Group Oral Case Presentation:

Medical Surgical Nursing III

(NCM 118L)

In Partial Fulfillment of the

Requirements for the Subject

NCM 118L: Nursing Care of Clients With Life-threatening Conditions,

Acutely-Ill, Multi-Organ Problems, High Acuity and Emergency Situations,
Acute and Chronic (RLE)

Submitted by:
Principe, Roy Adrian P.
Reyes, Gaius A.
Rosales, Joeshua G.
Sumilang, Maricar R.
Tan, Je Anne D.
Tolopia, Ashley V.
Tumbaga, Richelle A.
Vergara, Trieshel M.
Valderama, Angel Mae

Group No. 5 | BSN-4104

 TABLE OF CONTENTS

MALARIA

I. INTRODUCTION

Definition

Prevalence and Incidence

II. PERSONAL HISTORY

History of Present Illness

III. PHYSICAL ASSESSMENT

IV. ANATOMY AND PHYSIOLOGY

V. PATHOPHYSIOLOGY

VI. LABORATORY AND DIAGNOSTIC PROCEDURE

VII. DRUG STUDY

VIII. NURSING CARE PLAN

IX. RECOMMENDATION

X. PROGNOSIS
I. INTRODUCTION

A. Definition

Appendicitis is a medical condition that occurs when the vermiform appendix, a

finger-shaped pouch located at the right lower quadrant of the abdomen, becomes

inflamed. However, depending on if there were any atypical developmental

abnormalities, such as midgut malrotation, or if there are any other certain cases, such as

pregnancy or prior abdominal surgeries, it can be found nearly anywhere in the abdomen.

In the fifth week, the embryonic development of the appendix begins. The midgut rotates

to the external umbilical cord before returning to the abdomen and rotating the cecum. As

a result, the appendix is located in its regular retrocecal place. It can show as a more

chronic condition, however it usually presents as an acute disease within 24 hours. The

presenting symptoms may be more subdued if there has been a perforation with a

confined abscess. There is uncertainty over the appendix's intended purpose. Today, it is

acknowledged that this organ, particularly in the young, functions as a lymphoid organ

and may have an immunoprotective role. According to certain theories, the appendix

serves as a container for good intestinal bacteria. Others contend that it serves no

meaningful purpose and is merely a residue of the developing process.

B. Prevalence and Incidence

Foreign

According to Deppen et al. (2023), with a mean age of 28, appendicitis

most frequently affects people between the ages of 5 and 45. 233 incidents per

100,000 individuals roughly represent the incidence. Males are slightly more
likely than females to experience acute appendicitis throughout their lifetimes; the

incidence rates are 8.6% and 6.7%, respectively. Approximately 300,000 hospital

admissions for appendicitis-related conditions occur yearly in the United States.

According to a systematic analysis from the Global Burden of Disease

Study 2019, the age-standardized prevalence and incidence rates of appendicitis

in 2019 were 8.7 and 229.9 per 100,000 population, respectively. The age-

standardized YLDs rate was 2.7 in 2019. In Europe and America, the incidence of

appendicitis is about 100 per 100,000 patients per year. The peak incidence occurs

between the second and third decades of life. One out of every 15 people (7%)

will develop acute appendicitis in their lifetime. Moreover, no statistically

significant differences were observed between the male and female individuals in

all groups. Ethiopia, India, and Nigeria showed the largest increases in the age-

standardized prevalence rate between 1990 and 2019. Generally, positive

associations were found between the age-standardized YLD rates and

sociodemographic index at the regional and national levels (Guan et al., 2023).

Local

Appendicitis deaths in the Philippines reached 276 in 2020, accounting for

0.04% of total deaths, according to the most recent WHO data. The Philippines

ranks 92nd in the world with an age adjusted death rate of 0.32 per 100,000

population (WHO, 2020).

 C. Objectives

This case study intends to achieve the following objectives:

1. Increase understanding of Appendicitis and its etiology

2. Know the major concepts in assessing patients with suspected Appendicitis

3. Identify diagnostic procedures for determining an inflamed and/or ruptured

appendix

4. Understand the signs and symptoms, as well as pathophysiology of an

gastrointestinal disorder such as Appendicitis

5. Analyze and be able to learn the nursing and medical management of patients

with Appendicitis and have undergone ‘E’ Appendectomy.

