Appendicitis/Appendectomy SKINNY Reasoning

Appendicitis/Appendectomy SKINNY Reasoning 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%  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 by Acute abd. pain, progressively worse. Localized RLQ. Treated with 400 mpg Motrin Vomits x 3 Pain was sudden, not attributed to an MOI, localized to the area of the appendicitis. He attempted to treat with an anti inflammatory but it continues to progress. He is in a fetal position and cant maintain oral hydration . RELEVANT Data from Social History: Clinical Significance: Lives in the inner city, with single mother and 3 siblings. Plays sports nformation he has a single mother and 3 siblings. Receiving care needed maybe difficult due to resources and time. 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: 100.5 Temp 106 H/R 20 R Pain assessment Raised temp: Potential infection Raised HR: tachycardia from pain, anxiety, infection Raised respiration: hyperventilating (watch SPO2), due to pain, anxiety Pain assessment details characteristics of his pain helping to identify underlying cause. Because his pain is sharp, continues, provokable, and located in the LQR it may be appendicitis