ALMIN, RAZELLE S.

GROUP 1

BSN 3Y2-2
NCMB316 RLE
COURSE TASK

RUPTURED
APPENDICITIS
CLINICAL SCENARIO:
NURSING HEALTH HISTORY
A. Patient’s Profile
Name: Patient GRL Birthday: May 4, 1973
Age: 48 years old Sex: MALE
Nationality: Filipino Religion: Born Again Christian
Marital Status: Married Address: Valenzuela City
Chief Complaint: Severe Epigastric pain Admitting Diagnosis: Appendicitis

1. Conceptualize the pathophysiological alterations distinct to the case.

 Trace the pathophysiological changes and highlight problems that are
experienced by the client.
ANSWER: Patient have appendicitis, which is infection or inflammation of
appendix, so patient developed gastric pain and appendectomy was done due to
rupture peritonitis was occurred, which is infection.

 Connect the pertinent nursing care and medical – surgical management to

the various signs and symptoms presented by the client.

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 ANSWER: Analgesic to control pain, appendectomy to treat condition, blood
pressure maintenance, maintaining hygienic practices, breathing exercises.
 Interpret the laboratory results obtained from the patient.
ANSWER: Abnormal hematology values are noted, it may due to infection and
inflammatory reaction.

2. Make a drug study with first column with generic, brand name, dosage,
frequency, route and classification; second column with mechanism of action,
third column with rationale why giving the drug, fourth column with common
side effects of the drugs and last column with nursing considerations while
taking the drug.
Generic, Mechanism of Action Rationale Common Side effects Nursing
Brand Name, of the Drugs Considerations
Dosage,
Frequency,
Route and
Classification
Tramadol is a central CONTRAINDICATION:  Constipation  Give with
Generic: acting u-opioid receptor  Hypersensitivity to  Nausea antiemetic for
Tramadol agonist and SNRI tramadol or opioids.  Dizziness nausea, vomiting
(serotonin/norepinephrin Known or suspected  Vertigo  Take with or
Brand Name: e reuptake-inhibitors) that gastrointestinal  Headache without food
Ultram, is structurally related to obstruction, including  Vomiting  May cause
Ultram ER, codeine and morphine. paralytic ileus.  Anxiety serotonin or
Ryzolt, ConZip Concurrent use of  Agitation neuroleptic
Monoamine oxidase  Diarrhea malignant
Dosage: 50mg inhibitors (MAOIs) or  Dry mouth syndrome-like
use within last 14  Urinary retention reactions.
days.  Urinary frequency  Avoid OTC
Frequency:  Patients under the age  Vasodilation medications
Run for 24 of eighteen should not  Abdominal pain unless approved
hrs. be given the by provider
medication if they  Rx
Route: TIV have had a history of
tonsillectomy or
Classification: adenoidectomy.
Opioid
analgesic INDICATIONS
 This medication is
an opioid analgesic,

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 prescribed for
moderate to severe
pain in adults. It
works by changing
the way the body
senses pain.

Generic, Brand Name, Mechanism of Action Rationale Common Side effects Nursing
Dosage, Frequency, of the Drugs Considerations
Route and Classification
Bactericidal: Inhibits INDICATION:  Headache  Avoid use
Generic: Metronidazole DNA synthesis in Treatment of bacterial  Dizziness unless needed
specific anaerobes infection  Ataxia metronidazole
Brand Name: Flagyl causing cell death.  Insomnia may be
CONTRAINDICATION:  Vertigo carcinogenic
Dosage: 500mg Contraindicated with  Fatigue
hypersensitivity to  Incontinence  reduce
metronidazole; use  GI upset dosage in
Frequency: q 6hrs cautiously with CNS hepatic
disease, hepatic disease.
Route: IV disease, candidiasis.