II. PERSONAL HISTORY

Name: Patient X
Age: 35 years old
Admitting Chief Complaint: Pain in Lower Abdomen and Vomiting twice
Final Diagnosis: Suppurative Appendicitis

A. History of Present Illness

Patient X, a 35 year old female with a height of 151 cm and weight of 58 kg, was

brought to Batangas Healthcare Specialist where she was assessed. Prior to

admission; the patient complains of epigastric pain in the right lower quadrant and

states that she has lost her appetite and has already vomited two times that day.

Hence, the patient was admitted. Assessment showed that all the vital signs were
 within normal range. However, the pre-op diagnosis shows that the client is suffering

from Suppurative Appendicitis and was immediately subjected to an emergency

appendectomy.

III. PHYSICAL ASSESSMENT

REVIEW OF PHYSICAL

SYSTEMS ASSESSMENT

GASTROINTESTI PAIN IN THE Appendicitis usually involves a gradual onset

NAL LOWER of dull, cramping, or aching pain throughout

ABDOMEN the abdomen. As the appendix becomes more

swollen and inflamed, it will irritate the lining

of the abdominal wall, known as the

peritoneum. This causes localized, sharp pain

in the right lower part of the abdomen. The

pain tends to be more constant and severe than

VOMITING the dull, aching pain that occurs when

symptoms start.

This leads to distension and an increase in the

intraluminal and intramural pressure. As the

condition progresses, the resident bacteria in

the appendix rapidly multiply. Distension of

the lumen of the appendix causes reflex

anorexia, nausea and vomiting, and visceral

pain.
IV. ANATOMY AND PHYSIOLOGY

In this case study, patient X is clinically diagnosed with appendicitis, which is directly associated and concerned with the

gastrointestinal system. The gastrointestinal tract is a pathway 7 to 7.9 meters (23 to 26 feet) in length that extends from the mouth to

the esophagus, stomach, small and large intestines, and rectum, to the terminal structure, the anus. When food is ingested, it is

propelled through the Gl tract, coming into contact with a wide variety of secretions that aid in its digestion, absorption, or elimination

from the GI tract.

ORGAN ANATOMY PHYSIOLOGY

The oral cavity is a space that extends from the inner It provides sensory analysis of food material before
surface of the lips to the beginning of the oropharynx, swallowing and mechanical processing via the action
Oral Cavity which is marked by the junction of the hard and soft of the teeth, tongue, and palatal surfaces. The oral
(Mouth) palate above; the anterior pillars, or the palatoglossal cavity also provides lubrication by mixing food
arches, laterally; and the terminal sulcus of the tongue material with mucus and salivary gland secretions
below. and limited digestion of carbohydrates and lipids.

Pharynx The pharynx is a 12-14 cm, or 5 inch, long tube The pharynx serves as a passageway of food
extending behind the nasal and oral cavities until the material to the esophagus. During swallowing,
voice box (larynx) and the esophagus. closure of the nasopharynx and larynx occurs to
maintain the proper direction of food, a process
achieved by cranial nerves IX and X.
 Esophagus The esophagus is located in the mediastinum, anterior The primary function of the esophagus is to transport
to the spine and posterior to the trachea and heart. This food materials into the stomach via waves of
hollow muscular tube, which is approximately 25 cm contraction of its longitudinal and circular muscle,
(10 inches) in length, passes through the diaphragm at known as peristalsis.
an opening called the diaphragmatic hiatus. The upper
one-third of the esophagus is predominantly skeletal
muscle, the middle one-third is a mixture of skeletal
and smooth muscle, and the lower one-third is
primarily smooth muscle.

Stomach The stomach is situated in the left upper portion of the The stomach stores food during eating, secretes
abdomen under the left lobe of the liver and the digestive fluids, and propels the partially digested
diaphragm, overlaying most of the pancreas. A hollow food, or chyme, into the small intestine.
muscular organ with a capacity of approximately 1500
mL.

Small Intestine The small intestine is the longest segment of the GI Chyme is directed to the small intestine, where
tract, accounting for about two thirds of the total digestion continues. Unlike the stomach, which has
length. It folds back and forth on itself, providing minor absorptive properties, 90% of food absorption
approximately 70 m (230 ft) of surface area for occurs in the small intestine.
secretion and absorption. The small intestine mucosa
has villi, and each villus has multiple microvilli, which
increase the surface area for optimal absorption.
 Vermiform The vermiform appendix is a vestigial hollow tube It is an appendage that has little or no physiologic
Appendix that is closed at one end and is attached at the other function.
end to the cecum, a pouchlike beginning of the large
intestine into which the small intestine empties its
contents.

