I.

INTRODUCTION
A. Overview of the Study
The appendix is a small, finger-like appendage about 10cm (4in) long that is
attached to the cecum just below the ileocecal valve. The appendix fills with foods and
empties regularly into the cecum. Because it empties insufficiently and its lumen is small,
the appendix is prone to obstruction and is particularly vulnerable to infection.

Appendicitis is inflammation of the appendix. the small worm-like projection from the first
part of the colon. Appendicitis usually involves infection of the appendix by bacteria that
invade it and infect the wall of the appendix. Appendicitis can progress to produce an
abscess (a pocket of pus) and even peritonitis (inflammation of the lining of the abdomen
and pelvis). 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).

Appendicitis is the most common reason for emergency abdominal surgery.

Approximately, 7 percent of the population will have appendicitis at some time in their lives;
males are more affected than females and teenagers more than adults. Although it can
occur in any age, it occurs more frequently between the ages 10-30 years.

1
 A. Objective of the Study
This study aims to gather and understand the information regarding the
patient’s condition, to provide appropriate nursing care management who undergone
appendectomy and to be able to gain knowledge about the disease process of acute
appendicitis.

B. Scope and Limitation of the Study

The paper is a case study of Mr. A 33 years-old, who was admitted at Davao
Medical Center, Davao City with a diagnosis of acute appendicitis.
The study further covers the profile of the patient and its illness which was
gathered through chart reading and annotations. It will also cover as its subject’s to the
patient’s present illness which is acute appendicitis.
Furthermore, the study was conducted at the said hospital with a limited time
of 8 hours only. Therefore, the information gathered by the interviewer were limited only
to the span of time spend with the client.

2
II. Health History

Patient's Profile

Name : Mr. A
Birth date : 12-16-75
Birth place : Davao del Sur
Age: 33 years old
Sex : Male
Status : Married
Religion : Roman Catholic
Address: : Sta. Rosa, Mambago, Island
Garden City of Samal
Occupation : Inspector
Name of Mother : Mrs. N
Name of Spouse : Mrs. J
Diagnosis : T/C Acute Appendicitis
Operation Diagnosis : Supporative Appendicitis
Time of Operation : STAT
Operation Started : 11:20 pm
Operation Finished : 11:45 pm
Anesthesia : Sub-arachnoid block
Time begun : 11:05 pm
Physician : Dr. Josil R. Cruz
Surgeon: Dr. Cosep
Anesthesiologist : Dr. Laforteza
Instrument Nurse : Ms. Donnah Lourdes Abangan

Sponge Nurse : Ms. Jenny Lyn Pegalan

Circulating Nurse : Joseph Aguilar
Ma. Kristina Mangao
Case number : 2009010362

3
Hospital number : 2030235
Hospital : Davao Medical Center
Current behavior : LOC
Temp : 37 degrees Celsius
Pulse : 72 beats per minute
Resp : 20 cycle per minute
BP : 130/80 mm Hg

History of Present illness

5 days prior to admission, patient had onset of RLQ pain radiating to the
hypogastric region. Had associated nausea and vomiting (-) anorexia persistent
prompted consult was referred to this institution.

III. DEVELOPMENTAL DATA

Erik Erikson’s Theory of Psychosocial Development

An American psychoanalyst, Erik Erikson, proposed a related series of psychosocial

stages of personality growth that strongly stresses the importance of culture and society
in the development of the personality. Erikson describes eight developmental stages
covering the entire life span. At each stage, there is a conflict between the two opposing
forces. Erikson’s theory thus emphasizes the interaction of internal psychological growth
and the support of the social world. Psychoanalytic theories offer a rich portrayal of
personality growth that emphasizes the complex emotional and sometimes the irrational
forces within each person.

Our client belongs to the 7th stage of Erikson’s developmental theory of middle
adulthood, generativity versus stagnation (25 - 65 years old). In this stage, people
extend their concern from themselves and their families to the community and the world.
They may become politically active, work to solve environmental problems, or
participate in far-reaching community or world-based decision.

4
 People with a sense of generativity are self-confident and are better able to juggle
their various lives. People without this sense become stagnated or self-absorbed. Those
who have devoted themselves to only one role are more likely to find themselves at the
end of middle age with a narrow perspective and lack of ability to cope with change.

