CASE STUDY

ON
APPENDICITIS

SUBMITTED TO SUBMITTED BY

Mrs. Manu Nagra Ms. Sandhya

Associate Professor M.Sc. Nursing 1st Year
Medical Surgical Nursing Medical Surgical Nursing
SPHE College of Nursing, Gharuan SPHE College of Nursing,
Mohali (Punjab) Gharuan, Mohali( Punjab)

SUBMITTED ON: 6 – SEP -2021

 BIODATA OF PATIENT

Name: - SHEETA DEVI

Age: - 48 years

Patient I.D:- 201512230899

Sex: - Female

Bed no/ Ward: - 2/Surgical Ward

D.O.A:-20//11/2021

Address: - Trikuta Nagar

Educational status: - Graduate

Marital status: - Married

Religion: - Hindu

Occupation: - Home maker

Diagnosis: - Appendicitis

Dr. In charge: - Dr. Aman

Chief complaint: - Patient was admitted in the hospital with chief complaints of

 Acute abdominal pain

 Loss of appetite
 Pain when coughing
 Fever and chills
 vomiting and Nausea
Present medical history: - Patient admitted to SARWAL Hospital with
complaints of pain and discomfort , loss of appetite,fever. She was diagnosed with
Appendicitis.

Past medical history: -No significant history of Asthma,Kidney

failure,Hypertension, Diabetes Mellitus.

Allergic history: - Patient is non allergic to any drug and foods.

Present surgical history: - Patient having Appendectomy present surgical history.

Past surgical history: - Patient had not any surgical history related to disease
condition.

Family history: - No history of Kidney failure in patient’s family. All the

members of patient’s family are healthy. No history of Diabetes Mellitus.

Family Tree:-

KEYS:-

Female:-

Male:-

Family composition:-
 Sr. Name Age Sex Relation Marital Occupatio Health
No status n status status
1 Girdhari lal 51 M Husband Married Shopkeeper Healthy
yrs
2 Ram lal 10yr M Son Unmarrie Student Healthy
s d
3 Neetu 8yrs F Daughter Unmarrie Student Healthy
d

PERSONAL HISTORY

Oral hygiene- Maintained

Frequency- Twice a day

Bath- Regular

Frequency- Once a day

Diet- Non-Vegetarian

No. of meal per day- Three times a day

Sleep and rest: - 7 hours/day

Elimination: Bowel per day – once a day

 Constipation- no
 Self voiding - yes

Mobility and exercise:-

 Walking habit - yes

 Exercise:- Rarely

Substance use:-

 Drug- no

VITAL SIGNS

DAY 1st
 Sr. Vitals Normal values Patient values remarks
no.
1 Temperature 98.4 F 1040F Pyrexia
2 Pulse 72-80 beats/min 99 beats/min Increased
3 Respiration 16-24 breath/min 24 breath/min Normal
4 Blood pressure 120/80 mm/Hg 140/80 mm/Hg Hypertension

DAY IInd

Sr. Vitals Normal values Patient values Remarks

no.
1 Temperature 98.6 F 1010 F Pyrexia
2 Pulse 72-80 beats/min 90 beats/min Normal
3 Respiration 16-24 breath/min 22 breath/min Normal
4 Blood pressure 120/80 mm/Hg 110/80 mm/Hg Normal

DAY IIIrd

Sr. Vitals Normal values Patient values Remarks

no.
1 Temperature 98.6 F 990 F Normal
2 Pulse 72-80 beats/min 80 beats/min Normal
3 Respiration 16-24 breath/min 24 breath/min Normal
4 Blood pressure 120/80 mm/Hg 110/70 mm/Hg Normal

INVESTIGATION

INVESTIGATION NORMAL PATIENT’S REMARKS

VALUE VALUE
Hemoglobin 11.7-13.5gm F 12gm Normal
13.7- 16.7gm M
Total leukocyte count 4000-11000cu/mm3 78000cu/mm3 Normal
Platelet Count 1.5- 4.5lac 166000cu/mm3 Normal
Prothrombin time 10-12 sec 12.1 sec Normal
 Computed Tomography No organic Organic Normal
Scan
Magnetic Resonance Brain damage Damage seen Normal
Imaging

