I.

TITLE PAGE

Submitted to:

Ms. Pamela Montecarlo Garlet, RN

Submitted by:

Jesse James Edjec BN3N

Date
DECEMBER 1, 2009
II. TABLE ON CONTENTS

I. Introduction ---------------------------------------------------------------------

II. Objectives ----------------------------------------------------------------------

III. Anatomy and Physiology ---------------------------------------------------

IV. Definition of Terms ----------------------------------------------------------

V. Baseline Data ------------------------------------------------------------------

VI. Nursing History (Gordon’s Functional Health Pattern) -----------------

VII. Health History ---------------------------------------------------------------

VIII. Assessment ------------------------------------------------------------------

IX. Laboratory and Radiology --------------------------------------------------

X. Pathophysiology ---------------------------------------------------------------

XI. Nursing Care Plan ------------------------------------------------------------

XII. Drug Study -------------------------------------------------------------------

XIII. Health Teaching ------------------------------------------------------------

XIV. Bibliography ----------------------------------------------------------------

I.INTRODUCTION

Patient R.C. is a 17 year-old boy who was admitted at the

CLMMRH last November 24, 2009 due to severe pain at her right lower
quadrant, the patient was diagnosed with acute appendicitis. The patient
underwent emergency appendectomy few hours prior to admission when he
had sudden onset of epigastric pain, that later localized to the right lower
quadrant.

Appendicitis is the inflammation of the vermiform appendix and was

first described as a pathologic condition by Reginald Fitz in 1886; it is
caused by an obstruction attributed to infection, stricture, fecal mass, foreign
body or tumor. Appendicitis can affect either gender at any age, but is most
common in male ages 10-30. Appendicitis is the most common disease
requiring surgery and one of the most commonly misdiagnosed diseases.

Appendectomy, removal of the appendix, is the standard treatment for

acute appendicitis, it is important to immediately remove the appendix after
the diagnosis to prevent the occurrence of the life-threatening complication
of appendix.
The most frequent complication of appendicitis is perforation.
Perforation of the appendix can lead to a periappendiceal abscess (a
collection of infected pus) or diffuse peritonitis (infection of the entire lining
of the abdomen and the pelvis). The major reason for appendiceal
perforation is delay in diagnosis and treatment. In general, the longer the
delay between diagnosis and surgery, the more likely is perforation. The risk
of perforation 36 hours after the onset of symptoms is at least 15%.
Therefore, once appendicitis is diagnosed, surgery should be done without
unnecessary delay.

I have never experienced appendicitis my whole life, and thus I am grabbing

this opportunity to uncover certain answers and find solutions or
interventions in handling this kind of disease. This discussion is very
important to me because acute appendicitis is one of the most common
surgical emergencies seen in the Philippines. Over 250,000 appendectomies
are performed annually.
II. NURSING OBJECTIVE

A. GENERAL

• To widen and enhance the student nurse’s knowledge and skills

through additional research about the nature of the disease, its signs
and symptoms, its pathophysiology, its diagnosis and treatment.

• Gather as much information and knowledge about appendicitis which

is one of the most common surgical emergencies in the country.

• To formulate the appropriate nursing intervention and plan of care to

prevent further complications as well as to promote wellness

B. SPECIFIC

• To obtain necessary information regarding the patient and her

condition

• To assess the patient’s overall health status

• To identify patient’s health care needs through analysis of all the data
gathered

• To assist the patient throughout rehabilitation, recovery and discharge

• To impart necessary health teachings to the patient

• To perform appropriate nursing care in conjunction with the condition

of the patient
III. ANATOMY AND PHYSIOLOGY

The Appendix is a closed-ended, narrow tube up to several inches in length

that attaches to the cecum , the first part of the colon, like a worm. The anatomical
name for the appendix is vermiform appendix which means worm-like appendage.
It's pencil-thin and normally about 4 inches (7 cm) long. The appendix is usually
located in the right iliac region, just below the ileocecal valve (designated
McBurney's point) and can be found at the midpoint of a straight line drawn from
the umbilicus to the right anterior iliac crest. The inner lining of the appendix
produces a small amount of mucus that flows through the open center of the
appendix and into the cecum.
The wall of the appendix contains lymphatic tissue that is part of the immune
system for making antibodies. During the first few years of life, the appendix
functions as a part of the immune system, it helps make immunoglobulin. But after
this time period, the appendix stops functioning. However, immunoglobulins are
made in many parts of the body; thus, removing the appendix does not seem to
result in problems with the immune system.
Like the rest of the colon, the wall of the appendix also contains a layer of muscle,
but the muscle is poorly developed.

