Introduction

Mr.Harish got admitted into Victoria hospital with the complaints of nausea, vomiting,
pain at right iliac region since 5 days. physician examined and diagnosed as appendicitis . I have
posted in surgical ward and observed the patient and selected for my case study.

PATIENT PROFILE
NAME : Mr.Harish

AGE/SEX : 55 years/ male

HOSP NO : 888482

BED NO :3

DATE OF ADDMISSION : 09.09.2009

EDUCATION ; TCH

MARITAL STATUS ; married

RELIGION : Hindu

WARD : Male surgical ward, (17th)

ADRESS : Mr.Harish, #38, Sultan playa, Kalasipalya, Bangalore.

DIAGNOSIS : APPENDICITIS

SOURCE OF INFORMATION : patient, record, relatives.

CHEIF COMPLAINTS :nausea, vomiting, pain at right iliac region.

APPLICATION OF BETTY NEUMAN'S SYSTEMS MODEL

OBJECTIVES:
 to assess the patient condition by the various methods explained by the nursing theory
 to identify the needs of the patient, and to select a theory for the application according to
the need of the patient
 to apply the theory to solve the identified problems of the patient
 to demonstrate an effective communication and interaction with the patient.
 to evaluate the extent to which the process was fruitful.
STRESSORS AS PERCEIVED BY CLIENT
(Information collected from the patient and his wife)
1. Major stress area, or areas of health concern
 Patient was suffering from severe abdominal pain , nausea, vomiting, reduced appetite
and gross weight loss(5kg with in 4 months)
 Patient is been diagnosed to have Appendicitis one week back.
 Patient underwent operative procedure i.e.Appendicectomy on 10/09/2009.
 Psychologically disturbed about his disease condition- anticipating it as a life threatening
condition. Patient is in depressive mood and does not interacting.
 Patient is disturbed by the thoughts that he became a burden to his children with so
many serious illnesses which made them to stay with him at hospital.
 Patient has pitting type of edema over the ankle region, and it is more during the evening
and will not be relieved by elevation of the affected extremities.
 He had developed BPH few months back (2008 January) and underwent surgery TURP
on November 15. Still he has mild difficulty in initiating the stream of urine.
 Patient is not suffering with diabetes and hypertention.

2. Life style patterns

 patient is a retired school teacher
 cares for wife and other family members
 living with his son and his family
 active in temple
 participates in community group meeting i.e. local politics
 has a supportive spouse and family
 taking mixed diet
 no habits of smoking or drinking
 spends leisure time by reading news paper, watching TV, spending time with family
members and relatives

3. Experience of similar problem

 The fatigue is similar to that of previous hospitalization (after the surgery of the BPH)
 Severity of pain was some what similar in the previous time of surgery i.e. TURP.
 Was psychologically disturbed during the previous surgery i.e. TURP.
  What helped them- family members psychological support helped him to over come the
crisis situation

4. Anticipation of the future

 Concerns about the healthy and speedy recovery.
 Anticipation of changes in the lifestyle and food habits
 Anticipating about the demands of modified life style
 Anticipating the needs of future follow up

5. Patient activities to help himself

 Talking to his friends and relatives
 Reading the religious materials i.e. reading the Bible
 Instillation of positive thoughts i.e. planning about the activities to be resume after
discharge, spending time with grand children, going to the church, return back to the
social interactions etc
 Avoiding the negative thoughts i.e. diverts the attentions from the pain or difficulties, try
to eliminate the disturbing thoughts about the disease and surgery etc
 Trying to accept the reality etc.

6. Activities expected from others

 Family members visiting the patient and spending some time with him will help to a
great extent to relieve his tension.
 Convey a warm and accepting behaviour towards him.
 Family members will help him to meet his own personal needs as much as possible.
 Involve the patient also in taking decisions about his own care, treatment, follow up etc

STRESSORS AS PERCEIVED BY THE CARE GIVER.