Classification:
Nitroimidazole,
antimicrobials

Generic, Brand Name, Mechanism of Action Rationale Common Side effects Nursing
Dosage, Frequency, of the Drugs Considerations
Route and Classification
Suppress gastric acid INDICATION:  Headache  Administer
Generic: Omeprazole secretion by specific GERD, frequent  Nausea drug before
inhibition of the heartburn  Vomiting meal is serve
Brand Name: hydrogen potassium  Diarrhea  Monitor for
Prilosec ATPase enzyme CONTRAINDICATION:  Constipation any urinary
system at the Hypersensitivity to  Abdominal elimination
Dosage: 40mg secretory surface of omeprazole and its pain such as pain
the gastric parietal components.  Flatulence or discomfort
Route: OD/IV cells; blocks the final  Dry mouth associated
step of acid with urination

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Classification: production.  If severe
Antisecretory proton diarrhea is
Pump Inhibitors observed drug
may needed
to be
discontinued.

Generic, Brand Name, Mechanism of Rationale Common Side Nursing

Dosage, Frequency, Action effects of the Drugs Considerations
Route and
Classification
The drugs can be used INDICATION:  Confusion  Before giving
Generic: concurrently with Serious infection,  Dizziness drug ask the
Gentamycin Sulfate carbenicillin for the Endo carditis  Hypotension patient about
treatment of serious staphylococcus  Seizures allergic
Brand Name: pseudomonas infection, GI infection  Nausea reactions to
Gentamycin infections; however,  Vomiting penicillin
drug should not be CONTRAINDICATION:  Apnea  Monitor Vital
Dosage: 80mg mixed in the same Pregnancy Lactation signs of the
flask because patient
Frequency: q 6hrs. carbenicillin will active  Monitor
gentamycin hematologic
Route: TIV and
coagulation
Classification: parameters.
Anti-infective:
aminoglycoside antibiotic

Generic, Brand Mechanism of Action Rationale Common Side effects Nursing Considerations
Name, Dosage, of the Drugs
Frequency, Route
and Classification
 Inhibits INDICATION: CNS:  Monitor BP
Generic: Ketorolac prostaglandin Short term management  Drowsiness upon
synthesis of pain (not to exceed 5  Abnormal administration.
Brand Name: Toradol producing days total for all routes thinking <90/80 never
peripherally combined).  Dizziness administer,
Dosage: 40mg mediated  Euphoria Refer to the
analgesia.  Headache doctor.
Frequency: q 6hrs Also has CONTRAINDICATION: RESP:  Patients who
antipyretic  Hypersensitivity  Edema have asthma.
Route: TIV and anti- cross-sensitivity  Pallor Aspirin induced
inflammatory with other NSAIDs  Vasodilation allergy and
Classification: properties. may exist pre- GI: nasal polyps

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Nonsteroidal Anti- perioperative use.  GI Bleeding are at
inflammatory agents,  Therapeutic  Known alcohol  Abnormal increased risk
nonopioids effect: intolerance use taste for developing
analgesics Decreased cautiously in  Diarrhea hypersensitivity
pain - History of GI  Dry mouth reaction.
bleeding  Dyspepsia Assess for
- Renal  GI pain rhinitis asthma
Impairment  Nausea and urticaria.
(dosage GU:  Assess pain
reduction may  Oliguria (note type
be required)  Renal toxicity location and
- Cardiovascula  Urinary intensity). Prior
r disease frequency to and 1-2 hrs.
DERM: following
 Pruritis administration.
 Purpura  Ketorolac
 Sweating therapy should
 Urticaria always be given
HEMAT: initially by IM
 Prolonged or IV route.
bleeding Oral therapy
time should be use
LOCAL: only as a
 Injection site continuation of
pain parental
NEURO: therapy.
 Paresthesia  Caution patient
MISC: to avoid
 Allergic concurrent use
reaction of alcohol
aspirin NSAIDs
 Anaphylaxis
acetaminophen
or other OTC
medication
without
consulting
health care
provider.
Generic, Brand Name, Mechanism of Rationale Common Side Nursing
Dosage, Frequency, Action effects of the Considerations
Route and Drugs
Classification
Second-generation INDICATION: body as a whole:  Determine
Generic: cephalosporin that  Pharyngitis, thrombophlebitis history of
Cefuroxime inhibits cell wall tonsilitis (IV SITE); pain, hypersensitivity
synthesis, infections of the burning, cellulitis reactions to
Brand Name: promoting osmotic urinary and lower (IV site); cephalosporins,

