Appendicitis Concept Map

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Cultural considerations, ethnicity, occupation, religion,

family support, insurance. (1) (14)

Socioeconomic/Cultural/Spiritual Orientation &

Psychosocial Considerations/Concerns, to include

the following Social Determinants of Health

The patient works as a marketing manager at one of the

local companies. She lives with her fiancee but they have

no kids. Her mother passed away when she was younger

and her father is currently living with her sister after he

suffered a stroke in the past years.

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

14,000

Neutrophil

Proportion

55 to

8/29/20

CRP mg/dl

0-19

mg/dl

8/29/20

Total

bilirubin

mg/dl

8/29/20

1 mg/ dl

ALT

Up to

U/L

8/29/20

AST

Up to

U/L

8/29/20

Ultrasonography: enlarged appendix in

the right iliac fossa and hyperechoic

swollen periappendiceal fat.

Medical Management/ Orders/ Medications & Allergies (2)

Name

Dose

Freq.

MOA

Considerations

Onset/Peak

/Duration

(Insulin)

Salbutamol

100

µg/in

haler

Inh

alat

ion

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

der

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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Appendicitis Concept Map