Father Saturnino Urios University Nursing Program Butuan City

An Individual Case Study of Acute Appendicitis, Ruptured with Generalized Peritonitis

Candy L. Tolo
Students Name

Mr. Florian D. Balan, R.N.

Supervising Clinical Instructor

INTRODUCTION

Appendix, as many people thought that it is just a useless organ in humans body, with no use and function at all. But Appendix actually plays significant role in our body, it really do. It has its own specialize function. God didnt made humans body without a reason, same thing with the appendix, it doesnt exist without a purpose. Appendix is a very small and narrowed structure with 8-10 cm long, common cause of abdominal surgery in children and even in adults. Being its small and narrowed structure, it makes it prone to inflammation and obstraction. Appendicitis is the inflammation of the appendix, obstruction by the fecalith, gallstone, or any foreign material or from spasm. By that, the appendix becomes edematous and inflamed. You can determine or manifests if you have appendicitis once signs occurs as follows: nausea and vomiting, general periumbical pain, mild pain from severe pain and localized pain in the lower right quadrant (LRQ) of the abdomen, rebound tenderness can help in determining. Once you have appendicitis, the common major complication of it is Peritonitis. Peritonitis is the inflammation of the peritoneum. Peritoneum is the delicate, smooth, transparent, serous membrane that lines the abdominal and pelvic cavities and is reflected over the organs contained in them. This usually caused when there is bacteria that envades in the peritoneum that can be considered as a foreign object in the said membrane. The indicative signs of peritonitis include rigid boardlike abdomen, hypotension, tachycardia, tachypnea. About 10% of the population will have appendicitis. Males are more affected than in Females. It occur at any age. One of the common surgery that done by the physician in patient with appendicitis is Appendectomy or the removal of the appendix.

DEFINITION OF TERMS
APPENDECTOMY

Surgical or removal of the appendix

APPENDICITIS

Inflammation of the appendix

FECALITH

Hardened mass of fecal material

HYPOXIA

Diminished amount of oxygen in the tissue

ISCHEMIA

Local temporary reduction of blood supply of an area due to obstruction in the blood vessels supplying the area due to vasoconstriction.
LAPAROTOMY

Surgical opening of the flank, opening in the abdominal wall.

LAVAGE

The irrigation or washing out of an organ such as the stomach or colon, or the instillation and withdrawal of a rinsing fluid from a body cavity such as peritoneal cavity.
NECROSIS

Death tissue or bone, may cause lack of normal circulation to a part, bacterial invasion.
PERITONITIS

Inflammation of the peritoneum, usually secondary to disease of one of the abdominal organs.
REBOUND TENDERNESS

A condition in which pain is felt when pressure over a part is released.

NURSING HEALTH HISTORY

Nursing Health History is a systematic collection of the data use to determine a patients functional health pattern status. It is a chronological guide to the different events that lead to the development of certain medical condition. The nurse collects physiologic, psychologic, sociocultural, developmental and spiritual patient data. These data assist the nurse in identifying nursing diagnoses and enables the nurse to come up with effective interventions for the successful management of the case of the patient. Thus, nursing health history is a vital aspect in rendering quality nursing care. Gathering data from my chosen patient through verbal interview, interactions, patients history, and hospital records started on June 27, 2010 July 2, 2010. In compliance with the principle of confidentiality and maintain the privacy and dignity. I therefore withhold the real name of my patient. Thus, I shall address him Patient Ordna. He is a 44-year old man, married to a 42-year old wife and a mother of 2 children and currently residing at Montilla Blvd. Cancer St.Butuan City. Patient Ordna was admitted last June 27, 2010 in Butuan Maternity Hospital, Medical-Surgical Ward. On December 9, 1965, around 10:00 am in the morning, Patient Ordna came to life through a Normal Spontaneous Vaginal Delivery in Cephalic presentation, attended by a mananabang in their house at Montilla Blvd. He didnt experienced any illnesses during his childhood. wala jud pud ko ka testing anang gatas na timpla-timpla, gi breastfeed raman gani k okay mas sustansyado daw as verbalized by the Pateint Ordna. sayo man daw ko nakalakaw atong bata paku,ambot nakalimot naku kung kanus-a to gi ingnan man pud ko sa akong nanay ato as verbalized by patient Ordna.