The large intestine is the second to last part of the digestive system—the
final stage of the alimentary canal is the anus —in vertebrate animals. Its function
is to absorb water from the remaining indigestible food matter, and then to pass
useless waste material from the body. This article is primarily about the human
gut, though the information about its processes are directly applicable to most
mammals.
The large intestine consists of the cecum and colon. It starts in the right iliac
region of the pelvis, just at or below the right waist, where it is joined to the
bottom end of the small intestine. From here it continues up the abdomen, then
across the width of the abdominal cavity, and then it turns down, continuing to its
endpoint at the anus.
The large intestine is about 1.5 metres (4.9 ft) long, which is about one-fifth of the
whole length of the intestinal canal.

The cecum or caecum (from the Latin caecus meaning blind) is a pouch,
connecting the ileum with the ascending colon of the large intestine. It is separated
from the ileum by the ileocecal valve (ICV) or Bauhin's valve, and is considered to
be the beginning of the large intestine. It is also separated from the colon by the
cecocolic junction.
IV. DEFINITION OF TERMS

ABDOMEN - the part of the body of a vertebrate that contains the stomach,
intestines, and other organs

APPENDIX - anatomy small outgrowth from large intestine: a blind-ended tube

leading from the first part of the large intestine (cecum), near its junction with the
small intestine. In humans it is small, occurs in the lower right-hand part of the
abdomen, and contains cells of the immune system

APPENDICITIS - Acute inflammation of the vermiform (wormlike) appendix, a

blind tube projecting from the cecum

APPENDECTOMY - operation to remove appendix: a surgical operation to

remove the appendix

ALIMENTARY CANAL - the principal part of the digestive system. It begins at

the mouth and extends to the anus

ANUS - the opening at the lower end of the alimentary canal through which feces
are released

CECUM - the pouch in which the large intestine begins, which is open at one end

COLON – the large intestine

EPIGASTRIUM - the upper middle part of the abdomen

ILEOCECAL VALVE - a membranous structure between the cecum and the

small intestine that regulates the passage of food material from the small intestine
to the large intestine and also prevents the passage of toxic waste products from
the large intestine back into the small intestine

IMMUNOGLOBULIN - glycoprotein with a high molecular weight that acts like an

antibody and is produced by white blood cells during an immune response
INFECTION - injurious contamination of the body or part of the body by
pathogenic agents, such as fungi, bacteria, protozoa, rickettsiae, or viruses, or by
the toxins that these agents may produce

LARGE INTESTINE - last section of the intestinal tract: the end section of the
alimentary canal reaching from ileum to anus, and consisting of the cecum, colon,
and rectum. Its function is to extract water and form feces

MCBURNEY'S POINT - and can be found at the midpoint of a straight line

drawn from the umbilicus to the right anterior iliac crest

OBSTRUCTION - block or hindrance: somebody or something that causes or

forms a blockage or hindrance

PATHOLOGIC - extreme: uncontrolled or unreasonable

PERFORATION - making holes or having them: the act of making a hole or

holes in something or the state of being perforated

PERITONITIS - inflammation of abdomen lining: inflammation of the

membrane that lines the abdomen (peritoneum)

PERIUMBILICAL AREA – within the umbilicus

ROVSIGN SIGN - exist when the lower left abdomen is palpated by the doctor,
but causes pain in the right

PSOAS SIGN - If the hip is moved and stretched, this can cause pain to be felt at
the spot where the appendix lies

STRICTURE - a severe criticism or strongly critical remark

TUMOR - an abnormal uncontrolled growth or mass of body cells, which may be

malignant or benign and has no physiological function
V. BASELINE DATA

Name: R. C.

Address: Talisay city

Age: 17

No. of Dependents:

Birthdate: September 19, 1992

Birthplace: Kabangkalan City

Gender: Male

Civil Status: Single

Religion: Roman Catholic

Educational level: College level

Nationality: Filipino

Occupation: none

Date of admission: November 24, 2009

Attending Physician: Dr. Taroja

Chief complaint: Abdominal Pain

Date of surgery: November 24, 2009

VI. NURSING HISTORY (Gordon’s Functional health pattern)

1. HEALTH MAINTENANCE – PERCEPTION PATTERN

> The client consults his doctor whenever he experiences some changes regarding his
health; this includes stomach pain, high fever, and any other health problems. He never
believed in “hilots” or any natural remedies. He takes medicines such as biogesic for
fever, solmux for occasional cough and some antibiotics. He also takes clusivol and
enervon once a day as his daily supplement.