1. Major stress areas
 Persistent fatigue
 Massive weight loss i.e.( 3 kg of body weight with in 4 months)
 History of BPH and its surgery
 Persistence of urinary symptoms (difficulty in initiating the stream of urine) and edema
of the lower extremities
 Depressive ideations and negative thoughts
2. Present circumstances differing from the usual pattern of living
 Hospitalization
 acute pain ( before the surgery patient had pain because of the underlying pathology and
after the surgery pain is present at the surgical site)
 nausea and vomiting which was present before the surgery and is still persisting after
the surgery also
 anticipatory anxiety concerns the recovery and prognosis of the disease
 negative thoughts that he has become a burden to his children
 Anticipatory anxiety concerning the restrictions after the surgery and the life style
modifications which are to be followed.

3. Clients past experience with the similar situations

 Patient verbalized that the severity of pain, nausea, fatigue etc was similar to that of
patient’s previous surgery. Counter checked with the family members thats what they
observed.
 Psychologically disturbed previously also before the surgery. (collected from the patient
and counter checked with the relatives)
 Client perceived that the present disease condition is much more severe than the
previous condition. He thinks it is a serious form of dcancer and the recovery is very
poor. So patient is psychologically depressed.

4. Future anticipations
 Client is capable of handling the situation- will need support and encouragement to do
so.
 He has the plans to go back home and to resume the activities which he was doing prior
to the hospitalization.
 He also planned in his mind about the future follow up i.e continuation of medicine.

5. Activities of client that he can do to help himself

 Patient is using his own coping strategies to adjust to the situations.
 He is spending time to read religious books and also spends time in talking with others
 He is trying to clarify his own doubts in an attempt to eliminate doubts and to instill
hope.
 He sets his major goal i.e. a healthy and speedy recovery.
 6. Client's expectations of family, friends and caregivers
 He sees the health care providers as a source pt information.
 He tries to consider them as a significant members who can help to overcome the stress
 He seeks both psychological and physical support from the care givers, friends and
family members
 He sees the family members as helping hands and feels relaxed when they are with him.

Evaluation/ summary of impressions-

There is no apparent discrepancies identified between patient’s perception and the care givers
perceptions.
INTRAPERSONAL FACTORS
1. Physical examination and investigations
Height- 162 cm
Weight – 42 kg
TPR- 37o C, 74 b/m, 14 breaths per min
BP- 130/78 mm of Hg
 Eye- vision is normal; on examination the appearance of eye is normal. Conjunctiva is
pale in appearance. Pupils reacting to the light.
 Ear- appearance of ears normal. No wax deposition. Pinna is normal in appearance and
hearing ability is also normal.
 Respiratory system- respiratory rate is normal, no abnormal sounds on auscultation.
Respiratory rate is 16 breaths per min.
 Cardiovascular system- heart rate is 76 per min. on auscultation no abnormalities
detected. Edema is present over the left ankle which is non pitting in nature.
 GIT- patient has the complaints of reduced appetite, nausea; vomiting abdominal pain at
right iliac region , tenderness present, & food intake is very less. Mouth- on
examination is normal. Bowel sounds are reduced. Abdomen could not be palpated
because of the presence of the surgical incision. Bowel habits are not regular after the
hospitalization
 Extremities- range of motion of the extremities are normal. Edema is present over the
left ankle which is non pitting in nature. Because of weakness and fatigue he is not able
to walk with out support
 Integumentary system- extremities are mild yellowish in color. No cyanosis. Capillary
refill is normal.
  Genitor urinary system- patient has difficulty in initiating the urine stream. No
complaints of painful micturition or difficulty in passing urine.
 Self acre activities- perform some of his activities, for getting up from the bed he needs
some other person’s support. To walk also he needs a support. He do his personal care
activities with the support from the others
 Immunizations- it is been told that he has taken the immunizations at the specific
periods itself and he also had taken hepatitis immunization around 8 years back
 Sleep –. He told that sleep is reduced because of the pain and other difficulties. Sleep is
reduced after the hospitalization because of the noisy environment.
 Diet and nutrition- patient is taking mixed diet, but the food intake is less when
compared to previous food intake because of the nausea and vomiting. Usually he takes
food three times a day.
 Habits- patient does not have the habit of drinking or smoking.
 Other complaints- patient has the complaints of pain fatigue, loss of appetite, dizziness,
difficulty in urination, etc...

