I.

Introduction

Acute appendicitis is inflammation of the appendix, the narrow, finger-shaped organ that
branches off the first part of the large intestine on the right side of the abdomen. Although the
appendix is a vestigial organ with no known function, it can become diseased. In fact, acute
appendicitis is the most common reason for abdominal surgery in the world.
If it is not treated promptly, there is the chance that the inflamed appendix will burst, spilling
fecal material into the abdominal cavity. The usual result is a potentially life-threatening
infection (peritonitis), but the infection may become sealed off and form an abscess.
Appendicitis is usually caused by a bacterial infection, although the reason the appendix
becomes infected is unknown. The appendix may become obstructed by a lump of feces, calcium
salts, and fecal debris (called fecaliths) or tumors (rarely), leading to inflammation and infection.
Swelling and inflammation lead to infection, blood clot, or rupture of the appendix.To treat
appendicitis, the appendix must be removed (appendectomy) either through a small incision or
with a special instrument (laparoscope). Surgery should not be delayed more than a few hours. If
an abscess has formed, your doctor may drain it and prescribe antibiotics. Appendectomy may be
scheduled for a later date. Acute appendicitis is one of the most commonsurgical emergencies
seen in the Philippines. According to statistics as of Over 250,000 appendectomiesare performed
annually.
This case study aims to present the case of a 20 year old college student who experienced
sudden pain in his epigastric region then transferred to his right lower quadrant. The patient first
felt the pain in his epigastic region around 9 in the morning after breakfast last September 18,
2015, Friday. He thought that it was just an acid so he went to a nearby pharmacy and bought an
Antacid (Kremil S), but the pain he was feeling did not lessen. He gave a 9 out of 10 pain scale.

This case topic gave me interest because even though I havent experienced this yet but
some close to me have, especially my sister. also, with this case study, my knowledge about

1 | Page

appendicitis will be expanded and will help me deliver proper health teachings in the future.

II.

Nursing Objective

A. GENERAL
After 1 hour of nurse-client interaction, the student nurse will be able to:

Gain more information, knowledge and skillsthrough additional research about the nature
of the disease, its signsand symptoms, its pathophysiology, its diagnosis and treatment.

B. SPECIFIC
Specific
STUDENT-NURSE CENTERED
After 3 days of student nurse-patient interaction, the student nurse will be able to:
1. Assess the patients functional patterns, health history and signs and
symptoms manifested.
2. Review the anatomy and physiology of the affected system in a client
who had appendicitis.
3. Discuss the physiology and pathology in relation to disease process.
4. Identify the purpose and actions of different drugs given to the client.
5. Discuss the interpretation and implications of clients laboratory and
diagnostic results for Appendicitis.
PATIENT-CENTERED
After 3 days of student nurse-patient interaction, the patient will be able to:
1. Report adequate information to the student nurse regarding the
patients history, health condition, concerns and other relevant data.
2. Discuss actively with the student nurse in implementing the planned
nursing interventions.
3. Demonstrate improved capability in performing activities of daily
living.

III. ANATOMY AND PHYSIOLOGY

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The appendix (or vermiform appendix; also cecal [or caecal] appendix; vermix; or vermiform
process) is a blind-ended tube connected to the cecum, from which it develops embryologically.
The cecum is a pouch like structure of the colon, located at the junction of the small and
the large intestines.
The term "vermiform" comes from Latin and means "worm-shaped".

The human appendix averages 9 cm in length but can range from 2 to 20 cm. The diameter of the
appendix is usually between 7 and 8 mm. The longest appendix ever removed measured 26 cm
from a patient in Zagreb,Croatia.]The appendix is usually located in the lower right quadrant of
the abdomen, near the right hip bone. The base of the appendix is located 2 cm beneath
the ileocecal valve that separates the large intestine from the small intestine. Its position within
the abdomen corresponds to a point on the surface known as McBurney's point.
The appendix is connected to the mesentery in the lower region of theileum, by a short tube
known as the mesoappendix

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The most common diseases of the appendix (in humans) are appendicitis and carcinoid tumors
(appendiceal carcinoid). Appendix cancer accounts for about 1 in 200 of all gastrointestinal
malignancies. In rare cases, adenomas are also present.[20]

