HEALTH ASSESSMENT:

DEMOGRAPHIC DATA:

Name of the Patient : Mrs. krishnaveni

Age : 42 Yrs.

Sex : Female

Ward : Post operative ward (212)

Unit : II Unit

MRD Number : 73123

Marital Status : Married

Educational qualification : 8rd Std.

Religion : Hindu

Occupation : House wife

Family income : Rs. 1000/- Month

Address : W/o, Mr. CHINNAIYAN

2nd Street, Meenakshipuram,

Madurai.

Source : Case sheet, Daughter

Date of Admission : 11.11.18 AT 8.20 AM

Date of surgery : 20/11/18

Date of assessment : 12/11./18

Date of presentation : 23.11.18

Surgery : Hemorrhoidectomy

No. of Post- operative day : seven days complainnts of pain

Reason for Hospitalization : Patient complaints of vomiting pain over anus since 3 days.

1
HISTORY OF PRESENT ILLNESS:

Patient has complaints of bleeding per rectum since 2 days, pain over lower Abdomen since 3 days,
decreasedUrine output since 2 days,hard stools with blood stools since 2 days. She visited a clinic nearby
her house and then she was referred to Government Hospital, Madurai,

PAST HEALTH HISTORY :

Patient underwent surgery 20 Years back. But information not available. She was exposed to

Chikungunya fever 1 year back and was treated. The history of Hypertension , Diabetes mellitus,

Epilepsy or Asthma. No known drug allergies.

FAMILY HISTORY:

She lives in a Nuclear family. There is no family history of Hypertension, Diabetes mellitus, She

has 5 children.

42yrs

52yrs

35yrs 36yrs 30yrs 35yrs 31yrs 34yrs 32yrs 33yrs 28yrs 30yrs

--male

--female

--patient

2
SOCIO-ECONOMIC BACKGROUND:

She has been living in own house which has water and drainage facility, good ventilation. All the

basic facility available. No pet animals and garden is present.

PERSONAL HISTORY:

Born as home delivery at her place.

She has good experience in all milestones of age. She has good rapport

with others.

She follows Hindu religion.

She speaks Tamil.

She follows mixed diet.

She has disturbed pattern of sleep.

Her bowel and bladder elimination pattern is regular., last 2 days she has

increased urine output, loose stools.

No habit of smoking, drug abuse, alcohol and tobacco chewing.

Activities of daily living are good.

MENSTRUAL HISTORY:

She attained menarche at 15 years of age and menopause 23 years back.

MARITAL HISTORY:

She got married at the age of 18 years, her marriage is non-consanguineous type.

OBSTETRICAL HISTORY:

S.N ORDER TERM/ MODE OF PLACE BIRTH SEX WEIGH HEALTH

O OF PRETE DELIVER OF ATTENDA OF T OF STATUS
BIRTH RM Y BIRTH NT THE THE
BABY BABY
1 G1P1L1 Term Normal Hospital Doctor Female Healthy
A0
2 G2P2L2 Term Normal Hospital Doctor Female Healthy
A0
3 G3P3L3 Term Normal Hospital Doctor Female Healthy
A0
3
 4 G4P4L4 Term Normal Hospital Doctor Female Healthy
A0
5 G5P5L5 Term Normal Hospital Doctor Female Healthy
A0

PHYSICAL EXAMINATION
General Appearance : He is conscious, oriented, well built.

Hair and Scalp : Black and grey hairs present, equally distributed. No dandruff and no pediculosis.

Eyes : Normal vision and PERRLA present, no conjunctivitis, corneal discoloration

present. He wears spectacles sometimes.

Ears : No discharge present, symmetrical normal hearing capacity.

Nose : Normal anatomical presentation, Nasal septum not deviated, nasal mucosa pink in

colour.

Mouth and Throat:

Lips : Lips are dry.

Tongue : Tongue is coated, no ulcers.

Gums & Mucous : Pink in colour, no ulcers, no halitosis.

Teeth : Only few teeth present.