2. Psycho- socio cultural

 Anxious about his condition
 Depressive mood
 Patient is a retired teacher and he is Hindu by religion.
 Studied up to TCH
 Married and has 4 children(2sons and 2 daughters)
 Congenial home environment and good relationship with wife and children
 Is active in the social activities at his native place and also actively involves in the
religious activities too.
 Good and congenial relationship with the neighbours
 Has some good and close friend at his place and he actively interact with them. They also
very supportive to him
 Good social support system is present from the family as well as from the
neighbourhood.

3. Developmental factors
 Patient confidently says that he had been worked for 32 years as a teacher and he was a
very good teacher for students and was a good co-worker for the friends.
 He told that he could manage the official and house hold activities very well
  He was very active after the retirement and once he go back also he will resume the
activities

4. Spiritual belief system

 Patient is Hindu by religion
 He believes in god and used to go to temple and also an active member in the religious
activities.
 He has a personal religious books and he used to read it min of 2 times a day and also
whenever he is worried or tensed he used to pray or read religious books.
 He has a good social support system present which helps him to keep his mind active.

INTERPERSONAL FACTORS
 Has supportive family and friends
 Good social interaction with others
 Good social support system is present
 Active in the agricultural works at home after the retirement
 Active in the religious activities.
 Good interpersonal relationship with wife and the children
 Good social adjustment present

EXTRAPERSONAL FACTORS
 All the health care facilities are present at his place
 All communication facilities, travel and transport facilities etc are present at his own
place.
 His house at a village which is not much far from the city and the facilities are available
at the place.
 Financially they are stable and are able to meet the treatment expenses.

SUMMARY
 Physiological- thin body built. Nausea, vomiting, reduced appetite, reduced urinary out
put. Abdominal pain at right iliac region, Diagnosed to have Appendisities.
 Psycho socio cultural factors- patient is anxious about his condition. Depressive mood.
Not interacting much with others. Good support system is present.
 Developmental –no developmental abnormalities. Appropriate to the age.
  Spiritual- patient’s belief system has a positive contribution to his recovery and
adjustment.

INVESTIGATION:

Date Type Patient value Normal valve Remarks

26.08.09 Hemoglobin 12.9 13.19g/dl Normal

WBC 11000 4000-11000 Normal

cells/cumm
Sodium 140meq/dl Normal
135-145meq/dl
Potassium 4meq/dl Normal
3.5-5meq/dl
Chloride 98meq/dl Normal
97-107meq/dl
ESR 20meq/dl Normal
<30mm/hr
Urea 16mg/dl Normal
10-20mg/dl
Creatine 1mg/dl Normal
0.5-1.5mg/dl
RBC 120mg/dl Normal
80-130mg/dl
Normal
Medication

Date Drug Name Dose Route Action Side effects Nurses responsibility

26.08.09 Inj.cefotaxim 1gm IV/BD Higly gram-negative anti- -anaphylactic -assess the patient vital
e biotic producing reaction signs
organisms,active against
-GI disturbance -give test dose before giving
pseudomonas anaerobic
full dose
bacteria and spirochetes -Thrombocyto
-watch for anaphylactic
penia
reaction
-Candidiasis

2.Inj. 100mg IV/BD opioid analgesics by -respiratory -watch for side effects
activating opioid depression
Tramodol -It should be given IM/IV
receptors in the central
-hypotension route only
and peripheral nervous
systems Pulmonary -watch for side effects
edema watch for complication

3.Inj.Rantac 50mg IV/BD H2 receptor antagonist, it -none reported, -it should be given in empty
blokes the histamine h2 other: headache, stomach
receptors , and prevents dizziness, rarely
histamine mediated hepatitis, Watch for any allergic
gastric acid secretion confusion, reaction.
hypersensitivity
 Anatomy and physiology of Appendix

The GI System

The gastro-intestinal system is essentially a long tube running right through the body, with
specialised sections that are capable of digesting material put in at the top end and extracting
any useful components from it, then expelling the waste products at the bottom end. The
whole system is under hormonal control, with the presence of food in the mouth triggering off
a cascade of hormonal actions; when there is food in the stomach, different hormones activate
acid secretion, increased gut motility, enzyme release etc. etc.

Nutrients from the GI tract are not processed on-site; they are taken to the liver to be broken
down further, stored, or distributed.