Father of patient Ordna doent had any diseases but his mother was known to be diabetic and hypertensive. Patient Ordna has 5 siblings. He is the 4th child. He has heath problems previously he admitted in MJ Santos hospital due to Ulcer. Until he was diagnosed to have Acute Appendicitis, ruptured with generalized Peritonitis. Pt. Ordnas childhood illness were only fever, coughs, and colds. And his mother treat those illnesses only with herbalmedicines. Since pt. Ordna is an employer in Post Office he wakes up 7 in the morning, since he have to prepare his self in going to his work. He differentiate his sleep pattern in their house and in the hospital. sa among balay makatarong ko ug tulog kaysa dinhe sa hospital as verbalized by pt. Ordna. makaihi man pud ko sa isa ka adlaw ug ka 4, tapus makalibang ko usahay ka 2 sa isa ka adlaw,depende sa akong mga gipang kaon. Pt. Ordna usually eats rice, noodles, eggs, vegetables,canned goods, and dried fish. Usahay karne ug baka kung maka sweldo as verbalized by him. Pt. Ordnas house was made of half wood and half concrete. With 3 bedrooms with kitchen and living room suit for their family number. Pt. Ordna is a committed husband and a father to his 2 children. He is a employer in Post Office. Based on Erik Eriksons stages of Psychosocial Development, the developmental task of Patient Ordna is to establish a sense of Generativity versus Stagnation which is experienced during middle adulthood aged 35-65 years old. He manifests the positive side of this stage. He is the bread winner in their family. He extend his concern from himself to his family. As a father, he developed self-confidence and able to juggle his life.

It was June 20,2010 in the afternoon when Patient Ordna first experienced pain in his abdomen. He experienced the pain for 1 week, onset on and off abdominal pain. He had self medicated with Buscopan 1 tab.he thought the the pain that he experienced will just disappear. But as days passed the pain is still present and become worse. June 27,2010 11:15 am Patient Ordna was admitted at the Emergency Room in Butuan Maternity Hospital. He was accompanied by his wife with chief complains of Abdominal Pain with scanty urination. He was seen and examined by Dr. L with orders as follows: please admit to ward of choice, secure consent to care, TPRBP q4,NPO,labs: ,U/A,S/E. D5LR was the first venoclysis in 1000 cc.meds: Tramadol 50 mg IV every 8 hours. On the same day was his schedule for his operation. Pre-op orders; NPO, and order to prepare the following for OR use: bupivacaine 0.5%,#2 D5NM 1L 400 cc level @ 3 gtts/min, #3 D5LR 1L FD, #4PNSS 1L @ 30 gtts/min. 12:55 pm was time started of the operation and ended 2:00pm on the same day. After the operation he was transferred in Post Anesthesia Care Unit and the findings was Color- Pink, Respiration- can breath deeply and cough, Circulation-BP within 20% of normal, Consciousnessawake, alert and oriented, Activity-moves all extremities.Metronidazole was being hooked for antibacterial OD IVTT. July 1, 2010 when I first interact with my patient. He was 1 day post AP and peritoneal lavage. He was lying on bed awake with D5LR 1L @ 800 cc level, regulated at 30 gtts/min, hooked at left basillic vein; infused well. Same day Soft Diet was being emphasized by Dr. L since he was post AP. Encouraged to ambulate. Demonstrated he proper going out in bed. Those interventions was continued all through out hospitalization.

July 2,2010, Dr. L was visited patient Ordna, and that time he complains of cough and he needs a meds that can help relieve the cough. By that new orders carried-out, meds: Ceterazine 10 mg 1 tab now OD, Ciprofloxacin 500 mg 1 tab TID, Metronidazole 500 mg 1 tab TID, Buscopan 1 tab. July 3,2010 seen and examined by Dr. L and ordered for MGH.IVF discontinue. July 4,2010 patient Ordna was discharged at 9 am with Final Diagnosis of Acute Appendicitis, Ruptured with Generalized Peritonitis.

