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TABLE OF CONTENTS I. Introduction II. Objectives General Objectives Specific Objectives III.

I. Patients Data A) Vital Information B) Family Background C) History of Past illness D) History of Present illness E) Effects and Expectation F) Genogram G) Developmental Data IV. Review of Systems Physical Assessment V. Textbook Discussions A) Complete Diagnosis B) Anatomy and Physiology C) Definition of terms D) Etiology and Symptomatology E) Pathophysiology VI. Laboratory Examination VII. Complete Doctor's Order VIII.List of Drugs Drug Study IX. List of Nursing Case Plan X. Prognosis XI. Bibliography

INTRODUCTION This is a case of Mrs. Rose, female patient, was admitted at provincial hospital Last April 26, 2010 at around 2:10 pm and was diagnosed of having acute appendicitis and was scheduled for operation for ceasarian operation The appendix is a finger-like appendage about 10 cm (4m) long that is attached to the ceccum just below the ileocecal valve. The appendix fills with food and empties regularly into the cecum, because it empties inefficiently and its lumen is small, the appendix is prone to obstruction and is particularly vulnerable to infection. Appendicitis is an inflammation of the vermiform appendix that develop most commonly in adolescents and young adults. It can occur at any age but is rare in clients younger than 2 years and reaches a peak incidence in clients between 20 and 30 years. It is not common in older adult however, when it does occur in such clients, rupture of the appendix is more common. According to the statistics appendicitis affects 7% to 12% of the population. It is the most common reason for emergency abdominal surgery in the United States. The classic manifestations of appendicitis begin with acute acute abdominal pain that comes in waves. At first, the pain may be perceived merely as discomfort that makes the client feel that passing flatus or having a bowel movement will bring relief. Assessment may reveal vomiting that begins after the pain starts, loss of appetite, low-grade fever, coated-tongue and bad breath. Mild leukocytosis is usually present, with the white blood cell (WBC) count between 10,000 and 15,000/mm. Pain at Mcburney's point, which lies midway between the right anterior superior iliac crest and the umbilicus, confirms the diagnosis. This is what happened to Ms. Gev, a 21 years old patient, she was admitted because of the pain perceived at right lower quadrant. Surgical management was done during his hospitalization. This case was made to create awareness to the listener about appendicitis thereby imparting knowledge.

OBJECTIVE OF THE STUDY General Objectives: At the end of 2 hours presentation, the reader will be able to have adequate knowledge about appendicitis. Specific Objectives: After the case presentation, the listener will be able to: 1. Know the important information regarding my patient. 2. Appreciate the result of physical assessment. 3. Know and understand the real meaning of appendicitis. 4. Understand the anatomy and physiology of the system affected with appendicitis. 5. Trace the pathophysiology of the disease. 6. Know the predisposing, factors and precipitation factors of the disease occurrence. 7. Interpret the laboratory result and know the nursing responsibility. 8. Know the signs and symptoms of the disease. 9. Identify the drugs that the physician ordered for the wellness of the patient 10. Identify the possible nursing diagnosis of the clients with appendicitis.

PATIENT'S VITAL INFORMATION Patient's Name Age Sex Address Birth Date Civil Status Citizenship Religion Occupation Educational Attainment Date Admitted Time Admitted Admitting Diagnosis Attending Physician Name of the Institution Post-operative Diagnosis Chief complaint Name of Partner Age Name of Father Occupation Name of Mother Occupation : : : : : : : : : : : : : : : : : : : : : : Mrs. Rose 21 years old Female Purok Rosas, Barangay Dajay, Surallah, South Cotabato August 03, 1977 Single Filipino Roman Catholic None High School Graduate April 26, 2010 2:00 am Acute Appendicitis Jose June Tabanda, MD South Cotabato Provincial Hospital Acute appendicitis Procedure : Mr. JM 21 years old Mr. DV Farmer Mrs. ML Housekeeper

