


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HEMATOLOGY

May 6, 2007

CBC

Total WBC *11.76

Total RBC 4.69

Hemoglobin 134

Hematocrit 0.40

MCV 81.4

MCH 26.8

MCHC 32.9

Platelet Count 227

Differential Count

Lymphocytes 91

Monocytes 7

Eosinophils 2

Basophils 13.5


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IV. ANATOMY AND PHYSIOLOGY

The appendix is a small finger-like projection that comes off the

cecum of the large intestine and has no apparent function in the human.

When the opening in the sac is blocked, it leads to an inflammation of

the appendix called appendicitis. This condition occurs most commonly

in the young, between childhood and young adulthood.

Appendicitis is an emergency condition and requires urgent surgical

removal of the appendix. The appendix is a narrow, muscular tube. One

end is attached to the first part of the large intestine, while the other end is

closed. The position of the appendix in the body can vary from person to

person. An average adult appendix is about 4 inches (10cm) long. However, it

can vary in length from as less as an inch to 8 inches. Its diameter is usually

about about 6 to 7 mm.

The function of the appendix is unknown. Foods that have not been digested

tends to move into the appendix and are forced out again by the contractions

of appendix. In herbivorous animals like cow and goat, the appendix can

function. In man, this has become what is called as a vestigial organ (an

organ that is no more required). The vermifom appendix or appendix in short,

is a small part of the bowel or intestine. It is situated on the right side of the

abdomen at the junction of the small and large intestines. It is a small narrow

sac approximately 10 cm long and 1 cm wide. The appendix is a vestigial

organ, that is, it serves no useful purpose.

The appendix is a small projection that develops from a portion of

the large intestine called the cecum. As the appendix develops it

lengthens and the tip can be found in almost any position about the

cecum.


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- The appendix is a finger-like projection from the beginningof the large bowel called the cecum. The blood supply for theappendix lies in a fatty tissue, the mesoappendix.


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IX. NURSING MANAGEMENT

a. Ideal Nursing Management (NCP)

NURSING DIAGNOSIS: Nutrition: imbalanced, risk for less than body

requirements

Risk factors may include

Inability to ingest or digest food or absorb nutrients because of biological,

psychological, or economic factors

Increased metabolic demands

Possibly evidenced by

[Not applicable, presence of signs and symptoms establishes an actual

diagnosis.]

DESIRED OUTCOMES/EVALUATION CRITERIACHILD WILL:

Nutritional Status (NOC)

Ingest nutritionally adequate diet for age, activity level, and metabolic

demands.

Demonstrate stable weight/progressive weight gain toward goal.

ACTIONS/INTERVENTIONS

Nutrition Management (NIC)

Independent

Identify children at risk for malnutrition (e.g.,intestinal surgery, hypermetabolic states,

restricted intake, prior nutritional

deficiencies).

Determine ability to chew, swallow, taste;

RATIONALE

Provides opportunity for early

intervention.


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presence of mechanical barriers; or

conditions such as lactose intolerance,

cystic fibrosis, diabetes, inflammatory bowel

diseases.

Determine childs current nutritional status

using age-appropriate measurements,

including weight and body build, strength,

activity level, sleep/rest cycles.

Elicit information from child/parent of

younger child regarding typical daily food

intake, determining foods and beverages

normally consumed. Note types of snacks.

Discuss eating habits and food preferences

(likes and dislikes).

Determine psychological factors, cultural orreligious desires/influences on dietary

choices.

Determine whether infant is breastfed or

formula-fed and typical pattern of feedings

during a 24-hr period. Note type and

amounts of solid foods an infant/young

toddler eats.

Auscultate bowel sounds. Note

These factors can affect ingestion

and/or digestion of nutrients, and

specific dietary choices.

Identifies individual nutritional

needs and provides comparative

baseline.

Baseline information to determine

adequacy of intake. Knowledge of

childs specific likes/dislikes may

be helpful in meeting childs

nutritional needs during a time

when appetite is suppressed or

child has no interest in food.

Dietary beliefs, such as

vegetarianism, can affect

nutritional intake. Ethnic food

choices can improve a childs

intake when appetite is poor.