MEDICATION

Sr. DRUG DOSE FREQUENCY ROUT ACTION

No E
1. Tab.Paracetamol 1mg O.D Oral Analgesic
2. Inj. Ampicillin 500mg B.D IV Antibiotic
3. Tab.Omeprazole 20mg B.D Oral Proton pump
inhibitor
4. Inj. Gentamycin 160 mg O.D IV Antibiotic

DRUG STUDY

TRADE SALT MECHAN DOSE / INDICATI CONTR ADVERSE

NAME NAME ISM OF ROUTE ON AINDIC REACTIONS
ACTION ATION
Ampicin Penicilli Antibiotic 1g every Infections of Amino CNS-
n 6 hours gastrointesti penicilli convulsive
nal tract and n is seizures with
soft tissues. highly high dose
bacterici GI-
dal even diarrhea,nausea
at low and vomiting
concentr
action.
Zantac Ranitidin Antaacid 50 mg Treatment Inhibit CNS-
e 1amp and the Confusion,dizz
every 8 prevention action of iness.
hourly of histamin GI- altered
heartburn,aci e at the taste ,black
d H2 . tongue.
indigestion CV-
Arrhythmias

PHYSICAL EXAMINATION

HEAD TO TOE EXAMINATION

General appearance

1. Nourishment :- Nourished
2. Body built: - Patient is thin built
3. Health:-Un healthy
4. Activity: - Dull activity.

Mental status

1. Consciousness: - Patient is conscious

2. Look:- Dull looked

Posture

1. Body curve:- Normal curvature of the body

2. Movement:- Poor range of motion of extremities

Skin condition

1. Color:- Fair
2. Texture:- Dry
3. Temperature:- Cold extremities
4. Lesions:- lesion present in the skin
5. Scars:- No scars
Head and face

1. Scalp: - Normal, no dandruff present.

2. Face: - Round face.
3. Hair color: black

Eye

1. Eyebrows:- Symmetrical in shape

2. Eyelashes: - Lashes are present, no sty present.
3. Eyelids:- Normal eyelids
4. Eyeballs:- rolling of eyes
5. Conjunctiva:- normal, pink
6. Sclera:- white
7. Pupils:- normal in size and good reaction to light
8. Lens:- Lens is normal
9. Vision:- Normal vision

Ear

1. External ear:- Normal external ears

2. Hearing:- Normal hearing
3. Any other: No significant abnormalities detected during examination

Nose

1. Location: - Centrally located

2. External Nares: - Normal nares

3. Nostrils: - Normal nostrils

4. Olfaction: - Good olfactory sense

5. Deviation: - not deviated septum

6. Bleeding: - not present

Mouth and pharynx

1. Lips: - Dryness present on the lips.

 2. Teeth:- No complaint of dental carries , plaque.
3. Mucus membrane and gums:- Normal gums, mucus membrane is normal
4. Tongue: - tongue is dry.
5. Throat and pharynx:- Normal throat and pharynx no enlargement or
redness of the tonsils

Neck

1. Lymph nodes:- Not palpable

2. Thyroid glands:- No enlargement of thyroid glands
3. Range of motion:- Normal range of motion

Chest

1. Thorax:- Normal thorax

2. Breath sounds:- Bilateral with prolonged, no added sounds
3. Heart:- Heart S1 and S2 sounds are normal , no murmur sound heard on
auscultation

Abdomen

1. Observation:- Tenderness in abdomen

2. Auscultation:- Decreased mobility rate
3. Palpitation:- Hard to some extent
4. Percussion:- Gas formation

Extremities

1. Movement of joints:- Less joint movement

2. Clubbing:- No clubbing of the fingers
3. Ankle edema: - Ankle edema is absent.
4. Reflex:- Normal reflexes
ANATOMY AND PHYSIOLOGY

Vermiform appendix

In human anatomy the appendix (or vermiform appendix; also cecal is a blind
ended tube connected to the cecum from which it develops embryologically. The
cecumis a pouchlike structure of the colon. The appendix is near the junction of
the small intestine and the large intenstine.

