CASE STUDY -Appendicitis and Appendectomy

John Washington, 14 years old Primary Concept Inflammation Interrelated Concepts (In order of emphasis) • Pain • Stress • Clinical Judgment • Patient Education • Communication NCLEX Client Need Categories Percentage of Items from Each Category/Subcategory Covered in Case Study Safe and Effective Care Environment Management of Care 17-23% Safety and Infection Control 9-15% Health Promotion and Maintenance 6-12% Psychosocial Integrity 6-12% Physiological Integrity Basic Care and Comfort 6-12% Pharmacological and Parenteral Therapies 12-18% Reduction of Risk Potential 9-15% Physiological Adaptation 11-17% History of Present Problem: John Washington is a healthy 14-year-old African American male who weighs 150 lbs. (68.2 kg). He came to the emergency department because he woke up this morning at about 2 am with "excruciating" generalized abdominal pain around his belly button that has been progressively getting worse over the past several hours. It is now 2 pm. He took ibuprofen 400 mg PO this morning, which decreased the pain some but is now more painful and uncomfortable. The pain is now localized to his RLQ. The pain increases with walking and movement but he feels better when he lies down in a fetal position. He vomited three times after he drank some orange juice for breakfast this morning and has had nothing to drink since. He continues to feel nauseated but has not had an emesis since this morning. Personal/Social History: John lives with his mother and three younger brothers. He is active in athletics and has a strong social network of friends and family in the inner-city neighborhood where he lives. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction of Risk Potential) RELEVANT Data from Present Problem: Clinical Significance: - Acute abdominal pain, pain progressively getting worse for past 2 hours, pain medication helped a little but pain is worse now, pain localized to RLQ, pain worsens with movement, vomiting - Showing signs and symptoms of appendicitis. Medications do not provide long-term relief because the appendicitis needs to be addressed. The pain localized to RLQ is an indication that it is indeed appendicitis. It is important to address before it ruptures. RELEVANT Data from Social History: Clinical Significance: - Mother and three younger brothers, athletic lifestyle - Mother and younger brothers may indicate he has a good support system; however no father being mentioned could indicate payment issues. Him being an athlete and being in severe pain while moving must be a serious issue Patient Care Begins: Current VS: P-Q-R-S-T Pain Assessment: T: 100.5 F/38.1 C (oral) Provoking/Palliative: Movement, palpation P: 106 (regular) Quality: Sharp, cramping R: 20 (regular) Region/Radiation: Mid abdomen, RLQ BP: 142/76 Severity: 8/10 O2 sat: 99% RA Timing: Continuous What VS data are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction of Risk Potential/Health Promotion and Maintenance) RELEVANT VS Data: Clinical Significance: - Temperature 100.5 - Pulse: 106 - BP: 142/76 - Pain: 8/10, sharp + cramping, continuous pain in RLQ - Temperature could indicate infection - Elevated pulse is interrelated with his severe pain - Elevated BP is interrelated with his severe pain - The characteristics of the pain and location are very indicative of appendicitis Initial Assessment by Primary Nurse What body system(s) will the nurse most thoroughly assess based on the problem and the clinical data collected to this point? (Reduction of Risk Potential/Physiologic Adaptation) PRIORITY Body System(s): PRIORITY Nursing Assessments: ABDOMEN/GI - Inspect abdomen, assess skin for any redness, inflammation, heat. Assess abdomen for any distention. Auscultate abdomen, palpate abdomen and check for rebound tenderness (McBurney’s point). It is important to be careful when palpating because there is suspected appendicitis.