Large Intestine The large intestine consists of an ascending segment

on the right side of the abdomen, a transverse segment
that extends from right to left in the upper abdomen,
and a descending segment on the left side of the
abdomen.

Rectum The rectum measures between 12 to 15 cm in length The rectum functions primarily as a temporary
from the rectosigmoid junction to the dentate line in reservoir for feces storage. It also plays an integral
the anal canal. role in controlling defecation as well as maintaining
continence.
Anus It is located within the anal triangle of the perineum The functions of the anal canal include the
and in between the fat-filled and wedge-shaped maintenance of fecal continence and defecation.
ischioanal, or ischiorectal, fossae that accommodate its
expansion for the passage of fecal material.
Illustration Depicting the Gastrointestinal System

Figure 1. The Major Endocrine Organs

V. PATHOPHYSIOLOGY

Inflammation of the appendix, a little pouch-like organ connected to the cecum in the

large intestine, is the hallmark of appendicitis. Although the precise etiology is not always

known, it is thought to be caused by the appendix being obstructed, which can result in

inflammation and infection.

Figure 2. Pathophysiology of Appendicitis

VI. LABORATORY AND DIAGNOSTIC PROCEDURE

A. Complete Blood Count

DATE: May 05, 2023

Result Reference Range

Platelet 434 (H) 150.0 - 400.0 ×/uL

WBC 18.94 (H) 4.50 - 11.50 ×/uL

Segmenters 95.0% (H) 54.0 - 62.0%

Lymphocytes 1.7% (L) 25.0 - 30.0%

The table presents the Hematology test of a patient with suppurative appendicitis.

The complete blood count (CBC) is one of the most commonly used laboratory tests for

the diagnosis of acute appendicitis (AA). Many studies have focused on the role of white

blood cell (WBC), platelet count (PLT), lymphocyte (L), neutrophil (N), C-reactive

protein (CRP), and Lymphocyte-C-reactive protein ratio (LCR) values in the diagnosis of

Acute Appendicitis (Daldal & Dagmura, 2020).

The first complete blood count (CBC) test upon admission of the patient has

resulted in a significantly high platelet count of 434×/uL. and high WBC count of

18.9×/uL. On the other hand, Segmenters had a high percentage while Lymphocytes

resulted in 1.7% which indicates low percentage.

 According to a study, the WBC, neutrophils, platelet count has been reported to

be higher in patients with acute appendicitis confirmed by the pathology report for

appendicitis. Moreover, the likelihood of acute appendicitis increases as the WBC value

increases and if the values are higher, the risk of complicated acute appendicitis becomes

higher. Therefore, it can be said that WBC values play an important role in determining

the severity of acute appendicitis (Peksoz & Bayar, 2020).

B. Serum Electrolyte Test

DATE: May 05, 2023; 5:53 pm

Result Reference Range

Sodium 138.3 135.00- 145.00 mmol/L

Potassium 4.10 3.50 - 5.50 mmol/L

The patient's serum electrolyte test for sodium and potassium comes out normal.

A serum electrolyte test in individuals suspected of having appendicitis allows for a

thorough assessment of the patient's hydration state, renal function, and electrolyte

balance. It guides optimal management and ensures that any potential problems are

identified and treated as soon as possible (Turhan et al., 2022).

In line with this, sodium is being tested for hyponatremia or low levels of sodium

in the blood with patients suspected with acute appendicitis. According to a study,

hyponatremia is a new marker of perforated appendicitis and therefore, serum sodium

 level measurement should be considered in patients with a clinical presentation consistent

with appendicitis if complications are suspected (Turhan et al., 2022).

On the other hand, potassium is being tested for signs of dehydration since the

patient reported vomiting. Appendicitis frequently results in vomiting and decreased fluid

intake, resulting in dehydration. Potassium is a necessary electrolyte that aids in fluid

balance in the body. Hence, testing potassium levels can aid in determining hydration

status and directing proper fluid replacement.

C. Urinalysis: NORMAL FINDINGS

A urinalysis was additionally carried out on the patient at 5:07 pm, which

revealed normal results. Urine tests are done to rule out urinary tract infections and/or

kidney stones. These conditions can mimic appendicitis symptoms. Appendicitis, in some

cases can cause symptoms similar to a urinary tract infection, such as uncomfortable

urination or difficulty passing urine. This could imply an appendix problem rather than a

bladder problem (Medlineplus, 2019)

D. ECG: NORMAL FINDINGS

The patient’s result in the ECG test indicates normal findings as well. In most

cases, there is no clear link between having an ECG (electrocardiogram) for appendicitis.