The appendix averages 10 cm in length , but can range from 2 to 20cm.The

diameterof the appendix is usually between 7 and 8 mm.The appendix is located in
the lower right quadrant of the abdomen, or more specifically , the right iliac fossa
the position with in the abdomen corresponds to a point on the surface known as
Mc Burney’s point. While the base of the appendix is at a fairly constant location 2
cm below the ileocaecal valve, the location of the tip of the appendix can vary
from being retrocaecal to being in the pelvis to being extraperitoneal. In rare
individuals with situs inversus, the appendix may be located in the lower left side.

Major Function

Although it was long accepted that the immune tissue , called gut associated
lymphoid tissue, surrounding the appendix and elsewhere in the gut carries out a
number of important function.

The digestive tract’s immune system is often referred to as gut-associated

lymphoid tissue and work to protect the body from invasion.

The mucosa associated lymphoid tissue is the diffuse system of small

concentration of lymphoid tissue found in various sites of the body such as
gastrointestinal tract, thyroid, breast, lung, salivary glands, eye,and skin.
DISEASE CONDITION

APPENDICITIS

It is thought to result from obstruction of the appendiceal lumen,typically by

lymphoid hyperplasia but occasionally by a fecalith, foreign body, or even worms.
The obstruction leads to distension, bacterial overgrowth and inflammation.

CAUSES

IN BOOK PICTURE IN PATIENT PICTURE

Inflammation Present
Trauma to abdomen Absent
Pus formation Absent
Intestinal worms Absent
Metabolism disorder Absent
Abdominal swelling Present
Congenital defect Absent
Tumors Absent

PATHOPHYSIOLOGY

Due to etiological factor

Obstruction of the appendiceal lumen (inside the appendix)
ꜜ
Build up of mucous in the appendix
ꜜ
Increased appendiceal lumen pressure
ꜜ
 Decreased blood flow to the appendix
ꜜ
Decrease oxygen delivery
ꜜ
Ulceration of the appendix mucosal lining
ꜜ
Promotes microbe invasion
ꜜ
Inflammation and swelling of the appendix
ꜜ
Appendicitis
CLINICAL MANIFESTATION
IN BOOK PICTURE IN PATIENT PICTURE
Temporary confusion Present
Vomiting Present
Dizziness Present
Tightening of the chest Absent
Fever with chills Absent
Irritability Absent

DIAGNOSTIC EVALUATION

IN BOOK PICTURE IN PATIENT PICTURE

Ultrasonography DONE
Abdominal Radiography DONE
CT scan Shows appendiceal wall
thickening
Barium Enema study To detect appendicitis
Lumbar Puncture NOT DONE
MANAGEMENT

Medical management:

IN BOOK PICTURE IN PATIENT PICTURE

Gentacidin GIVEN
Ampicillin GIVEN
Cefepime GIVEN
Zantac Ranitidine GIVEN
Ampicin, Ampicillin GIVEN
Metronidazole GIVEN

Surgical management:

IN BOOK IN PATIENT
Appendectomy DONE
Laproscopic Appendicectomy NOT DONE
Coventional Appendicectomy NOT DONE

NURSING MANAGEMENT

 Move harmful object out of way.

 Maintain NPO status.
 Administer fluids intravenously to prevent dehydration
 Monitor bowel sounds
 Monitor for changes in level of pain
 Position right –side lying or low to semi fowler position to promote comfort

NURSING ASSESSMENT

ASSESSMENT
  Assess the level of pain
 Assess the signs and symptoms of patient
 Monitor vital signs
 Assess the tenderness and abdominal rigidty
 Ask the patient regarding the factors and events that precipitate the
APPENDICITIS

NURSING DIAGNOSIS

 Risk for infection related to surgical incision at right lower quadrant of the
body.
 Impaired skin integrity related surgical incision.
 Acute pain related to inflammation of the appendix
 Anxiety related to possible surgery secondary to acute appenditcitis.

