‫َّللا َوبَ َر َكتاُُ ُُ‬ ‫ُ‬

‫علَ ْي ُك ْم َو َر ْح َمة َّ ِ‬
‫سالَ ُم َ‬
‫ال َّ‬
 A. DEFINITION

Appendicitis is inflammation of the vermivormis

appendix, and is the most frequent cause of acute
abdomen. This disease can affect all ages, both men and
women, but more often attacks men aged between 10 and
30 years (Mansjoer, Arief, et al., 2007).
 B. CLASSIFICATION

1. Acute appendicitis
2. Purulenta Appendicitis (Supurative Appendicitis)
3. Chronic appendicitis
4. Recurrent appendicitis
 C. ETIOLOGY

The cause of appendicitis is definitely unknown. However,

the occurrence of appendicitis is generally due to bacteria.
In addition, there are many precipitating factors in the
occurrence of this disease including blockage of the
appendix lumen, lymph tissue hyperplasia, fecalite,
appendix and ascaris worm tumors which can cause
blockages.
 D. ANATOMICAL PHYSIOLOGY

The appendix in latind language is referred to as

Appendixvermiformis. The appendix is located at the end of
the sacrum approximately 2 cm below the anterior ileosaekum,
empties into the posterior and medial part of the saekum. In the
third meeting, the taenia is: taenia anterior, medial and
posterior. Clinically the appendix is located in the Mc area.
Burney is an area of 1/3 of the center of the line that connects
the box with the center. The position of the appendix is in
Laterocecal which is lateral to the ascending colon.
E. PATHOPHYSIOLOGY
Infections due to bacteria, viruses,
fungi, petrified stools, living patterns,
foreign matter.

Appendicitis

Inflammation

Edema

Infection
Increased bacterial Appendicitis (lower Intestinal
intestinal flora right of the abdominal obstruction
cavity)

Constipation Secondary abscess

Stimulate nerve
receptors
1. Pelvis

Pain 2. Diaphragm
3. Hepar

Leukocyte Count Increases

Hypertermia
•CLINICAL MANIFESTATION

Lower quadrant pain is felt and is usually accompanied by mild

fever, nausea,vomitingand loss of appetite.

Pain presses locally at McBurney's point when pressure is applied.

Loose tenderness is encountered.

There is constipation or diarrhea.

Lumbar pain, if the appendix is ​circular behind the cecum.

Pain of defecation, if the appendix is ​near rectal.

 •COMPLICATION
Abscess
An abscess is an inflammation of the appendix that contains pus.
Palpable soft mass in the right lower quadrant or pelvic region. This
mass is initially phlegmonic and develops into a cavity containing pus.
This occurs when gangrenous appendicitis or micro-perforation is
covered by the omentum.

b. Perforation
Perforation is the rupture of the appendix containing the pus so
that the bacteria spread to the abdominal cavity.
a. Perforation rarely occurs in the first 12 hours from the start of illness,
but increases sharply after 24 hours

c. Peritononitis
Peritonitis is inflammation of the peritoneum, a dangerous
complication that can occur in acute or chronic forms. If the infection is
widespread on the peritoneal surface causing generalized peritonitis.
PREVENTIF
1. Ahigh-fiber diet will greatly help smooth the flow of food movements in the
digestive tract so it does not accumulate long and harden.

2. Drinking at least 8 glasses of water a day and not delaying bowel movements will
also help smooth the overall digestive tract movement.

MANAGEMENT
Management that can be done in patients with appendicitis includes conservative
management and surgery.
Conservative
countermeasuresConservative prevention is mainly given to patients who do not
have access to surgical services in the form of antibiotics. Giving antibiotics is
useful for preventing infection.

Operation
If the diagnosis is correct and clearly found Appendicitis, the action taken is
surgery to remove the appendix (appendectomy).

Tertiary
PreventionThe main purpose of tertiary prevention is to prevent the occurrence
of more severe complications such as intra-abdominal complications.
SUPPORTING EXAMINATION

a. Laboratory

Consisting of complete blood examination and C-reactive protein (CRP).

On complete blood tests, it was found that leukocyte
counts were between 10,000-18,000 / mm3 (leukocytosis) and neutrophils were
above 75%, whereas in CRP there was an increased serum

b. Radiology

Consisting of ultrasound examination (USG) and Computed Tomography

Scanning (CT scan). The ultrasound examination found an part in the place
of inflammation in the appendix, whereas CT scan found a cross section
with fecalith and an extension of the appendix that
had inflammation and widening of the cecum.
CASE STUDY

A man 19-year-old came to Muhammadiyah Hospital Palembang with

complained of abdominal pain in the right lower quadrant with a pain
scale of 7 from 3 days before entering to the hospital. Pain will increase
when he walk. Patient’s has constipation for 3 days.
At present the diet of patients is irregular and rarely consumes foods
containing fiber. From the result of assessment, the patient has
anorexia and rovsing’s sign. The patient complains that his body
feels hot. The general condition of the patient really looks sick, fever.
Medical diagnostics of the patient is appendicitis. Examination results
obtained BP : 130/80 mmHg, RR : 20 x / min, P : 90 x / min,
T : 38,5 C, and Leukocytes : 13,000.
ASSESSMENT
•Patient Identity
Name: Mr. J
Age: 19 years old
Male gender
Medical diagnosis: Appendicitis

History of the disease

Complaints generally : abdominal pain pain in the right lower quadrant
with a pain scale of 7, constipation, anorexia and rovsing’s sign,
the general condition of the patient really looks sick, fever.