An ECG test measures and evaluates the electrical activity of the heart, typically to look

for abnormalities in cardiac rhythm or function while the diagnosis of acute appendicitis

is typically based on clinical evaluation, physical examination, and sometimes imaging

tests like ultrasound or CT scan. In certain situations, a patient with appendicitis may also

experience chest discomfort or other symptoms that point to a cardiac problem. In such

instances, a healthcare professional may request an ECG test to rule out any cardiac

issues or to help pinpoint the cause of the symptoms (Sarihan et al., 2018).

Furthermore, having an ECG test for preoperative assessment is crucial because if

surgery for appendicitis is indicated, an ECG can provide vital information about the

patient's cardiac health prior to the procedure. This allows the medical team to anticipate

potential hazards, plan accordingly, and initiate suitable preoperative management,

resulting in the best possible outcome for the patient.

VII. DRUG STUDY

DRUG STUDY #1

Action/ Indication & Side Effect &

Generic Name Brand Name Nursing Action
Classification Contraindications Adverse Reaction

Omeprazole Losec CLASSIFICATIO Prevention of SIDE EFFECTS INTERVENTIO

N: aspiration-related N/
complications Frequent (7%): EVALUATION
PHARMACOTHER during surgery. Headache.
ROUTES/DOSAGE: PriLOSEC APEUTIC: Evaluate for
40 mg IV, Once a Benzimidazole. therapeutic
day Occasional (3%– response (relief of
PriLOSEC OTC CONTRAINDICA GI symptoms).
TIONS 2%): Diarrhea,
CLINICAL: abdominal pain,
Proton pump Hypersensitivity to nausea
inhibitor. omeprazole, other Question if GI
proton pump discomfort,
inhibitors. Rare (2%): nausea, diarrhea
ACTION: occurs.
Dizziness, asthenia,
vomiting,
Inhibits hydrogen- constipation, upper
potassium respiratory tract PATIENT/
adenosine infection, back pain, FAMILY
triphosphatase rash, cough. TEACHING
(H+/K+ ATP
pump), an enzyme
on the surface of Report headache,
gastric parietal onset of black,
cells. tarry stools,
ADVERSE diarrhea,
REACTIONS abdominal pain.
Therapeutic
Effect: Increases Pancreatitis,
gastric pH, reduces hepatotoxicity,
gastric acid interstitial nephritis
production. occur rarely.

May increase risk

of C. difficile
infection.
 DRUG STUDY #2

Action/ Indication & Side Effects &

Generic Name Brand Name Nursing Action
Classification Contraindication Adverse Reaction

Ketorolac Acular CLASSIFICATIO Short-term relief of SIDE EFFECTS BASELINE

N: mild to moderate Frequent: ASSESSMENT
Acular LS pain. Headache, nausea,
PHARMACOTHER abdominal Assess onset, type,
ROUTES/DOSAGE: Acuvail, Apo- APEUTIC: NSAID cramps/pain, location, duration of
30 mg IV q8 Ketorolac pain.
CLINICAL: CONTRAINDICA dyspepsia
Sprix Analgesic TION
Torado Hypersensitivity to Obtain baseline
Occasional:
ketorolac, aspirin, Diarrhea renal/hepatic
ACTION: or other NSAIDs. function tests.
Inhibits COX-1 and Intracranial
COX-2 enzymes, bleeding, ADVERSE
resulting in hemorrhagic REACTION INTERVENTION/
decreased diathesis, EVALUATION
prostaglandin incomplete Peptic ulcer
synthesis; reduces Monitor renal
hemostasis, high GI bleeding, function, LFT,
prostaglandin levels risk of bleeding;
in aqueous humor gastritis urinary output.
concomitant use of
Therapeutic aspirin, NSAIDs, Severe hepatic
Effect: Produces probenecid, or reaction
Monitor daily
analgesic, pentoxifylline; (cholestasis, pattern of bowel
antipyretic, anti- jaundice) occur activity, stool
inflammatory effect Labor and delivery rarely. consistency.
Advanced renal Nephrotoxicity
impairment or risk (glomerular
of renal failure, nephritis, interstitial Observe for occult
active or history of nephritis, nephrotic blood loss.
peptic ulcer disease, syndrome) may
chronic occur in pts with
inflammation of GI preexisting renal Assess for
tract, recent or impairment. therapeutic
history of GI response: relief of
bleeding/ Acute pain, stiffness,
ulceration. hypersensitivity swelling; increased
reaction (fever, joint mobility;
Perioperative pain chills, joint pain)
in setting of CABG reduced joint
occurs rarely. tenderness;
surgery.
improved grip
Prophylaxis before strength.
major surgery