2. NUTRITION – METABOLIC PATTERN

> Patient eats 3 times a day and drinks water at same time. Has good appetite and has no
significant dietary restrictions. He said that he is heavier before than the present. He likes
to eat different kinds of foods, especially chicken adobo. He doesn’t like his food dry, it
always comes with a soup.

3. ELIMINATION PATTERN

> Patient approximately voids 5 times a day and defecates everyday. This is his
elimination pattern before his hospitalization. Under normal conditions, client has normal
elimination pattern, but due to his operation, his elimination pattern is also altered.

4. ACTIVITY AND EXERCISE PATTERN

> Client does his own self exercise, he jogging and crutches during weekends

5. SLEEP AND REST PATTERN

> Client has no problem when it comes to rest or sleep periods. He sleeps 8 hours a day,
from 9pm till 7 in the morning, he sometimes takes a nap in the afternoon.

6. COGNITIVE PERCEPTION

> Patient has complete level of visual, auditory, olfactory and gustatory functioning and
can speak or pronounce words clearly.
7. SELF-PERCEPTION SELF-CONCEPT PATTERN

> Client is on appropriate age, he has high level of self-esteem. And very confident in
facing different kinds of personalities.

8. ROLE RELATIONSHIP PATTERN

> Client is the second child from the five children. He has his own responsibilities in
doing chores inside the house, and responsible for the safety of his younger sisters and
brothers.

9. SEXUALITY RELATIONSHIP PATTERN

> Client has no experienced of having a companion of his opposite sex. And is not
experiencing any problems with regards to his reproductive organs and sexual response.

10. COPING-STRESS PATTERN

> When the client experience some difficulties and problems he shares it to his friends
and ask them for opinions and solutions. He plays computer as his problem management.

11. VALUES AND BELIEF PATTERN

> Client has no beliefs in other religions. He is a roman catholic and he doesn’t believe in
any other Gods. He has its own values in life that has been taught by their churh.
VI. HEALTH HISTORY

1. History of Present Illness

Patient was in usual state of good health until November 24, 2009,
after having his dinner he experienced a severe pain at his abdomen which
started at the area around his periumbilical area shifted to right lower
quadrant region. He was immediately rushed to the hospital and was
admitted at CLMMRH at 9:55 PM, He was diagnosed with acute
appendicitis. He underwent an emergency appendectomy a few hours prior
to admission, November 23, 2009. Her operation begun at 12:08 AM and
ended at 12:40 AM, her surgeon was Dr. Taroja
According to the patient, He had been experiencing mild pain at her
abdominal region since he was 14 years old, He even consulted it to the
doctor but they did not pay much attention to it thinking that it was just a
manifestation of his kidney problem and that it was nothing serious.
The patient’s vital signs during the shift were as follow:
Temperature: 36.2 °C
Pulse Rate: 86 bpm
Respiratory Rate: 20 cpm
Blood Pressure: 120/80 mmHg

2. Past Health History

a. Childhood illness
> The client has only experienced stomach pain and minor health
problems such as occasional cough, colds, and mild fever.

b. Past Hospitalization
> Patient has no previous hospitalization, no history of Hypertension,
Diabetes, Cancer, no known allergies.

c. Serious/ chronic illness

> The client has no experience of any serious or chronic illness. He
only experienced stomach pain and minor health problems such as
occasional cough, colds, and mild fever.

d. Previous Surgery
> No previous history of surgical operation.

3. Family/ Social History

No known family history of Hypertension, diabetes, pulmonary tuberculosis,

cancer, allergies and other hereditofamilial diseases.