Appendicitis
Appendicitis is a condition characterized by inflammation of the appendix. Pain often begins in
the center of the abdomen, corresponding to the appendix's development as part of the
embryonic midgut. This pain is typically a dull, poorly localized, visceral pain.
As the inflammation progresses, the pain begins to localize more clearly to the right lower
quadrant, as the peritoneum becomes inflamed. This peritoneal inflammation, or peritonitis,
results in rebound tenderness (pain upon removal of pressure rather than application of pressure).
In particular, it presents at McBurney's point, 1/3 of the way along a line drawn from the anterior
superior iliac spine to the umbilicus. Typically, point (skin) pain is not present until the parietal
peritoneum is inflamed, as well. Fever and an immune system response are also characteristic of
appendicitis.
Appendicitis usually requires the removal of the inflamed appendix, in an appendectomy either
by laparotomy orlaparoscopy. Untreated, the appendix may rupture, leading to peritonitis,
followed by shock, and, if still untreated, death.
Surgery
The surgical removal of the vermiform appendix is called an appendectomy. This removal is
normally performed as an emergency procedure when the patient is suffering
from acute appendicitis. In the absence of surgical facilities,intravenous antibiotics are used to
delay or avoid the onset of sepsis. In some cases, the appendicitis resolves completely; more
often, an inflammatory mass forms around the appendix. This is a relative contraindication to
surgery.
The appendix is also used as a means to access the colon in children with paralysed bowels or
major rectal sphincter problems. The appendix is brought out to the skin surface and the
child/parent can then attach a catheter and easily wash out the colon (via normal defaecation)
using an appropriate solution.
4 | Page

IV. DEFINITION OF TERMS

1. ABDOMEN - the part of the body of a vertebrate that contains the stomach,intestines,
and other organs
2. APPENDIX - anatomy small outgrowth from large intestine: a blind-ended tubeleading
from the first part of the large intestine (cecum), near its junction with thesmall intestine.
In humans it is small, occurs in the lower right-hand part of theabdomen, and contains
cells of the immune system
3. APPENDICITIS - Acute inflammation of the vermiform (wormlike) appendix, a blind
tube projecting from the cecum
4. APPENDECTOMY - operation to remove appendix: a surgical operation toremove the
appendix
5. ALIMENTARY CANAL - the principal part of the digestive system. It begins atthe
mouth and extends to the anus
6. CECUM - the pouch in which the large intestine begins, which is open at one end
7. EPIGASTRIUM - the upper middle part of the abdomen
8. ILEOCECAL VALVE - a membranous structure between the cecum and thesmall
intestine that regulates the passage of food material from the small intestineto the large
intestine and also prevents the passage of toxic waste products fromthe large intestine
back into the small intestine
9. IMMUNOGLOBULIN - glycoprotein with a high molecular weight that acts like
anantibody and is produced by white blood cells during an immune response
10. MCBURNEY'S POINT - can be found at the midpoint of a straight linedrawn from the
umbilicus to the right anterior iliac crest
11. PERFORATION - making holes or having them: the act of making a hole or holes in
something or the state of being perforated
12. STRICTURE - a severe criticism or strongly critical remark
13. VERMIFORM - resembling or having the form of a worm

V. Baseline Data
Name of patient: K.G.
5 | Page

Age: 20 years old

Address: Victorias City, Negros Occidental
Birthdate: June 5, 1995
Birth Place: Victorias City, Negros Occidental
Gender: Male
Civil Status: Single
Religion: Roman Catholic
Educational Level: College student
Nationality: Filipino
Occupation: Student
Person next to kin: Mother (C.G.)
Source of History: Patient
Admitting Physician: Johanna Errika S. Desales, M.D.
Attending Physician: Dr. Manuel
Agency: Corazon Locsin Montelibano Memorial Regional Hospital
Area: General Surgery Ward 1
Chief Complaint: Right Lower Quadrant Pain
Date of Admission: Sept 19, 2015
Admitting Diagnosis: Acute Appendicitis
VI. Nursing History
11 Gordons Functional Health Patterns

