==INTRODUCTION:==

Appendicitis:

Appendicitis, is the most common cause of acute surgical abdomen in the US, is the most common reason for emergency abdominal surgery. Although it can occur at any age, it more commonly occurs between the ages of 10 and 30 years. Appendicitis is a condition characterized by inflammation of the appendix It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of peritonitis and shock.Reginald Fitz first described acute and chronic appendicitis in 1886,and it has been recognized as one of the most common causes of severe acute abdominal pain worldwide. A correctly diagnosed non-acute form of appendicitis is known as "rumbling appendicitis".


Urinary Tract Infection (UTI)

Urinary tract infection are caused by pathogenic microorganisms in the urinary tract ( the normal urinary tract is sterile above the urethra). UTI are generally classified as infections involving the upper or lower urinary tract and further classified as uncomplicated or complicated, depending on other patient-related factors.
The most common type of UTI is acute cystitis often referred to as a bladder infection. An infection of the upper urinary tract or kidney is known as pyelonephritis, and is potentially more serious. Although they cause discomfort, urinary tract infections can usually be easily treated with a short course of antibiotics. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine.



PATIENT CHART
Name:Geri Royce

Age: 11y/o Gender: M

Chief complaint: low grade fever

History of Present Illness: he had nausea and vomiting

Medical Diagnosis:T/C Apendicitis, r/t UTI

ANATOMY and PHYSIOLOGY
Digestive System
Appendix-
is a blind-ending tube that comes off of the first part of the colon, the cecum. In fact, the appendix resembles a worm arising from the colon, hence its full name vermiform appendix which in Latin means worm. The appendix has no known function. It is believed that it may have a role in the immune system. Since the appendix is a dead-end tube, stool can get trapped in it. Trapped stool is called a fecalith. As a result of the fecalith, the appendix can become inflamed and appendicitis develops. If the inflammation persists, the appendix is at risk for rupture.

Images:

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Urinary System


Kidney: The kidneys are bean-shaped organs located behind the stomach that screen the body’s blood and remove wastes for subsequent excretion in the form of urine. The kidney has three regions: the outer cortex, the central medulla, and the inner pelvis.


Ureter: The ureters transport the urine from the kidneys to the bladder for storage.

Nephron: The basic unit of the kidney is the nephron. Each kidney is composed of roughly 1 million nephrons. Kidney
nephrons filter the blood, reabsorbing what the body needs and excreting the rest as urine.


Urinary bladder: is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible (or elastic) organ, the bladder sits on the pelvic floor. Urine enters the bladder via the ureters and exits via the urethra.


Male gonads

The Male Reproductive System is consists of:
  • testes
  • ducts: epididymis, vas deferens, urethra
  • accessory glands: seminal vesicles, prostate glands, Cowper’s gland
  • supporting structures: scrotum, penis
External Structures:
  1. Penis – comprised of 3 columns of erectile tissues (2 corpus cavernosa on the sides of the shaft; 1 corpus spongiosum around the urethra).
    • Consists of the Shaft and the Glans Penis
      • Shaft – contains the urethra which is the passageway for urine and semen
      • Glans – is highly sensitive (well supplied with sensory receptors) and is located at the dismal end of the penis.
  2. Scrotum – rugated skin-covered muscular pouch/sac suspended from the perineum. It contains the testes, epididymis and the lower portion of the spermatic cord.
male reproductive system2
male reproductive system2
Internal Structures:

  1. Testes – considered the male gonads are 2 oval organs, 4-5 cm long within the scrotum.
  2. Epididymis - It is where some sperm stored and a part of the fluid that surrounds the sperm (semen/seminal fluid) is produced by cells lining the epididymis.
  3. Vas deferens/Ductus deferens – a tube surrounded by arteries and veins and protected by a thick fibrous coating. It carries sperm from epididymis into the pelvic cavity.
  4. Seminal vesicle - 2 convoluted pouches that lie along the lower portion of the bladder and empty into urethra by way of ejaculatory ducts.
  5. Prostate Gland – lies just below the bladder. It secretes a thin alkaline fluid that when added to the secretion from the seminal vesicle and sperm from the epididymis further protects the sperm from being immobilized by natural low pH (acidic) level of the urethra due to passage of urine through the same lumen.
  6. Urethra – hollow tube leading from the base of bladder, passing through the prostate gland, continues to the outside through the shaft and glans penis.
  7. Cowper’s glands – lie beside the prostate gland and by short ducts empty into the urethra.