VII. ASSESSMENT
Systems Review
Cephalo Caudal

a. General appearance
> Neat Appearance with dark complexion and short curly hair
> Wearing T-shirt with matching long pants

b. Vital signs
> Blood Pressure: 120/80 mmHg
> Temperature: 36.2°C
> Pulse Rate: 86 bpm
> Respiratory Rate: 20 cpm

c. Integumentary
> Warm to touch; Afebrile, T: 36.2°C
> With good skin turgor

d. Cardiovascular
> With IVF #1 PLR 1L x 100cc/hr, infusing well at right cephalic vein
> Blood pressure of 120/80 mmHg, Pulse rate of 80 bpm
> With good capillary refill at less than 2 seconds

e. Respiratory
> Breathes spontaneously to room air at 34 cpm
> With symmetrical rise and fall of chest upon respiration

f. Abdomen
> Flat abdomen with thumblike protrusion of his right lower quadrant

g. Gastrointestinal Tract
> On NPO as ordered
> Has not defecated upon assessment
> Able to pass out flatus upon assessment
> With normoactive bowel sounds at 13 cpm

h. Gastrourinary Tract
> Able to void freely to a light yellow colored urine

i. EENT
> Pupils Equally Round and Reactive to Light Accommodation
> With pinkish conjunctiva

j. Musculoskeletal
> Moderately active, moving freely; ambulatory
IX. LABORATORY AND RADIOLOGY

HEMATOLOGY REPORT

Test requested: CBC, Platelet (November 24, 2009)

Laboratory/ Results Normal values Interpretations Implication
Diagnostic Test
Hemoglobin 163 g/L 130-180 normal
Hematocrit 0.49 % 0.40-0.54 normal
RBC Count 5.4 x 4.5-6.2 Normal
COAGULATION
PROFILE
Platelet Count 290 x10 150-450 normal
WBC Count 19.4 x109/L 4.5-10.0 increased
DIFFERENTIAL
COUNT
Neutrophil 55-65
Segmented 81 % 50-60 increased
Lymphocytes 18 % 25-35 decreased
Eosinophil 01 % 1-3 normal
TOTAL 100 %

URINALYSIS REPORT (November 24, 2009)

NORMAL ACTUAL Implication Nursing Responsibility

COLOR Light or pale Light Yellow Normal
Yellow
CHARACTER Clear Slightly turbid Abnormal > increase fluid intake
ALBUMIN (-) (-) Normal
REACTION 4.6-8 6.5 pH Normal
SPECIFIC 1.010-1.025 1.010 Normal
GRAVITY
PUS CELL 0 2-4 Abnormal > increase fluid intake
>Administer antibiotic as
ordered
SQUAMOUS (-) (+) Abnormal > increase fluid intake
>Administer antibiotic as
ordered
BACTERIA (-) (+) Abnormal > increase fluid intake
> increase intake of Vitamin
C
>Administer antibiotic as
IDEAL LABORATORY STUDIES:

1. WHITE BLOOD CELL COUNT

The white blood cell count in the blood usually becomes elevated with
infection. In early appendicitis, before infection sets in, it can be normal, but most often
there is at least a mild elevation even early. Unfortunately, appendicitis is not the only
condition that causes elevated white blood cell counts. Almost any infection or
inflammation can cause this count to be abnormally high. Therefore, an elevated white
blood cell count alone cannot be used as a sign of appendicitis.

2. ABDOMINAL X-RAY

An abdominal x-ray may detect the fecalith (the hardened and calcified, pea-
sized piece of stool that blocks the appendiceal opening) that may be the cause of
appendicitis. This is especially true in children.

3. ULTRASOUND

An ultrasound is a painless procedure that uses sound waves to identify organs

within the body. Ultrasound can identify an enlarged appendix or an abscess.
Nevertheless, during appendicitis, the appendix can be seen in only 50% of patients.
Therefore, not seeing the appendix during an ultrasound does not exclude appendicitis.
Ultrasound also is helpful in women because it can exclude the presence of conditions
involving the ovaries, fallopian tubes and uterus that can mimic appendicitis.

4. LAPAROSCOPY

Laparoscopy is a surgical procedure in which a small fiber optic tube with a

camera is inserted into the abdomen through a small puncture made on the abdominal
wall. Laparoscopy allows a direct view of the appendix as well as other abdominal and
pelvic organs. If appendicitis is found, the inflamed appendix can be removed with the
laparascope. The disadvantage of laparoscopy compared to ultrasound and CT is that it
requires a general anesthetic.
X. PATHOPHYSIOLOGY

Obstruction of the appendix

(by fecalith, lymph node, tumour, foreign objects)

↓
Inflammation

↓
Increase intraluminal pressure

↓
Distention of the Appendix → causes pain
↓
Decrease venous drainage

↓
Blood flow and oxygen restriction to the appendix

↓
Bacterial Invasion of the Blood wall →causes fever
↓
Necrosis of the appendix

↓
Acute pain on RLQ

The pathophysiology of appendicitis is the constellation of processes that leads to

the development of acute appendicitis from a normal appendix. The main thrust of events
leading to the development of acute appendicitis lies in the appendix developing a
compromised blood supply due to obstruction of its lumen and becoming very vulnerable
to invasion by bacteria found in the gut normally.