6 | Page

1. Health Maintenance Perception Pattern

The client is 20 years old and is a student of Carlos Hilado Memorial State College in
Talisay City. He was admitted last September 19, 2015 at 4:00pm in Corazon Locsin
Monetelibano Memorial Regional Hospital. The patient was first hospitalized at Teresita Lopez
Jalandoni Provincial Hospital on September 18, 2015 for he was experiencing epigastric pain
with the pain scale of 10 out of 10. He went to TLJPH after hours of experiencing in his
epigastric region. His fellow On the Job trainees massaged the affected area for they thought
hangin was the cause of pain but instead it would relieve, the pain worsen.
The client is not alcoholic but drinks soft drinks almost every day for approximately 2-3
times a day. The patient also never tried smoking and doesnt have any vices. He does jogging,
walkin and playing basketball as a form of exercise. He is very cooperative and does take the
doctors orders seriously.

2. Nutritional-Metabolic Pattern

K.G., the patient typically eats processed foods as well as fast foods for he likes the taste
of it as well as it doesnt required to be cooked. He sometimes eats vegetables but it only
depends on his mood. Whenever the food has coconut milk in it, he likes eating it. After the
surgery, he had a loss of appetite but it only lasted for a day because according to him, he felt he
is already starving himself. K.G. is on diet a tolerated which means he can eat anything as long
as can tolerate eating the food.
He used to take OTC drugs whenever he has fever or experiences pain. It was actually his
first time to take an Antacid medicine, for he thought the epigastric pain that he felt prior to
admission was due to acid.

3. Elimination Pattern

According to the patient, he usually urinate 250-500cc of urine and it is yellowish in

colour. He defecates once a day to a well-formed stool. After the surgery, even until upon the
assessment of the student nurse, he has not yet defecated.

4. Activity & Exercise Pattern

7 | Page

During the clients spare time, he would usually sleep or play computer games.
According to him, it takes him 5 hours in playing in the computer. Currently, he is completing his
required hours in his OJT. He works at Transcor Motors Inc. located at Singcang, Bacolod City
and does whatever their chief mechanic tells them to do.
During his hospitalization, he verbalized he prefers walking around rather than lying on
bed, because he feels weaker when he is just in bed. Sometimes he moves with assistance when
standing up and going to the bathroom. But he likes to do things on his own and insists to do
things without assistance.

5. Sleep & Rest Pattern

The client doesnt have a good sleeping pattern upon staying in the ward. He would
usually have 3 hours of sleep due to several factors; the noise in his surroundings made by the
other patients and their SO that kept on bothering him in his sleeping time, as well as he doesnt
feel comfortable because of poor ventilation and he would always fan himself.
He feels tired when he is lying in bed so he prefers walking around as it can help him
breath fresh air and as well as exercise his body. He feels more energized when he is moving a
lot.

6. Cognitive Perceptional Pattern

The client is very cooperative and is coherent in his surroundings. Before his surgery, he
was asked if he was nervous about the procedure to be done, and he answered that he is not. He
showed his bravery even after the procedure. He said that the procedure will not long and the
pain will just disappear.

7. Self-Perception and Self-Concept Pattern

The client is aware of his condition and understands the consequence that goes with it.
Most of the time, he is on bed but would request that he would do walking to feel more
energized, to lessen the weakness he feels and for him not to get bored. He also expresses his
desire to go home to resume his works in his OJT and live a normal life again.

8. Role Relationship Pattern

8 | Page

The client has a strong support system. His mother is always with him all throughout his
hospital stay and just goes home whenever she needs to get some additional needed things. His
father works for the family as a driver. He has a one older brother who already works at Central
Victorias (Sugar Central Victorias) in Victorias City and a twin brother who, as the same as him,
is in his OJT. His friends and classmates often ask his condition if he is doing fine and some of
them visit him. Her girlfriend for 6 months is also with him in the hospital, helping his mother in
watching him. They have a sweet bonding and the patient would always laugh and smile
whenever she is around and when they are talking.

9. Sexuality-Reproductive Pattern

In Sigmund Freuds Psychosexual Theory, the patient is in the Genital Stage. This stage is
the last stage in his theory as it begins in puberty until the death of a person. It is a time of
adolescent sexual experimentation, the successful resolution of which is settling down in a loving
one-to-one relationship with another person in our 20s. Sexual instinct is directed to heterosexual
pleasure, rather than self pleasure like during the phallic stage. The client has expressed his
purity towards sex. Even though he has a girlfriend for 6 months, he verbalized that this is his
first serious relationship as well as the longest so far. His priority at this time is his studies
because he is already graduating and will soon work to help in the finances of their family.