Providing usual and typical

feedings is important to infant well-

being and early growth.


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characteristics of stool (color, amount,

frequency, and so on).

Discuss with parent what types of candy,

other sweets, snacks, and sodas child

eats/drinks.

Emphasize importance of well-balanced,

nutritious intake. Provide information

regarding individual nutritional needs and

ways to meet these needs within financial

constraints. Avoid arguing over food intake.

Provide food without comment.

Review drug regimen, side effects, and

potential interactions with other

medications/over-the-counter drugs.

Clarify family/caregiver access to/use of

resources such as food stamps, budget

counseling, WIC, community food bank,

and/or other appropriate assistance

programs.

Collaborative

Establish a nutritional plan that meets

individual needs incorporating specific food

Provides information about

digestion/bowel function and may

affect choice/timing of feeding.

Identifies what child eats in a

typical day. Provides opportunity

for identifying and providing

healthy snacks.

Although nutritious intake is

important, arguing over food is

counterproductive. Providing age-

appropriate guidelines to children

as well as to parents/care provider

may help them in making healthy

choices.

Timing of medication doses,

interaction with certain foods canalter effect of medication or

digestion/absorption of nutrients.

May be necessary to improve

childs intake and/or availability of

food to meet nutritional needs.

Corrects/controls underlying


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restrictions, special dietary needs.

Consult dietitian/nutritional team as

indicated.

Review indicated laboratory data (e.g.,

serum albumin/prealbumin, transferring,

amino acid profile, iron, blood urea nitrogen

[BUN], nitrogen balance studies, glucose,

liver function, electrolytes, total lymphocyte

count, indirect calorimetry).

causative factors (e.g., diabetes,

cancer, malabsorption syndrome,

and anorexia).

Useful in determining individual

nutritional needs and therapeutic

diet.

Indicators of nutritional health and

effects of nutrients in organ

function.

NURSING DIAGNOSIS: Fluid volume, risk for imbalance


Lack of adequate intake, increase in fluid needs, e.g. fever

Rapid/sustained loss, e.g., hemorrhage, burns, vomiting, diarrhea, fistulasRapid/excessive fluid replacement


[Not applicable; presence of signs and symptoms establishes an actual

diagnosis.]

DESIRED OUTCOMES/EVALUATION CRITERIACHILD WILL:

Hydration (NOC)

Demonstrate adequate fluid balance as evidenced by stable vital signs,

palpable pulses/good quality, normal skin turgor, moist mucous

membranes; individual appropriate urinary output; lack of excessive

weight fluctuation (loss/gain), and absence of edema.

PARENT/CAREGIVER WILL:


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Verbalize understanding of childs fluid needs.

Promote adequate age-appropriate fluid intake.


Fluid Management (NIC)

Independent

Note potential sources of fluid loss/intake,

presence of conditions such as diabetes,

burns, use of total parenteral nutrition

(TPN), etc.

Note childs age, size, weight, and

cognitive abilities.

Monitor vital signs, mucous membranes,

weight, skin turgor, breath sounds, urinary

and gastric output, amount of blood

draws, hemodynamic measurements.

Review childs intake of fluids.

Determine childs normal pattern of

elimination, and whether child is toilet

trained.

RATIONALE

Causative/contributing factors for

fluid imbalances.

Affects ability to tolerate fluctuations

in fluid level and ability to respond to

fluid needs.

Indicators of hydration status. Note:

Hypotension indicative of developing

shock may not be readily observed

in pediatric patients until very late in

the clinical course.

Children often do not take in enough

oral fluids to meet hydration needs.

Provides information for baseline

and comparison. If child is in

diapers, output may be determined

by weighing diapers.


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Determine whether child has problems

with urination, such as urine retention,

bed-wetting, burning, holding.

Note uses of drainage devices such as

nasogastric tube, wound drain; use of

laxatives, enemas, and suppositories.

Collaborative

Administer IV fluids via control

device/pump.

Replace electrolytes as indicated by oral

route whenever possible.

Monitor laboratory results, e.g.,

hemoglobin/hematocrit (Hb/Hct), BUN,

urine osmolality/specific gravity.