Throat & Neck : No enlargement of tonsils and thyroid. No stiffness or palpable lymph nodes

present. Trachea is in midline. No Jugular Vein distension.

Chest : Symmetrical, Symmetrical chest movement present on breathing.

Abdomen : No Abdominal distension, no scars or organomegaly.

Genitalia : Normal anatomical presentation, Urethral meatus is present in centre.

Extremities : No congenital abnormalities, muscle weakness present. Able to perform range of

motion (all 4 limbs). Peripheral line present in Left forearm, 18G venflon. It is

patent and secured well.

Back and Spine : Normal curvature seen, no pressure ulcers present.

SYSTEMIC ASSESSMENT

CENTRAL NERVOUS SYSTEM:

He is conscious, oriented to time, place and person. He has good memory, GCS is normal.

4
RESPIRATORY SYSTEM:

Inspection : Symmetrical chest movement present on respiration. He has cough with expectoration,

Dyspnea present on exertion. Respiratory rate is 26 beats/min.

Auscultation : Bilateral air entry present, normal vesicular breath sound present.

Percussion : Normal resonance felt, absence of dull or hyper reasonance.

CARDIOVASCULAR SYSTEM:

Inspection : Temporary pace maker present.

Palpation : Carotid pulse present, no jugular vein distension.

Auscultation : S1 S2 sound heard, no murmur. Pulse rate before TPI – 40 beats/min.

Percussion : Normal resonance felt. After TPI, Heart rate is 76 beats/min.

GASTROINTESTINAL SYSTEM:

Inspection : Contour of abdomen is flat, no surgical scars, visible veins.

Auscultation : Normal bowel sounds heard in all 4 quadrants.

Percussion : Normal.

Palpation : No tenderness, organomegaly present.

Bowel movements: Present.

Stools : Eliminates once daily. After hospitalization, did not pass for lass 2 days.

MUSCULO SKELETAL SYSTEM:

Skin turgor : Good

Peripheral pulses : Present.

Range of Motion : Able to perform

Congenital abnormalities : Absent

Paralysis/shortening of limbs : Absent

Right thigh pacemaker is connected.

ENDOCRINE SYSTEM:

No generalized or local lymphadenopathy.

GENITO URINARY SYSTEM:

5
 No ulcers, swelling, infection, discharge present. No dribbling, dysuria, incontinence seen. He has
increased frequency of urination.

INTEGUMENTARY SYSTEM:

Turgor : Good and elastic.

Temperature : Normal, warm, no pigmentation, inflammation or parasthesia.

VITAL SIGNS:

Temperature : 97.6 F

Pulse : 76 beats/min

Respiration : 26 breaths/min

Blood Pressure : 130/80 mm of Hg.

PAIN SCORE:

0 1 2 3 4 5 6 7 8 9 10

Patient has pain of score 2.

OXYGEN SATURATION:

SpO2 is 92% in room air, with 6 lit O2, Mr. Arul Raj maintains SOS (whenever necessary).

INVESTIGATIONS
INVESTIGATIONS PATIENT VALUE BOOK VALUE REMARKS
Hemoglobin 13.2 cells/dL 14 – 17 Normal
TC 7600 cells/mm3 4000 – 10000 Normal
ESR 25mm/hr 10-20 increased
Glucose 154 mg/dL 80 – 120 Normal
Urea 18 mg/dL 35 – 45 Normal
Creatinine 1.0mg/dL 0.4-1.4 Normal
Sodium 136mg/dL 135-145 Normal
Potassium 3.6 mEq/L 0.4 – 1.4 Normal

6
 SGOT 34U/L 5-40 Normal
SGPT 12U/L 7-56 Normal
Blood Group A+ 3.5 – 5.0
BT 1.15 sec 2 – 15 min Normal
CT 3.30 sec < 9 min Normal

Chest X-Ray: Lungs clear.

ECG: Sinus tachycardia.

USG: Thickened and inflamed appendix noted. Thickness of 9mm with complaints of inflammatory fat
stranding surrounding.