JEAN PIAGET’S STAGES OF COGNITIVE DEVELOPMENT

Cognitive development refers to the manner in which people learn to think reason
and use language. It involves a person’s intelligence, perceptual ability, and ability to
process information. According to Piaget, cognitive development is an orderly
sequential process in which a variety of new experiences must exist before intellectual
abilities can develop.

It is divided into five major phases: Sensorimotor Phase, Preconceptual Phase,

Intuitive Phase, Concrete Operational Phase and the Formal Operational Phase.

ROBERT HAVIGURST’S DEVELOPMENTAL TASK THEORY

Robert Havigurst believed that learning is basic through life and that people
continue to learn throughout life. He described the growth and development as
occurring during six stages, each associated with 6 to 10 tasks to be learned.
A developmental task is a “task which arises at about a certain period in the life
of an individual, successful achievement of which leads to his happiness and to success
with later tasks, while failure leads to unhappiness in the individual, disapproval by
society, and difficulty with the later tasks”.
The patient belongs to the Middle Age.

Middle age:

1. Achieving adult civic and social responsibility

5
2. Establishing and maintaining an economic standard of living
3. Assisting teenage children to become responsible and happy adults
4. Developing adult leisure-time activities
5. Relating oneself to one’s spouse as a person\
6. Accepting and adjusting to the physiologic changes of middle age
7. Adjusting to aging parents

IV. ANATOMY AND PHYSIOLOGY

NORMAL APPENDIX

INFLAMMED APPENDIX

6
 The appendix is a small, fingerlike or a worm like tube located where the
large and small intestines join, it has no known function in humans. The
anatomical name for the appendix is Vermiform Appendix, which means
worm-like appendage. Inflammation of the appendix called Appendicitis
usually requires immediate medical attention. The surgical procedure of
removal of the appendix is called Appendectomy.

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 6 to 7 mm.

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 human, this has become what is called as a vestigial organ
(an organ that is no more required).

The appendix once appeared to have no function in the human body. There have been no reports of
impaired immune or gastrointestinal function in people without an appendix.

V. PATHOPHYSIOLOGY OF APPENDICITIS

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.
After the blockage occurs, bacteria which normally are found within the appendix 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, for example, inflammation, that line the
wall of the appendix.

7
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 cancer.

8
 PATHOPHYSIOLOGY

Acute appendicitis – A severe and rapidly developing attack of appendicitis,

characterized by abdominal pain and tenderness usually in the right lower quadrant.

Predisposing factors: Precipitating factors:

1. Ages in 10 to 30 years 1. Lifestyles (Food

2. Viral, Bacterial and Fungal infections

Obstruction of the appendix lumen by faecolith, enlarged lymph node, worms, tumour,
or indeed foreign objects.

Increased intra-luminal pressure

Occlusion of the lymphatic channels, then the venous return

Arterial supply becomes undermined

Reduced blood supply to the wall of the appendix

Appendix wall break up and rot

Necrosis and perforation of the appendix.

Pus formation

The content of the appendix (faecolith, pus and mucus secretions) are then released
into the general abdominal cavity
Legend:
Peritonitis
- Pathology
Bacterial colonization
- Clinical Manifestations
Acute appendicitis

Abdominal fever Nausea and

pain
9 in the vomiting
RLQ
PATHOPHYSIOLOGY OF APPENDECTOMY

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. The surgeon
enters the abdomen and looks for the appendix which usually is in the right lower
abdomen. After examining the area around the appendix to be certain that no additional
problem is present, the appendix is removed. This is done by feeing 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 the abscess is present, the pus can be
drained with drains that pass from the abscess and through the skin. The abdominal
incision is then closed.

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). If appendicitis is found, the appendix can be removed with special
instruments that can be passed into the abdomen, just like the laparoscope, through
small puncture wounds. The benefits of the laparoscopic technique include less post-
operative pain (since much of the post-surgery pain comes from incisions) and a
speedier return to normal activities. An additional advantage of laparoscopy is that it

10
allows the surgeon to look inside the abdomen to make a clear diagnosis in cases in
which the diagnosis of appendicitis is in doubt.

If the appendix is not ruptured (perforated) at the time of surgery, the patient generally is
sent home from the hospital after surgery in one or two days. Patients whose appendix
has perforated are sicker than patients without perforation, and their hospital stay often
is prolonged (four to seven days), particularly if peritonitis has occurred. Intravenous
antibiotics are given in the hospital to fight infection and assist in resolving any abscess.

