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Appendicitis Concept Map

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History of Present Illness (HPI), Pathophysiology of Admitting Dx
(Cite References) Medical, Surgical, Social History (1).
The patient stated that she was constipated in the last few days but she
thought that it will pass. After that, she started having cramps but again
didn't focus too much on them. Two days ago her abdomen started to hurt
but she considered that this was because of constipation and should pass
by itself soon. Even so, yesterday the pain became hard to bare and it
localized itself in the right iliac area. She also had a headache so when
she checked her temperature she saw that her temperature was a little bit
higher than normal. She knew that something was wrong with her and her
fiancee who works in the healthcare service recommended her to go to
the emergency room in order to get examined because of the possibility
of an appendicitis.
Pathophysiology of Admitting DX: In the first place, there is an
obstruction of the appendiceal lumen which leads to mucous
accumulating in the appendix because the appendix is constantly
secreting this substance. The pressure in the appendiceal lumen increases
which reduces the blood flow to this organ. Because of the hypoxia state
which is a result of the low blood flow, ulceration is formed on the
mucosal lining of this organ which promotes bacterial invasion.
Ultimately this leads to the inflammation of the appendix and the feeling
on pain in the right iliac fossa (Humes,Simpson,2006)
Medical History
* Diabetes type 1: a pathology in which the beta cell of the pancreas is
destroyed because an immune response which leads to an absolute insulin
deficiency. The onset is rapid and usually at patients under 30 years old.
If we measure their insulin level we will see that there is little to no
insulin. A common complication is represented by ketosis coma. The
pathology needs to be kept under control with diet, exercise and
nevertheless insulin administration. (Atkinson,Eisenbarth,Michels,2014)
*Asthma: a chronic lung pathology which is characterized by the fact
that the airway obstruction is reactive. What actually happens is that the
muscle which surrounds the airways contract during the asthma attack
making it impossible to breathe. The triad representative for this
pathology is represented by the following manifestations: mucus
formation, inflammation, and edema. (Kudo,Isigatsubo,Aoki,2013)
Surgical History
The patient denies any previous surgical history. This was her first
surgical procedure.
-Laparoscopic appendectomy: 1 to 3 incisions are done into the abdomen.
This procedure is preferred rather than the traditional open that consists
of opening the patient in order to remove the appendix. Overall the first
one is preferred because of the less scar tissue which will form after the
surgery is tone. (Hori,Machimoto,Hata,Kato,2017)
Social History
Patient A.M is a 25 years old woman, engaged, working as a marketing
manager. She declines consuming alcohol or drugs but admits of smoking
from time to time (especially when stressed) and eating a lot of fast food
as her schedule is very busy and she doesn't have time for cooking.
Chief Complaint
Pain in the lower abdomen since yesterday, low
fever, and vomiting since this morning
Admitting Diagnosis
Acute appendicitis
Patient Information
(1)
Name: A.M
Age:25 years
Gender: Female
Code Status: Full Code
DPOA: n/a
Living Will: n/a
Patient Education (In Pt.) & Discharge Planning (home needs)
The patient had to undergo Laparoscopic Appendectomy for her
pathology. Education for discharge
*In terms of activity: resume light activities once at home; avoid lifting
anything that is heavier than 10 pounds, limit sports activities for the
upcoming 1-2 weeks; during showers gently wash around the incision
with soap and water; avoid driving.
*In terms of diet: in the upcoming days focus on eating low fat,
blanded food such as rice, mashed potatoes , puddings and low-fat
yogurt. In case of constipation, it is allowed to take a fiber laxative.
*Call the physician in case the pain is worsening or if the incision starts
swelling; if fever is higher than 101.5 F, the abdominal pain increases,
if you are experiencing severe diarrhea, nausea or vomiting.
Concept Map
Student Name:
Instructor:
Diagnostic Test/ Lab Results with dates
and Normal Ranges (3)
Test
Norms
Date
Current
Value
WBC
5,000
10,000
8/29/20
18
14,000
Neutrophil
Proportion
%
55 to
73
8/29/20
18
80
CRP mg/dl
0-19
mg/dl
8/29/20
18
9
Total
bilirubin
mg/dl
7
8/29/20
18
1 mg/ dl
ALT
Up to
42
U/L
8/29/20
18
24
AST
Up to
37
U/L
8/29/20
18
21
Ultrasonography: enlarged appendix in
the right iliac fossa and hyperechoic
swollen periappendiceal fat.
Medical Management/ Orders/ Medications & Allergies (2)
Name
Dose
RT
Freq.
MOA
RN
Considerations
Onset/Peak
/Duration
(Insulin)
Salbutamol
100
µg/in
haler
Inh
alat
ion
2
inhal/
4-6 h
-Short acting
Beta 2
adrenergic
agonist .