PHYSICAL ASSESSMENT
Physical assessment is an essential part of the health history. It is a complete thorough cephalocaudal assessment that enables heathcare provider to identify nursing problems and prioritize them. This needs good and open communication approach both from the nurse and the patient. This field requires the use of four senses such as vision, earing, touch and sense of smell. Four basic techniques are used in performing physical assessment: inspection, palpation, percussion and auscultation. The assessment of Patient Ordna was conducted July 1,2010 in room Medical-Surgical Ward of Butuan Maternity Hospital. Equipment used during Physical thermometer,wristwatch with second hand, stethoscope, tape measure, notebook and pen. GENERAL ASSESSMENT Patient Ordna has proportionate body build. He wasnt able to take a bath during my first interaction with him. He was very weak. He has limited range of motion, slowed movement and needs assistance when moving. Because of pain felt even bearable guarding behavior and protective gestures were noted. Temperature of 36.9 degree celcius, pulse rate of 91 bpm, respiration rate of 22 cpm, and blood pressure of 120/80mmHg. SKIN,HAIR AND NAIL ASSESSMENT Patient Ordna has dark complexion. He has lighter red in color in his palms and soles. His skin was dry and cold to touch. His hair is black in color. Skin hair is finely distributed. The nail beds are smooth, hard and pink in color. Nails are long and dirt lodging inside. Assessment were sphygmomanometer,

NECK Neck color was the same with patients skin. Can look in left, right, up and down. No presence of lymph nodes. HEAD AND FACE Head is symmetrical, round and hard. Scalp is smooth and as lighter colored compared to patients skin. No presence of lesions and lumps were palpated. Face is symmetrical. EYES Patient Ordna can see in distance. Eyebrows were symmetrically aligned. Eyelashes were short, curled outward. Eyes blinked. Pupils are black in color, equal in size and rounded. NOSE Able to smell. Symmetrical, skin color was uniform with face. EARS Ears were equal in size and similar in appearance. Color is the same with the skin. MOUTH Lips were light pink, smooth with no lesions. Yellowish discoloration of teeth was noted and tooth decays are present in upper teeth. CHEST AND LUNGS Color is the same with the skin. Chest is symmetrical and had equal expansion. HEART Radial and pulse were the same.

BREAST AND AXILLAE No masses noted.

UPPER EXTREMITIES Both arms are symmetrical and without deformities..skin color is the same. No tenderness and no tremors on both extremities. ABDOMEN With dressing at the abdomen. Umbilicus was noted with dirt. INGUINAL AREA AND GENITALS Not applicable LOWER EXTREMITIES Skin color is the same. Both extremities have no bone deformities and both are equal. There were slowed in movements due to pain felt by the patient.

NURSING CARE PLAN LIST

NCP #

NURSING DIAGNOSIS

DATE IDENTIFIED

DATE EVALUATED

Acute Pain

July 1,2010

July 1,2010

Activity Intolerance

July 1,2010

July 1, 2010

Risk for Injury

July 2,2010

July 2,2010

Self-care Deficit

July 3,2010

July 3, 2010

Risk Infection

for July 3,2010

July 3,2010

NURSING CARE PLAN #1

Date Identified: July 1,2010 Date Evaluated: July 1,2010 S> sakit akong tahi,makaya-kaa pero naa man gihapon sakit O>guarding behavior >protective gestures >facial grimace >slowed movement >pain scale of 6 NURSING DIAGNOSIS>Acute Pain related to abdominal incision secondary to post appendectomy. PLANNING>Within 3 hours of nursing interventions the patient wilbe able to report reduction of pain from 6 to 2. IMPLEMENTATION> 1. Assess general condition. TO HAVE INFORMATIONS BEFORE DOING NURSING CARE. 2. Assess the location of the incision area. TO LIMIT FROM APPLYING SUCH ACTIVITIES TO THE PATIENT.

3. Obtain patients degree of pain every now and then. TO HAVE A BASELINE THE LEVEL OF CAE TO GIVE.AND EVELUATE THE PATIENTS RESPONSE TO PAIN. 4. Provide comfort measures. TO HASTEN THE PAIN FELT BY THE PATIENT.PHARMACOLOGICAL PAIN MANAGEMENT.

5. Encourage to verbalize occurrence of pan. TO EVEUATE THE RESPONSE OF PAIN. 6. Demonstrate the proper deep breathing exercise. FOR PROPER COPPING OF PAIN AND PROMOTE LUNG EXPANSION. 7. Advise to do diversional activities. TO REDUCE THE TENSION.

