LICEO DE CAGAYAN UNIVERSITY

COLLEGE OF NURSING

NCM501203

NCM501203

A Care Study

POLYPECTOMY

Submitted to:

AS PARTIAL FULFILLMENT OF THE COURSE REQUIREMENT

FOR NCM501203

Submitted by:

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

I. INTRODUCTION

a. Overview of the Case

A polyp is an abnormal growth of tissue (tumor) projecting from a mucous

membrane. If it is attached to the surface by a narrow elongated stalk it is said to

be pedunculated. If no stalk is present it is said to be sessile. Polyps are

commonly found in the colon, stomach, nose, urinary bladder and uterus. They

may also occur elsewhere in the body where mucous membranes exist like the

cervix and small intestine.

Cervical polyps are fingerlike growths that start on the surface of the

cervix or endocervical canal. These small, fragile growths hang from a stalk

and push through the cervical opening.

The cause of cervical polyps is not completely understood. They may be

associated with chronic inflammation, an abnormal response to increased levels

of estrogen, or clogged cervical blood vessels.

Cervical polyps are relatively common, especially in women over

age 20 who have had children. Only a single polyp is present in most

cases, but sometimes two or three are found. They are rare in females

who have not started menstruating.

Abnormal vaginal bleeding is one of the manifestation in this kind of

condition, especially after intercourse, douching, menopause, and even

abnormal heavy periods (menorrhagia), white or yellow mucous discharge

(leukorrhea)

A pelvic examination reveals smooth, red or purple, fingerlike projections from

the cervical canal. A cervical biopsy typically reveals mildly atypical cells and

signs of infection. Polyps can be removed during a simple, outpatient procedure.

Gentle twisting of a cervical polyp may remove it, but normally a polyp is taken

out by tying a surgical string around the base and cutting it off. Removal of the

polyp's base is done by electrocautery or with a laser.

Because many polyps are infected, an antibiotic may be given after the

removal, even if there are no or few signs of infection. Although most cervical

polyps are non-cancerous (benign), the removed tissue should be sent to a

laboratory for further examination. Typically, polyps are benign and easily

removed. Regrowth of polyps is uncommon.

II. HEALTH HISTORY

a. Profile of Patient

Patient’s Name:

Birth Date:

Birthplace:

Age: 39 years old

Sex: Female

Status: Married

Religion:

Nationality: Filipino

Address:

Allergy: None

Date of Admission: May 17, 2007

Time of Admission: 8:30 am

Chief Complaints: Vaginal bleeding on and off

Diagnosis: Dysfunctional Uterine Bleeding

III. DEVELOPMENTAL TASK

ERIK ERICKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT

VI. MEDICAL MANAGEMENT

DOCTOR’S ORDER RATIONALE

May 17, 2007

Admit to Gynecology:

> Temperature every 4 hours

> Soft diet, NPO

> Labs: CBC stat., U/A, FBS,

Hgb, Ultrasound, Chest X-ray,

ECG, Alkaline phosphate.

> Intake and Output every shift

> D5LR I L @ KVO

> Meds:

> 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.

> 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.

- ampicillin 1 IVT every 8° Anst

- famotidine 1 amp IVT every

12°

May 18, 2007

> for Evacuation and Curettage

and Polypectomy

>Meds:

>

>diazepam 5 grams IVT

> infuse 20 “u” oxytocin 1 IVF –

30

> methylosomets 1 amp DBP <

8°

> Abdominal massage

> Follow-up D5LR 1 L @ 30

gtts/min. oxytoxin 10 “u”

> Kills susceptible bacteria

> Decreases gastric acid levels and prevents

heartburn.

> for operation to remove cervical polyps.

>

> Relieves anxiety, muscle spasms and

seizures; promotes calmness and sleep.

Causes potent and selective stimulation of

uterine and mammary gland smooth muscle.

>

> To relax the abdomen.

> > 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

Implication

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

osmotic

instability.

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.

- Assess patient’s pain or temperature before and dring therapy.- Assess patient’s drug history.- Be alert for adverse reactions and drug interactions.

- Assess patient’s infection before therapy.- Ask patient about previous reactions to cephalosporin- Be alert for adverse reactions and drug

interactions.

VIII. DRUG STUDY

Name of

drug

Date

Ordered

Classification Dosage/

Frequency

Route

Mechanism of

Action

Specific

Indication

Contraindications Side Effects Nursing Implication

Tramadol May6,2007 Pharmacologic

class: opioid

agonist

Therapeutic

class:

analgesic

300 g IVTT

every 8

hours.