SOURCE OF INFORMATION Patient Patient's chart Patient's partner

FAMILY BACKGROUND Ms. ROSE is the 4th daughter of Mr. D and Mrs. M. she is 33 years old at this age she already have her first baby. Her grandparents are already dead but she doesn't know the reason behind it. Her parents are still alive but she doesn't know any disease that they possess. Her father is a farmer while her mother is a housekeeper. Their farm is the only source of their family's income They are 10 in the family including her parents and seven siblings. Her parents decide for them due to the fact that they are still young to make such decisions. HISTORY OF PAST ILLNESS Ms. Rose verbalized that this is her second time to be hospitalized, previously because of dengue fever but she can't remember the date. She also said that whenever she experienced diseases like cough, fever and flu. She just but overthe-counter drugs like paracetamol and biogesic. She said that she is not consulting quack doctors whenever she is sick. They are not also taking herbal medicine except those drugs in a capsule and tablet form already. She added that she has no allergies to any kind of food and medicine. She confessed that this is her first time to undergo a surgical operation. She haven't experienced any accidents and injuries. She delivered her baby on the 31 st day of October at home. She said that she had no complications during her delivery. HISTORY OF PRESENT ILLNESS Two hours prior to admission, the patient experienced pain localized at right lower quadrant with vomiting within that span of time, she also tried to take medicine but the pain did not disappeared. So her family decided to take her at the hospital at around 02:00 in the morning dated April 26.2010 During her admission, she decided not to undergo appendectomy because the pain disappeared and she thought that it will not reappear. Her attending physician likewise her surgeon is Dr. Jose June Tabanda and was diagnosed to have acute appendicitis. EFFECTS OF ILLNESS TO SELF Emotionally my patient is not prepared to undergo surgery, she is quite worried for her baby and anxious about her present condition. She is not financially prepared as well. I am not sure if it is the effect of anesthesia, but during the interview my patient was having difficulty remembering her remote memory like her parent's age. EFFECTS OF ILLNESS TO FAMILY The family doesn't expect this to happen, as a result they are not financially prepared. They are emotionally stressed and worried also.

EXPECTATIONS TO SELF The patient expects to recover very soon. She is also expecting, that they can settle her account so that she can go home. Due to the fact, that she really wants to see her baby. EXPECTATION FROM THE FAMILY The family expects that the patients will recover soon and that they can settle the account immediately. They are also expecting that she will not be hospitalize again.

REVIEW OF SYSTEMS GENERAL: The patient said that she never experienced fever prior to April 26, 2010. She denies of experiencing weight loss. she also verbalize body weakness and due to pain. SKIN: The patient states that she experienced having skin darkening on her neck during her pregnancy.. She also said that she has no rashes/allergies to any food. HEAD: The patient verbalized that nagasakit ang ulo ko kis-a She also said that she doesn't experienced any head injury and she never observed tenderness. EYES: The patient said that wala man problema sa mata ko, makakita man ko maayo. She denies of experiencing temporary loss of vision. NOSE: The patient said that she also has no allergies to any odor. She denies of having sinus problem and she has no problem in term of her sense of smell. THROAT: She said that she experienced having a toothache and denies any experience of gum bleeding. She doesn't have difficulty swallowing as per said. RESPIRATORY: Patient states that wala man ko gaproblema kung mag ginhawa ako, daw okay lang man siya. She denies of having chest pain and hemophysis.

CARDIOVASCULAR: The patient said that she has no problems in her heart, as a matter of fact she is not

hypertensive. GASTROINTESTINAL: The patient said that she experienced vomiting on the day she was admitted to the hospital. She also said that she experienced constipation. GENITOURMARY: She said that she has no problems in urination. And she voids 5-6 times a day. She also said that these are no presence of blood in her urine. MUSCULOSKELETAL: She denies of having problems in moving. One said that she doesn't have arthritis. She states that she is a little bit weak because of pain. PSYCHIATRIC: She admits that she is anxious and worried because of her baby.

PHYSICAL ASSESSMENT REPORT November 13, 2007 3:00 PM GENERAL: A mesomorphic individual with an in IV fluid infusion of DSLR 30 gtts/min attached at left metacarpal vein. She is not distress looking individual, oriented to time and place but can't remember some information. Can speak well with audible voice and can understand my question. SKIN, HAIR AND NAILS She possesses brown color of the skin. Skin rashes are out present, no abrasions and lesions noted. She is wet with her sweat. The nails are cut and clean. Clubbing are not observed-capillary refill within 3 second. HEAD The skull is rounded (normocephalic) and possesses symmetrical facial movement. No lesions and tenderness noted. Hair is evenly distributed which is straight and black in color. She has a poor memory. EYES AND VISION Eyes are bilateral to each other. No discharges noted. The eyeballs can move normally and round. Can see far objects. Eyeballs are distributed normally, eye brows are black and can elevate it, present in a normal condition. Conjunctiva is a little bit pinkish in color. No deformities noted, eyes are moist normally. No discharge noted. Pupils are equally round reactive to light accommodation. EARS AND HEARING Pinna are in normal size located to the left and right of the head. Auricles are in the same color, no lesions and abnormalities noted. No discharges observed and can hear whispered words 2 feet apart. NOSE External nerves are symmetric and found in the midline of the face. Septum is present in a normal condition. Deformities are not observed

