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Case Study of Ruptured Appendicitis With Localize Peritonitis (Final)

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SURIGAO EDUCATION CENTERKm. 2, 8400 Surigao City, Philippines

RUPTURED APPENDICITIS WITH LOCALIZE PERITONITIS

A CASE PRESENTATIONPresented to:

THE FACULTY OF THE COLLEGE OF ALLIED MEDICAL SCIENCES NURSING DEPARTMENT SURIGAO EDUCATION CENTER

In Fulfillment Of the Requirements for the Degree BACHELOR OF SCIENCE IN NURSING LEVEL 3Presented by: ARGUILLAS, Grace za T. CHUA, Emily L. COSTINIANO, Daryll Richmond J. ENARIO, Cheryl C. EVIOTA, Lanie Ann A. GIER, Rosemarie M. PADILLA, Ruth D. PAQUEO, Michael M. RAMOS, Honna Bina N. REPUTANA, Jane A.

OCTOBER 2011

DEDICATION This case presentation is indeed the fruit of our endeavor. A sweet success from the sweat of our hard work that worth every single moment and time that we share in making this, precious art of learning. Of all the sacrifices, we would heartily dedicate our case presentation to the following people: To our parents, who undyingly showed their moral and financial support to us, as we take every fruitful steps of our endeavor. To our clinical instructors, for imparting us their knowledge on how are we going to perform all different procedures of the nursing process, to make us fully equipped as we embark towards the realization of our chosen profession. And most especially to our Heavenly Father, who showered us all the guidance and the abundance of grace.

THE PRESENTORS

ACKNOWLEDGEMENT As the presenters of this group case presentation, with deep appreciation and heartfelt gratitude, we would like to acknowledge the following people who have supported us and made this study a successful one: To our parents who morally and financially supported us. For their encouragement and understanding why were always late in coming home. To our instructors who undoubtedly impart their knowledge and showed their support to us. To all staff of Caraga Regional Hospital, who gave us the permit to copy all the information necessary for this educational output to be completed from the patients chart. To the patient and patients family who never ceased to answer whatever questions we have raised. And most especially, to our Heavenly Father for giving us all the blessings, strength, wisdom and enlightenment that we are able to complete all the information needed. Indeed, this case study has definitely enhanced and advanced our knowledge in our chosen career.

THE PRESENTORS

CASE CONTENTS

TITLE

PAGE

DEDICATION ACKNOWLEDGMENT INTRODUCTION REVIEW OF RELATED LITERATURE PATIENT HEALTH HISTORY PHYSICAL ASSESSMENT 12 CRANIAL NERVE ASSESSMENT REVIEW OF SYSTEM LABORATORY EXAM ANATOMY AND PHYSIOLOGY PATHOPHYSIOLOGY DRUG STUDY NURSING CARE PLAN DISCHARGE PLAN APPENDICES A. B. C. BIBLIOGRAPHY INTRAVENOUS FLUID FAMILY GENOGRAM DEFINITION OF TERMS

INTRODUCTION

Our body has composed of twelve (12) different body systems; one of this is the digestive system. Digestive system breaks down food into absorbable units that enter the blood for distribution to body cells; indigestible foodstuffs are eliminated as feces. Digestion takes place almost continuously in a watery, slush environment. The large intestine absorbs the water from its inner contents and stores the rest until it is convenient to dispose of it. Attached to the first portion of the large intestine is a pouch called the vermiform appendix. According to our ancestors and even on the present time, appendix has no function in the human body but it is part of the large intestine. However, many theories, that human appendix have a function; it carries good bacteria. With function or without, appendix can be fatal when it gets infected and not treated right away.

The appendix is a small fingerlike appendage about 10 cm (4 in) long, attached to the cecum just below the ileocecal valve. The appendix fills with food and empties as regularly as does the cecum, of which it is small, so that it is prone to become obstructed and is particularly vulnerable to infection (appendicitis). Appendicitis is the most common cause of acute inflammation in the right lower quadrant of the abdominal cavity. It is thought that appendicitis begins when the opening from the appendix into the cecum becomes blocked. The blockage may be due to build-up thick mucus within the appendix or stool that enters the appendix from the cecum. The mucus or stool hardens, becomes rock-like, and blocks the opening. This rock is called Fecalith.