Occasionally, the surgeon may find a normal-appearing appendix and no other cause
for the patient's problem. In this situation, the surgeon may remove the appendix. The
reasoning in these cases is that it is better to remove a normal-appearing appendix than
to miss and not treat appropriately an early or mild case of appendicitis.

11
 VI. Medical Management
DATE ORDERED MEDICAL ORDERS
February 2,2009 Please admit patient under GSII
7:20pm
NPO
- to decrease intestinal fluid losses.
- to prepare patient for surgery.
Labs:
•CBC
- to check for abnormalities.
- The white blood cell count in the blood usually becomes
elevated with infection. In early appendicitis, before infection
sets in, it can be normal, but most often there is at least a mild
elevation even early. Unfortunately, appendicitis is not the only
condition that causes elevated white blood cell counts. Almost
any infection or inflammation can cause this count to be
abnormally high. Therefore, an elevated white blood cell count
alone cannot be used as a sign of appendicitis.

•UA

- to check for abnormalities.

- Urinalysis is a microscopic examination of the urine that

detects red blood cells, white blood cells and bacteria in the
urine. Urinalysis usually is abnormal when there is
inflammation or stones in the kidneys or bladder. The
urinalysis also may be abnormal with appendicitis because the
appendix lies near the ureter and bladder. If the inflammation
of appendicitis is great enough, it can spread to the ureter and
bladder leading to an abnormal urinalysis. Most patients with
appendicitis, however, have a normal urinalysis.
Meds:
• Cefoxitin 1g IVTT q 8h

- for serious infections of the abdomen caused by

12
 staphylococcus aureus.

- a second-generation cephalosporin that inhibits cell-wall

synthesis, promoting osmotic instability; usually bactericidal.

• Ranitidine 50mg IVTT q 8h

- completely inhibits action of histamine on the H2 receptor

sites of parietal cells, decreasing gastric acid secretion.

Start venoclysis PLR 1L to run @ 120 cc/hr

Please schedule for STAT AP
- is performed as soon as possible to decrease the risk of
perforation.
- to correct or prevent fluid and electrolyte imbalance and
dehydration.
- surgical removal of appendix.
February 2, 2009 Please secure consent
8:40pm - right to self-determination or autonomy. Autonomy is the
right to choose and follow one’s own plan of life.
Inform OR/EROD
AP Prep
- to prepare for the operation.
Additional Meds:
• Ampicillin + Sulbactam 1.5g IVTT ran then q 8h

- aminopenicillin that inhibits sell-wall synthesis during microorganism

multiplication.

• May give cemeprazole IVTT ran --- of ranitidine 40mg

ANESTHESIOLOGIST POST-OP ORDERS
February 2,2009 S/P Appendectomy under SAB
11:35pm - a state of sensation in the lower part of the body produced
by injection of a local anesthetic drug into the subarachnoid
fluid space.
13
To PACU until stable then to surgery cast
NPO temporarily
- the digestive system as well as the lungs are not yet ready
for food intake because of the effects of anesthesia.
VS q 15mins. x 1hr, then q hourly until stable, then q 4 hours
thereafter.
- to monitor vital signs.
IVFTF w/ D5LR 1L to run @ 120 cc/hr
Medications:
• Tramadol 25mg slow IVTT q 8h x 3 doses then PRN for
severe pain

- for moderate to moderately severe pain.

- Unknown. Centrally acting synthetic analgesic compound not

chemically related to opiates. Drug is thought to bind to opioid receptors
and inhibit reuptake of norepinephrine and serotonin.

• Ketorolac 30mg IVTT q 6h x 4 doses then shift to celecoxib 200mg

amp 1 cap BID.

- for short-term management of moderately severe pain, acute pain for

single dose treatment.

- (ketorolac) Unknown. Produces anti-inflammatory, analgesic and

antipyretic effects possibly by inhibiting prostaglandin synthesis.

- (celecoxib) thought to inhibit prostaglandin synthesis, primarily via

inhibition of cyclooxygenase-2 (COX-2), thereby producing anti-
inflammatory, analgesic, antipyretic effects.

• Ranitidine 50mg q 8h IVTT while on NPO

- completely inhibits action of histamine on the H2 receptor

sites of parietal cells, decreasing gastric acid secretion.

14
 • Continue Ampi and Sulbactam 750mg IVTT q 8h

- for gastrointestinal infections.