Obstruction of the appendix lumen by fecalith, enlarged lymph node, worms,

tumor, or indeed foreign objects, brings about a raised intra-luminal pressure, which
causes the wall of the appendix to become distended. Normal mucus secretions continue
within the lumen of the appendix, thus causing further build up of intra-luminal
pressures. This in turn leads to the occlusion of the lymphatic channels, then the venous
return, and finally the arterial supply becomes undermined. Reduced blood supply to the
wall of the appendix means that the appendix gets little or no nutrition and oxygen. It also
means a little or no supply of white blood cells and other natural fighters of infection
found in the blood being made available to the appendix. The wall of the appendix will
thus start to break up and rot. Normal bacteria found in the gut gets all the inducement
needed to multiply and attack the decaying appendix within 36 hours from the point of
luminal obstruction, worsening the process of appendicitis. This leads to necrosis and
perforation of the appendix. Pus formation occurs when nearby white blood cells are
recruited to fight the bacterial invasion. A combination of dead white blood cells,
bacteria, and dead tissue makes up pus. The content of the appendix (fecalith, pus and
mucus secretions) are then released into the general abdominal cavity, bringing causing
peritonitis.
 So, in acute appendicitis, bacterial colonization follows only when the process
have commenced.

These events occur so rapidly, that the complete pathophysiology of appendicitis takes
about one to three days. This is why delay can be deadly.

Pain in appendicitis is thus caused, initially by the distension of the wall of the
appendix, and later when the grossly inflamed appendix rubs on the overlying inner wall
of the abdomen (parietal peritoneum) and then with the spillage of the content of the
appendix into the general abdominal cavity (peritonitis). Fever is brought about by the
release of toxic materials (endogenous pyrogens) following the necrosis of appendicael
wall, and later by pus formation. Loss of appetite and nausea follows slowing and
irritation of the bowel by the inflammatory process.

Early symptoms of appendicitis are those symptoms that most people with this
condition may recognize and complain of.

They include lower right sided abdominal pain of gradual onset, feeling sick (or
nausea), and loss of appetite.

Any one with these three symptoms can be assumed to have appendicitis until proven
otherwise.

• Abdominal pain

This pain typically starts from around the belly button (peri-umbilical
region), or the upper central abdomen (epigastrium) and then move downwards
and to the lower right abdomen (right iliac fossa). When the pain occurs in this
pattern, it is the most dependable of all symptoms of appendicitis, as over 8 out 10
(80%) cases that present this way is definitely due to the appendix. In some other
individuals, the pain starts right way from the right iliac fossa. Depending on
where the tip of the appendix is, the pain could even be on the right flank (retro-
caecal appendix). If the appendix is quite long, and in the pelvic cavity, it could as
well cause lower left abdominal pain, with frequent passage of urine if the
inflamed appendix irritates the bladder.

When the appendix is severely inflamed, the pain can be localized to a

spot on the outer one third of a line drawn between the belly button and front of
the tip of the waist bone called the McBurney’s point. The Mc Burney’s point is
also often the point of maximum tenderness when the abdomen is examined. The
pain is even worse when the hand is suddenly removed from that spot because of
the appendix rubbing on the covering of the abdomen (Rebound tenderness).

There is also a sign referred to as the Rovsign sign. This is said to exist
when the lower left abdomen is palpated by the doctor, but causes pain in the
right. If the appendix is the pelvic type, examining the back passage (rectal
examination) would cause some pain too. If the hip is moved and stretched, this
can also cause pain to be felt at the spot where the appendix lies. This is referred
to as the psoas sign.
XI. Nursing Care Plan

> PRE-OPERATIVE NURSING CARE PLAN

Assessment Diagnosis Rationale Expected Nursing Intervention Justification Evaluation
Outcome