MOUTH AND NECK Outer lips are slightly dry, able to pursed lip. She can move her head without discomfort. Lymph nodes are not palpable. Uvula is found in the middle upper of the mouth. Gums is slightly pink in color. Teeth are in normal condition, no dentures and have a complete set of teeth. There is no visible mass on the thyroid gland during inspection. The gland moves down when swallowing but is not visible. No abnormalities noted. CHEST AND LUNGS Has a respiratory rate of 25 breaths per minute. Can breath normally without using the accessory muscle. No harsh sound noted during auscultation. ABDOMEN Abdomen is soft and flat. Presence of pain in the incision site is observed. Striae are still present. No lesions noted. EXTREMITIES UPPER : No deformities and swelling observed. Able to flex, extend and rotate.. Rashes are not noted in both arms and hands. LOWER: Normal range of motion is observed. There is no lesions present. The nails are dirty in this extremities. There is no amputated parts of the body. GENITALS No deformities noted during the operation. The patient denies to show this part during assessment.

ANATOMY AND PHYSIOLOGY The Large Intestine Cecum is the proxional end of the large intestine and is where the large and small intestine meet at the ileocecal junction. The cecum is located in the right lower quadrant of the abdomen near the iliac fossa. The cecum is a sac that extends inferiorly about 6 cm past the ileocecal junction. Attached to the cecum is a tube about 9 cm long called the appendix. The colon is about 1.5-1.8 m long and consist of four parts: ascending colon, transverse colon, descending colon and the sigmoid colon. RECTUM is a straight, muscular tube that begins at the termination of the sigmoid colon and ends at the anal canal. The muscular tunic is smooth muscle and it is relatively thick in the rectum compared with the rest of the digestive tract. ANAL CANAL is the last 2-3 cm of the digestive tracts. It begins at the inferior end of the rectum and ends at the anus. The smooth muscle layer of the anal canal is even thicker than that of the rectum and forms the internal and sphinotes. In humans, the vermiform appendix is a small, finger-sized structure, found at the end of our small caecum and located near the beginning of the large intestine .The adjective "vermiform" literally means "worm-like" and reflects the narrow, elongated shape of this intestinal appendage. The appendix is typically between two and eight inches long, but its length can vary from less than an inch (when present) to over a foot. The appendix is longest in childhood and gradually shrinks throughout adult life. The wall of the appendix is composed of all layers typical of the intestine, but it is thickened and contains a concentration of lymphoid tissue. Similar to the tonsils, the lymphatic tissue in the appendix is typically in a constant state of chronic inflammation, and it is generally difficult to tell the difference between pathological disease and the "normal" condition .The internal diameter of the appendix, when open, has been compared to the size of a matchstick. The small opening to the appendix eventually closes in most people by middle age. A vermiform appendix is not unique to humans. It is found in all the hominoid apes, including humans, chimpanzees, gorillas, orangutans, and gibbons, and it exists to varying degrees in several species of New World and Old World monkeys.

Throughout medical history many possible functions for the appendix have been offered, examined, and refuted, including exocrine, endocrine, and neuromuscular functions (Williams and Myers 1994, pp. 28-29). Today, a growing consensus of medical specialists holds that the most likely candidate for the function of the human appendix is as a part of the gastrointestinal immune system. Several reasonable arguments exist for suspecting that the appendix may have a function in immunity. Like the rest of the caecum in humans and other primates, the appendix is highly vascular, is lymphoid-rich, and produces immune system cells normally involved with the gut-associated lymphoid tissue (GALT) (Fisher 2000; NaglerAnderson 2001; Neiburger et al. 1976; Somekh et al. 2000; Spencer et al. 1985). Animal models, such as the rabbit and mouse, indicate that the appendix is involved in mammalian mucosal immune function, particularly the B and T lymphocyte immune response (Craig and Cebra 1975)