Complaints now :
patients say abdominal pain, constipation for 3 days, patient complains
that his body feels hot.
•Special basic needs
•Nutrition pattern
•Anorexia (an eating disorder that makes a person experience starvation
B. ANALYSIS DATA
Data Etiology The analysis of the problem

1. DS : Lumen Obstruction Ackute Pain

 Patients complained of ↓
abdominal pain in the right lower Appendicitis
quardrant from 3 days before ↓
Secretion Mucus Increasing
entering to the hospital.
↓
 Patients complained that will Paralytic Ileus
pain increase when he walk ↓
DO : abdominal distension
 BP : 130/80 mmhg ↓
RR :20times/min Abdominal pain in the right lower
P : 90times/min quardrant
↓
T: 38,5 C
Acute pain
 The patients is seen grimacing in
pain
 Pain Scale : 7
2. DS : Inflammatin in cites Hyperthermia
The patients complained ↓
that his body feels hot Appendis
DO : ↓
T: 38,5 C The response of the
hypothalamus to the
inflammatory
↓

Increased body
temperature
↓
Hyperthermia
3. DS : A diet low in fiber Constipation
Patients complained that ↓
has been constipation for The mass of faecal dense
3 days ↓
DO : Lumen Obstruction
Intentinal peristalsis 4 ↓
times/ min Appendicitis
Patients experienced ↓
abdominal distension abdominal distension
↓
Constipation
C. NURSING DIAGNOSE

a. Pre operation
1. Acute pain associated with biological injury agent (distention
of intestinal tissue by inflammation)
2. Changes in the pattern of elimination (constipation) are
associated with a decrease in peritaltik.
3. Hyperthermia associated with sepsis is proven by skin feeling
hot
 D. NURSING CARE PLANNING
No Nursing diagnose Nursing Outcome Classification Nursing Interventions Rationale
(NOC) Classification (NIC)
1. Pain related to Label :Pain control Label :Management -to find out how far
physical injury After nursing care 2x24 pain the level of paun is
agent hours, it is expected that the - Assess the level of and is an early
(postoperative pain will decrease with the pain, location and indicator to be able to
appenditomy results criteria: characteristics pain provide futher action
incision - explain to the patient -the right information
wound). indicator scale about the cause of the can reduce the
OD:- painful pain patient’s anxiety level
now target
facial - teach slow or deep and increase patuent
expressions -the client is 2 5 breath diaphragmatic knowledge about pain
SD : -change in able to breathing techniques -deep breath can
appetite control pain breathe in adequate o
- Reporting 2 5 2 so that the muscles
pain become relaxation so
decreases by as to reduce pain
using pain
management
2. Changes in the Label : Label : -Helps in establishing
pattern of Bowel elimination Management of effective irrigation
elimination After nursing care2 x 24 constipation schedules
(constipation) hours, it is expected that -Ensure client - the return of
are associated client constipation is resolved defecation habits and gastriintestinal
with a decrease with the results criteria: previous lifestyle. function may be
indicator scale
in peritaltik. -Auscultation of delayed by intra-
OD : now target bowel sounds peritonial
- hyperactive -Review dietary inflammation
bowel sounds 1. BAB 1-2 2 5 patterns and amount / - Adequate input and
- anorexia times / day type of fluid input. fiber, coarse food
SD : 2. Soft feces 2 4 -Give high-fiber giving shape and
-The patient 3. Bowel foods. liquid are important
2 5
says pain in the intestines factors in determining
abdomen 5-30 times the consistency of
-The patient / minute stool.
says the stool is
hard
3. Hyperthermia After nursing action for 2 x 24 - monitor - to see the
associated with hours, the body temperature is temperature and development of
sepsis is proven expected to be overcome by the other vital signs vital signs that can
be dangerous
by skin feeling criteria for results: vital signs - skin color
- to see the height
hot monitor and of the temperature
OD : temperature and elasticity of
-T: 38,5 C indicator scale - monitor intake the skin in the
SD : now target and output, be patient
-The patients 1.body 2 5 aware of - reduce the level
complained that temperature changes in fluid of dehydration that
his body feels 2.systolic blood 2 5 loss that is not the patient feels
pressure when the liquid
hot felt
3.pulse pressure 2 5 that comes out is
not felt giving
comfort to the
client
 E. IMPLEMENTATION AND EVALUATION PRE OPERASI
Date/tim Implementation Evaluation
e
May 15, 1. Check the parts on the body part S : S: patients say accute pain
2019 R/Pain is felt suddenly when coughing and lesses
At 14.00 holding cough
2. Ask the patient O: skale pain 5
R/Pain is felt like being slashed patient can sleep
patient had can walk
3. Check client history again
R/pain in the left chest radiates behind the back A : the problem is partially
resolved
4. Provide appropriate analgesic drugs to the
client
R/sudden pain
P : intervention continued
5. Help patients in administering medication
R/Pain scale 5
May 15, 1. Ask the patient and the last family of S : Patients say
2019 bowel movements constipation little lesses
At 14.00
2. Ask the patient and family about the
shape and volume of defecation O : Shape and volume of
beforehand defecation beforehand