Mr. P., 16 years old, College student resides at Vasquez St. Surigao City while attending school at SSCT. He grew up at Brgy. Villa Flor, Gigaguit, Surigao Del Norte. Admitted at Caraga Regional Hospital last September 01, 2011 and diagnosed with ruptured appendicitis with localized peritonitis. His chief complaint was severe abdominal pain scale of 10/10 and vomiting 5-7 times in one day.

According to oxfordjurnals.org, the authors analyzed National Hospital discharge survey data for the years 1979-1984. Approximately 250,000 cases of appendicitis occurred annually in the United States during this period. The highest incidence of primary positive appendectomy (appendicitis) was found in persons aged 10-19 years old; males had higher rates of appendicitis than females for all age groups. Furthermore, the incident rate of appendicitis in the Philippines is approximately 215,604 persons, out of estimated population of 86, 241, and 6972.

Appendicitis is an inflammation of the appendix, a 3 1/2-inch-long tube of tissue that extends from the large intestine. If the inflammation and infection spread through the wall of the appendix, the appendix can rupture, causing infection of the peritoneal cavity called peritonitis. The pain become more diffuse, abdominal distention develops as a result of paralytic ileus, and the patients condition become worsens. In Mr. Ps case, he has ruptured appendicitis with localized peritonitis. We choose the case of Mr. P, to know the nature of the disease the risk factors, its complications and preventable measures; because, the complications of the disease cause many devastating health problem if left untreated.

REVIEW OF RELATED LITERATURE

Appendicitis, the most common cause of acute inflammation in the right lower quadrant of the abdomen, is the most common reason for emergency abdominal surgery especially when ruptured occurs. According to Brunner & Suddarth, about 7% of the population will have appendicitis at some time in their lives; males are affected more than females and teenagers more than adults. Although it can occur at any age, it occurs most frequently between the ages of 10 and 30 years old. It is thought that appendicitis begins when the opening from the appendix into the cecum becomes blocked. The blockage may be due to a build-up of thick mucus within the appendix or to stool that enters the appendix from the cecum. The mucus or stool hardens, becomes rock-like, and blocks the opening

Appendicitis usually happens after an infection in the digestive tract, or when the tube connecting the large intestine and appendix is blocked by trapped feces or food. Both situations cause inflammation, which can lead to infection or rupture of the appendix. Untreated, mortality is high, mainly because of the risk of rupture leading to peritonitis and shock. Also, if the abdomen on palpation is also involuntary guarded (rigid) there should be a strong suspicion of peritonitis.

Signs and Symptoms: Pain starting around the navel, then moving down and to the right side of the abdomen. The pain gets worse when moving, taking deep breaths, coughing sneezing or being touched (McBurneys point). Loss of appetite Nausea, and Vomiting Change in bowel movements, including diarrhea or constipation or unable to pass gas. Fever Rovsings sign: continuous deep palpation starting from the left iliac fossa upwards (counterclockwise along the colon) may cause pain in the right iliac fossa, by pushing bowel contents towards the ileocaecal valve and thus increasing pressure around the appendix. Psoas sign: is the right lower-quadrant pain that is produced with either the passive extension of the patients right hip (pt. lying on the left side, with knee in flexion) or the patients active flexion of the right hip while supine. Straightening out the legs causes pain because it stretches these muscles, while flexing the hip activated the iliopsoas and therefore causes pain. Obturator sign: if an inflamed appendix is in contact with the obturator

internus, spasm of the muscle can be demonstrated by flexing and internal rotation of the hip. This maneuver will cause pain in the hypogastrium. Dunphys sign: increased pain in the right lower quadrant with coughing. Kochers Sign: the appearance of pain in the epigastric region or around the stomach at the beginning of disease with a subsequent shift to the right iliac region. Stikovskiy (resensteins) sign: increased pain on palpation at the right iliac region as patient lies on his/her left side. Blumberg sign: also referred as rebound tenderness. Deep palpation of the viscera over the suspected inflamed appendix followed by sudden release of the

pessue causes the severe pain on the site indicating positing Blumbergs sign and peritonitis.

Risk Factors Risk factors for Appendicitis are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way. Having a risk factor for Acute Appendicitis makes the chances of getting the condition higher but does not always lead to Acute Appendicitis. Age: Appendicitis can occur in all age groups but it is more common between the ages of 11 and 20. Gender: A male preponderance exists, with a male to female ratio (1.4: 1) and the overall lifetime risk is 8.6% for males and 6.7% for females. A male child suffering from cystic fibrosis is at a higher risk for developing appendicitis.

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