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

patients

hypersensitive 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 patient’s

pain before starting

the therapy.

- Monitor CV and

respiratory status.

- Monitor patient for

drug dependence.

Be alert for adverse

reaction.

Name of

drug

Date

Ordered

Classification Dosage/

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 in patients hypersensitive to drug or any of its components.Use cautiously in patients with impaired kidney function.

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 patient’s infection before therapy.- Ask patient about previous reactions to cephalosporin- Be alert for adverse reactions and drug interactions.

-Assess patient’s GI

condition before

starting therapy.

- Be alert for adverse

reactions of drug

interactions.

VII. LABORATORY RESULTS

DIAGNOSTIC TESTS

URINALYSIS

May 6, 2007

Specimen: Random Sample

Color: Yellow

Appearance: Hazy

Glucose: negative

Protein: negative

Reaction: 6.0 pH

Specific gravity: 1.030

Microscopic

WBC: 0-2

RBC: 0-3

Epithelial Cells: plenty

Pus Cells: 3-7 hpf

Mucus Threads: none seen

Urates: moderate

CHEMISTRY:

Alkaline 160 mg/dl

Creatinine G 0.6 u/l

Glucose- G 79 mg/dl

HEMATOLOGY

May 17, 2007

CBC

Total WBC 9.7

Hemoglobin 13.0

Hematocrit 37.7

MCV 81.4

MCH 26.8

Platelet Count 265

Differential Count

Lymphocytes 42

Segmenters 58

Basophils 13.5

HBsAg – non reactive

ULTRASOUND

Cervix 3.0 x 2.90 cm

Endometrium 0.77cm

Uterus 5.3 x 5.2 x 4.1 cm

Right ovary 2.3 x 1.50 cm

Left ovary 2.67 x 1.50 cm

CHEST X-RAY

Finding:

There is no evidence of active parenchyma infiltrates.

Heart is not enlarged.

Aorta, trachea, diaphragm and sinuses are unremarkable.

IV. ANATOMY AND PHYSIOLOGY

The cervix (from Latin "neck") is the lower, narrow portion of the uterus

where it joins with the top end of the vagina. It is cylindrical or conical in shape

and protrudes through the upper anterior vaginal wall. Approximately half its

length is visible with appropriate medical equipment; the remainder lies above

the vagina beyond view. It is occasionally called "cervix uteri", or "neck of the

uterus".

Ectocervix

The portion projecting into the vagina is referred to as the portio vaginalis

or ectocervix. On average, the ectocervix is 3 cm long and 2.5 cm wide. It has a

convex, elliptical surface and is divided into anterior and posterior lips.

External Os

The ectocervix's opening is called the external os. The size and shape of the

external os and the ectocervix varies widely with age, hormonal state, and

whether the woman has had a vaginal birth. In women who have not had a

vaginal birth the external os appears as a small, circular opening. In women who

have had a vaginal birth, the ectocervix appears bulkier and the external os

appears wider, more slit-like and gaping.

Endocervical canal

The passageway between the external os and the uterine cavity is referred to as

the endocervical canal. It varies widely in length and width, along with the cervix

overall. Flattened anterior to posterior, the endocervical canal measures 7 to 8

mm at its widest in reproductive-aged women.

Internal Os

The endocervical canal terminates at the internal os which is the opening of the

cervix inside the uterine cavity.

Cervical crypts

There are pockets in the lining of the cervix known as cervical crypts. They

function to produce cervical fluid.[1]

Histology

The epithelium of the cervix is nonkeratinized stratified squamous epithelium at

the ectocervix, and simple columnar epithelium at the cervix proper.[2][3] At certain

times of life, the columnar epithelium is replaced by metaplastic squamous

epithelium, and is then known as the transformation zone.

Nabothian cysts are often found in the cervix.

Functionality

During menstruation the cervix stretches open slightly to allow the endometrium

to be shed. This stretching is believed to be part of the cramping pain that many

women experience. Evidence for this is given by the fact that some women's

cramps subside or disappear after their first vaginal birth because the cervical

opening has widened.

During childbirth, contractions of the uterus will dilate the cervix up to 10 cm in

diameter to allow the child to pass through.

During orgasm, the cervix convulses and the external os dilates. Dr. R. Robin

Baker and Dr. Mark A. Bellis, both at the University of Manchester, first proposed

that this behavior worked in such a way as to draw any semen in the vagina into

the uterus, increasing the likelihood of conception. Later researchers, most

notably Elisabeth A. Lloyd, have questioned the logic of this theory and the

quality of the experimental data used to back it.