PATIENT/
FAMILY
TEACHING
Avoid aspirin,
alcohol.
Report abdominal
pain, bloody stools,
or vomiting blood.
If GI upset occurs,
take with food,
milk.
 DRUG STUDY #3

Action/ Indication & Side Effects &

Generic Name Brand Name Nursing Action
Classification Contraindication Adverse Reaction

Tramadol Ultram CLASSIFICATIO Relief of moderate SIDE EFFECTS BASELINE

N: to moderately Frequent (25%– ASSESSMENT
severe pain 15%): Dizziness,
PHARMACOTHER
ROUTES/DOSAGE: vertigo, nausea, Assess onset, type,
APEUTIC: Opioid CONTRAINDICA
50 mg IV, every 8 Analgesic TION constipation, location, duration of
hours headache, pain.
CLINICAL: Contraindicated drowsiness.
Generally acting with allergy to Assess drug history,
analgesic tramadol or opioids esp. carbamaze-
for acute pine, analgesics,
intoxication with CNS depressants,
ACTION: alcohol, opioids or Occasional (10%-
MAOIs.
psychoactive drugs 5%): Vomiting,
Binds to mu-opioid
pruritus, CNS Review past
receptors in CNS,
stimulation (e.g.,
inhibiting ascending medical history,
nervousness,
pain pathway. esp. epilepsy,
anxiety,agitation,
seizures.
Inhibits reuptake of tremor, euphoria,
norepinephrine, mood swings, Assess renal
serotonin, inhibiting hallucinations),
function, LFT.
descending pain asthenia,
pathways. diaphoresis,
dyspepsia, dry INTERVENTION/
Therapeutic EVALUATION
mouth, diarrhea.
Effect: Reduces
pain Monitor pulse, B/P,
Rare (less than renal/hepatic
5%): function.

Malaise, Assist with

vasodilation, ambulation if
anorexia, dizziness,vertigo
flatulence, rash, occurs. Dry
blurred vision, crackers, cola may
urinary re relieve nausea.

tention/frequency, Palpate bladder for

menopausal urinary retention.
symptoms. Monitor daily
pattern of bowel
activity, stool
ADVERSE consistency. Sips of
REACTION
water may relieve
Asterixis (tremor of dry mouth.
the hand that
resembles a bird Assess for clinical
flapping its wings improvement,
and is best seen record onset of
when individual
attempts to extend relief of pain.
their wrists),
dizziness, Monitor closely for
weakness, misuse or abuse.
headache,
PATIENT/
drowsiness
FAMILY
TEACHING
CV: Orthostatic
May cause physical
hypotension
dependence.

Patients with a
GI: Nausea, history of drug
anorexia, vomiting, abuse are at
diarrhea
increased risk for
misuse or abuse.
GU: Polyuria, Take medication
nocturia only as prescribed.

Avoid alcohol,
Hematologic: other narcotics,
Hypokalemia sedatives.

May cause
Local: Pain,
phlebitis (an
inflammation that drowsiness,
causes a blood clot dizziness, blurred
to form in a vein, vision.
usually in leg)
Avoid tasks
at injection site requiring alertness,
motor skills until
response to drug is
Other: muscle established.
cramps and muscle
spasms, weakness, Report severe
arthritic pain constipation,
difficulty breathing,
excessive sedation,
seizures, muscle
weakness, tremors,
chest pain,
palpitations.
 DRUG STUDY #4