7
DRUG NAME DOSE/ROUTE/FREQUENCY GROUP AND ACTION SIDE EFFECTS NURSES
RESPONSIBILITIES
Inj. Piptaz 4.5GM/IV/BD Anti-infective broad Lethargy, Anxiety, - Assess for infections:
spectrum, extended Twitching, Insomnia, stools, temperature,
penicillin, beta lactamase Dizziness, Nausea, urine, wound.
inhibitor. Vomiting, Anemia, Rash, - Maintain intake
Interferes with cell wall Constipation, Abdominal output chart to report
replication of susceptible pain, Glossitis, Oliguria oliguria.
organisms, osmotically - Checkfor blood and
unstable cell wall swells and hepatic studies, renal
bursts from osmotic pressure. studies everyday.
Protects piperacillin from - Administer the
enzymatic degeneration.
Inj. Metrogyl 500MG/IV/TD Anti- Headache, Irritability,
infective,Nitromidazole Insomnia, Blurred vision,
derivative: Sore throat, Dry mouth,
Binds and disrupts DNA Edema, Diarrhoea,
structure inhibiting bacterial Discolouration of Urine,
nucleic acis synthesis. Dysuria, Rash, Flushing.
Inj. Tramadol 100MG/IV/BD Opioid analgesicsinhibits Sweating, Dizziness,
reuptake of norepinephrine, Tachycardia, Headache,
serotonin and enhance Palpitation, Insomnia,
serotonin release. It alters Orthostatic hypertension.
perception and response to
pain by binding to M-opiate
receptors in the CNS.
Inj. Rantac 150mg/IV/BD H2 histamine receptor Dizziness, Headache,
antagonist: Constipation, Agitation,
Inhibits histamine at H2 Nausea, Vomiting,
receptor site at parietal cells, Tachycardia, Blurred vision,
which inhibits gastric acid Rash.
secretion.

8
SURGICAL MANAGEMENT

Under spinal anaesthesia Hemorroidectomy [Link] incision made and the accumulated tissues are
[Link] sutured in layers.

9
NURSING DIGNOSIS:

PRE-OPERATIVELY: PRE-OPERATIVE NURSING DIAGNOSIS:

 Client Acute pain related to inflammatory process as evidenced by client verbalization

 Deficient fluid volume related to vomiting as evidenced by dry lips and oral mucous

 Activity intolerance related to weakness as evidenced bed riddenes

 Impaired oral mucous related to poor hydration as evidenced by dry oral mucous, coated tongue

 Imbalanced nutrition less than body requirement related to anorexia as evidenced by weakness

 Deficient knowledge [Link] treatment process as evidenced by frequent questioning

 Risk of injury to related to IV cannulation

POST-OPERATIVE NURSING DIAGNOSIS:

 Acute pain related to surgical incision as evidenced by patient verbalization, pain scale reading.

 Deficient fluid related to decreased fluid intake and drains as evidenced by dry skin and oral mucous,

poor skin turgor.

 Imbalanced nutrition less than body requirement related to poor oral intake as evidenced by

weakness

 Impaired physical mobility related to weakness and pain as evidenced by bedriddeness

 Activity intolerance related to fatigue as evidenced by patient verbalization

 Fatigue related weakness as evidenced by bedriddeness

 Deficient knowledge regarding treatment process and follows up care as evidenced by frequent

questioning

 Risk for infection related to insertion of drain tubes, catheter.