8. Encourage fluid intake. TO PROPER CIRCULATION OF FLUIDS. 9. Do guarding technique and protective gestures. TO PROTECT THE INCISION AREA.

10. Administer pin relief medication as ordered by the physician. PHARMACOLOGIC EFFECTS. EVALUATION>After 2 hours of nursing interventions, the patient was able to report reduction of pain. mga 2 or 3 dai as verbalized by patient.

NURSING CARE PLAN #2

Date Identified: July 1,2010 Date Evaluated: July 1,2010 S> lahi raman akong kakayahan sa una sa wala pa ko na operahan. Kaysa karon na naoperahan naku O>cannot carry heavy things >needs assistance when moving NURSING DIAGNOSIS>Activity Intolerance related to pain discomfort secondary to post appendectomy. PLANNING> Within 2 hours of nursing interventions, patient will be able to use identified techniques to enhance activity tolerance. IMPLEMENTATION> 1. Assess general condition. TO HAVE INFORMATIONS BEFORE DOING NURSING CARE. 2. Assess the location of the incision area. TO LIMIT FROM APPLYING SUCH ACTIVITIES TO THE PATIENT. 3. Increase fluid intake TO FACILITATE PROPER CIRCULATION OF THE BODY. 4. Practice deep breathing exercise. PROPER LUNG EXPANSION.

5. Encourage to express feelings. TO KNOW THE RESPONSE OF PATIENT. 6. Instruct to refrain from any strenous activity. NOT TO WORSEN THE CONDITION OF THE PATIENT.

7. Demonstrate 3 stages of going out in bed. 1. Sit on bed, 2. Sit on bed with legs dangling,3. Hold edge of bed. TO GRADUALLY AMBULATE BY THAT IT WILL NOT CREATE ANOTHER INJURY. 8. Advise to promote comfort measures. TO LESSEN THE PAIN FELT BY THE PATIENT.

9. Provide safety measures. TO PREVENT ANOTHER INJURY. 10. Advise to take rest periods. TO RELAX FEELINGS EVALUATION> After 1 hour of nursing intervention, patient able to acquire techniques in activity intolerance. maghinay man ko ug lihuk aron makaya as erbalized by patient.

NURSING CARE PLAN #3

Date Identified: July 2,2010 Date Evaluated: July 2,2010

S> malipong ko pag mo bangon taz kapuyan ko mo bangon O> needs assistance when moving >needs significant others in going to comfort room >prefer to lie on bed or to relax than moving out in bed >pauses when closing his eyes NURSING DAGNOSIS>Risk for injury related to altered mobility secondary to post appendectomy. PLANNING> Within 2 hours of nursing interventions, patient will verbalize understanding of individual factors ha contribute to possibility of injury. IMPLEMENTATION> 1. Assess general condition. TO HAVE INFORMATIONS BEFORE DOING NURSING CARE. 2. Assess the location of the incision area. TO LIMIT FROM APPLYING SUCH ACTIVITIES TO THE PATIENT.

3. Demonstrate 3 stages of going out in bed. 1. Sit on bed, 2. Sit on bed with legs dangling,3. Hold edge of bed. TO GRADUALLY AMBULATE BY THAT IT WILL NOT CREATE ANOTHER

4. Emphasize never to bend down all the way to the floor and stand quickly. NOT TO ABRUT THE CONDITION OF PATIENT. 5. Instruct to refrain from any strenous activity. THAT MAY RESULTS IN HOLDING BREATH AND BEARING DOWN. 6. Encourage fluid intake. TO PROPER CIRCULATION OF FLUIDS.

7. Demonstrate the proper deep breathing exercise. FOR PROPER COPPING OF PAIN AND PROMOTE LUNG EXPANSION. 8. Instruct to clear pathway going to bathroom or to any area Properly lighted.TO FACILITATE CLEAR WAY TO PROTECT PATIENT FROM ANOTHER INJURY.