Appendix

Appendix is a small, finger like appendage about 10cm long (4in) that is attached to the
cecum just below the iliocecal valve. The appendix fills with food and empties regularly into
the cecum. Because it empties insufficiently and its lumen is small, the appendix is prone to
obstruction and is particularly vulnerable to infection.

APPENDICITIS

INTRODUCTION
Appendicitis is a common condition that affects 7% of the population, according to
the American Academy of Family Physicians. Persons of any age may be affected, with the
highest incidence occurring during the second and third decades of life. Rare cases of neonatal
and prenatal appendicitis have been reported. Increased vigilance in recognizing and treating
potential cases of appendicitis is required for the very young and old who have a higher rate
of complication.

MEANING
The appendix is a narrow tubular pouch attached to the intestines. When the appendix
is blocked, it becomes inflamed and results in the condition known as appendicitis. If the
blockage continues, the inflamed tissue becomes infected with bacteria and begins to die from
a lack of blood supply, which finally results in the appendix bursting (perforated appendix).

10
CAUSES
 There is no clear cause of appendicitis.
 Fecal material is thought to be one possible obstructing object.
 Bacteria, viruses, fungi, and parasites can be responsible agents of an infection that leads
to swelling of the tissues of the appendix wall, including Yersinia species, adenovirus,
cytomegalovirus, actinomycosis, Mycobacteria species, Histoplasma species, Schistosoma
species,
 pinworms, and Strongyloides stercoralis. Also,
swelling of the tissue from inflammatory bowel diseases such as Crohn's disease may cause
appendicitis.
 It appears that appendicitis is not hereditary or transmittable from person to person.

PATHOPHYSIOLOGY
The appendix becomes inflamed and edematous

The appendix becomes kinked or occluded by a fecalities ,tumor,or foreign body.

The inflammation process increases intraluminal pressure

Initiating a progressively sever generalized or upperabdominal pain

Later the inflamed appendix fills with pus.

SYMPTOMS
 Appendicitis typically begins with a vague pain in the middle of the abdomen often
near the navel or "belly button" (umbilicus).
 The pain slowly moves to the right lower abdomen (toward the right hip) over the next
24 hours.

11
  In the classic description, abdominal pain is accompanied with nausea, vomiting,
 lack of appetite, and
 fever.
 All of these symptoms, however, occur in fewer than half of people who develop
appendicitis. More commonly, people with appendicitis have any combination of these
symptoms.
Symptoms of appendicitis may take 4-48 hours to develop. During this time, someone
developing appendicitis may have

 varying degrees of loss of appetite,

 vomiting, and
 abdominal pain.
 Some may have constipation,
 diarrhea, or
 there may be no change in bowel habits.
 Early symptoms are often hard to separate from other conditions including
 gastroenteritis (an inflammation of the stomach and intestines). Many people
admitted to the hospital for suspected appendicitis leave the hospital with a
diagnosis of gastroenteritis; true appendicitis is often mis-diagnosed as
gastroenteritis initially. Children and the elderly often have fewer symptoms, which
makes their diagnosis less obvious and the incidence of complications more
frequent.

DIAGNOSTIC TESTS
Lab work: Although no blood test can confirm appendicitis, a blood sample is sent for
laboratory analysis to check the

 white blood cell count, which is typically elevated in an individual with appendicitis.
However, normal levels can be present with appendicitis, and elevated levels can be
seen with other conditions.
 A urine test may be performed to exclude urinary tract infection (or pregnancy) as
the cause of the symptoms.

Imaging tests: Appendicitis is diagnosed by the

 classic symptoms and the physical exam (the doctor's examination of the patient's
abdomen). Imaging tests are used when the diagnosis is not readily apparent.
 Most medical centers now use a CT scan of the abdomen and pelvis to help evaluate
abdominal pain suspected of being caused by appendicitis.
 Ultrasound scanning is currently commonly used in small children to test for
appendicitis.

12
APPENDICITIS TREATMENT
Self-Care at Home

 There is no home care for appendicitis.