-Investigate
lung sounds and
blood pressure
-Allow 1 minute
between
inhalations
2-3 minutes
Long
acting
insulin
100
units
/ml
hy
po
der
mi
c
1/
day
Basal insulin-
increases the
level of insulin
reduces
hyperglicemia
-Monitor the
patients blood
glucose
-Increase the dose
in case the blood
glucose is high
Onset: 1-2 h
Duration of
action : 24 h
No peak
Erickson’s Developmental Stage Related to pt. & Cite
References (1)
Since our patient is 25 years old, based on Erikson stages of
development we would classify her in the 6th stage which
corresponds to intimacy vs isolation and the main virtue is love.
This represents that period of adulthood during which people
start falling in love and plan building a family. In case the person
is not able to achieve all these things (developing intimacy with
others) then they might choose isolation which will deeply affect
their upcoming years. In the case of our patient, she is currently
employed at a company which she doesn't really enjoy but her
income is good enough to be able to maintain a quality lifestyle.
She is engaged for the last 4 years so overall we can state that
she is successful when referring to the Erikson's scale.
(Santrock,2012)

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Priority nursing diagnosis #1
Acute Pain - Since the patient
went an appendectomy
procedure she might fee
unpleasant feelings at the site of
the intervention. This pain comes
from the tissue which was
damaged during the procedure
and can be mild to severe in the
beginning but it is expected to
return to normal in less than 6
months. (Ackley,Ladwig,2013)
Vital Signs (4)
Temperature : 101 F
Pulse : 105 beats/ minute
Respiration : 23 cycles /
min
Blood Pressure : 130 / 81
Neurological (5)
The patient shows no
sign of speech disorders,
no paralysis , no
sensitive disturbance.
All the reflexes are
present.
Respiratory (7)
The lung were
examined and they
showed no signs of
pathologies ; they were
clean with no
wheezing.
O2 Sat = 98%
Priority nursing diagnosis #2
The risk for infections. Because
the patient has undergone a
surgery maneuver her body might
fight less effectively against
bacterias and also there is a
possibility for them to enter the
body through the surgical hole.
Because of that, it is important to
measure the risks and inform the
physician immediately when there
are changes. During surgery, the
primary defense (the skin) is
inadequate in order to protect the
body against different types of
pathogens.
Outcome/Goal #2
-A correctly healing wound
without complications
-No sign of erythema,
inflammation, puss and no
fever(Ackley,Ladwig,2013).
Outcome/Goal #1
-Be able to report that the pain of the
patient is controlled or relieved
-The patient is able to sleep relaxed
without having to face pain
-Be able to teach the patient different
relaxation techniques and diversional
activities that should lower their pain.
Interventions #1
-Keep the patient in semi Fowler's
position: Supine position will
accentuate the pain because of the way
gravity acts on the body. This position
tends to lessen the pain
-Provide different types of activities
that will make the patient forget about
the pain
-Administer analgesics as it was
indicated with the physician
-In the first 24 to 48 hour place a bag
with ice on the abdomen as this will
relieve the pain and will desensitize
the nerve endings.
(Ackley,Ladwig,2013)
Interventions # 2
-Inspect the incision and the dressing.
In case of any kind of drainage inform
the physicians. This will help in
detecting possible infections process in
the early stages
-Administer antibiotics. Usually,
antibiotics are given before the
intervention as a measure of
prophylaxis but are not continued after
the surgery. (Ackley,Ladwig,2013)
Assessment/ Evaluation #1
The nurse should evaluate the severity of the pain, its
characteristics, and its location. Based on this we can determine
how effective the medication are and also how the healing
process is going. Changes in characteristics might orient us
towards a complication such as peritonitis or abscess.
Watch closely for possible complications of the surgery such as
an unexpected fever. Note the temperature, heart rate and blood
pressure of the patient. (Ackley,Ladwig,2013)
Assessment/ Evaluation #2
-Inspect periodically the incision and the drainage and note if
something changes.
-Monitor the vital signs of the patient such as fever, diaphoresis
or increasing in terms of abdominal pain as those can be signs
of infection.
-Watch closely for any possible surgical complications.
-In case it is required, obtain drainage specimens in order to
find out which bacteria infected the patient and to be able to
start an effective antibiotic theraphy. (Ackley,Ladwig,2013)
PC Interventions
-Practice and also instruct the patient in regard to an aseptic
wound care which will eventually reduce the risk of bacteria.
-In case of the localizes abscess get prepared with incision and
drainage.
-Administer the correct antibiotic in case of infection and change
the antibiotic if it's required after the lab result came back with the
sensibility towards another antibiotic. (Ackley,Ladwig,2013)
PC Evaluation Plan
Monitor the patient's heart rate, blood pressure, fever and inspect
regularly the wound. Determine if the patient is responding to the
administered antibiotic.
If the patient starts feeling better in a few days if the wound starts
healing and the fever stops rising than the goal was met for this