ETIOLOGY

PREDISPOSING FACTORS Age

RATIONALE

REMARKS

Appendicitis commonly occurs in person aging from 10-30 years. It reaches a peak incidence in clients between 20 and 30 years. May patient is 21 years old. In the United States 7% of the population will have appendicitis at one time in their lives, males are affected more than females. Asian and African less likely to develop appendicitis as compared to Americans

Present

Sex

Not Present

Race

Present

PRECIPITATING FACTORS Low-fiber diet

RATIONALE

REMARKS

Person who has a low fiber diet is more prone to appendicitis because they lack Present ; The patient has bulk which makes their stool to be refined, a low fiber diet. avoiding breakdown of small matters that will lodge into the lumen causing appendicitis.

Obstructive Material / Fecalith

Impacted fecalith can obstruct the appendix Not Present thereby increasing the intraluminal pressure which leads to appendicitis.

Parasites

Certain parasites like E.. coli pinworm, ascaris & taenia, can obstruct appendix which will lead to appendicitis.

Not Present

COMPLETE DOCTOR'S ORDER DATE AND TIME April 23, 2010 10:00 am DOCTOR'S ORDER RATIONALE REMARKS

Pls admit to P500 This is done for further evaluation of This is done patients condition and management immediately. as well. To ensure patients safety.

TPR 98o

Getting the vital sign of the patients This is followed / aids the physicians to properly carried out by the diagnose the client thereby planning NOD. for the treatment is done.

NPO

NPO is ordered to the patient due to Patient was instructed the fact that she will undergone and followed. operation which will require proper visualization of the field as well as it will promote the cleansing of the abdominal part thereby reducing the risk for infection. This is done to determine any abnormalities that will manifest in the blood. Urinalysis is done to confirm that it is really an appendicitis or it is an infection in the genitourinary system. Lab exam done, Lab result attached to the chart, abnormal findings reported to the physician.

Labs: CBC stat Urinalysis-stat

IVF-D5LR 30 gtts/min

D5LR, a hypertonic solution,is given D5LR @ 30tts/min to the patient to maintiain fluid & was infused. electrolyte balance as well as it will serve as the pportal for IVTT adminiatration. This antibiotics was given to provide Carried out protection for infection.

Meds: Cefuroxime 750mg

Metronidazole 50mg

Drug acting tricomonacides and Done to treat some amebicide that works inside & disorder outside of the intestine. It is aso used for the GIT infection.

Tramadol 50mg IVTT now Centrally acting synthetic analgesic Given to the patient then 98o compound not chemically related to

opioid to relief mild to severe pain. Ranitidine 1 amp IVTT This decreases acid secretion Given to the patient thereby decreasing stomach pain to person who are in NPO

Ketorolac 30 mg IVTT now This decreases feeling of pain from Given to the patient then q8 hr mild to moderate while having anti inflammatory and anti pyretics effects

For Appendectomy This is ordered by the physician to Done surgically in treat underlying condition and to aseptic techniques prevent the occurrence of complications Appendectomy prep. Done This is done to decrease the no. of Done carefully, bacteria in that area thereby avoiding to hurt/harm decreasing chance of infection. the patient. This is done to inform the OR and This is done prior anesthesiologist and this is also done patient will go to OR. to find out if there is an available slot for this operation. This is done to empty the patients This is done bladder as well as it will aids the aseptically nurse in monitoring the urine ouput peri-operatively. Referring the patient in a correct Done condition will prevent the exhaustion of both,nurse & physician in giving the intervention. The patient decided not to undergo Signed by the patient the operation so the physician let her sign beside the order for legal purposes. This drug is given to prevent the Given to the patient occurrence of infection in GUT. Compititively inhibits action of Done for the wellness histamine or the H2 receptor sites of of patient. parietal, decreasing gastric acid secretion to prevent gastric irritation.

Inform OR / anesthesiologist

Insert foley catherer F 14

refer accordingly

6:00 am

HAMA

Ciprofloxacin 500 mg Ranitidine

7:20 am

Post-operative Admitting the patient to recovery Patient admitted to

9:20 am

To RR, then toward once stable

room aids the nurse in proper RR. monitoring of the condition of the patient because patient who are post operative are high risk for the occurrence of complications. Vital sign monitoring every 15 Carried out by the minutes is a must to post NOD strictly. anesthetize client because homeostasis of the patinet was disrupted due to ansthesia administration. The patient is NPO post surgery Patient was because all muscles in the instructed and abdomen is relaxed in which followed. introducing food can cause aspiration pneumonia. This will correct hydration of the IVF infused at patient that was disrupted by the desired drops surgery. This decreases feeling of pain from Given to the patient mild to moderate while having anti at desired dosage. inflammatory & anti pyretics effect. A centrally acting synthetic Given to the patient at analgesic compound not desired dosage. chemically related to opioids to relief mild to severe pain. This decreases acid secretion Given to the patient at thereby decreasing stomach pain desired dosage. to a person in NPO.