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 CRITERIA—CHILD 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;

presence of mechanical barriers; or

conditions such as lactose intolerance,

cystic fibrosis, diabetes, inflammatory bowel

diseases.

Determine child’s 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

RATIONALE

Provides opportunity for early

intervention.

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

child’s specific likes/dislikes may

normally consumed. Note types of snacks.

Discuss eating habits and food preferences

(likes and dislikes).

Determine psychological factors, cultural or

religious 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

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.

be helpful in meeting child’s

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 child’s

intake when appetite is poor.

Providing usual and typical

feedings is important to infant well-

being and early growth.

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

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

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).

may help them in making healthy

choices.

Timing of medication doses,

interaction with certain foods can

alter effect of medication or

digestion/absorption of nutrients.

May be necessary to improve

child’s intake and/or availability of

food to meet nutritional needs.

Corrects/controls underlying

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

Risk factors may include

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

Rapid/sustained loss, e.g., hemorrhage, burns, vomiting, diarrhea, fistulas

Rapid/excessive fluid replacement

Possibly evidenced by

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

diagnosis.]

DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD 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:

Verbalize understanding of child’s fluid needs.

Promote adequate age-appropriate fluid intake.

ACTIONS/INTERVENTIONS

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.

RATIONALE

Causative/contributing factors for

fluid imbalances.

Note child’s 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 child’s intake of fluids.

Determine child’s normal pattern of

elimination, and whether child is toilet

trained.

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.

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.

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.

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.

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)

Risk factors may include

Inadequate primary defenses (broken skin, traumatized tissue, altered

peristalsis)

Inadequate secondary defenses (immunosuppression)

Invasive procedures

Possibly evidenced by

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

diagnosis.]

DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT 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).

ACTIONS/INTERVENTIONS

Infection Control (NIC)

Independent

Assess vital signs frequently, noting

unresolved 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.

Perform/model good handwashing

technique. Monitor staff/patient

compliance.

Monitor/restrict visitors and staff as

appropriate. Provide protective

isolation if indicated.

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

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.

Collaborative

Obtain specimens/monitor results of

serial blood, urine,

wound cultures.

Administer amoebecides e.g.,

Metronidazole.

Identifies causative microorganisms

and helps in

assessing effectiveness of

antimicrobial regimen.

Therapy is directed at anaerobic

bacteria.

X. Actual Nursing Management (SOAPIE)

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 to Distension of intestinal tissues by inflammation

P At the end of 30 minutes of rendering nursing intervention the patient will 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 in semi-Fowler’s position. - Being informed about progress of situation provides emotional support, helping to decrease anxiety. Gravity localizes inflammatory exudate 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 patient was able to verbalized relief/ control of pain.

S SUBJECTIVE:

O - Facial grimace - Guarding - Restlessness

A Knowledge, deficient regarding condition, prognosis, treatment, self-care, and discharge needs related to Lack of exposure/recall; information misinterpretation

P At the end of 30 minutes of rendering nursing intervention the patient

will be able to verbalize understanding of disease process and potential complications.

I Identify symptoms requiring medical evaluation, e.g., increasing pain; edema/erythema of wound; presence of drainage, fever. - Prompt intervention reduces risk of serious complications, e.g., delayed wound healing, peritonitis.

Encourage progressive activities as tolerated with periodic rest periods. - Understanding promotes cooperation with therapeutic regimen, enhancing healing and recovery process.

Discuss care of incision, including dressing changes, bathing restrictions, and return to physician for suture/staple removal. - Understanding promotes cooperation with therapeutic regimen, enhancing healing and recovery process.

E At the end of 30 minutes of rendering nursing intervention the patient was able to verbalized understanding of disease process and potential complications.

S SUBJECTIVE: “

O Poor appetite when eating.

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

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

I Encouraged bed rest and limited activity.

- Decreasing metabolic needs aids in preventing caloric depletion and conserves 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 o symptoms.

E At the end of 1 hour, patient was able to demonstrate good appetite and already 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

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 patient’s 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.

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.Nurse’s Pocket Guide.F.ADavis Company:

Philadelphia.

www.yahoo.com

V. PATHOPHYSIOLOGY

Predisposing factors:

Age Gender Lifestyle

Precipitating factors:

Infections

Appendicitis

obstruction of the narrow appendiceal lumen.

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

gastroenteritis gastrointestinal 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