 If the condition is suspected, contact a doctor or go to an emergency department.
 Avoid eating or drinking as this may complicate or delay surgery.
 If the person is thirsty, he/she may rinse their mouth with water.
 Do not take (or give your child) laxatives, antibiotics, or pain medications because
these may cause delay in diagnosis that increases the risk of rupture of the appendix or
mask the symptoms, which makes diagnosis more difficult.

Surgery
 The best treatment for appendicitis requires surgery to remove the appendix (the
operation is called an appendectomy) before the appendix opens or ruptures. While
awaiting surgery, the patient will be given IV fluids to keep hydrated. The patient will
not be allowed to eat or drink because doing so may cause complications with the
anesthesia during surgery.
 Surgery is commonly done laparoscopically (through small incisions using a camera in
the abdominal cavity). However, in some cases it may be necessary to do an open
abdominal procedure to take the appendix out.
 Up to 20% of surgeries for appendicitis reveal a non-inflamed appendix (negative
appendectomy). The difficulty in making a definite diagnosis of this medical problem
and the risk of missing the acutely inflamed appendix (and the patient becoming very
ill due to perforation) makes a certain rate of misdiagnosis inevitable. Women in
particular have a high rate of negative appendectomy as ovarian and uterine problems
make the diagnosis more difficult. CT scanning prior to surgery has been shown to
decrease this percentage to closer to 7%-8% in women.

Follow-up
After an uncomplicated appendectomy, the patient may gradually resume a normal diet
with a restriction in physical activity for at least two to four weeks. The doctor will check the
incision the following week to look for possible wound infection.

Prevention
There is no way of predicting when appendicitis will occur. It cannot be prevented.

Outlook
 With uncomplicated appendicitis, most people recover with no long-term problems.
 If the appendix ruptures, there is a greater than 10 times risk of complications,
including death. This increase in risk generally is found in the very young, elderly, and
those with weakened immune systems, including people with diabetes.
Whether a perforated appendix is a significant risk for infertility has not been well
established. Some experts recommend that this be considered in young women who might be
at risk.

13
CAMPARISION WITH THE PATIENT PICTURE AND BOOK PICTURE

SIGNS AND SYMPTOMS

BOOK PICTURE PATIENT PICTURE

CAUSES
 There is no clear cause of appendicitis. Fecal material is thought to be
one possible obstructing object
 Fecal material is thought to be
one possible obstructing object.
 Bacteria, viruses, fungi, and
parasites can be responsible agents of an
infection that leads to swelling of the
tissues of the appendix wall.
 swelling of the tissue from
inflammatory bowel diseases such as
Crohn's disease may cause appendicitis.
 It appears that appendicitis is not
hereditary or transmittable from
person to person.

SIGNS AND SYMPTOMS SIGNS AND SYMPTOMS

 Vague epigastric or periambulical * epigastric or periambulical

pain progresses to right lower pain progresses to right lower
quadrent pain and is usually quadrent pain and is usually not
accompanied by low grade fever accompanied by low grade fever.

 Nausea * Nausea is present

 vomiting * Patient had vomiting
 Indigestion and gas bloating * Bloating and gas is not present
 Fever 14
* Fever is not present
 BOOK PICTURE PATIENT PICTURE

 Palpable abdominal mass  Palpable abdominal mass is not

present
 Rebound tenderness  Rebound tenderness present
 Pain on urination  Pain on urination present
 Loss of appetite  Loss of appetite
 Local tenderness at Mc Burney’s  Local tenderness at Mc Burney’s
point present Point

Pathophysiology Pathophysiology

The appendix becomes inflamed and The appendix becomes inflamed and
edematous edematous

The appendix becomes kinked or occluded by The appendix becomes kinked or occluded by
a fecalities ,tumor,or foreign body. a fecalities ,tumor,or foreign body.

The inflammation process increases The inflammation process increases

intraluminal pressure intraluminal pressure

Initiating a progressively sever generalized or Initiating a progressively sever generalized or

upperabdominal pain upperabdominal pain

Later the inflamed appendix fills with pus. Later the inflamed appendix fills with pus.