10
Subjective data: the client verbalizes that he is having severe pain In the surgical site
Objective data : Dull facial expression, tiredness, fatigue.
Diagnosis : Acute pain related to surgical incision.
Goal : The patient pain will be relieved.
Planning Implementation Rationale Evaluation

 Observe and document The pain level is no. 8 in  Assists in

location, severity (0– pain scale reading. differentiating cause of
10 scale), and pain, and provides
character of pain information about
(steady, intermittent, disease progression The patient pain is reduced
colicky) and resolution,.
.  Severe pain not
 Note response to relieved by routine
medication, and report The physician is informed measures may indicate
to physician if pain is regarding client condition developing
not being relieved complications or need
for further intervention
 Bed rest in low-
 Promote bedrest, Fowler’s position
allowing patient to Proper and comfortable bed reduces intra-
assume position of is provided abdominal pressure;
comfort. however, patient will
naturally assume least
 Use soft or cotton painful position.
linens; calamine Soft cotton linen are  Reduces irritation and
lotion, oil bath; cool or provided dryness of the skin and
moist compresses as itching sensation.
indicated
 Cool surroundings aid
11
 Control environmental Calm and quite environment in minimizing dermal
temperature provided discomfort

 Encourage use of Music therapy is provide  Promotes rest,

relaxation techniques. through head phones. redirects attention,
Provide diversional may enhance coping
activities.
 Helpful in alleviating
 Make time to listen to Good IPR maintained with anxiety and refocusing
and maintain frequent The client. attention, which can
contact with patient relieve pain

 Maintain NPO status, NG tube is inserted and on  Removes gastric

insert and/or maintain continuous RT aspiration secretions that
NG suction as stimulate release of
indicated cholecystokinin and
gallbladder
 Sedatives: Inj. Tramadol im guven contractions.
Phenobarbital
 Promotes rest and
 Antibiotics [Link] IV given relaxes smooth muscle

12
Subjective data : The client verbalized that his body temperature is increased

Objective data : The body temperature is 101o.f

Diagnosis : Hyperthermia related to infection as evidenced by vital signs.

Goal : Maintain normal body temperature of the client

Planning Implementation Rationale Evaluation

Assess the client condition The client has pyrexia To know the base line data
Check vital signs The temperature is 101 f For proper management The client body temperature is
reduced to 99. f
Provide cold compress Cold applied on fore head, axilla To reduce the temperature
and groin region
Provide tepid sponging Tepid sponging is given every Reducing temperature by
hourly conduction
Administer iv fluids IV fluids RL administered To minimise temperature and
maintain fluid volume
Advice to take cool drinks Fresh fruit juices are given To reduce core temperature

Provide cool environment Fan is switched on to provide cool Cool environment reduce surface
environment temperature
Administer antipyretics inj . paraceptamol 500mg/ im To minimize the temperature
given
Reassess the temperature The temperature is 99. F To know the treatment outcome

13
Subjective data : The client verbalize that his lips are dry

Objective data : The client’s skin is dry and urine output is reduced

Diagnosis : Deficient fluid volume related to surgical blood loss and drains as evidenced by poor skin turgor,
decreased urine output.

Goal : Maintain normal fluid and electrolyte level for the client.

Planning Implementation Rationale Evaluation

Assess the degree of The patient skin turgor is For knowing the base line
dehydration reduced data
Advice to take more oral Educated to take atleast 2 Increased oral intake
fluids liters of fluid per day maintains normal fluid The patient fluid status is
improved
volume
Provide fresh fruit juice Advice to provide fresh fruit Maintains normal electrolyte
juice level
Maintain I/O chart The intake and output is Know the patient status
monitored
Administer IV fluids IV fluid RL administered Maintain normal fluid
volume
Reassess the degree of The skin turgor is normal Knowing the effectiveness of
dehydration planning

14
 Subjective data: The client verbalized that he cannot eat properly
Objective data: The client is weak and tired
Diagnosis: Imbalanced nutrition less than body requirement related to loss of appetite as evidenced by weakness.
Goal : Improve the nutritional status of the client.
Planning Implementation Rationale Evaluation