Arrange with laboratory to combine

common tests and draw smallest amount

of blood that is necessary to perform

required tests.

Evaluation of these issues is

important for determining cause and

treatment of underlying problem.

May increase fluid and electrolyte

losses.

Because smaller volumes are

administered, close monitoring and

regulation is required to prevent fluid

overload while correcting fluid

balance.

Oral replacement solutions

formulated for children are often

safer and better tolerated when

given orally if time/condition allows.

Indicators of adequacy of

hydration/therapeutic interventions.

Excessive/repetitive blood draws

may markedly reduce Hb/Hct levels

in pediatric patients.

NURSING DIAGNOSIS: Infection, risk for (septicemia)



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Inadequate primary defenses (broken skin, traumatized tissue, altered

peristalsis)

Inadequate secondary defenses (immunosuppression)

Invasive procedures


[Not applicable; presence of signs and symptoms establishes an actual

diagnosis.]

DESIRED OUTCOMES/EVALUATION CRITERIAPATIENT WILL:

Infection Status (NOC)

Achieve timely healing; be free of purulent drainage or erythema; be afebrile.

Risk Control (NOC)

Verbalize understanding of the individual causative/risk factor(s).


Infection Control (NIC)

Independent

Assess vital signs frequently, notingunresolved or

progressing hypotension, decreased

pulse pressure,

tachycardia, fever, tachypnea.

Note changes in mental status (e.g.,

confusion, stupor).

Note skin color, temperature, moisture.

Monitor urine output.

RATIONALE

Signs of impending septic shock.Circulating endotoxins eventually

produce vasodilation, shift of fluid from

circulation, and a low cardiac output

state.

Hypoxemia, hypotension, and acidosis

can cause

deteriorating mental status.

Warm, flushed, dry skin is early sign of

septicemia. Later manifestations

include cool, clammy, pale skin and


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Perform/model good handwashing

technique. Monitor staff/patient

compliance.

Monitor/restrict visitors and staff as

appropriate. Provide protective

isolation if indicated.

Collaborative

Obtain specimens/monitor results of

serial blood, urine,

wound cultures.

Administer amoebecides e.g.,

Metronidazole.

cyanosis as shock becomes refractory.

Reduces risk of cross-

contamination/spread of infection.

Reduces risk of exposure to/acquisition

of secondary infection in

immunosuppressed patient.

Identifies causative microorganisms

and helps in

assessing effectiveness of antimicrobial

regimen.

Therapy is directed at anaerobic

bacteria.

X. Actual Nursing Management (SOAPIE)


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S SUBJECTIVE: Sakit akong tiyan diri dapit sa akong kilid as verbalized by the

patient.

O - Facial grimace

- Guarding- Restlessness

A Alteration in comfort pain related toDistension of intestinal tissues by inflammation

P At the end of 30 minutes of rendering nursing intervention the patientwill be able to verbalize relief/ control of pain.

I Assess pain noting location, characteristics and intensity. (0-10 scale).- Helps evaluate degree of discomfort.

Provide accurate, honest information to patient/SO. Keep at rest insemi-Fowlers position.- Being informed about progress of situation provides emotionalsupport, helping to decrease anxiety. Gravity localizes inflammatoryexudate into lower abdomen or pelvis, relieving abdominal tension,which is accentuated by supine position.

Apply hot or cold compress when indicated.

- Reduces pain

Provide comfort measures e.g. back rub, repositioning the patient.- Promotes relaxation and may enhance coping abilities.

DEPENDENT:

Administer medications as indicated e.g. narcotics, analgesics.- Relieves pain enhances comfort and promotes rest.

E At the end of 30 minutes of rendering nursing intervention the patientwas able to verbalized relief/ control of pain.

S SUBJECTIVE:


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O - Facial grimace- Guarding- Restlessness

A Knowledge, deficient regarding condition,

prognosis, treatment, self-care, and discharge needs related toLack of exposure/recall; information misinterpretation

P At the end of 30 minutes of rendering nursing intervention the patientwill be able to verbalize understanding of disease process and potentialcomplications.

I Identify symptoms requiring medical evaluation, e.g.,increasing pain; edema/erythema of wound; presence ofdrainage, fever.