MANAGEMENT
Medical management Medical management
 Antibiotic  Inj.cefotaxime
 Analgesics
 H2 receptor antagonists  Inj. Tramodal

Surgical management  Inj. Rantac

Surgical management
 Laparoscopic appendicectomy
 Appendicectomy
 Appendicectomy Patient undergoing
Appendicectomy

15
NURSING PROCESS

I. NURSING DIAGNOSIS
Acute pain related to the presence of surgical wound on abdomen secondary to
appendisectomy
Desired Outcome/goal: to reduce the pain.

Nursing action

Primary prevention Secondary Tertiary prevention

prevention

 Assess severity of pain by using a  Teach the patient  Educate the client
pain scale about the relaxation about the
 Check the surgical site for any techniques and importance of
signs of infection or make him to do it cleanliness and
complications  Encourage the encourage him to
patient to divert his maintain good
 Support the areas with extra
mind from pain and personal hygiene.
pillow to allow the normal
alignment and to prevent strain to engage in  Involve the family
pleasurable members in the
 Handle the area gently. Avoid
activities like taking care of patient
unnecessary handling as this will
with others  Encourage
affect the healing process
 Do not allow the relatives to be with
 Clean the area around the
patient to do the client in order
incision and do surgical dressing
strainous activities. provide a
at the site of incision to prevent
And explain to the psychological well
any form of infections
patient why those being to patient .
 Provide non-pharmacological activities are  Educate the family
measures for pain relief such as contraindicated. members about the
diversional activity which
 Involve the patient pain management
diverts the patients mind.
in making decisions measures.
 Administer the pain medications about his own care  Provide the
as per the prescription by the and provide a primary and
pain clinics to relieve the positive secondary
severity of pain. psychological preventive
 Keep the patient’s body clean in support measures to the
order to avoid infection.  Provide the primary client whenever
preventive care necessary.
when ever
necessary

16
Evaluation – patient verbalized that the pain got reduced and the pain scale score also was
zero. His facial expression also reveals that he got relief from pain.

II. NURSING DIAGNOSIS

Activity intolerance related to fatigue secondary to pain at the surgery site, and
dietary restrictions
Outcome/ goals: to developed appropriate levels of activity free from excess fatigue, as
evidenced by normal vital signs & verbalized understanding of the benefits of gradual
increase in activity & exercise.

Nursing actions

Primary prevention Secondary prevention Tertiary prevention

 Adequately oxygenate the  Instruct the client to  Encourage the

client avoid the activities client to do the
 Instruct the client to avoid which causes mobility exercises
the activities which causes extreme fatigue.  Tell the family
extreme fatigue  Advice the client to members to
 Provide the necessary perform exercises to provide
articles near the patients strengthen the nutritious diet in
bed side. extremities& a frequent
promote activities intervals
 Assist the patient in early
ambulation  Tell the client to  Teach the patient
avoid the activities and the family
 Monitor client’s response
such as straining at about the
to the activities in order to
stool etc importance of
reduce discomforts.
 Teach the client psychological
 Provide nutritious diet to well being in
about the
the client. recovery.
importance of early
 Avoid psychological ambulation and  Provide the
distress to the client. Tell assist the patient in primary and
the family members to be early ambulation secondary level
with him. care if necessary.
 Teach the mobility
 Schedule rest periods exercises
because it helps to alleviate appropriate for the
fatigue patient to improve
the circulation

17
 Evaluation – patient verbalized that his activity level improved. He is able to do some of
his activities with assistance. Fatigue relieved and patient looks much more active and
interactive.

NURSING DIAGNOSIS-III
Impaired physical mobility related to presence of dressing, pain at the site of
surgical incision
Outcomes/goals: Improved physical mobility as evidenced by walking with minimum
support and doing the activities in limit.

Nursing action

Primary prevention Secondary prevention Tertiary prevention

 Provide active and  Provide positive  Educate and re-

passive exercises to all reinforcement for educate the client
the extremities to even a small and family about the
improve the muscle improvement to patients care and
tone and strength. increase the recovery
 Make the patient to frequency of the  Support the patient,
perform the breathing desired activity. and family towards
exercises which will  Teach the mobility the attainment of
strengthen the exercises the goals
respiratory muscle. appropriate for the  Coordinate the care
 Massage the upper patient to improve activities with the
and lower extremities the circulation and family members and
which help to improve to prevent other disciplines
the circulation. contractures like physiotherapy.
 Provide articles near
 Mobilize the patient  Teach the
to the patient and
and encourage him importance of
encourage doing
to do so whenever psychological well
activities within limits
possible being which
which promote a
feeling of well being.  Motivate the client to influence indirectly
involve in his own the physical
care activities recovery
 Provide primary  Provide primary
preventive measures preventive
whenever necessary measures whenever
necessary

18
 Evaluation – patient’s physical activity improved and he is able to move from bed with
support. Patient started doing the active and passive exercises and he verbalized
improvement.