 Monitor the client status The client is weak and To know the base line
dull. data
 Assess the nutritional
status of the client
The client nutritional To identify the clients The client’s nutritional
status is poor. nutritional status status have been
 Monitor the weight of improved.
the client
The weight of the client To known the clients
 Provide easily digestible is 68 kg. condition
diet
Semi solid foods like For easy absorption and
porridge are provided. digestion
 Provide more fresh fruit
juices
Fresh fruit juices are
provided Improve fluid status of
the client
 Advice to take plenty of
water
15
 Educated to take more Improve fluid and
 Provide palatable food to than 3 liters of fluids electrolyte levels.
the client
Attractive foods are To improve the appetite
 Advice to take high provided to the client
protein diet

 Educate to reduce Egg and vegetables are Promotes wound healing

carbohydrate and fat rich provided process
diet
Health education given To prevent further
 Reassess the nutritional regarding diet complications
status
The nutritional status is To known the
reassessed effectiveness of planning

16
 Subjective data: The client verbalized that that he could not perform any activity
Objective data: The client looks dull and inactive.
Diagnosis: Activity intolerance related fatigue as evidenced by patient verbalization.
Goal : Improve the activity level of the client
Planning Implementation Rationale Evaluation
 Monitor the clients The client is unable perform To know the base line data of
activity level his activities the client

 Provide adequate bed Bed rest provided to the

rest toe client client To provide proper rest to the
client The activity level of the
client is improved
 Advice to avoid Advised to avoid strenuous Prevent tiredness
strenuous activities activities

 Schedule the clients The clients activities are For improving the activity of
activity scheduled the client

 Teach active and Active and passive range of For improving the muscle
passive range of motion exercise is taught to tone of the client.
motion exercise the client

17
 Advice the client to Advised to perform mild Improve the activity of the
perform non tiring activities client
activities

 Provide support to the Client is assisted whenever Help in clients needs

client when necessary necessary

 Reassess the client’s The activity level of the To evaluate the effectiveness
activity level. client is assessed of planning

18
 Health education

1. Balanced diet
Eating well is key to maintaining strength, energy, a healthy immune system and general lung
heath. The key to a healthy balanced diet is not to ban or omit any foods or food groups but to
balance what you eat by consuming a variety of foods in the right proportions. At a high level, the
basic elements of a healthy diet include the right amount of protein, fat, carbohydrates, vitamins,
minerals and water
 fruits ( bananas, oranges, and pineapples)
 vegetables (leafy greens, carrots, and potatoes)
 lean meats
 whole grains
 beans and nuts
Low-carbohydrate diets may help prevent or improve serious health conditions, such
as metabolic syndrome, diabetes, high blood pressure and cardiovascular disease. In fact, almost any diet
that helps you shed excess weight can reduce or even reverse risk factors for cardiovascular disease and
diabetes. Most weight-loss diets — not just low-carb diets — may improve blood cholesterol or blood
sugar levels, at least temporarily. Grains, Fruits, Vegetables, Milk, Nuts, Seeds, Legumes (beans, lentils,
peas

[Link] of motion exercise

To maintain joint mobility is done by putting each of the patient’s joints through all possible movements to
increase and/or maintain movement in each joint.

 To prevent contracture, atony (insufficient muscular tone), and atrophy of muscles.

 To stimulate To improve coordination.
 To increase tolerance for more activity.
 To maintain and build muscle strength
 circulation, preventing thrombus and embolus formation.

Passive.

These exercises are carried out by the nurse, without assistance from the patient

Passive exercises will not preserve muscle mass or bone mineralization because there is no voluntary
contraction, lengthening of muscle, or tension on bones.

Active Assistive : These exercises are performed by the patient with assistance from the nurse. Active
assistive exercises encourage normal muscle function while the nurse supports the distal joint

Active : Active exercises are performed by the patient, without assistance, to increase muscle strength.

19
Resistive. :These are active exercises performed by the patient by pulling or pushing against an opposing
force

Isometric.