10. Coping and Stress Tolerance Pattern

The client has an optimistic outlook in life. He doesnt have any vices and never tried
one. At the hospital, he expresses his desire to move more to lessen the weakness he felt
whenever lying down. He also verbalized about the uncomfortable environment in the ward. In
the chart, he already have a doctors order of may go home.
11. Values and Beliefs Pattern

The client is Roman Catholic but seldom go to church. But he verbalized that he often
prays especially when he is about to ride his motorcycle. He also prayed before his surgery and
thanked God because it became successful and there were no side effects from the anesthesia
felt.

VII. Health History

1. History of present illness
9 | Page

1 day prior to admission, the patient had sudden onset of epigastric pain, radiating to the
RLQ, the patient had 3 episodes of vomiting approximately 90cc each, yellowish in color,
associated with loss of appetite.

2. Past Health History

a) Past Illnesses
- The client had only experienced minor health problems such as occasional cough,
colds, and fever.
b) Past hospitalization
- Patient has no previous hospitalization, no history of Hypertension, Diabetes,
Cancer, no known allergies.
c) Serious Illness/Chronic Illness
- The client doesnt have any serious illness/chronic illness.
d) Previous Surgery
- The client has no previous surgery.

3. Family/Social History
- According to the patient, he is a non-smoker. He never tried smoking for it is against the
will of his mother. He is also a non-alchoholic drinker but drinks soft drinks almost every
day for approximately 2-3 times a day.

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VIII. Assessment
September 21, 2015 (Monday)
LOC:

Awake, lying flat on bed in a supine position

Oriented to time, place and time
Responsive to verbal and nonverbal stimuli

HEENT:

Normal face symmetry and head circumference

Hair evenly distributed; scalp in good condition

Pupils are equally round and reactive to light and accommodation

With pinkish conjunctiva

CARDIOVASCULAR:

Blood pressure of 120/70 mmHg taken at right arm in a lying position

Pulse rate of 82 bpm
With good capillary refill at less than 2 seconds

RESPIRATORY:

Breathes spontaneously to room air at 20 cpm

With symmetrical rise and fall of chest upon respiration

GIT:

On DAT as ordered

Able to consume 1 cup of rice with a viand

Has not defecated upon assessment

GUT:

Able to void to a yellow colored urine in a moderate amount approx 500ml

MS:
Able to move both upper and lower extremities upon assessment
INTEGUMENTARY:

Warm to touch

Afebrile Temp of 36.8C

With good skin turgor

11 | P a g e

IX. Laboratory
HEMATOLOGY
Ward requested date and time:09/19/15 1:10 PM
Date and time rendered: 09/19/15 1:59 PM
Date and time of collection:09/19/15 2:53 PM
Date and time released: 09/19/15 3:22 PM

Exam Name
Hematocrit
Hemoglobin

Result
0.45
148

RBC Count
WBC Count

5.30
14.2

Segmenters
Lymphocytes
Monocytes
Basophils
Platelet

Unit
L/L
g/L

Normal Value
.40-.54 L/L
130-180 g/L

10^12/L
10^9/L

4.5-5.5 10^12/L
4.5-11.0 10^9/L

76

13

25-35%

10

0-15%

0-1%

286

10^9/L

50-70%

150-400 10^9/L

Implication
High white
blood cell count
is also called
leukocytosis. A
high white
blood cell count
usually
indicates:An
increased
production of
white blood
cells to fight an
infection

REMARKS: Please correlate clinically for appropriate interpretation of result.