Actual > Anxiety related Independent:

to impending After days of After 8 hour of nursing
Objective: nursing 1.Perform a comprehensive - to include location, interventions:
surgery as interventions, the assessment of pain characteristics, duration
evidenced by Appendicitis client will be able frequency, severity (0 to 10 1- Goal met:
> poor eye contact
>Extraneous restlessness to: or face scale) and the client has able to
movement (rocking ↓ precipitating/ aggravating manage pain and smile
Definition: 1.Verbalize factors.
movements) And able to verbalize
Disturbed awareness of awareness of feelings
>Restlessness Admission feelings of
behavior is due to - This can point to of anxiety.
2. Observe the
Subjective: apprehension of anxiety. the clients level of
clients behavior.
the outcome of ↓ anxiety.
Note any unusual
“Nakulbaan ko sa the surgery and activities.
operasyon na matabo” imagined threat to 2- Goal met:
Appendectomy 2. Defecate the client has able to
as verbalized by the one’s health. 3. Encourage adequate rest
- to prevent fatigue defecate during my shift
patient. Anxiety - periods
↓
A state of
Risk: poor eating habits & 3. Continue usual Collaborative:
change in usual foods
apprehension, daily activities.
3.- Goal met:
pattern uncertainty, and Anxiety the client has able to play
1. Administer anti- - Helps to manage with his younger brother and
fear resulting
anxiety the pt. experiencing cheery smile noted
Strength: good family from the drugs/sedatives, as
support and optimistic in anticipation of a anxiety.
life ordered.
realistic or
fantasized 2. Review
threatening event medications - Helps minimize
or situation, often regimen and side effects of drugs
impairing possible that may aggravate
physical and interactions, the condition.
psychological especially with OTC
functioning. drugs/alcohol, and
so forth. Discuss
appropriate drug
substitutions,
 changes in dosage
or time of dose.

1 Risk (NCP)

> POST-OPERATIVE NURSING CARE PLAN

Assessment Diagnosis Rationale Expected Nursing Intervention Justification Evaluation
Outcome
Actual >Acute pain Independent:
Appendicitis After days of 1.Perform a comprehensive - to include location, After 8 hour of nursing
related to tissue
Objective: nursing assessment of pain characteristics, duration interventions:
injury secondary interventions, the frequency, severity (0 to 10
>Facial Grimace to surgical ↓ client will be able or face scale) and
>Guarding behavior intervention as Admission to: precipitating/ aggravating
>Cannot ambulate evidenced by factors.
>Pain score of 6 report of 6 pain 2.Encourage use of - To distract attention
>Incision site in the ↓ 1- Goal met:
scale. 1. Verbalize relaxation techniques and reduce tension
abdomen (7 inches) is the client has able to
erythematous.
reduction of
Definition: Appendectomy pain from 6 to manage pain and smile
4. and will be 3. Provide comfort - Topromote no
Subjective:
measures pharmacological pain
Pain is ↓ able to
“Nagasaki tang akun ambulate management
characterized by
tinay-an”. verbalized its intensity,
by the patient. Post 4. Encourage adequate rest - to prevent fatigue
location and periods
appendectomy 2. The Client will 2- Goal met:
Risk: poor eating habits &
duration be able to Client has able to maintain
demonstrate Collaborative:
change in usual foods pain level and have not
pattern Acute Pain is ↓ nonpharmacologi aggravated.. and breathing
cal technique for 1. Administer - To maintain
common to the exercise noted
Strength: good family relaxation. analgesics, as “acceptable” level of
client who Presence of
support and optimistic in indicated pain
undergone surgical incision
life
surgery procedure
because there is a 2. Review medications
- Helps minimize side
break in the skin ↓ regimen and possible
effects of drugs that may
interactions, especially
aggravate the condition.
with OTC drugs/alcohol,
Source: NANDA Acute pain and so forth. Discuss
appropriate drug
substitutions, changes in
dosage or time of dose.
XII. DRUG STUDY

Name of Drug Dosage Mechanism of action Indication Contraindication Adverse reaction Nursing considerations
Frequency
Route