These exercises are performed by the patient by contracting and relaxing muscles while keeping the part in a
fixed position. Isometric exercises are done to maintain muscle strength when a joint is immobilized. Full
patient cooperation is required

[Link] Style Modification

 Avoid strenuous activities

 Avoid exposure to extreme hot or cold temperature
 Withdraw yourself from excessive noise
 Take adequate best rest
 Avoid use of tobacco, pan
 Avoid taking excessive carbohydrate rich food like rice etc.
 Take protein , vitamin and mineral rich diet
 Take plenty of tender coconut water
 Take fiber rich diet

3. Follow up care

 Consult the doctor if you have muscle weakness

 Seek medical care if symptoms persists
 Consult physician if side effects of drugs occurs
 Take your medication regularly
 Do not skip medications
 Take medication in full step
 Seek medical care regularly

4. Regarding Treatment Process

 Take medication regularly as prescribed
 Do o skip medications
 Seek medical care when symptoms persists or re occurs
 Have a check of your serum potassium level
 Avoid the triggering fact

20
21
CONCLUSION:

I hereby conclude that by doing this clinical presentation I have gained profound knowledge
about prognosis of the disease condition, develop assessment skills, formulating nursing
diagnosis, planning nursing care, implementing & evaluating the care provided &
understanding the purpose of diagnostic tests. Scrutinizing this care study it is found that
having diagnosed hemorrhoids is a stressful condition to the patient; apart from medical
management nursing care is precious to this patient. In which I have focused my career in
many ways to attend the prime needs of the patient. Further I found psychological support
plays a major role in reducing the impending fear of death.

I hereby conclude that by taking my care study client, I have gained

profound knowledge about prognosis of the disease condition, develop assessment skills,
formulating nursing diagnosis, planning nursing care, implementing & evaluating the care
provided & understanding the purpose of diagnostic tests.

I would like to thank Mrs. [Link] madam,Lecturer [Link](N),M.B.A.(HM)., .,

ward staffs, student nurse for this opportunity to gain adequate knowledge from this case
presentation.

22
IX .Bibliography:

Brunner and Suddarth, (2009) Medical - Surgical Nursingp, 8 th edition, J.B Lippincott,
Philadelphia.
Davidson, (2002) Principles and practice of Medicine,and surgery, 14th edition Churchill
living stone, Edinburgh.
Brunner and Suddarth, (2009) Medical - Surgical Nursing, 8 th edition, J.B Lippincott,
Philadelphia.
Watson, (1993) Medical - surgical Nursing and related Physiology, The person with
disorders of myocardial blood supply, 4th edition, ELBS, London,

Journal reference:
Journal of American Cancer Society.

American Joint Committee On Cancer Breast.7th edition new York.

23
 APPENDIX:
Extending from the inferior end of the large intestine’s cecum, the human appendix is a narrow pouch of
tissue whose resemblance to a worm inspired its alternate name, vermiform (worm-like) appendix. It is
located in the right iliac region of the abdomen (in the lower right-hand abdominal area), measuring about
four inches long and roughly a quarter of an inch in diameter.

Like the rest of the digestive tract, the appendix is made of an inner layer of mucosa with submucosa,
muscularis, and serosa layers surrounding it.... [Continued from above] . . . Unlike the rest of the large
intestine, however, the submucosa of the appendix contains many masses of lymphoid tissue. The presence
of lymphoid tissue suggests that the appendix may play a role in the immune system in addition to the
digestive system.

The appendix is not a vital organ and medical researchers still debate its exact function in our bodies. One
hypothesis suggests that it is a vestigial remnant of a once larger cecum. This larger cecum would have been
used by vegetarian ancestors to digest cellulose from plants. Supporters of this hypothesis therefore
conclude that the appendix no longer serves any purpose for us.

Another hypothesis suggests that the appendix acts as a storage area for beneficial bacteria during times of
illness. Beneficial bacteria living in the appendix could survive being flushed out of the large intestine by
diarrhea. The appendix would therefore help a person to recover more rapidly from illness by enabling the
bacteria to re-colonize the intestines after the illness has passed.