ABO & Rh Typing Result Form

ABO Typing:

Rh Typing: POSITIVE

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X. Pathophysiology
Pedisposing Factors

Precipitating Factor

Age (20 years old)

Male

Diet
Lifestyle

Obstruction of the lumen

Increase Intraluminal Pressure

Occlusion of capillaries and venules, ischemia of appendiceal wall, subsequent bacterial

infection

Inflammation of appendix

Breakdown of mucosa lining of the appendix

Gangrene and perforation of appendix

Acute Pain
Pain upon moving

Appendectomy

Limited Mobility

Activity Intolerance

13 | P a g e

ASSESSMENT

Subective:
"Gasakit
ang akon
pilas kung
maggiho
kag ubo,
as

NURSING
DIAGNOSIS
Acute Pain
related to
presence of
surgical
incision as
evidenced by
verbal reports
of pain

verbalized

RATIONALE

Predisposing
Precipitating Factors
Factors

20 years old
Lifestyle
Male
Surgical operation

by the

DESIRED
OUTCOME
After nursing
care, the client
will:

Reference:

Presence of surgical
incision

(Doenges,
Vital signs Marilyn E., Murr,
Alice C.,
taken as
Moorhouse,
follows:
Mary Frances.
BP 120/70 (Diagnoses,
prioritized
mmHg
Interventions
T 36.8 C
and Rationales
PR - 82
11thEd.,F.A. Davis
Company.)
bpm

Ass
pai
usin
pai
sca
10)

Kee
res
sem
Fow
pos

1. Report pain is
relieved/
controlled
2. Appear
relaxed, able
appropriately

Collabora
:

Objective:

Independ

to sleep/ rest

patient

NURSI
INTERVE
ON

Acute pain

Adm
er
anal
s as
orde

RR - 20cpm
Postoperative
wound

ASSESSMENT

NURSING
DIAGNOSIS

RATIONALE

DESIRED
OUTCOME

14 | P a g e

NURSI
INTERVE
ON

Subective:

Fluid Volume
"Gapanaluk deficit related to
preoperative
a ko kapila vomiting
gid antis
gin

verbalized

Precipitating Factors
Factors

20 years old
Lifestyle

operahan,
as

Predisposing

Male
Reference:

(Doenges,
Marilyn E., Murr,
Alice C.,
patient
Moorhouse,
Mary Frances.
Objective:
(Diagnoses,
Vital signs prioritized
Interventions
taken as
and Rationales
follows:
11thEd.,F.A. Davis
BP 120/80 Company.)
by the

After nursing
care, the client
will:

1. Maintain
adequate

Mon
vita
sign
(BP
PR)

fluid

Inflammation of the
appendix

balance as
evidenced
by moist
mucous

Potective reflex
controlled by a region
of medulla

membrane
s, good
skin turgor

Several episodes of
Vomiting

mmHg

Insp
mu
me
nes
ass
skin
turg
and
cap
refi

Mon
I&O
not
urin
colo
con
rati

Fluid Volume

T 36.5 C

Independ

Deficit

PR - 96
bpm
RR - 26cpm

ASSESSMENT

NURSING
DIAGNOSIS

RATIONALE

DESIRED
OUTCOME

15 | P a g e

NURSI
INTERVE
ON

Subective:

Risk for Infection

"Ginahalun related to, surgical
incision
gan ko man
ang pilas ko
Reference:

(Doenges,
pa gid bala Marilyn E., Murr,
Alice C.,
haw, as
Moorhouse,
verbalized Mary Frances.
(Diagnoses,
by the
prioritized
patient
Interventions
and Rationales
11thEd.,F.A. Davis
Objective:
Company.)
Vital signs

Precipitating Factors
Factors

a) Achieve
timely
wound
healing

Lifestyle
Male

impeksyon

taken as

Independ

After nursing
care, the client
will:

20 years old

kay basi
magka

Predisposing

Inflammation of the
appendix

b) Display
signs free
of

Surgical prodecure
done

infection/
inflammati
on

Post operative wound

Monit
vital
signs
Note
onset
fever
chills
diaph
s

Pract
good
hand
ing a
asept
woun
care

Collabora
:

Risk for infection

follows:

Admini
antibio
as orde

BP 120/70
mmHg
T 36.8 C
PR - 82
bpm
RR - 20cpm
DRUG NAME

DOSAGE/
FREQUENCY/
ROUTE

MECHANISM OF
ACTION

INDICATION

CONTRAINDIC
ION

16 | P a g e

GENERIC NAME:

Dosage:

Ranitidine
hydrochloride

50mg

Frequency:
Q8H
BRAND NAME:
Zantac

Route:
IVTT

CLASSIFICATION:
Histamine-2
Antagonist

DRUG NAME

DOSAGE/
FREQUENCY/
ROUTE

Competitively
inhibits the
action of
histamine at the
H2 receptors of
the parietal
cells of the
stomach,
inhibiting basal
gastric acid
secretion and
gastric acid
secretion that is
stimulated by
food, insulin,
histamine,
cholinergic
agonists,
gastrin and
pentagastrin

MECHANISM
OF ACTION

Short term
treatment of
active
duodenal
ulcer
Maintenance
therapy for
duodenal
ulcer at
reduced
dosage
Short-term
treatment of
active,
benign
gastric ulcer
Short-term
treatment for
GERD
Treatment of
erosive
esophagitis

INDICATION

Contraindicate
with allergy to
ranitidine,
lactation
Use cautiously
with impaired
renal or hepat
function

CONTRAINDICATIO

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GENERIC NAME:

Dosage:

Omeprazole

40mg

Frequency:
1 tab OD
BRAND NAME:
Losec (CAN)

Route:
Oral

CLASSIFICATION:
Antisecretory
drug
Proton pump
inhibitor

Gastric acidpump inhibitor.

Suppresses
gastric acid
secretion by
specific
inhibition of the
hydrogenpotassium
ATPase enzyme
system at the
secretory
surface of the
gastric parietal
cells; blocks the
final step of
acid production

Name of Drug

Dosage, Route
and Frequency

Mechanism of
Action

Short-term
treatment of
active
duodenal
ulcer
Treatment of
heartburn or
symptoms of
GERD
Short-term
treatment of
active benign
gastric ulcer
GERD, severe
erosive
esophagitis,
poorly
responsive
symptomatic
GERD
Long-term
therapy:
treatment of
pathologic
hypersecreto
ry conditions
Prolisec OTC:
Treatment of
frequent
heart burn (2
or more days
per week)

Contraindicate
with
hypersensitivi
to omeprazole
or its
components
Use cautiously
with pregnanc
lactation

Indication

18 | P a g e

Contraind
n

Generic Name:
Celecoxib
Brand Name:
Lincox
Classification:
Analgesic
NSAID

IVTT
50mg
Q8h

Selectively
inhibits the
enzymatic
activity of
cyclooxygenase
-2 (COX-2)
thereby
inhibiting the
interactions of
prostaglandins
resulting in
reduced pain
felt.

It is used for
acute Pain &
Primary
Dysmenorrhea,
Ankylosing
Spondylitis,
Osteoarthritis,
Rheumatoid
Arthritis, Familial
Adenomatous
Polyposis (Offlabel), and renal
impairmen

Contraindicated to
patients with
allergies to
sulfonamides,
celecoxib, NSAIDs,
or aspirin;
significant renal
impairment;
pregnancy (third
trimester);
lactation.
Use cautiously with
impaired hearing,
hepatic and CV
conditions
.

CNS
dizz
inso
tire
oph

CV:

Der
pru
mu
sto

GI,
pai
flat

Hem
Neu
eos
leu
pan
thro
agr
gra
apl
dec
bon
dep
me

Oth
ede
rea
ana

MEDICATION

EXERCISE

TREATMENT

HYGIENE

19 | P a g e

It is important that
the medications are
taken as prescribed
by the physician.
Once medications
are ordered, it is
essential for the
client to comply.
1. Ranitidine
Hydrochloride
C: Histamine-2
Antagonist
H: Competitively
inhibits the action of
histamine at the H2
receptors of the
parietal cells of the
stomach, inhibiting
basal gastric acid
secretion and gastric
acid secretion that is
stimulated by food,
insulin, histamine,
cholinergic agonists,
gastrin and
pentagastrin

E: Q8H
C: If you also are

29

using an antacid, take

it exactly as
prescribed, being
careful of the times of
administration
Have regular medical
follow up care to
evaluate response
Report sore throat,
fever, unusual
bruising or bleeding,
tarry stools,
confusion,
hallucinations,
dizziness, severe
headache, muscle or
joint pain
K: Administer oral
drug with meals and
at bedtime
Decrease doses in
renal and liver failure
Provide concurrent

Deep breathing
exercises

The way you

breathe affects
your whole body.
Breathing
exercises are a
good way to
relax, reduce
tension, and
relieve stress.

a) Hospital
admission to treat
appendicitis
b) Administration of
antibiotics for
infection
c) CBC: to measure
several
components of the
blood

a) Take a bath
daily. If client
is unable to
do so,
encourage
client to take
a sponge
bath.
b) Change linens
when needed.
c) Comb hair,
cut nails and
do other
necessary
actions in
order to have
a clean,
kempt
appearance.
d) Wear clean
and
comfortable
clothing
e) Practice
proper hand
washing.