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Zinacef instability; usually respiratory tracts superinfection penicillin and
bactericidal and skin structure positive cob’s test history of
Dosage: 1.5 g infections caused allergies
by Streptococcus GI: particularly to
Route: TIV pneumoniae and  Diarrhea drugs before
S. pyogenes  Nausea therapy is
Classification: haemophillus  Antibiotic initiated
CEPHALOSPORINS influenzae, associate - Report
2ND GENERATION Staphylococcus d colitis onset of
aureus, Escheria SKIN: loose stools
coli.  Rash - Absorption
CONTRAINDICATION:  Pruritis of
 Contraindicated in  Urticaria cefuroxime
patients’ is enhanced
hypersensitivity to UROGENITAL: by food.
drug.  Increased - Notify
 Use cautiously in serum prescriber
patients cretonne about
hypersensitive to and Bun. rashes or
penicillin because  Decrease superinfecti
of possible of d ons.
cross sensitivity creatinine
with other beta- clearance
lactamase .
antibiotics.
 Use caution in
breast feeding
women and in
patients with
history of colitis or
renal sufficiency.

Generic, Brand Name, Mechanism of Rationale Common Side effects Nursing Considerations
Dosage, Frequency, Action of the Drugs
Route and Classification
is a combination of a INDICATION:  Diarrhea  History of
Generic: B-lactam antibiotic  Unasyn is  Rash allergies to
Ampicillin and and a B-lactamase indicated for  Swollen penicillin’s,
Sulbactam inhibitor. Ampicillin the treatment black, or Cephalosporins,
works by binding due to hairy tongue or other
Brand Name: proteins (PBPs) to suspectable  Vaginal allergies; renal
Unasyn inhibits bacterial cell

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 wall synthesis. strains of the itching or disorders
Dosage: 1.5 mg designated discharge lactation.
microorganisms  Pain where  Check IV site
Frequency: q 8hrs  Skin and skin the medicine carefully for
structure was injected sign of
Route: TIV infections thrombosis or
 Intra- drug reaction.
Classification: abdominal  Administer oral
Penicillin’s, Amino Beta- infection drug on an
Lactamase inhibitors  Gynecological empty
infections stomach, 1hr.
before or 2 hrs.
CONTRAINDICATION: after meals
 Contraindicate with a full glass
d in individual of water; do
with a history not give with
of serious fruit juice or
hypersensitivity soft drinks
reactions (e.g.,  Do not give IM
Stevens- injection in the
Johnson case site;
syndrome) to atrophy can
ampicillin occur
sulbactam or to  Monitor
the other beta- injection site.
lactam
antibacterial
drugs.
 Patients with a
previous
history of
cholestatic
jaundice
hepatic
dysfunction
associated with
unasyn.

Generic, Brand Name, Mechanism of Action Rationale Common Side effects Nursing
Dosage, Frequency, of the Drugs Considerations
Route and Classification
Arcoxia is a non- INDICATION:  Stomach  Identify and
Generic: steroidal anti-  To treat the upset very the client
Arcoxia inflammatory drug symptoms  Dizziness identity
(NSAIDs) that exhibits osteoarthritis  Constipation  Check the
Brand Name: anti-inflammatory,  To treat gout  Diarrhea medication

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Etoricoxib analgesic and anti- attacks  Foot edema parallel to the
pyretic activities in  To treat short  Palpitations doctor’s
Dosage: 120mg animal models. term pain,  Short of order.
Arcoxia is a potent including cramp breath  Check the
Route: OD/PO orally active highly like pain or  High blood allergies
selective discomfort pressure  Verify the
Classification: Anti- cyclooxygenase-2 before or client is
inflammatory, Pain (COX-2) inhibitor with during a breastfeeding
reliever and above the clinical menstrual or have a plan
dose range. period and pain of breastfeed
associated with her baby
minor dental  Instruct the
procedures client to
swallow
CONTRAINDICATION: Arcoxia with
 Contraindicate water.
d with allergy  Inform the
to Arcoxia client that if
hypersensitivity he/she will
active peptic skip the
ulceration, GI medication do
bleeding not take the
congestive medication
heart failure, twice.
hypotension  Inform the
renal doctor’s if the
impairment. some of the
adverse effect
persist.