NURSING DIAGNOSIS- IV
Imbalanced nutrition related to anorexia and vomiting
Outcomes/goals: to improve the nutritional status improved as evidenced by increased
appetite and decreased vomiting

Nursing action

Primary prevention Secondary prevention Tertiary prevention

 Assess the  Provide positive  Educate and

nutritional status. reinforcement for reeducate the client
 Assess fluid level . even a small and family about the
 Provide more oral improvement to patients care and
diet increase the recovery
 Provide fluid rich frequency of the  Support the patient,
diet. desired food intake and family towards
 Provide articles near  Teach about less the attainment of the
to the patient and and frequent diet goals
encourage doing intake.  Teach the
activities within
 Maintain intake and importance of
limits which promote
output chart psychological well
a feeling of well
 Motivate the client being which
being.
to involve in his influence indirectly
own care activities the physical recovery

 Provide primary  Provide primary

preventive preventive measures
measures whenever whenever necessary
necessar

Evaluation – patient’s nutritional status is improved and he is able to take food.

19
 HEALTH EDUCATION

DATE TOPIC HEALTH EDUCATION

NUTRITION  Advised the patient to take high calorie diet.
 Advised to take small frequent diet.
 Advised to take plenty of oral fluid.
 Advised to take food rich in vitamin ‘c’ to promote healing.
 Advised the family member to increase the palatability of
the food.
 Advised to take high fiber diet.
 Advised the family members to feed the patient according
to his comfort.

 Advised the pt about treatment and its continuation,

 Advised about timings of medicine intake.
TREATMENT  Advised to take full course of medicine.
 Advised the importance of medicine intake and harms if
discontinued.
 Explained about the side effects of the medicine and the
remedies for that.
 Advised to have plenty of oral fluids with the medicine to
prevent constipation and side effects.

 Advised the patient to maintain good personal hygiene.

 Advised the patient to take daily bath and wear clean
cloth.
 Advised to keep the Niles short, and keep the ears clean.
 Advised the family members to maintain good hygiene
PERSONAL during food preparation & serving.
HYGIENE  Advised the pt about the importance of personal hygiene
and how it influence on shealth.

HEALTH
EDUCATION

DATE
TOPIC

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 EXERCISE

 Advised the patient to do deep breathing and coughing

exercise.
 Advised the patient to do leg exercises to prevent DVT.
 Advised the pt to avoid vigorous exercises.
 Advised the patient to support the incision sight during
coughing and sneezing.
 Advised about the importance of early ambulation.
 Advised, not to lift heavy objects for around 3months.
 Advised to avoid straining while passing stools.

 Advised the pt about treatment and follow up care.

 Advised to take treatment continuously.
 Advised to come for follow-up checkups.
FOLLOW UP  Advised to seek immediate medical attention in case of
any problem.
 Advised to inform to the doctor about the problems.
 Advised to keep all the records of health for further
reference.

Summary:
Mr. Harish got admitted in male Surgical ward, Victoria hospital with the complaints of
severe abdomen pain nausea, vomiting since 3 days. After the thorough assessment doctor
diagnosed him as appendicitis. I observed the patient Mr. Harish was vomiting, nausea, and

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restlessness due to abdomen pain. I planned and started giving care for 3 days after the care
patient general condition improved. and from the hospital with stable vital signs.

Conclusion
The Neumann’s system model when applied in nursing practice helped in identifying
the interpersonal, intrapersonal and extra personal stressors of Mr.Harish from various
aspects. This was helpful to provide care in a comprehensive manner. The application of
this theory revealed how well the primary, secondary and tertiary prevention
interventions could be used for solving the problems in the client.

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