1. Ketorolac 30mg, Possesses anti- > Management of > Hypersensitivity to CNS: drowsiness, sedation, > Use as part of a regular
tromethamine IVTT inflammatory, analgesics severe, acute pain in the drug or allergic dizziness, headache analgesic schedule rather than on
(Toradol) q8 and antipyretic effects adults that requires symptoms to aspirin or CV: edema, hypertension, as needed basis.> Give oral form
analgesia and the opiate other NSAID’s. palpitations, arrhythmias with meals
level, usually in a > Active peptic ulcer , GI: nausea, dyspepsia, GI > If pain returns within 3-5
CLASSIFICATION: postoperative setting recent GI bleeding or pain, diarrhea, peptic hours, the next dose can be
CNS drugs / NSAID’s perforation, history of ulceration, vomiting, increased by up to 50 %
peptic ulcer or GI constipation, flatulence, > Do not mix IV/IM ketorolac in
bleeding. stomatitis a small volume with morphine
> Advanced renal Hematologic: decreased sulfate, meperinide HCL,
impairment platelet adhesion, pupura, promethazine HCL, or
prolonged bleeding time hydroxyzine HCL, will
Skin: pruritus, rash, precipitate from solution.
diaphoresis
Other: pain at injection site

2. Ranitidine 50mg, Inhibits histamine at H2 > Used in the > Hypersensitivity to CNS: vertigo, malaise, > Assess patient for abdominal
IVTT receptor site in the gastric management of various drug or its components headache. pain. Note presence of blood in
CLASSIFICATION: q8 parietal cells, which inhibits gastrointestinal > Alcohol intolerance EENT: blurred vision emesis, stool, or gastric aspirate
GIT drugs / Antiulcer gastric acid secretion. disorders such as (with some oral Hepatic: jaundice > Ranitidine may be added to
drugs dyspepsia products) Other: burning and itching at total parenteral nutrition solution
gastrointestinal reflux > History of acute injection site, anaphylaxis, > Evaluate results of laboratory
disease [GERD], peptic porphyria. angioedema tests, therapeutic effectiveness
ulcer and zolunger- and adverse reactions
ellisou syndrome. (bradycardia, PVC’s,
Prophylaxis of GI tachycardia, CNS changes, rash,
hemorrhage from the gynecomasticia, GI disturbance
stress ulceration and in and hepatic failure.)
patients at risk of > Assess knowledge and teach
developing acid patient appropriate use, possible
aspiration during side effects or appropriate
general anesthesia interventions and adverse
prophylaxis of symptoms to report.
mendelson syndrome.
 Name of Drug Dosage Mechanism of action Indication Contraindication Adverse reaction Nursing considerations
Frequency
Route

1. Cefuroxime 500mg, Second-generation > Perioperative > Contraindicated in CV: phlebitis, > Before administration, ask
1 tab cephalosporin that inhibits prevention patients thrombophlebitis patient if he is allergic to
CLASSIFICATION: TID cell-wall synthesis, hypersensitivity to drug GI: pseudomembranous penicillin or cephalosporins.
Anti-invectives/ promoting osmotic or other cephalosporins. colitis, nausea and vomiting, > Obtain specimen for culture
Cephalosporins instability; usually >Use cautiously in anorexia, diarrhea and sensitivity tests before
bactericidal. patients hypersensitive Hematologic: transient giving first dose.
to penicillin because of neutropenia, eosinophilia, > For I.M. administration, inject
possibility of cross- hemolytic anemia, deep into a large muscle, such as
sensitivity with other thrombocytopenia. the gluteus maximus or the
beta-lactam antibiotics. Skin: maculopapular and lateral aspect of the thigh
erythematous rashes, urticaria, > Absorption of cefuroxime is
pain, induration, sterile enhanced by food.
abscesses, temperature
elevation.
Other: hypersensitivity
reactions, serum sickness,
anaphylaxis.

2. Meloxicam 15mg, Unknown, may inhibit > Relief from pain > Contraindicated in CNS: dizziness, headache, > Rehydrate dehydrated patients
1 tab prostaglandin synthesis, to patients insomnia, fatigue before starting drug
CLASSIFICATION: OD prn for produce anti-inflammatory, hypersensitivity to CV: arrhythmias, palpitations, > Watch for signs and symptoms
NSAID, CNS drug pain analgesic and antipyretic drug. tachycardia, heart failure, of overt poor overall health
effects hypertension >NSAIDs can cause fluid
GI: abdominal pain, diarrhea, retention: closely monitor
dyspepsia, flatulence patients who have hypertension,
edema, or heart failure.