- Prompt intervention reduces risk of seriouscomplications, e.g., delayed wound healing, peritonitis.

Encourage progressive activities as tolerated withperiodic rest periods.- Understanding promotes cooperation with therapeuticregimen, enhancing healing and recovery process.

Discuss care of incision, including dressing changes,bathing restrictions, and return to physician forsuture/staple removal.

- Understanding promotes cooperation with therapeuticregimen, enhancing healing and recovery process.

E At the end of 30 minutes of rendering nursing intervention the patientwas able to verbalized understanding of disease process and potentialcomplications.

S SUBJECTIVE:

O Poor appetite when eating.


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A Nutrition: Imbalances, less than body requirements related to poorappetite.

P At the end of 1 hour, patient will be able to demonstrate good appetiteand verbalized her feelings concerning resumption of diet.

I Encouraged bed rest and limited activity.

- Decreasing metabolic needs aids in preventing caloric depletion andconserves energy.

Intake and output recorded.

- Useful in identifying specific deficiencies and determining GI response

to foods.

Recommended rest before meals.

-Quiets peristalsis and increase available energy or eating.

Encouraged patient to verbalize feelings concerning resumption of diet.

- Hesitation to eat may result of fear that food will cause exacerbation osymptoms.

E At the end of 1 hour, patient was able to demonstrate good appetite andalready spoken about her feelings concerning resumption of diet

XI. HEALTH TEACHINGS

Name of Patient: Judy Ann Roque

MEDICATIONS Advised and encouraged patient

or family to give the patient

paracetamol when she has

fever.

Do not give patient more than 5

doses in 24 hours unless


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prescribed by physician.

EXERCISE Take some rest to prevent stress

and other complications.

TREATMENT Maintain clear surroundings.

OUT-PATIENT

(Check-up)

Advised the parents to visit the

nearest hospital for further

check-up for their child.

DIET Diet as to age.

Increase fluid intake.

XII. REFERRALS AND FOLLOW-UP

To allow continuous monitoring of the patients healing progress, patient

was encouraged to consult her doctor 2 weeks after discharge for follow-up

check up of her general condition. This will ensure thorough follow up of her

condition and prevention of potential complications. Apart from this, patient was

advised to increase fluid intake, make sure that proper hand washing is practiced

before and after eating.

XIII. BIBLIOGRAPHY

Black, Joyce M. 1993. Medical-Surgical Nursing- A Psychologic Approach. 4th ed.

W.B Saunders Company: Philadelphia, Pennsylvania,USA.


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Smeltzer, Suzanne C.et al.2004. Medical Surgical Nursing. - 10th ed.Lippincott

Williams and Wilkins: Philadelphia

Price, Sylvia A. 1997. Pathophysiology: Clinical Concepts of Disease Processes.

5th ed. Mosby Year Book, Inc: United States of America

Carpenito, Lynda Juall.2000. Nursing Diagnosis: Application to Clinical Practice.

8th ed. Lyndal Juall Carpenito: United States of America.

Pillitteri, Adele. 2003. Maternal and Child Health Nursing.4rth ed.Wolter Kluwer

Company: Hong Kong.

Doenges, Marilynn E.2006.Nurses Pocket Guide.F.ADavis Company:

Philadelphia.

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V. PATHOPHYSIOLOGY

Predisposing factors:

Age

Gender


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Lifestyle

Precipitating factors:

Infections

Appendicitis

obstruction of the narrow appendiceal lumen.

Obstruction has many sources, including fecaliths, lymphoid hyperplasia (relatedto viral illnesses such as upper respiratory infections, mononucleosis, or

gastroenteritisgastrointestinal parasites, foreign bodies, and Crohn's disease

Continued secretion of mucus from within the obstructed appendix results in

elevated intraluminal pressure,

leading to tissue ischemia, over-growth of bacteria, transmural inflammation,

appendiceal infarction, and possible perforation.

Inflammation may then quickly extend into the parietal peritoneum and

adjacent structures.

s/s: epigastric pain, vomiting, anorexia, fever

Complications: wound infections, intra-abdominal abscess,intestinal obstruction, and prolonged ileus


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appendectomy_cs

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