Action & Indication & Side Effects &

Generic Name Brand Name Nursing Action
Classification Contraindications Adverse Reaction
Etoricoxib ARCOXIA Selectively inhibits Short term SIDE EFFECTS Assess client for
cyclo- oxygenase-2 treatment of history of allergic
VIII. Feeling sick
(COX-2) COX- 2 moderate pain reaction to
(nausea) and
ROUTES/DOSAGE: which is an isoform Arcoxia or for
vomiting
50 mg IV, every 8 of the enzyme that previous heart
hours has been postulated CONTRAINDICA failure, heart
to be primarily TION attack, bypass
responsible for the Heartburn, surgery, angina,
synthesis of Hypersensitivity; indigestion, peripheral arterial
mediators of pain. history of allergic uncomfortable disease, or
inflammation, and type reactions (e.g. feeling transient
fever. bronchospasm, ischaemic attack.
acute rhinitis, nasal
polysps, ADVERSE
angioneurotic REACTIONS Monitor blood
oedema, or
Hypersensitivity pressure regularly
urticaria) after
taking aspirin, Reactions: Swelling while taking this
of the face, lips, medication.
NSAIDs, or other
cyclooxygenase-2 tongue or throat
(COX-2) inhibitors; which may cause
difficulty in Take medication
active peptic
swallowing or with a glass of
ulceration or
gastrointestinal breathing Insomnia water to avoid
hemorrhage, or increased anxiety dehydration.
inflammatory Severe increase in
bowel disease; blood pressure,
congestive heart Arcoxia may be
Confusion,
failure, taken regardless of
Hallucinations
uncontrolled food intake.
Decreased Platelets,
hypertension or Atrial Fibrillation
with persistently or abnormal w
high blood pressure Stop the
rhythm of the heart,
(>140/90 mmHg), medication
Heart failure,
established immediately if
Stomach pain or
ischaemic heart gastrointestinal
Stomach in ulcers
lesions occur.
NURSING CARE PLAN
IX. RECOMMENDATION

Nurses treat patients with appendicitis in several phases of their condition from

arriving at the emergency department with sudden pain, to caring for them post-

operatively, to reviewing their discharge instructions with them once they return home.

Nurses must understand how to treat the symptoms and prevent infection and

complications that can result from appendicitis.

Consequently, we have constructed the acronyms for METHODS.

M – MEDICATIONS

After an appendectomy, the recovery process involves following specific instructions to

ensure a smooth recuperation. Home care and medications are typically a part of the post-

appendectomy recovery plan. However, it's essential to follow the healthcare provider's

recommendations and prescriptions. Here are the following medications that were

prescribed to the patient of post-appendectomy care:

1. Pain Medications

Pain medication is prescribed to the patient to help manage the

discomfort and pain that can occur after surgery. These medications can

include over-the-counter pain relievers, prescription medications like opioids

(for short-term use), or other pain management strategies such as non-

steroidal anti-inflammatory drugs (NSAIDs) or local anesthetics. The goal is

to balance pain relief with minimizing potential side effects and risks of pain

medications.
 The Patients are given clear instructions on how to take the

prescribed pain medication, including dosage and timing. It's important for

patients to follow these instructions carefully, report any severe or increasing

pain to their healthcare provider, and be aware of potential side effects or

adverse reactions.

Overall, pain management is an essential part of post-

appendectomy care to ensure that the patient can recover comfortably and

effectively from the surgical procedure.

2. Antibiotics

In some cases such as complications or infections, antibiotics are

prescribed to prevent or treat infection after surgery. It's essential for the

patient to follow the prescribed course and complete the full course of

antibiotics as directed by their healthcare provider. This helps ensure that any

infection is fully treated and prevents the development of antibiotic-resistant

bacteria.

As with all aspects of post-operative care, the use of antibiotics and

their specific dosages should be determined by the medical team based on the

patient's unique circumstances and the surgeon's judgment. Patients should

follow their healthcare provider's recommendations and seek clarification if

they have any concerns about their treatment plan.

E – EXERCISE
 Exercise is important for the patient at home for several reasons, although the

timing and type of exercises should be guided by a healthcare provider's

recommendations. Here's why exercise can be beneficial in the post-appendectomy

recovery process:
 1. Preventing Complications. Movement and gentle exercises help reduce the

risk of post-operative complications, such as blood clots and pneumonia.

Staying relatively active can improve circulation and respiratory function.

2. Rebuilding Strength. Surgery can lead to muscle weakness and loss of

physical strength. Appropriate exercises can help rebuild muscle tone and

improve overall strength, aiding in the recovery process.

3. Preventing Constipation. Post-operative pain medications and a less active

lifestyle can lead to constipation. Light exercises can promote regular bowel

movements and prevent constipation.

4. Improving Range of Motion. Gentle stretching and range-of-motion

exercises can help maintain or improve joint flexibility, especially around the

surgical incision area.

It is crucial to emphasize that the type and intensity of exercise should be based

on the individual's overall health, the specific surgical procedure, and the surgeon's or

healthcare provider's recommendations. Patients should not engage in strenuous activities

or exercises that may strain the abdominal area until they receive approval from their

healthcare team.
Common post-appendectomy exercises may include:

1. Gentle walking. This is often one of the first activities recommended to

promote circulation and prevent blood clots.