- aminopenicillin that inhibits sell-wall synthesis during microorganism

multiplication.

• Start Metronidazole 500mg IVTT q 8h

- to prevent postoperative infections.

- unknown. May cause bactericidal effect by interacting with bacterial

DNA. It’s active against many anaerobic gram negative bacilli and
anaerobic gram-positive cocci.

O2 inhalation via face mask @ 4-6 LD

- to provide oxygen.
Keep warm and thermoregulated
IVF regulated.
Refer accordingly

 Patient discharge to PACU

 Sensory Status: Awake Skin Condition: Pale, Cool Transported with: IVF
D5LRiL
 Post-op Diagnosis: Supporative Appendectomy

15
 Drug Sudy

Name
of Date Classificatio Dose/Frequen Mechanis Specific Contra- Side Nursing
Drug ordere n cy/ route m of action Indication indication Effects Precaution
(Brand d s
Name)
Cefoxiti 2-02- Cephalospori 1g IVTT q 8h A second A serious Contraindicat CV- Use
n 09 ns generation infection GU ed to patients hypotensi cautiously in
cephalospo tract; blood hypersensitiv on patient
rin that stream and e to drug or GI- hypersensiti
inhibits cell- inttra other nausea ve to
wall abdominal cephalospori and penicillin
synthesis, infection n. vomiting, because of
promoting caused by diarrhea possibility of
osmotic susceptible GU- acute cross-
instability; organism renal sensitivity
usually such as failure with other
bactericidal staphylococc Hema- beta-lactam
us aureus, hemolytic antibiotics.
E. Coli, anemia,
Klebsiella. RESPI-
Pre- dysmnea
operative Skin-
prophylaxis. sterile
abscesse
s

16
Name of
Drug Date Classificati Dose/Frequenc Mechanis Specific Contra- Side Nursing
(Brand ordere on y/ route m of action Indicatio indication Effects Precaution
Name) d n s
Ranitidin 2-02- Anti-ulcer 50mg IVTT q 8h Competitive Duodena Contraindicat ENT- Use
e 09 drugs ly inhibit l and ed to patient blurred cautiously
action of gastric hypersensitiv vision in patient
histamine ulcer e to drug and Hepatic- with
on the H2 those with jaundice hepatic
ate acute Other- dysfunction
receptors porphyria. burning . Adjust
ciites of and dosage in
parital cells, etching at patients
decreasing injection with
gastric acid site, impaired
secretion. anaphylaxi renal
s, function.
angioedem
a

17
 Name
of Drug Date Classificati Dose/Frequen Mechanism Specific Contra- Side Nursing
(Brand ordere on cy/ route of action Indicatio indication Effects Precautio
Name) d n ns
Tramad 2-02- Narcotic and 25mg slow Unkown. Moderate Contraindicat CNS- monitor CV
ol 09 opioid IVTT q 8h x 3 Ecentrally to ed in patients headache, and
analgesic doses then acting moderate hypersensitiv nervousnes respiraroty
PRN synthetic ly severe e to drug and s, seizures status.
analgesic pain in those with CV- Withhold
compound acute vasodilatio those and
not intoxication n, notify
chemically from alcohol, EENT- prescriber
related to hypnotics, visual if
opiates. centrally disturbance respiration
Drug is acting s or rate is
thought to analgesics, GI- below 12
bind to opioids, or abdominal bpm.
opioid psychotropic pain, Monitor
receptors drugs. anorexia bowel and
and inhibit flatulence bladder
reuptake of GU- urine function.
norepinephri retention, Anticipate
ne and urinary need for
serotonin frequency, laxative.
proteinuria
Respi-
respiratory
depression
Skin-
pruritus
diaphoresis
, rash