PATHOPHYSIOLOGY








TPR SHEET NAKATABLE DIN SAME SA VL FORM
Medication
frequency
1st day
2nd day
gentamycin SO4



buscopan 10mg



aeknil 300mg/ml




DRUG COMPUTATION
Drug #1
Drug #2
Drug #3
D/S X DILUENT

40mg / 40mg/amp
=1amp
D/S X DILUENT

10mg / 40mg/tab
=.25 or 1/4 tab
D/S X DILUENT

3OOmg / 750mg x 5ml
= 2ml

Date
Shift
Bottle #
Solution
gtts/min
Amt.infused
Amt. endorsed
Oct. o3/10
7:00-3:00
1
D5LR 1L
62.5gtts/mins
94cc
906cc

3:00-11:00
11:00-7:00













IVF COMPUTATION
gtts/min
vol. of IVF x 60 gtts/cc
no. of hrs x 60 min

1000cc x 60 gtts/cc
16 hrs x 60 min

= 62-63 gtts/min

- amnt. infused
1000 cc
16 hrs
= 62. 5 cc / hr

62.5 cc/ hr x 1 1/2 hr
= 94 cc

- amnt. endorsed
1000cc - 94 cc
= 906 cc







INPUT SUMMARY




Date
Time
IVF
ORAL
BLOOD
IV MEDS
MISC
TOTAL

7:00-3:00
94cc


3CC

97CC

3:00-11:00







11:00-7:00







7:00-3:00







3:00-11:00







11:00-7:00







OUTPUT SUMMARY
DATE
TIME
NGT
BLOOD
URINE
VOMITUS/STOOL
MISC
TOTAL

7:00-3:00


35cc
3X/shift



3:00-11:00







11:00-7:00







7:00-3:00







3:00-11:00







11:00-7:00







DRUG STUDY
MEDICATION
CLASSIFICATION
ACTION
INDICATION
CONTRAINDICATION
ADVERSE REACTION
NSG CONSIDERATION
GENERIC NAME: GENTAMYCIN SULFATE
BRAND NAME: CIDOMYCIN / GARAMYCIN
anti-infectives aminoglycosides
Inhibits protein synthesis by binding directly to the 30s ribosomal subunit bactericidal.
  • Serious infections caused by sensitive strains of Pseudomonas aeruginosa, E-coli, Proteus, Klebsiella, Staphylococcus.
  • To prevent endocarditis before GI or GU procedure or surgery.
  • Patients hypertensive to drug / other aminoglycosides.
  • Use cautiously in neonates, infants, elderly, and patients with impaired renal function or neuromuscular disorders.
  • CV: hypotension
  • GI: nausea and vomiting
  • GU: Nephrotoxicity
  • Respi: Apnea
  • Other: Anaphylaxis
  • Obtain specimen for C/S test before giving.
  • Evaluate patient's hearing before & during therapy. Notify prescriber if patient complains of tinnitus, vertigo or hearing loss.
  • Weigh patient & review renal function before therapy begins.
  • Obtain blood peak level 1hr after IM injection or 30 mins after IV infusion finishes.
  • Maintain peak levels at 4 to 12 meq/ml & trough levels at 1 to 2 meq/ml
GENERIC NAME; HYOSCINE-N-BUTYLBROMIDE
BRAND NAME:
BUSCOPAN
gastrointestinal
antispasmodics
Inhibits muscarinic actions of acetylcholine on autonomic effectors innervated by prostaglandine cholinergic neurons. May affect neural pathways originating in the inner ear to inhibit nausea & vomiting.
  • Spastic States
  • Delirium, preanesthetic sedation, and obstatric amnesia with analgesics
  • to prevent nausea & vomiting from motion sickness
  • Patients with hypersensitivity to barbiturates.
  • Use cautiously in patients with autonomic neuropathy.
  • Use cautiously in chidren
  • Use cautiously in patients with hot / humid environments ( can cause heatstroke)