2. Deep breathing exercises. These can help prevent respiratory complications.

3. Range-of-motion exercise. Simple stretches to maintain joint flexibility.

4. Core-strengthening exercises. Gentle exercises to engage abdominal muscles

and improve core strength.

Patients should always consult their healthcare provider for personalized

recommendations and guidance on when it's safe to resume more strenuous activities and

exercises.

T – TREATMENT/TIPS

Recovery after an appendectomy is typically straightforward, but it's essential for

the patient to follow some guidelines to ensure a smooth and safe recuperation. Here are

some tips for the patient at home:

1. Follow Medical Advice. Adhere to the instructions provided by your

healthcare provider, including medication schedules and recommendations for

diet, exercise, and wound care.

2. Hydration. Stay well-hydrated by drinking plenty of water or clear fluids.

Dehydration can slow down the healing process.

3. Avoid Driving. You may need to refrain from driving for a period, typically

until you are off pain medications and can perform emergency maneuvers

comfortably.
 4. Listen to Your Body. If ever the patient is experiencing increasing pain,

fever, redness, or swelling around the incision site, or any other concerning

symptoms, contact immediately the healthcare provider.

5. Support and Assistance. Do not hesitate to seek help from friends and family

for tasks that may be difficult during recovery period, such as grocery

shopping, cooking, or transportation to medical appointments

6. Emotional Well-Being. Recovery can be a challenging time emotionally.

Reach out to friends and family for support, and consider relaxation

techniques or activities that help reduce stress and anxiety.

Remember that recovery times can vary from person to person, so be patient and

give your body the time it needs to heal. If you have any questions or concerns during

your recovery, don't hesitate to contact your healthcare provider. Your medical team can

provide you with personalized guidance and address any issues that may arise.

.
H – HEALTH TEACHING

Nurses play a vital role in providing health teaching to post-appendectomy

patients before they are discharged from the hospital. Effective education helps patients

understand how to care for themselves at home, recognize potential complications, and

promote a smoother recovery. Here are some key topics that nurses typically cover in

their health teaching for the patient in this case.

1. Incision Care. Provide detailed instructions on how to care for the surgical

incision site, including cleaning, dressing changes (if needed), and when it's

safe to remove dressings.

2. Activity and Rest. Provide guidance on when it's safe to resume light

activities, like walking, and when to avoid strenuous exercises and heavy

lifting.

3. Signs of Infection. Educate patients on the signs of infection, including

increasing pain, fever, redness, swelling, or discharge around the incision site.

Instruct them to report any of these symptoms promptly.

4. Follow-Up Appointments. Stress the importance of attending all follow-up

appointments with their healthcare provider to monitor their recovery.

5. Emergency Contact Information. Provide the patient with contact

information for the healthcare provider or hospital in case of any questions,

concerns, or emergencies.

6. Wound Protection. Discuss the importance of protecting the incision site

from trauma and sun exposure, especially if it's in an area exposed to sunlight.
 7. Medication Management. Review the importance of taking antibiotics (if

prescribed) as directed and completing the full course.

8. Preventing Blood Clots. Provide information on measures to prevent blood

clots, such as ankle exercises, staying hydrated, and early ambulation.

O – OPD (Outpatient Department)

The patient was given instructions by Doctor Agbay to not remove the

appendectomy dressing at home and wait for the follow up and check up on October 30,

2023 that will take place at Batangas Healthcare Specialist Medical Center.

The dressing serves as a barrier that helps prevent bacteria and contaminants from

entering the surgical incision site. Removing the dressing at home without proper sterile

conditions could increase the risk of infection. It also provides a layer of protection over

the incision, shielding it from potential trauma, friction, and environmental factors that

could hinder the healing process. The dressing also allows healthcare providers to

monitor the incision site during follow-up appointments, which is important for

identifying any signs of infection, inflammation, or other complications. Lastly, the

appendectomy dressing helps maintain a clean and controlled environment around the

incision site, which is conducive to proper wound healing.

D – DIET

The diet should be gentle on the digestive system and gradually transition from

clear liquids to solid foods as tolerated. Here are some diet recommendations for the

patient recovering at home after an appendectomy:

A. Clear Liquid Diet (Post-Surgery):

 Clear broths (chicken, beef, or vegetable).

 Clear fruit juices (apple, white grape).

 Clear herbal tea or plain water.

 Popsicles or ice chips.

B. Full Liquid Diet (Progression):

 Full-fat yogurt (plain or flavored).