18
 Name
of Date Classificati Dose/Freque Mechanis Specific Contra- Side Effects Nursing
Drug order on ncy/ route m of Indication indication Precaution
(Brand ed action s
Name)
Ketorol 2-02- Nonsteroid 30mg IVTT q Unknown. Short-term Hypersensiti CNS- sedation, Carefully
ac 09 al anti 6h x 4 doses Produces managem vity to drugs dizziness, observe
inflammator then shift to anti ent of and in those headache patient with
y drugs celecoxib inflammato moderatel with active CV- edema, coagulophat
200mg amp 1 ry, y severe, peptic ulcer hypertension, ies and
cap BID analgesic, acute pain disease, arrhythmias those taking
anti pyretic for single- recent GI GI- GI pain anti
effects, dose bleeding or diarrhea, peptic coagulants.
possibly treatment perforation, ulceration Ketorolac
by advanced Hema- inhibits
inhibiting renal decreased platelets
prostaglan impairment, platelet aggravation
din risk for adhesion,prolon and can
synthesis rena.l ged bleeding prolong
impairment time bleeding
from volume Skin- rash, time. This
depletion, diaphoresis effect will
suspected or Other- pain at disappear
confirmed injection site within 48
CV bleeding, hour or
hemorrhagic discontinuin
diathesis, g drug.
incomplete
hemostasis,
or high risk
of bleeding

19
 Name
of Drug Date Classificatio Dose/Frequenc Mechanism Specific Contra- Side Nursing
(Brand ordere n y/ route of action Indicatio indication Effects Precautions
Name) d n
celecoxi 2-02-09 Nonsteriodal 200mg amp 1 Thought to pain Hypersensitivit Abdomina History of GI
b anti cap BID inhibit y including l pain, bleeding;
inflammatory prostaglandin those in whom diarrhea, renal/hepatic
dugs synthesis, attacks of nausea, insufficiency;
primarily via angioedema, oedema, asthma or
inhibition of rhinitis and dizziness, allergic
cyclooxygenas urticaria have headache, disorders;
e-2 (COX-2), been insomnia, hypertension;
thereby precipitated by upper monitor
producing anti- aspirin, respirator haemoglobin
inflammatory, NSAIDs or y tract or haematocrit
analgesic and sulfonamides. infections; levels for
anti pyretic Severe hepatic rash. signs of
effects impairment; Potentiall anaemia.
severe heart y Fatal: History of
failure; Serious cerebrovascul
inflammatory skin ar disease or
bowel disease; reactions ischaemic
peptic ulcer; such as heart disease.
renal exfoliative
impairment dermatitis,
(CrCl <30 Stevens-
ml/min); Johnson
pregnancy and syndrome,
lactation. and toxic
epidermal
necrolysis.

20
 Name of
Drug Date Classification Dose/Frequency Mechanism Specific Contra- Side Nursing
(Brand ordered / route of action Indication indication Effects Precautions
Name)
Metronidazole 2-02-09 Anti protozoal 500mg IVTT q 8h A direct-acting Prevention Hypersensitive CNS- Use
trichomonacide of post to drug or headache, cautiously in
and amebecide operative other weakness, patients with
that works at infection in nitroimidazole dizziness blood
CV-
both intestinal contaminated derivatives dyscrasia or
flattened
and extra or potentially CNS disorder
T wave,
intestinal sites. contaminated edema and in those
It’s thought to surgery GI- retinal or
enter the cells abdominal visual field
of micro cramping changes. Also
organism that or pain, in patients
contain epigastric with hepatic
nitroreductase. distress disease or
Unstable GU- alcoholism
compounds are darkened and in those
urine,
then formed who take
polyuria,
that bind to hepatotoxic
dysuria
DNA and Hema- drugs.
inhibit transient
synthesis leucopeni
causing cell a
death. Respi-
URTI
Skin-rash
Other-
fever,
decrease
libido

21
VII. Nursing Management
IDEAL NURSING CARE PLAN
NURSING DIAGNOSIS: Impaired skin integrity related to surgical incision secondary
to appendectomy as evidence by presence of dressing located at the center of the
abdomen.
GOAL: To maintain skin integrity and to avoid potential associated risks.
EXPECTED OUTCOMES: wound has able to heal, and maintained the absence of
microorganisms.

INTERVENTION RATIONALE
1. Emphasize principles of 1. for aseptic technique in
asepsis, especially hand cleaning the wound and to avoid
washing and proper methods infections-presence of
of handling used dressing. microorganisms.
2.Discuss the relationship 2. Maintaining intact skin
between adequate nutrition
(especially fluids, protein,
vitamin B and C, iron and
calories) and healthy skin
3. Provide adequate bed rest 3. To gain energy and to
promote wound healing.
4. Establish a turning or 4. To promote wound healing,
repositioning schedule client must be positioned to keep
pressure to the wound.
5. Provide antibiotics as 5. For antibactiricidal
prescribed

22
NURSING DIAGNOSIS: Risk of constipation, related to effects of medication
GOAL: Maintain or restore normal bowel elimination pattern.
EXPECTED OUTCOMES: After 1 day of interventions patient has able to defecate with
normal amount of stool.