VS q15 till stable then q40

NPO

Cont. IVF patient DSLR

Meds: 1. betorlac IVTT now the age 98o

2. Tramadol 50mg IVTT now then 98o

3. Ranitadine 50mg IVTT 98o next dose 2 pm

Cont. cefuroxime and Continuation of antibiotics is a must Given to the patient at Metronidanide as to prevent that the bacteria will desired dosage. ordered. develop resistance to this drugs. Keep warm thermo regulated. The temperature tend to deplete Done some fluids also the anesthesia can cause chilling effect to the patient. .I & O monitoring ensures fluid and I & O monitored as electrolyte status of the patient ordered. thereby prompting the nurse for any abnormalities. A sedated client needs Oxygen given

I & O q hourly x 8o then per shift

O2 inhalation 2ml

until awake

supplemental oxygen to be able to support the intracellular & extracellular respiration thereby maintaining or regaining the homeostasis This will aid the nurse in Done determining any development of complication. This is done to avoid exhaustion of Done energy of the doctor .

Watch out for any unusuality Refer

Bibliography
1. Black JM, Hawks, JH, (2005), Med-Surg Nursing: Clinical Management for positive Outcome (7 th Ed.) Singapore, Elsevier Inc. 2. Bullock, BL Henze, R.L (2000) Focus on Pathophysiology Philadelphia, Lippincoot William and Wilkins 3. Doenges, ME, Moorhouse, MF, Geissler Burr, Ac. (2005) Nursing Diagnosis Manual, Planning, Individuals Documenting Client Care, USA F.A. Davis Company 4. Smeltzer, S.C Bare, B.S. Hinkle, JL et al, Brunner and Suddarths textbook of head-surg Nursing (Hth Ed.) Philadelphia, Lippincott William and Wilkins

5. Wynsberghe, D.V; Noback C.R.; Carola, R. (1995) Human Anatomy and Physiology (3rd ed) United States of America, McGraw-Hill, Inc.

Bibliography 2. Black JM, Hawks, JH, (2005), Med-Surg Nursing: Clinical Management for positive Outcome (7 th Ed.) Singapore, Elsevier Inc. 5. Bullock, BL Henze, R.L (2000) Focus on Pathophysiology Philadelphia, Lippincoot William and Wilkins 6. Doenges, ME, Moorhouse, MF, Geissler Burr, Ac. (2005) Nursing Diagnosis Manual, Planning, Individuals Documenting Client Care, USA F.A. Davis Company 7. Smeltzer, S.C Bare, B.S. Hinkle, JL et al, Brunner and Suddarths textbook of head-surg Nursing (Hth Ed.) Philadelphia, Lippincott William and Wilkins

6. Wynsberghe, D.V; Noback C.R.; Carola, R. (1995) Human Anatomy and Physiology (3rd ed) United States of America, McGraw-Hill, Inc.

Problem List 1. 2. 3. 4. Pain related to surgical incision as manifested by facial grimace. Risk for infection related to surgical wound Risk for injury related to effects of anesthesia Fear related to impending surgery and prognosis.