20 | P a g e

antacid therapy to
relieve pain
Administer IM dose
undiluted, deep into
large muscle group

2. Omeprazole
C: Antisecretory
drug
H: Gastric acidpump inhibitor:
Suppresses gastric
acid secretion by
specific inhibition of
the hydrogenpotassium ATPase
enzyme system at
the secretory
surface of the
gastric parietal
cells; blocks the
fibal step of acid
production.
E: OD
C:Instruct patient to
notify health care
professional if
Headache,
dizziness, asthenia,
vertigo, insomnia,
apathy, anxiety,
paresthesias,
dream
abnormalities. Rash
, inflammation,
urticaria, pruritus,
alopecia, dry skin.
K: Administer
before meals.
Caution patient to
swallow capsules
whole-not to open,
chew, or crush
them. If using oral
suspension, empty
packet into a small
cup containing 2
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29

tbsp of water. Stir

and have patient
drink immediately;
fill cup with water
and have patient
drink this water. Do
not use any other
diluent.
3. Celecoxib
C: Analgesic
NSAID
H: Selectively
inhibits the enzymatic
activity of
cyclooxygenase-2
(COX-2) thereby
inhibiting the
interactions of
prostaglandins
resulting in reduced
pain felt.

E: Q8H
C: Instruct patient to
take celecoxib exactly
as directed. Do not
take more than
prescribed dose.
Increasing doses does
not appear to
increase
effectiveness.

29

Advise patient to
notify health care
professional promptly
if signs or symptoms
of GI toxicity
(abdominal pain,
black stools), skin
rash, unexplained
weight gain, edema
occurs.
K: Assess patients
range of motion,
degree of swelling,
and pain in affected
joints before and
periodically
throughout therapy.
Assess patient for
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allergy to
sulfonamides, aspirin,
or NSAIDS. Patients
with these allergies
should not receive
celecoxib.
May be administered
without regard to
meals.

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XIV. Conclusion/Recommendation

This case study illustrates and provides appropriate nursing diagnoses, interventions, and
outcomes relevant to a man who had appendicitis. It provides guidance for nurses in community
health settings when caring for patients with appendicitis.
The client/significant others should be aware of this condition. The significant other
should also acquire sufficient knowledge about the condition as well as on what to do when
another family member will experience the signs of appendicitis. If any of the said signs and
symptoms should occur in his family members like sudden pain in the epigastric region, they
should immediately go to the hospital or to their respective physician for early diagnosis and
treatment of the condition to apply the proper intervention and surgery to prevent further
complications.

XV. References
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1. Nurses Pocket Guide Diagnoses, Prioritized Interventions, and Rationales 11th Edition
by M. Doenges, M. Moorhouse, and A. Murr
2. Human Anatomy & Physiology by Elaine N. Marieb R.N., Ph.D., Ninth Edition
3. Medical-Surgical Nursing, 9th Edition by Sharon L. Lewis, RN, PhD, FAAN, Shannon
Ruff Dirksen, RN, PhD, Margaret M. Heitkemper, RN, PhD, FAAN and Linda Bucher,
4.
5.
6.
7.

RN, PhD, CEN

Nursing 2015 Drug Handbook by Lorraine Hallowell, Karen C. Comerford
http://www.livestrong.com/article/205546 -diet-as-tolerated/
http://nurseslabs.com
http://www.mayoclinic.org/symptoms/high-white-blood-cell-count/basics/causes/sym-

20050611
8. http://www.webmd.com/digestive-disorders/picture-of-the-appendix
9. http://emedicine.medscape.com/article/238798-overview#a3
10. http://www.medscape.com/viewarticle/766696_2

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