INTERVENTION
1. Increase fluid intake; 2000 to
300ml a day, hot water and fruit
juice are also recommended:
2. Increase fiber intake
(e.g vegetables, raw foods bran
products and whole grains
cereals and bread)
3. Avoid carbonated beverages,
chewing gum and gas forming
foods.
4. Privacy during defecation
5. Provide laxative as prescribed
RATIONALE
1. For additional re-absorption of
fluid from the large.
2. Necessary to provide fecal
volume.
3. This beverages can increase
the ingestion of air causes to
absence of stool, constipation
4. It is extremely important to
many people so that patients
can defecate
5. To soften the feces.

NURSING DIAGNOSIS: Risk of activity tolerance related to generalized weakness

secondary to surgery as evidenced by incision located at the center of abdomen.
GOAL: Promote self care after discharge

23
EXPECTED OUTCOMES: Patient has able to move freely with moderate activities in daily
living.

INTERVENTION RATIONALE
1. Provide bed rest. 1. To provide rest and gain
energy.
2. Helps the patient move 2. For step-by-step out of the
S “Agay! sakit akong
gradually from the lying position bed,tiyan” as verbalized by
for post-operative the patient.
patients
to the sitting position by raising recovery
the head O of the bed Facial and grimaced, guarding of incision site
encourages the patient to splint
the incision when applicable
3. Instruct out patient notAcute
to pain related toconserve
3. To surgical incision
energy.secondary to appendectomy
A
overexert herself in doingasdaily
evidence by presence of dressing located at the center of the
activities. abdomen.
4. Helps patient to stand on her 4. To assist the postoperative
Short term: At the end of 30 minutes nursing intervention, patients
bed P patient in getting out of bed for
pain/discomfort will be lessen
the first time after surgery.
Independent:
5. Provide emotional support to 5.Acknowledge.concerns,
1. Monitored vital signs
the patient and family encouraging their participations.
To assess further complication, to monitor patient’s status
2. Assess the patient’s incision site
To prevent infection
3. Provided comfortable environment
I
To alleviate patient’s pain
4. Report patient’s verbatim of pain to the nurse on duty
To let the nurse give proper intervention to the patient
5. Instructed patient to move lower extremities
To assess the effect of the anesthesia

At the end of 30 minutes nursing intervention, patient’s pain/discomfort

E
was reduced

24
Actual Nursing Intervention

25
VIII. REFERRAL AND FOLLOW-UP

The importance of follow-up treatment is stressed out to the patient and family because
of changing physical status. Referral for home care provides the home care nurse with the
opportunity to assess the patient’s environment, emotional status and the coping strategies
used by the patient and family roles often associated by an illness.

Assess patient for further complication such as presence of pus in the incision area,
wet, redness and itchy wound, signs and symptoms of complication of medication strategies.
If any of this may appear patient educate to go in nearest Health center for further actions.

26
IX. HEALTH TEACHINGS

MEDICATION Following medications were prescribed.

▪Antibiotics
▪Vitamin C
The patient should follow the medicine for her prescribed by her
physician.

Patient was encouraged to do the following exercises if not

EXERCISE
contra-indicated:
▪Moderate activities,
▪Slow motions (walking, sitting and lying after 1 day of post
operative)
▪Deep breathing to prevent pain

TREATMENT ▪Wound dressing daily (kept dry and intact)

▪Vitamin C rich foods increased for best healing process
▪Increased fluid intake to avoid constipation because of
medications adverse effects.
Health teachings were given to the patient regarding the
importance and the proper compliance of medications. Patient
was also encouraged to report the effect of treatment strategies.

▪Once at home, care should be taken that the wound is completely

dry and clean.
OUT PATIENT
▪Be back on the day requested for dressing
▪Medication compliance
▪Go to the clinic near to the house for monitoring purposes

27
 ▪Patient was encouraged to increase fluid intake, eat foods rich in
DIET Vitamin C, and DAT-diet as tolerated.

X. BIBLIOGRAPHY

A. Books
Cuevac, Frances et. al., Public Health Nursing in the Philippines. 10th edition, National

League of Philippines Government Nurses, Inc. pp. 118-309

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