Notre Dame of Tacurong College City of Tacurong Drug Study Name of Patient: Mrs. Rose Yr. &Sec: BSN-3 Age: 33 years old Diagnosis: acute appendecitis Attending Physician: Dr. Tabanda M.D NAME DRUG SIDE EFFECT ACTION Generic: Mechanisms CNS: dizziness, of Action: headache Ranitidine Potent antiGI: Nausea, ulcer drug that vomiting,GI Brand: competitively irritation,constipatio Zantac and reversibly n. inhibits EENT: blurred Classification histamine vision : action at H2 Hepatic: Jaundice Anti-ulcer receptor sites Others: burning and drug parietal cells itching at injection decreasing site. gastric acid secretions. MODE OF ADMINISTR ATION Bibliography: Route: Nursing Drug Handbook IVTT 2005, Page 712, 713 Dosage: ADVERSE EFFECT 50mg Indication; Duodenal and Anaphylaxis, angio Time: gastric ulcer edema q8 Prepared by: Group 4 Checked by: Gina Cuenca, RN, MN CONTRAINDICATION Contraindicated in patient hypersensitivity to drug and those with acute prophyria SPECIAL PRECAUTION Use cautiously in patient with hepatic dysfunctions DRUG INTERACTION Drug-Drug Antacids: May interfere with ramitidine absorption stragger doses, if possible. Diazepam: may decreased absorption of diazepam monitor patient closely. NURSING RESPONSIBILITIES 1. Before giving the drug, Practice Proper hand washing R: proper hand washing will reduce presence of microorganism in your hands, thus it will prevent another complication to your pt. 2. Check the patency of the IV tube, before giving the medicine. R: checking the patency of the IV tube will facilitate easy administration of the drug thus reducing discomfort to the patient 3. Administer the medicine once it has been prepared. R: Administering the drug after preparing will reduce incidence of mistake and ensuring the sterility and effectiveness of the medication. 4. Offer pt. some ice ships and small amount of crackers to prevent occurrence of nausea and vomiting. R: This will provide comfort to the pt since nausea and vomiting are considered as side effect of the said drug. 5. Infuse the medication at slow rate about 10-15 minutes. R: this will prevent or lessen the burning and itching sensation at the injection site which is seen as the usual complains of the patient,

therefore give it slowly to prevent it. 6. Before giving the drug, educate first the patient about the purpose of it. R: Giving information to the patient will facilitate cooperation and relieve their anxiety. 7. Instruct patient to rest after administering the drug. R: Having the patient to rest will promote comfort and prevent injury since one of the side effect of the drug is dizziness. 8. Provide safety to the patient by raising the side rails and always stay at the bedside giving assistance during ambulation. R: this will provide comfort to the pt. during the occurrence of Temporary blurred vision as a side effect of the drug. 9. Instruct patient to report any unusualities. R: Instructing our patient to report unusualities will help us to provide proper and prompt treatment. 10. Before giving the drug asses if the patient has taken a meal. R: Assessing if the patient has taken any food, because the drug works better when the stomach is empty. 11.encourage patient to include fibers in the diet to prevent constipation. R: Increase in fiber intake will prevent the pt from experiencing constipation as a side effect of the drug.

Notre Dame of Tacurong College City of Tacurong Drug Study Name of Patient: Mrs. rose Yr. &Sec: BSN-3 Age: 33 years old Diagnosis: acute appendecitis Attending Physician: Dr. Tabanda M.D NAME DRUG ACTION SIDE EFFECT Generic: Mechanism of Restlessness,anxiety, Action: Metoclopramide drowsiness, fatigue, Stimulates motility lassitude,dystonic of upper GI tract, Brand name: reaction,sedation, Increases Adverse Effect: Reglan esophageal Fever, sphincter tone, depression,akathisia, Classification: and insomia,confusion,su Anti ulcer blocksdopamine icide drug receptors at the ideation,seizures,neu Mode of chemoreceptor rolepti malignant Administration: trigger zone. syndrome,hallucinati ons,headache,extra Route: Bibliography: pyramidal IVTT symptoms,tardive Dosage: Nursing 2007 dyskinesia. - 5mg/ml drug handbook. CV: transient Time: hypertension,suprave PPDs Nuring ntricular tachycardia, drug Guide bradycardia. Indication: GI: nausea, bowel Prepared by: Group 4 Checked by: Gina Cuenca, RN, MN CONTRAINDICATION NURSING RESPONSIBILITIES Contraindicated in patients Assess pt first for any GI with hypersensitivity to complaints such as nausea and drugand in those with vomiting. pheochromocytoma or seizure disorders. R: this drus is only given to pt. experiencing nausea and vomiting Patients with presence of and assessment is needed prior to GI hemorrhage. giving it. Catraindicated to patients who are lactating and pts Assess pts Blood pressure prior to with breast cancer administering the drug. Special Precaution: Use cautiously in pts with R: drug may cause transient history of depression, hypertension and pt. must be parkinsons disease,or monitored closely. hypertension. Drug Interaction: Check for patency of the IV line before Drug-drug: administration and infuse the drug in anticholinergics, opiod abou 1-2 minutes. analgesics: may antagonize GI motility R: this may cause irritation of the effects of