3. Problems that occur in patients

4. Teach patients that food can help A : The problem little can
facilitate defecation be overcome

5. Give patients and families to give

enough drink P : Intervention continued
R/The client responds well to the actions Monitor fiber patien
taken Monitor water intake
patien
May 15, 1. Monitor the patient's vital signs S: the patient says fever
2019 down
At 14.00 2. Monitor the patient's body temperature
O: looks confortable
3. See whether there is a change in skin color
in the patient and the patient's skin elasticity A: the problem can be
overcome
4. Ask how the patient feels now
P: stop intervention
5. See if there is a change in body fluids in the
patient

6. Replace the patient's clothes with clothes

that can absorb sweat

7. Cover body parts with blankets

8. Give enough drink to the client

R/The client responds well to the actions taken
DISCUSSION
A. ASSESSMENT

1. Subjective data
From the results of the study, complaints were obtained, namely 19-year-
old male patients who were admitted to the Palembang Muhamadiyah
hospital in the emergency room with complaints of pain in the lower
right abdomen, constipation, fever, pain while walking and the patient
said lack of food containing fiber.

2. Objective data
From the results of the study conducted in getting the results, namely
patients. the patient was diagnosed with Appendicitis. From the results
of physical examination, there is pain in the lower right abdominal part.
BP: 130/90 mmhg, RR: 20x / m, T: 38.5 C, P: 90x / m, leukocytes:
13,000. From an ultrasound examination the patient does not have pus.
B. NURSING DIAGNOSIS

Nursing diagnoses are clinical decisions about the

response of individuals, families, and communities about health
problems, as a basis for selection of nursing interventions to
achieve the goals of nursing care in accordance with the authority
of nurses (Setiadi, 2012).
Nursing diagnoses on clients from the results of studies,
physical examinations, and diagnostic tests obtained, show that
the problems experienced are Acute pain associated with
biological injury agents (eg infection and others). , Hyperthermia
associated with sepsis, which is proven by skin intake is not
sufficient to be able to remove the stool.
C. NURSING INTERVENTIONS

Nursing interventions are part of the organizing phase in the

nursing process as a guideline for directing nursing actions in an effort
to help, alleviate, solve problems or to meet patient needs. Well-
written planning will provide clues to the meaning of nursing care,
because planning is a source of information for all those involved in
patient nursing care. This plan is the main means of communication,
and maintains continuity of patient nursing care for all team members
(Setiadi, 2012).
Acute pain is related to biological injury agents for 1 x 24
hours, the author carries out nursing actions in the patient Mr. T,
among others, re-examine the patient's vital signs, see the scale of pain
in the patient and give analgesics to the client to drink warm water,
analgesic administration is given to clients on the scale of pain
experienced by 7-10. recommended dose analgesic from the doctor, so
that the pain can be felt in patients.
D. NURSING IMPLEMENTATION

Implementation is the fourth stage of the nursing process

that starts after the nurse prepares a nursing plan (Potter & Perry,
2010).
Acute pain is related to biological injury agents for 1 x 24
hours, the author carries out nursing actions on the patient, among
others, checking the client's data again, examining the vital signs in
the patient and obtaining no change in pain is still the same, namely
on a scale of 7, the patient has an analgesic to reduce the pain, the
analgesic treatment results with a decrease in pain, which is a scale
of 5.
E. EVALUATION

Evaluation is the final step of the nursing process.

Evaluation is an intentional and continuous activity involving
patients, nurses and other health team members (Padila, 2012).

After nursing action on the medical diagnosis in the

patient, the evaluation of the last day obtained by the patient said
the pain was slightly reduced, the temperature that was felt to
have started to return to normal, constipation due to lack of fiber
also showed a good response from the patient's body.
F. DISCHARGE PLANNING

1. patients complete the intake of foods containing fiber

2. repair body fluids by consuming enough mineral water
3. avoid spicy foods
4. do not consume hard food
5. don't eat greasy
6. Consuming digestible foods
 CONCLUSION

In the nursing care of Mr. C with appendicitis in the hospital

Muhammadiyah Palembang, the authors take action for 2 x 24
hours and the authors found that nursing 3 diagnoses appeared on
Mr. C After nursing action for 2 x 24 hours later the problem still
unresolved.