Doctors typically remove an appendix if it becomes inflamed, and even a healthy appendix may be removed
during abdominal surgeries such as a hysterectomy. A doctor's justification for this removal is that the
appendix is susceptible to bacterial infections that lead to appendicitis, a fairly common and dangerous
inflammation of the appendix. Often one of the first signs of appendicitis is pain and tenderness near the
navel, often growing sharper and spreading downward into the lower right abdomen. The pain can grow
quite severe over the course of a few hours, so much so that it may be impossible to get comfortable or to
move without pain. Applying pressure to the area will commonly cause pain that can sharpen after releasing
the pressure (a phenomenon called "rebound tenderness"), though this is not always the case. Additional
common symptoms include nausea, vomiting, fever and others.
Tenderness and growing pain in the right abdomen that is noticeable enough to cause considerable
discomfort during movement or at rest warrants medical attention in order to reach a diagnosis and receive
any necessary treatment. Untreated appendicitis can lead to the rupture of the appendix, a serious medical
emergency wherein fecal matter leaks out of the cecum. Left untreated, the bacteria-laden fecal matter
spreads throughout the abdominal cavity, where the bacteria begin to digest the peritoneum that lines the
cavity. The infection and inflammation of the peritoneum, known as peritonitis, is a severely painful and
potentially fatal consequence of appendicitis.
Prepared by Tim

Definition
Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the
lower right side of your abdomen. The appendix doesn't seem to have a specific purpose.
Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the
navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually
becomes severe.
Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30.
Standard treatment is surgical removal of the appendix.
Symptoms
igns and symptoms of appendicitis may include:
24
 Sudden pain that begins on the right side of the lower abdomen
 Sudden pain that begins around your navel and often shifts to your lower right abdomen
 Pain that worsens if you cough, walk or make other jarring movements
 Nausea and vomiting
 Loss of appetite
 Low-grade fever that may worsen as the illness progresses
 Constipation or diarrhea
 Abdominal bloating
The site of your pain may vary, depending on your age and the position of your appendix. When you're
pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during
pregnancy.
Causes
A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The
bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not
treated promptly, the appendix can rupture.
Complications
Appendicitis can cause serious complications, such as:

 A ruptured appendix. A rupture spreads infection throughout your abdomen (peritonitis). Possibly
life-threatening, this condition requires immediate surgery to remove the appendix and clean your
abdominal cavity.
 A pocket of pus that forms in the abdomen. If your appendix bursts, you may develop a pocket of
infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through your abdominal
wall into the abscess. The tube is left in place for two weeks, and you're given antibiotics to clear the
infection.
Once the infection is clear, you'll have surgery to remove the appendix. In some cases, the abscess is
drained, and the appendix is removed immediately.
Tests and diagnosis
To help diagnose appendicitis, your doctor will likely take a history of your signs and symptoms and
examine your abdomen.
Tests and procedures used to diagnose appendicitis include:
 Physical exam to assess your pain. Your doctor may apply gentle pressure on the painful area.
When the pressure is suddenly released, appendicitis pain will often feel worse, signaling that the adjacent
peritoneum is inflamed.
Your doctor also may look for abdominal rigidity and a tendency for you to stiffen your abdominal
muscles in response to pressure over the inflamed appendix (guarding).
Your doctor may use a lubricated, gloved finger to examine your lower rectum (digital rectal exam).
Women of childbearing age may be given a pelvic exam to check for possible gynecological problems
that could be causing the pain.

 Blood test. This allows your doctor to check for a high white blood cell count, which may indicate
an infection.
 Urine test. Your doctor may want you to have a urinalysis to make sure that a urinary tract infection
or a kidney stone isn't causing your pain.
 Imaging tests. Your doctor may also recommend an abdominal X-ray, an abdominal ultrasound or a
computerized tomography (CT) scan to help confirm appendicitis or find other causes for your pain.