9. Emphasize to lower down level of bed and wheels locked. FOR SIMPLE GOING OUT IN BED. 10. Instruct to put pillow on the side o the patient if theres no side rails.TO PROTECT FROM FALLS AND INJURY. EVALUATION>After 1 hour nursing interventions, patient will verbalized understanding of individual factors that contribute to possibility to injury ako man balansehon ako paglihuk, mag hinayhinay lang ko.

ANATOMY AND PHYSIOLOGY Anatomy and physiology are he two branches of science which provide the foundation for understanding the bodys parts and functions. Anatomy is the study of structure and the relationships among structures of the body. It was derived from the Greek word tomy means to cut and ana means part. Physiology on the other hand. Is the study of mechanical physical, and biochemical functions of the humans in good health, their organs and the cells of which they are composed. It was derived from the word physio means nature and ology means study of. Functions reflect structural organization, so does structure reflect functions. Anatomy has to do with the names and relationships of the structures of the body and physiology is how those structures work. One cannot have one without other.

FUNCTIONS OF DIGESTIVE SYSTEM AND ITS PARTS

The primary function of the digestive system is to break down the food we eat into smaller parts so the body can use them to build and nourish cells and provide energy. The digestive system is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. Inside this tube is a lining called the mucosa. In the mouth, stomach, and small intestine, the mucosa contains tiny glands that produce juices to help digest food.

Two solid organs, the liver and the pancreas, produce digestive juices that reach the intestine through small tubes. In addition, parts of other organ systems (for instance, nerves and blood vessels) play a major role in the digestive system. Mouth The mouth is the beginning of the digestive tract; and, in fact, digestion starts here when taking the first bite of food. Chewing breaks the food into pieces that are more easily digested, while saliva mixes with food to begin the process of breaking it down into a form your body can absorb and use. Esophagus Located in your throat near your trachea (windpipe), the esophagus receives food from your mouth when you swallow. By means of a series of muscular contractions called peristalsis, the esophagus delivers food to your stomach Stomach The stomach is a hollow organ, or "container," that holds food while it is being mixed with enzymes that continue the process of breaking down food into a usable form. Cells in the lining of the stomach secrete a strong acid and powerful enzymes that are responsible for the breakdown process. When the contents of the stomach are sufficiently processed, they are released into the small intestine. Smallintestine Made up of three segments the duodenum, jejunum, and ileum the small intestine is a 22-foot long muscular tube that breaks down food using enzymes released by the pancreas and bile from the liver. Peristalsis also is at work in this organ, moving food through and mixing it with digestive secretions from the pancreas and liver. The duodenum is largely responsible for the continuous breaking-down process, with the jejunum and ileum mainly responsible for absorption of nutrients into the bloodstream.

Contents of the small intestine start out semi-solid, and end in a liquid form after passing through the organ. Water, bile, enzymes, and mucous contribute to the change in consistency. Once the nutrients have been absorbed and the leftover-food residue liquid has passed through the small intestine, it then moves on to the large intestine, or colon. Pancreas The pancreas secretes digestive enzymes into the duodenum, the first segment of the small intestine. These enzymes break down protein, fats, and carbohydrates. The pancreas also makes insulin, secreting it directly into the bloodstream. Insulin is the chief hormone for metabolizing sugar. Liver The liver has multiple functions, but its main function within the digestive system is to process the nutrients absorbed from the small intestine. Bile from the liver secreted into the small intestine also plays an important role in digesting fat. In addition, the liver is the bodys chemical "factory." It takes the raw materials absorbed by the intestine and makes all the various chemicals the body needs to function. The liver also detoxifies potentially harmful chemicals. It breaks down and secretes many drugs. Gallbladder The gallbladder stores and concentrates bile, and then releases it into the duodenum to help absorb and digest fats. Colon (large intestine) The colon is a 6-foot long muscular tube that connects the small intestine to the rectum. The large intestine is made up of the cecum, the ascending (right) colon, the transverse (across) colon, the descending (left) colon, and the sigmoid colon, which connects to the rectum. The appendix is a small tube attached to the cecum. The large intestine is a highly specialized organ that is responsible for processing waste so that emptying the bowels is easy and convenient.