NURSING GOALS

Short term goal:

 To maintain client condition

 To prevent from inlammation
 To encourage to use proper coping mechanism
 To encourage patient to have positive feeling

Long term goal:

 To control the onset of appendicitis

 To prevent from further complications
 To provide proper care after surgery
 To encourage for follow up treatment

NURSING CARE PLAN

ASSESSMEN DIAGNOS GOA INTERVENTI IMPLEMENTAT EVALUAT
T IS L ON ON ION

Subjective Acute pain To To assess the Encourage Pain is

Data: related remov level of the pain verbalization of reduce up to
Patient says that inflammati e the feelings about pain some extent
she has severe on ofthe pain
To alleviate
pain in the appendix. by Encourage patient
pain
abdomen proper to have diversional
Objective care activities such as
Data: reading books
I observed this watching TV
by patient face To Promote
become dull non- Provide comfort
and pale pharmacologic measures such as
pain quite and calm
management environment

Establish rapport
To gain trust
and cooperation
Encourage
adequate rest
To promote periods
wellness and
prevent fatigue
ASSESSME DIAGNOS GOAL PLANNIN IMPLEMENTATI EVALUATI
NT IS G ON ON

Subjective Risk of To To assess the Risk factors are Risk of

data: Patient infection reduce risk factors assessed infection is
says that I am related to the risk of infection. prevented to
not feeling rupture of of some extent
good due to the infectio
fever or appendix n To encourage Reduce the risk of
vomiting the patient to spread of bacteria.
good hand
Objective washing and
data: I aseptic Suggestive of
observed that wound care presence of infection
patient have or developing sepsis.
sever To monitor
vomiting vital signs,
reports of
increasing
abdominal Andibiotic are
pain administered if the
appendix is ruptured
To or abscessed
administer
antibiotics
drugs Continuing pain and
fever may signal an
To watch abscess
closely for
possible
surgical
complication
ASSESSME DIAGNOSI GOAL PLANNIN IMPLEMENTAT EVALUATI
NT S G ION ON

Subjective Deficient To To Prevent fatigue, Deficit

data: knowledge improv encourage promotes healing knowledge is
Patient says regarding e the progressive and felling of well reduced to
that I have disease knowle activities as being some extent
fear of death condition dge by tolerated
and always providi with
worried ng periodic rest
about my adequa periods
condition te
inform A calm and
Objective ation To provide positive
data: of her quiet environment is
I observed disease environment provided
that patient
has low Reinforcement is
knowledge To provide provided to the
regarding reinforceme patient
disease as nt to the
evidenced by patient
verbalization Prevent pulmonary
To complication
encourage
the patient
to cough,
breath
deeply,and Psychological
turn support is provided
frequently to the patient

To provide
psychologic
al support to
the patient
HEALTH EDUCATION

DIET

Educate the patient to take well balanced diet. Educate that small bites of food and
slow chewing is done

REST AND SLEEP

Encourage the patient to take proper rest and sleep to prevent further complications

HYGIENE

Educate the patients and family to maintain personal hygiene of the patient.

MEDICATION

Educate the patient and care giver about the medicine precaution

FOLLOW UP

Advice the patient about follow up care

Advice the patient that if they have any complication then informs the physician.

SUMMARY AND CONCLUSION

Patient admitted to Sarwal Government Hospital with complaints of fever ,

abdominal pain, Nausea and Vomiting. She was diagnosed with Appedicitis. He
takes treatment from Sarwal Government Hospital jammu
BIBLIOGRAPHY

 Bruner and Siddartha’s Text book of ‘Medical Surgical Nursing’, Edition

11th.

 Wilson and Ross,” Anatomy and physiology in health and illness”, Edn-10th.

 Medical Surgical Nursing Critical Thinking in client care, Edition 3 rd.

 http://www.gastro.org/wmspage.