25
 Treatments and drugs
Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may
be given a dose of antibiotics to prevent infection.
Surgery to remove the appendix (appendectomy)
Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10
centimeters) long (laparotomy). Or the surgery can be done through a few small abdominal incisions
(laparoscopic surgery). During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a
video camera into your abdomen to remove your appendix.
In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be
better for people who are elderly or obese. But laparoscopic surgery isn't appropriate for everyone. If your
appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need
an open appendectomy, which allows your surgeon to clean the abdominal cavity.
Expect to spend one or two days in the hospital after your appendectomy.
Draining an abscess before appendix surgery
If your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a
tube through your skin into the abscess. Appendectomy can be performed several weeks later after
controlling the infection.
Lifestyle and home remedies
Expect a few weeks of recovery from an appendectomy, or longer if your appendix burst. To help your body
heal:

 Avoid strenuous activity at first. If your appendectomy was done laparoscopically, limit your
activity for three to five days. If you had an open appendectomy, limit your activity for 10 to 14 days.
Always ask your doctor about limitations on your activity and when you can resume normal activities
following surgery.
 Support your abdomen when you cough. Place a pillow over your abdomen and apply pressure
before you cough, laugh or move to help reduce pain.
 Call your doctor if your pain medications aren't [Link] in pain puts extra stress on your
body and slows the healing process. If you're still in pain despite your pain medications, call your doctor.
 Get up and move when you're ready. Start slowly and increase your activity as you feel up to it.
Start with short walks.
 Sleep when tired. As your body heals, you may find you feel sleepier than usual. Take it easy and
rest when you need to.
 Discuss returning to work or school with your doctor. You can return to work when you feel up
to it. Children may be able to return to school less than a week after surgery. They should wait two to four
weeks to resume strenuous activity, such as gym classes or sports.
Alternative medicines:
medications to help you control your pain after your appendectomy. Some complementary and alternative
treatments, when used with your medications, can help control pain. Ask your doctor about safe options,
such as:

 Distracting activities, such as listening to music and talking with friends, that take your mind off
your pain. Distraction can be especially effective with children.
 Guided imagery, such as closing your eyes and thinking about a favorite place.

26
 Time plan
Date & Day Time Work plan
6.10.15 7-11AM  Went to the ward and selected the
I
client
4-6PM
 Nursing assessment done
 Provide comfort
 Make normal breath pattern
 Record vital signs
 Reassure the client
 Maintain normal circulation
 IVF given as per order
 Drugs given as per order
07.10.15 7-11AM  Provide comfort
II 4-6PM
 Record vital signs
 Provide oral hygiene
 Provide oral fluids milk, fruit
juices about 1200kcal
08.10.15 7-11AM  Provide comfort and basic care
III 4-6PM
 Explain the disease condition
 Participate with patient activity
 Prescribed drug given
09.10.15 7-11AM  Provide comfort and basic can
IV 4-6PM
 Prescribed drug given
 Provide semisolid diet with
1500kcal with resulted
cholesterol mild exercise

10.10.15 7-11AM  Move the client participate in

V 4-6PM
27
 daily activities
 Provide elimination needs main
safe and calm environment
 Prescribed drug given
11.10.15 7-11AM  Improve the individual coping .
VI 4-6PM
 Health education given
 Prescribed drug given
 To reduce to level of ignorance
about disease
12.10.15 7-11AM  Explained about advance
VII
treatment and facilities
 Make the patient to feel better
 Provide diet plan

28
INDEX

29
S.N PAGE
CONTENT
O NO
1. INTRODUCTION
2. OBJECTIVES
HEALTH ASSESSMENT
a) Health History
3. b) Physical Examination
c) Review Of Systems
d) Investigation Chart

DISEASE CONDITION
a) Definition
b) Review Of Anatomy& Physiology
c) Etiology
d) Pathophysiology
e) Clinical Manifestation
f) Diagnostic Evaluation
g) Management
4.
i. Medical
ii. Surgical
iii. Nursing
h) Complications
i) Patient Management
i. Medical
ii. Surgical
iii. Nursing

5. LIST OF NURSING DIAGNOSIS

6. NURSING CARE PLAN
7. TIME PLANNING
8.. HEALTH EDUCATION
9.. CONCLUSION
10. BIBLIOGRAPHY

30