Answer to Appendix case study [Appendicitis/Appendectomy SKINNY Reasoning Suggested Answer Guidelines]

Appendicitis/Appendectomy SKINNY Reasoning Suggested Answer Guidelines John Washington, 14 years old Primary Concept Inflammation Interrelated Concepts (In order of emphasis) • Pain • Stress • Clinical Judgment • Patient Education 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% CASE STUDY 1 SKINNY Reasoning Part I: Recognizing RELEVANT Clinical Data 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: Woke up this morning at about 2 am with "excruciating" generalized abdominal pain the past several hours that has been progressively getting worse. 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 feels better when he lies down and lies in a fetal position. Pain is a clinical RED FLAG, especially when there is no prior history. Sudden onset of pain that is severe and becomes gradually worse makes this complaint even more concerning. Took an adequate dose of pain medication that did relieve the pain temporarily. This is a classic clinical RED FLAG for appendicitis. The appendix is located in the RLQ. Early appendicitis tends to be generalized pain, but over time the pain becomes localized and is focused right where the inflammation is present. There is no one uniform set of symptoms for appendicitis; however, that migratory pain is a consistent symptom of acute appendicitis Inflammation from the appendix causes irritation/inflammation of the peritoneum. If appendicitis is the present problem, movement of any kind tends to worsen the pain, while lying quietly relieves the pain. RELEVANT Data from Social History: Clinical Significance: He is active in athletics and has a strong social network of friends and family in the inner-city neighborhood where he lives. No concerns present, but relevant to note that he has a strong social network to draw strength and support from