3. Ascorbic acid 250mg Vitamin C is essential in the > vitamin C > Contraindicated in CNS: paresthesia of limbs, > ascorbic acid aren’t
1 tab synthesis of collagen, a deficiency patients listlessness, confusion, flaccid interchangeable; verify
CLASSIFICATION: BID connective tissue protein of > Post operative hypersensitivity to paralysis. preparation before use.
Vitamin C the body incisions ascorbic acid CV: arrhythmias, heart block, > Make sure powders are
>Large doses of hypotension ECG changes. completely dissolved before
vitamin C should be GI: nausea, vomiting, diarrhea giving.
given with care to Metabolic: hyperkalemia >Enteric-coated tablets aren’t
patients with Respiratory: respiratory recommended because of
hyperoxaluria. paralysis. increased risk of GI bleeding and
small-bowel ulcerations.
XIII. HEALTH TEACHING
 Medication
`Ketorolac
tromethamine
(Toradol) 30mg IVTT q8
for acute pain
` Ranitidine 50mg, IVTT
q8
For inhibiting gastric acid
secretion.
`Teach the patient & folks
about the indications of the
drugs and let them know
the effect & adverse effects
of the medications.
Client must understand the
importance of drugs to their
body and why they must
acquire it.
Remind them to question
and not to administer
medication that have been,
improperly stored, look
discolored, or do not look
like their usual medication.
Advise the patient to
always read the label before
taking a drug, to take it
exactly as prescribed, and
never to share prescription
drugs.
Encourage them to ask
further questions about
their drugs.
After discussion make sure
the client understands and
ask to repeat if verification
is needed.
Exercise Treatment Hygiene Outpatient Diet
Medications Personal hygiene > Continue
> LEG pertains to hygiene prescription drugs Practice of ingesting
EXERCISES > Ketorolac practices performed by if symptoms comes food in a regulated
- Management an individual to care back fashion to achieve or
- to promote of severe, acute for one’s bodily health maintain a controlled
blood circulation. pain in adults that and well being through >Compliance to weight. In most cases
Moderate exercise in requires analgesia cleanliness. Conditions follow up check ups the goal is weight
the morning within and the opiate and practices that serve loss in those who are
the patient’s limit level, usually in a to promote or preserve > Continue ROM overweight or obese,
and with rest. Inform postoperative health. and leg exercises but some athletes
client that the normal setting. - to avoid further aspire to gain weight
activity can be Personal hygiene complications to (usually in the form
resumed after 3-4 > Ranitidine practices include: health of muscle) and diets
weeks. - inhibits gastric seeing a doctor, seeing can also be used to
acid secretion. a dentist, regular > Adequate fluids maintain a stable
Used in the washing (bathing or - for hydration body weight.
management of showering) of the
>ROM various body, regular hand > > Balanced diet
gastrointestinal washing, brushing and Prevention/Promoti - Eat fresh fruits and
-for circulation disorders such as flossing of the teeth, on of diseases must vegetables for
improvement. dyspepsia and and healthy eating. be implemented essential nutrients
Exercises may not be patients at risk of and minerals
important, but it can developing acid >self-help bath/Bed - strengthen
minimize the chance aspiration during bath > Rest for comfort immunity
of acquiring and general anesthesia
spreading of prophylaxis of >Tepid sponge bath > Careful handling > Avoid junk
diseases. mendelson of items in the and street
syndrome. >Brushing and flossing environment, to foods
the teeth minimize viral - to avoid GIT
Laboratory test - to remove dental contamination. infections
plaque - to prevent
>Regular complications such
monitoring of CBC >providing special oral as amoeba and
(platelets) care hepatitis.
- To prevent -to maintain intactness
lowering of of health of lips, > Regular bowel
platelets that may tongue and mucus elimination
cause spontaneous membranes of the
bruising & mouth.
bleeding -to prevent oral
> Urinalysis infections
- serves as
indication for
infection.

XIV. BIBILIOGRAPHY

1. Brunner and Suddarth's Textbook of Medical-Surgical

Nursing
i. by Suzanne C. Smeltzer and Brenda G. Brade
2. Fundamentals of Nursing by Kozier
3. Nurses’s Drug Handbook by George R. Spratto and
Adrienne L. Woods
4. Essentials of Human Anatomy And Physiology by Elaine N.
Marieb
5. Blackwell’s Nursing Dictionary
6. Nurse’s Pocket Guide by Marilyn E. Doenges
7. Pathophysiology by Thomas J. Nowak
8. (http://www.radiology.rsnajnls.org )
http://radiology.rsnajnls.org/cgi/content-nw/full/215/2/337/
9. http://www.aafp.org/afp/991101ap/2027.html
10. www.medicinenet.com