A Case Presentation of:BSN-119 Group 73

The agent-host-environment model is primarily used to predict illness rather than to promote wellness, although identification of risk factors that result from the interactions of the agent, host, and environment helps in promoting and maintaining health. Because each of agent-host-environment factors constantly interact with others, health is an ever changing state. Health is seen in when all three elements are in balance, while illness is seen in one when one, two, or three elements are not in balance.

(Fundamentals of Nursing by Kozier 2004)

Appendicitis is an inflammation of the inner lining of the vermiform appendix that spreads to its other parts. It may occur for several reasons, such as an infection of the appendix, but the primary cause in most cases is the obstruction of the appendiceal lumen. Appendicitis is a common and urgent surgical illness with generous overlap with other clinical syndromes, and significant morbidity, which increases with diagnostic delay. No single sign, symptom, or diagnostic test accurately confirms the diagnosis of appendiceal inflammation in all cases.

Obstruction of the appendiceal lumen is the primary cause of appendicitis. An anatomic blind pouch, obstruction of the appendiceal lumen leads to distension of the appendix due to accumulated intraluminal fluid. Ineffective lymphatic and venous drainage allows bacterial invasion of the appendiceal wall and, in advanced cases, perforation and spillage of pus into the peritoneal cavity.

Left untreated, appendicitis has the potential for severe complications, including perforation or sepsis, and may even cause death.

(emedicine.medscape.comLeBlond RF, DeGowin RL, Brown DD. DeGowin's Diagnostic Examination. 8th ed. McGraw-Hill; 2004:1040.)

We chose this certain topic for further study under the concept of Endocrine System & Metabolism. By this, we would be able to gain knowledge about its etiology and other certain revelations regarding the disease and its underlying factors. Particularly, statistics report that 1 of 5 cases of appendicitis is misdiagnosed; however, a normal appendix is found in 15-40% of patients who have an emergency appendectomy.

We hereby gathered selected data from our patient and also facts from certain references that would contribute and support the case.

A. Hypothesis

Acute Appendicitis due to fecalith obstruction of the appendiceal lumen which could lead to bacterial overgrowth and an increase in intraluminal pressure and sets off an inflammatory process that can lead to infection, thrombosis, necrosis, perforation, and peritonitis.

In our study of the patient’s condition, we have perceived that the predisposing factors which contributed to the occurrence of Acute Appendicitis are the Host and the Agent. There had been no any environmental factor involved to cause the disease, however, we cannot disregard or detach it for it is originally a part of the ecologic model.

The predisposing factors together with their components are as follows:

B. Predisposing Factors

1. Host Age: 39 years old Sex: Male Lifestyle (Nutrition): Low fiber diet

2. Agent Non-living: Fecaliths

C. The Lever

Agent

Host

EE

We have chosen the lever ecologic model because it is used to show the relationship between the host, agent, and environment. It is also used to determine if there is an imbalance among the three pre-disposing factors or there is one that contributes more than the other, which may lead to an occurrence of the disease.

Since the patient is male & at the age of 39, age is one factor because Appendicitis could occur in all ages and regarding the gender, there is higher incidence in men than in women. Due to his nutritional lifestyle which is low fiber diet, it could also cause Appendicitis because high fiber diet is truly recommended to prevent such disease. And the fecalith, as the agent, initiated the disease process through obstruction in the appendecial lumen that caused pain in the right lower quadrant of his abdomen, the client went to the hospital immediately.

D. AnalysisAppendicitis is the inflammation of the vermiform appendix,

usually acute, that if undiagnosed leads rapidly to perforation and peritonitis. The inflammation is caused by an obstruction such as a hard mass of feces or a foreign body in the lumen of the appendix, fibrous disease of the bowel wall, an adhesion, or parasitic infestation. The most common symptom is constant pain in midabdomen. Extreme tenderness occurs over the right rectus muscle. Appendicitis is also characterized by vomiting, a low grade fever of 99° to 102 ° F, an elevated white blood count, rebound tenderness, a rigid abdomen, and decreased or absent bowel sounds. Treatment is appendectomy within 24 to 48 hours of the first symptom because delay usually results in rupture and peritonitis as fecal matter is released into the peritoneal cavity.

(Mosby’s Pocket Dictionary of Medicine, Nursing, & Health Professions p. 106)

E. Conclusion

We therefore conclude that our hypothesis is correct because the patient had acute appendicitis due to fecalith obstruction to the lumen of the vermiform appendix affected by the patient’s age, gender, and lifestyle. It was manifested by atypical symptom of the right lower quadrant which was the reason why the client immediately went and reported to the hospital. It was also the reason why the client had undergone appendectomy within 24 hours of the first symptom because delay or when left untreated, it usually results in rupture, peritonitis , or even death.

F. RecommendationsThe best way to prevent Appendicitis is to eat plenty of

raw, fresh vegetables and fruits, whole grains and at least eight glasses of liquid a day will provide the fiber needed to prevent constipation and minimize the risk of the appendix becoming infected. However, if there are symptoms of appendicitis already, there are some herbs that have been known to help reduce the effects. These herbs include: detoxifying and fever-reducing herbs (Flos lonicerae, Fructus forsythiae, Herba taraxaci, Patrinia scabioseafolia, Gypsum fibrosum), circulation-enhancing herbs (Semen persicae, Radix paeoniae rubra, Squama manitis, Spina gleditsiae), and laxatives (Rhizoma rhei, Mirabilitum depuratum). Belladonna and Bryonia are classic homeopathic remedies often used for an inflamed appendix with symptoms.

F. Recommendations (continuation)Eat lactic acid fermented foods such as natural,

unsweetened yogurt to keep the bacterial culture in the colon healthy. Exercise regularly to help prevent fecal matter from lodging and hardening in the colon.

If surgery has been performed, Vitamin E supports wound healing and Vitamin C prevents infection and supports the immune system. Bioflavonoids work naturally with Vitamin C. These vitamins are excellent during any infection, and Vitamin C can be taken in high dosages if necessary. The B vitamins can be added to the regimen to provide the body with the extra strength needed for the stress of the surgery and illness.

(Dr. Eddy's Clinic Integrated Medicine - Web Journal )www.dreddyclinic.com

F. Recommendations (continuation)Treatments for Acute Appendicitis

The list of treatments mentioned in various sources for Acute Appendicitis includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

Emergency hospitalization Appendectomy Laparoscopic appendectomy Paracetamol Panadol Ibuprofen Diclofenac

F. Recommendations (continuation) Buscopan Over the counter pain medications Treatment depends on underlying cause Call emergency services in case of acute pain Appendecectomy Antibiotics

(www.wrongdiagnosis. com)

F. Recommendations (continuation)

The most important factor in your recovery after surgery is following the full course of treatment ordered by your healthcare provider, including taking all of any prescribed antibiotics. To feel better as soon as possible you should:

Rest. Get plenty of sleep but avoid staying in bed for long periods of time during the day. Eat foods high in protein while you are healing if your provider says it is OK. Eat small frequent meals. Gradually increase your walking and activity as directed by your provider. Keep your sutures clean.

Wash your hands before and after changing the dressing on your incision(s), and after disposing of the dressing.

Keep taking prescribed medicine until it is finished. Contact your provider if the following signs of wound infection appear:

› redness or warmth at the suture site › yellow or green drainage from the wound › fever.

F. Recommendations (continuation)

Wash your hands before and after changing the dressing on your incision(s), and after disposing of the dressing.

Keep taking prescribed medicine until it is finished. Contact your provider if the following signs of wound

infection appear: › redness or warmth at the suture site › yellow or green drainage from the wound › fever.

(www.med.umich.edu.com)