Stool, or waste left over from the digestive process, is passed through the colon by means of peristalsis, first in a liquid state and ultimately in a solid form. As stool passes through the colon, water is removed. Stool is stored in the sigmoid (S-shaped) colon until a "mass movement" empties it into the rectum once or twice a day. It normally takes about 36 hours for stool to get through the colon. The stool itself is mostly food debris and bacteria. These bacteria perform several useful functions, such as synthesizing various vitamins, processing waste products and food particles, and protecting against harmful bacteria. When the descending colon becomes full of stool, or feces, it empties its contents into the rectum to begin the process of elimination. Rectum The rectum (Latin for "straight") is an 8-inch chamber that connects the colon to the anus. It is the rectum's job to receive stool from the colon, to let the person know that there is stool to be evacuated, and to hold the stool until evacuation happens. When anything (gas or stool) comes into the rectum, sensors send a message to the brain. The brain then decides if the rectal contents can be released or not. If they can, the sphincters relax and the rectum contracts, disposing its contents. If the contents cannot be disposed, the sphincter contracts and the rectum accommodates so that the sensation temporarily goes away. Anus The anus is the last part of the digestive tract. It is a 2-inch long canal consisting of the pelvic floor muscles and the two anal sphincters (internal and external). The lining of the upper anus is specialized to detect rectal contents. It lets you know whether the contents are liquid, gas, or solid. The anus is surrounded by sphincter muscles that are important in allowing control of stool. The pelvic floor muscle creates an angle between the rectum and the anus that stops stool from coming out when it is not supposed to. The internal sphincter is always tight, except when stool enters the rectum. It keeps us continent when we are asleep or otherwise unaware of the presence of stool. When we get an urge to go

to the bathroom, we rely on our external sphincter to hold the stool until reaching a toilet, where it then relaxes to release the content

PATHOPHYSIOLOGY OF RUPTURED APPENDICITIS

LEGEND: - : patient do not manifest = : patient do manifest

Precipitating Factor

Predisposing Factor

(-)Age (-) Gender

Diet (=) (=) Lifestyle ( alcoholism, smoking)

Obstruction of the Appendicitis (by fecalith, lymph node, tumour, foreign objects)

Inflammation

Increase Intraluminal Pressure

Distention of the appendicitis

causes pain

Decrease Venous Drainage

Blood flow and oxygen restriction to the appendix

Bacterial Invasion of the Blood Wall

causes fever

Necrosis of the appendix

Ruptured Appendicitis

vague epigastrc/ periumbilical pain Progress in the rt. Lower Quadrant - rebound tenderness - Loss of appetite - fever - Nausea and vomiting - Pain when defecation and urination - pain in the lumbar ar

With medical interventions: Intervention

Without Medical

>Diagnostic tests such as: Abdominal X-ray ulceration - CT scan - Ultrasound - Laparoscopy - urinalysis -CBC >medications such as : - Tramadol, ceftriaxone, omeprazole, paracetamol, Ketorolac, clindamycin, avelox >Intermediate surgical intervention appendectomy Hemorrhagic green

With nursing intervention:

And green black gangrenous necrosis

-Vital checking -I&O monitoring -IV administration as prescribed Causes poisoning Ruptue of appendix

With surgical intervention: - appendectomy Peritonitis

-Exploratory Laparoomy Septicemia

Restoration of function Bad Prognosis

Good Prognosis Death

DRUG STUDY LIST

DRUG# Drug Name Classficati on Dosage Frequenc y Date First taken ROUT E

Tramadol

Narcotic 50mg Q6 hours and opioid x 4 doses analgesics Metronidaz Antibacteri 500mg TID ole al 1tab Cetrizine Antihistam ine Ciprofloxac Antibacteri in al Buscopan 10mg 1 OD tab 500mg 1tab TID OD

June2 IVTT 8,2010 July PO 1,2010 July PO 1,2010 July PO 1,2010 July PO 1,2010

3 4

Anticholin 1 tab ergic

DRUG #1 TRAMADOL Narcotic and Opiod Analgesics IVTT MECHANISM OF ACTION: Unknown. A 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. INDICATION: Moderate to moderately severe pain CONTRAINDICATION: Contraindicated in patients hypertensive to drug an I those with acute intoxication from alcohol, hypnotics, centrally acting analgesics, opiods , or psychotropic drugs. SIDE EFFECTS: Manifested: none Not manifested: constipation, nausea and vomiting,diarrhea,anorexia NURSING RESPONSIBILITIES: 1. 1O RIGHTS in giving meds 2. 3 CHECKS in giving meds 3. Monitor blood pressure for hypotension 4. Monitor Cardiac status 5. Monitor depression of respiratory and CNS 6. Monitor adequate urine output