 Creamed soups (strained).

 Applesauce.

 Fruit or vegetable juices without pulp.

 Pudding.

C. Soft Diet (As Tolerated):

 Mashed potatoes.

 Scrambled eggs.

 Oatmeal.

 Cooked or steamed vegetables (e.g., carrots, green beans).

 Cottage cheese.

 Plain white rice.

  Bananas.

 Soft, well-cooked pasta.

 Mild cheeses.

D. Regular Diet (Gradual Transition):

 Lean proteins (chicken, turkey, fish, lean cuts of beef or pork).

 Whole grains (brown rice, whole wheat bread).

 Fresh fruits and vegetables.

 Low-fat dairy products (milk, yogurt).

 Fibrous foods should be reintroduced gradually as tolerated.

Always follow the healthcare provider's specific dietary recommendations, as they

can tailor the diet to the condition and recovery progress.

S – SPIRITUAL HEALTH

Spiritual health can be an essential aspect of the recovery process for some

individuals. In this case study, the importance of spiritual health varies from person to

person, here are some reasons why it can be beneficial to the patient

1. Emotional Support. Spiritual beliefs and practices can provide a source of

comfort and emotional support during challenging times, such as post-surgery

recovery. They can help the patient to cope with stress, anxiety, and feelings of

vulnerability.

2. Resilience. Spirituality can contribute to the patient's resilience, helping them to

maintain a positive outlook and a sense of hope, which can be particularly

valuable during the recovery period.

 3. Sense of Purpose. Spiritual beliefs often involve a sense of purpose or meaning

in life. This can be a motivating factor for the patient to adhere to their recovery

plan and make healthy lifestyle choices.

4. Reduction of Stress. Practices such as meditation, prayer, or mindfulness, which

are often associated with spirituality, can help reduce stress and promote

relaxation, which can contribute to a more favorable recovery environment.

5. Coping Mechanism. Spiritual beliefs and practices can serve as a coping

mechanism, helping individuals navigate and make sense of the challenges and

changes in their lives, including post-surgery adjustments.

6. Values and Morality. Spiritual beliefs may guide the patient's values and moral

compass, influencing their decisions and behaviors, including those related to

health and recovery.

It is important to note that spirituality is a highly personal and individual aspect of

health and well-being. Not everyone is spiritually inclined, and the relevance of spiritual

health will vary from person to person. Healthcare providers should be sensitive to

patients' beliefs and preferences and, when appropriate, incorporate spiritual

considerations into the care and recovery process.

X. Prognosis

With an early operation, the chance of death from appendicitis is very low. The person

can usually leave the hospital in 1 to 3 days, and recovery is normally quick and complete.

However, older people often take longer to recover.

Without surgery or antibiotics (as might occur in a person in a remote location without

access to modern medical care), more than 50% of people with appendicitis die.

The prognosis is worse for people who have a ruptured appendix, an abscess, or

peritonitis.
XI. References

Ansari, P. (2023, October 13). Appendicitis. MSD Manual Consumer Version.

https://www.msdmanuals.com/home/digestive-disorders/gastrointestinal-

emergencies/appendicitis#v758089

Appendicitis - Symptoms and causes - Mayo Clinic.

https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/

syc-20369543.

Guan, L., Liu, Z., Pan, G., Zhang, B., Wu, Y., Gan, T., & Ouyang, G. (2023). The global,

regional, and national burden of appendicitis in 204 countries and territories,

1990–2019: a systematic analysis from the Global Burden of Disease Study 2019.

BMC Gastroenterology, 23(1). https://doi.org/10.1186/s12876-023-02678-7

Hinkle, J. L., Cheever, K. H. & Overbaugh, K. (2021). Brunner & Suddarth's textbook of

medical-surgical nursing. (15th ed.). Wolters Kluwer.

How do you know if you have appendicitis?.

https://microsoftstart.msn.com/en-ph/health/ask-professionals/expert-answers-on-

appendicitis/hp-appendicitis?

questionid=xon6cbzv&type=condition&source=bingmainline_conditionqna.

Ogobuiro, I., Gonzales, J., Shumway, K. R. & Tuma, F. (2023). Physiology,

Gastrointestinal. StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK537103/

Wang, Y. H. W., & Wiseman, J. (2023). Anatomy, Abdomen and Pelvis, Rectum.

StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537245/

What is Appendicitis and its possible symptoms, causes, risk and prevention methods?.

https://www.msn.com/en-us/health/condition/Appendicitis/hp-Appendicitis?

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