Generic, Brand Name, Mechanism of Action Rationale Common Side effects Nursing Considerations
Dosage, Frequency, of the Drugs
Route and
Classification
 Normal saline -  Hypotension  Monitor patient
Generic: is a sterile non frequently or:
Plain NSS pyrogenic  Signs of
solution for infiltration/sluggish
Brand Name: fluid and flow
0.9% sodium chloride electrolyte  Signs of phlebitis /
solution replenishment infection
 it contains no  Well time or
Dosage: 1000ml anti-microbial catheter and need
agents. to be replaced

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Frequency: q 8hrs.  The pH is 5.0  Condition of
(4.5 to 7.0) catheter dressing
Route: IV  To contains  Check the level of
9g/L sodium IVF
Classification: chloride with - Correct
Isotonic intravenous an osmolarity solution
solution of 308 medication
mosmol/L and volume
 It contains - Check and
154mEq/L regulate the
sodium and drop rate
chloride. - Change the IVF
solution if
needed
- Do not connect
flexible plastic

2. Make at least two nursing care plans based on your assessment that
needs to prioritize.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUAT
SUBJECTIVE: The Acute pain related After 4 hours of INDEPENDENT: After 4 hour
patient to inflammation of nursing  Investigate  Changes in nursing
complained of tissues as interventions the pain reports, location or intervention
abdominal pain. manifested by patient will noting intensity are patient was
abdominal pain demonstrate use location, not relaxation s
OBJECTIVE: initially the pain is of relaxations duration, uncommon other meth
 Facial worsened in skills, other intensity (0-10 but may promote co
mask of intensity became methods to scale), and reflect
pain sharp but localized promote comfort. characteristics developing
 Rebound to the right lower (dull, sharp, complications.
tenderness quadrant. constant).

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  Vital signs
taken as:  Maintain Semi  Reduces
Fowler’s abdominal
Temperature: 38oC position distention
RR: 25mins/bpm thereby
PR: 97 bpm reduce
BP: 140/100 tension.
mmHg
 Move patient  Reduce muscle
slowly and tension or
deliberately guarding
which help
minimize pain
of movement.

 Provide  Promotes
comfort relaxation and
measure like may enhance
back rubs, patients
deep coping abilities
breathing, by refocusing
instruct in attention.
relaxation or
visualization
diversional
activities.

 Provide  Reduces
frequent oral nausea and
care, remove vomiting,
toxins which can
environmental increase intra-
stimuli. abdominal
pressure of
COLLABORATIVE: pain.
 Administer
analgesics as  Reduce
prescribed. metabolic rate
acids in pain
relief and
promotes
healing.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: His Altered comfort After 8 hours of  Observe and  Provides After 8 hours of

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wife complaint of related to nursing document information nursing
severe epigastric epigastric pain interventions the location of the about disease intervention the
pain. patient pain will be pain (0-10 progression, pain was relieved
relieved or scale) and development or controlled.
OBJECTIVE: controlled. character of of
Vital signs taken the pain. complications
as: and
effectiveness
Blood pressure: of
140/90mmHg interventions

Respiratory Rate:  Promote bed  to reduce

25 breaths per rest intra-
minutes. abdominal
pressure
Pulse Rate:
97 Beats per  Control  to minimize
minutes environmental dermal
temperature discomfort
Temperature:
37.8oC  Encourage use  to promotes
relaxation test, redirects
technique attentions,
may enhance
coping.

 Administer  To reduce
medication as severe
indicated. pain/promotes
rest relaxes
smooth
muscles.

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