Antiemetics

disorders, diarrhea. GU: urinary frequency, incontinence. Hematologic: neutropenia, agranulocytosis. Skin: rash, urticaria. Other:prolactin secretion, loss of libido.

metoclopramide. Use together cautiously. CNS depressant: may cause additive. CNS effects: avoid using together. Levodopa: Levodopa and metoclopramide have opposite effects on dopamine receptors. Avoid using together. MAO inhibitors: may increase release of catecholamines in pts with hypertension. Phenothiazines: may increase risk of trapyramidal effects, monitor pt closely.

vein if infused in fast rate. Give appropriate dose ordered by the physician. R: Giving the drug in higher dose will produce drug induced advesr reaction such as hypertension. Educate pt. and SO that drug may cause temporarily neurological disorder such as involuntarily twisting of limb. R: this will let the pt. know that it is just temporary and pt. will feel at ease. Encourage pt. to do energy saving techniques that would help her not to feel fatigue such as sit instead of standing. R: the drug may cause fatigue as a side effect and this would help to alleviate the pt. from feeling it. Encourage patient not to engage in activities that require alertness. R: The drug may cause temporary impairment of mental status. Assist pt. during ambulation and provide a period for rest. R: this will prevent the occurrence of unnecessary injury since the drug

may cause drowsiness. Instruct pts SO to report any unusual feeling after receiving the medication. R: this is to provide prompt care and management to the patient.

NOTRE DAME OF TACURONG COLLEGE City of Tacurong Name of the Patient: Mrs. Rose Attending Physician: Dr. Tabanda M.D Checked By: Gina Cuenca RN, MN DRUG STUDY Diagnosis: Acute appendecitis Prepared by: Group 4 Year & Section: BSN 3

NAME Generic: Tramadol Brand: Vitram

Classification: Opioid Analgesic MODE OF ADMINISTRAT ION: ROUTE: IVTT DOSAGE: 300mg Frequency: 24 hrs.

DRUG ACTION Mechanism of Action: Unknown that a centrally acting synthetic analgesic chemically related to opioids. Thought to bind to opioids receptors and inhibit reuptake and norepinephrine and serotonin. Bibliography: Lippincott Williams & Wilkins Nursing Drug Handbook 2005, 25th edition, pgs. 405-406 Indication: Moderate to moderately severe

SIDE EFFECT

CONTRAINDICATION If the drug was tolerated it can cause diarrhea nausea, vomiting, headache, or migraine, dizziness and abdominal pain. SPECIAL PRECAUTION Use cautiously in pts hypersensitivity drug and other opiods, in breast feeding women, and patient intoxicated with alcohol. And also in pt with renal and hepatic impairment. DRUG INTERACTION Diuretics: May risk of adverse renal reactions.
DRUG-DRUG: Carbomazepine may increase Tramadol metabolism, patient long term carbomazepine therapy at up to 800mg daily may used to twice to recommend those Tramadol

NURSING RESPONSIBILITIES Stay at patients bedside and raised side rails. Drug causes dizziness, thus putting patient high risk for injury. Limit activities that requires excursion. To prevent headache and, and to lessen malaise Encourage patient to control oral fluid intake if diarrhea occurs. Fluid is restricted to pt. with urine retention and fluid excess in tissue spaces. Small amount of fluid can prevent dehydration as caused by diarrhea. Encourage patient to consume crackers and ice chips if nauseated. To allay feeling of nausea, thus prevents vomiting Assess clients visual acuity by asking patient if she can see object with in 5 meters To check if patient manifest visual disturbances. Encourage patient to include fiber in the diet Drug causes constipation, fiber facilitates vowel movement. Note for rashes on the skin after giving the medicine.

Dizziness, headache, malaise, diarrhea, N&V, visual disturbances, constipation, dry mouth, urine retention, rash ADVERSE EFFECTIVE CNS stimulation, asthenia, coordination disturbance, respiratory depression, hypertonia, and pruritus

pain.

This may be a sign of allergic reaction Always keep O2 at bedside. For immediate management of respiratory depression.