DRUG #2 and #4 METRONIDAZOLE and CIPROFLOXACIN ANTIBACTERIAL/ANTIBICIDE/ANTIBIOTIC PO MECHANISM OF ACTION: Antibacterial, cell death INDICATION: Abdominal Surgery CONTRAINDICATION: Allergy Use cautiously patients with hypersensitive Hepatic Disease SIDEEFFECTS: Dry mouth Dizziness Fatigue Fever Chills NURSING CONSIDERATIONS: 1. Take druf with food 2. Do not drink alcohol 3. 1O RIGHTS in giving meds 4. 3 CHECKS in giving meds

DRUG #3 CETIRIZINE ANTIHISTAMINE PO MECHANISM OF ACTION: Histamine receptor antagonist inhibits histamine t release and esinophil chemotaxis during inflammation leading to reduce swelling response. CONTRAINDICATIONS: Allergy Peptic Ulcer Asthmatic Attack SIDE EFFECTS: Palpitation, edema, dizziness, nausea and vomiting,diarrhea,abdominal pain,constipation, dry mouth,phayngitis, INDICATION: To post operative patient NURSING CONSIDERATIONS: 1O RIGHTS in giving meds 3 CHECKS in giving meds Monitor blood pressure for hypotension Monitor Cardiac status Monitor depression of respiratory and CNS Monitor adequate urine output

LABORATORY EXAMINATION NUMBER 1 WBC RESULT : 11.16X1O.9/L RANGE REFERCENCE: 5-10X10.9/L INTEPRETATION: INCREASED RBC RESULT : 5.23x10.12/L RANGE REFERCENCE: 3.5-5.6X10.12/L INTEPRETATION: NORMAL HGB RESULT : 14.0G/L RANGE REFERCENCE: 125-75G/L INTEPRETATION: NORMAL HCT RESULT : 0.42% RANGE REFERCENCE: 0.36-0.48 INTEPRETATION: NORMAL PLATELET RESULT : 210X10.9/L RANGE REFERCENCE: 150-400/L INTEPRETATION: NORMAL NEUTROPHILS RESULT : 0.60 RANGE REFERCENCE: 0.50-0.70 INTEPRETATION: NORMAL

URINALYSIS TEST COLOR RESULT: YELLOW REFERENCE RANGE: YELLOW O DEEP AMBER INTERPRETATION: NORMAL

TRANSPARENCY: HAZY REFERENCE RANGE: HAZY INTERPREATION: NORMAL PH RESULT: 6.0 REFERENCE RANGE: 4.6-8 INTERPRETATION: NORMAL

SPECIFIC GRAVITY: 1.010-1.025 INTERPRETATION: NORMAL

ALBUMIN: RESULT +2 INTERPRETATION: ABNORMAL SUGAR: NEGATIVE INTERPRETATION: NORMAL

DISCHARGE PLAN This is the process of moving the patient from one level of care to another. The process should start on admission of the patient by assessing the patients needs and identify resources available. The process should incorporate the multidisciplinary approach and involve all the appropriate health team professionals and offer wholistic patient care. M> No take home medications prescribed by the physician. E> Advise patient to stay in a well ventilated environment to aid in recovery Remind patient as well as the significant others to provide a safety measures. Encourage patient to have a clean environment T> Instructed to return for follow-up check-ups to the nearest Hospital, and watch for infection occurrence. H> Advise to practice proper hygiene especially handwashing before touching the operative area. Instruct to have rest periods not to abrupt in heavy task Encourage to do deep breathing exercise if pain is present Instruct to ambulate, exercise slowly

O> Instruct to note every alterations or signs and symptoms of infection. PAIN,SWELLING,REDNESS,PUS OR ANY DISCHARGES ETC. D> Encourage to have high protein to promote healing of the operative area Advise to increase fluid intake Advise not to drink alcohol,heavy meals, coffee and teas to disturb of sleep.