NOTRE DAME OF TACURONG COLLEGE COLLEGE OF NURSING

NURSING CARE PLAN


Name of Patient: Mrs. Rose Age: 33 yrs. old Diagnosis: acute appendecitis Attending Physician: Dr. Tabando M.D

ASSESSMENT Date: APRIL 26, 2010 Subjective Data: no verbal cues. Objective Data: Irritability noted Guarding behavior facial grimace noted.

NEEDS C O G N I T I V E P E R C E P T U A L

NURSING DIAGNOSIS Acute pain related to surgical procedure as evidenced by facial grimacing, guarding behavior and irritability Rationale: Unpleasant sensation and emotional experience from actual tissue damage. > pt. experiences piercing pain on the surgical wound due to expose

GOALS/OBJECTIVES General: After rendering effective nursing intervention the pt. will be able to verbalize reduce in pain with scale of 8 to 3 out of 10 Specific: After 8hrs. of nsg. Intervention the pt. will be able to: 1.) Report that pain is controlled. 2.) Verbalize methods that provide relief, such as diversional activities. 3.) Demonstrate use of relaxation skills as well as

NURSING INTERVENTION O1 Administer pain. medication as ordered. Instruct pt. to splint incision when coughing. O2 Provide diversional activities such as reading articles, & talking to people. Have the pt. perform breathing & coughing exercise if pain

RATIONALE To relieve pain. To reduce pain due to muscle contraction. To preoccupy pain perception by focus in other areas. To reduce the pain she fails.

EVALUATION Date: a Goal met as evidenced by pts. Verbalization of a in such as splinting the surgical wound when repositioning, and pt. have talk participative during therapeutic communication.

P A T T E R N By: Gordons Functional Health Patterns

nociceptors which detects pain sensation. Bibliography: Nurses Pocket Guide (Edition 11) by: Doenges, Moorhouse, Murr

diversional activities.

occurs. Encourage pt. to keep self in a dim lighted room. Assess pts. Perception of pain & how she feels it. Limit activities that requires exertion. Health teachings.

To reduce stimuli and stress. This may reduce feeling of anxiety thus promotes relaxation. This provides adequate bed rest. To reinforce pts. Skills in diverting pain.

NOTRE DAME OF TACURONG COLLEGE COLLEGE OF NURSING

NURSING CARE PLAN


Name of Patient: Mrs. Rose Age: 33 yrs. old Diagnosis: Acute appendecitis Attending Physician: Dr. Tabando M.D

ASSESSMENT Date: april 26, 2010 Subjective Data: sakit ang tinahian ka ang sugat mismo as verbalized pt. - pain scale of (severe) Objective Data: Facial Grimace noted Guarding Behavior noted Level of ADLs. Exudates on incision noted Diaphoresis

NEEDS N U T R I O N A L M E T A B O L I C

NURSING DIAGNOSIS Fluid volume excess r/t vasospasm secondary to preeclampsia as evidenced by edema of the lower extremities, a decreased in urine output & presence of protein in urine. Rationale: Increase isotonic fluid retention. > pt. experiences increased BP of 140/110 mmHg and has a

GOALS/OBJECTIVES General: After rendering effective nursing intervention the pt. will be able to have a stabilize fluid volume as evidenced by balanced I/O, v/s in the normal range, and with signs of edema. Specific: After 8hrs. of nsg. Intervention the pt. will be able to: 1.) verbalize understanding of individual dieatary/ fluid restrictions. 2.) Demonstrate behaviors to monitor fluid status and recurrence of

NURSING INTERVENTION O1 Health teachings on balance diet. Inform pt. that she will be restricted on fluids. Restrict & rationalized low fat and low salt diet as indicated. O2 Instruct pt. to keep urine output in container for 24 hours.

RATIONALE

EVALUATION

Date: This provides pt. Goal met as with cognizance evidenced by on healthy diet. lessened pedal For awareness edema. and compliance > pt. was able to to care. demonstrate to behaviors to prevent of fluid For clients excess such as understanding compliance to on dietary dietary protocol plan. [ low salt diet], controlled fluid intake. And pt. manifest stable A 24 hrs. urine BP of 110/80 collection will mmHg determine pts. Urine output. For changes

noted v/s: BP: 140/110 mmHg T: 36 P: 75 bpm RR: 24 cpm

P A T T E R N By: Gordons Functional Health Patterns

bipedal edema. Bibliography: Nurses Pocket Guide (Edition 11) by: Doenges, Moorhouse, Murr

fluid excess.

Measure abdominal girth.

may indicate increasing fluid retention/ edema.