  • CNS: Disorientation, Dizziness
  • CV: bradycardia, palpitaion
  • GI: Constipation, Nausea
  • GU: urinary hesitancy
  • Skin: rash, Dryness
  • Other: Heat intolerance
  • Raise side rails as a precaution because some patients become temporarily excited or disoriented
  • Tolerance may develop when therapy is prolonged
  • Overdose may cause adverse effects such as respiratory paralysis
GENERIC NAME:
PARACETAMOL
BRAND NAME:
AEKNIL
analgesics(opioid)
Produce analgesia by blocking pain impulses by inhibiting synthesis of prostaglandin in the CNS or of other substances that sensitize pain receptors to stimulation; the drug may relieve fever through central action in the hypothalamic heat regulating center.
  • Mild pain or fever
  • Patients hypersensitive to drug
  • Use cautiously in patients with long term alcohol use because therapeutic doses causes hepatoxicity.
  • Hepatic: Jaundice
  • Metabolic: Hypoglycemia
  • Skin: Rash
  • Hematologic: Hemmolytic anemia
  • Many OTC & prescription products contain acetaminophen.
  • Use liquid form for children & patients who have difficulty of swallowing
  • In children, don't exceed five doses in 24 hours.

NURSING CARE PLAN
ASSESSMENT
NURSING DIAGNOSIS
BACKGROUND KNOWLEDGE
PLAN OF CARE
INTERVENTIONS
RATIONALE
EVALUATION
Objectives:

- BP 110/60
- Temp 38
- PR 104 bpm
- RR 26/ min
- UO 35cc/hour
Deficient Fluid Volume related to Increased Metabolic Rate (Fever)


Monitor and document VS
Usually the pulse is weak, and may be irregular if electrolyte imbalance also occurs. Hypotension is evident in hypovolemia.
After Nursing Interverntion the patient was able to have a good skin turgor and decreased body temp




Provide oral hygiene.
This promotes interest in drinking.





Teach interventions to prevent future episodes of inadequate intake
Patients need to understand the importance of drinking extra fluid during bouts of diarrhea, fever, and other conditions causing fluid deficits.


ASSESSMENT
NURSING DIAGNOSIS
BACKGROUND KNOWLEDGE
PLAN OF CARE
INTERVENTIONS
RATIONALE
EVALUATION
Objectives:

- BP 110/60
- Temp 38
- PR 104 bpm
- RR 26/ min
- UO 35cc/hour
Acute Pain related to inflammed appendix

Pagkatapos ng 1 oras, ang pasyente ay magpapakita ng kabawasan sa sakit na kanyang nararamdaman
Suriin ang sakit na nararamdaman kabilang na ang lokasyon,uri, oras kung kailan sumasakit,kadalasan ng pagsakit, tindi at mga gawain na nagpapalala ng nararamdamang sakit.
Ang sakit ay isang pansariling karanasan na kinakailangang sabihin ng pasyente upang makagawa ng plano ng karampatang lunas.
Pagkatapos ng 1 oras, ang pasyente ay nagpapakita na ng kabawasan sa sakit na kanyang nararamdaman




Magbigay ng kaalaman tungkol sa mga natural na pamamaraan tulad ng pamamahinga, ginagabayang imahinasyon at masahe, bago at matapos makaramdam ang pasyente ng sakit sa apektadong parte.
Ang paggamit ng natural na istratehiya ay nakapagtataas ng endorphins, na tumutulong mabawasan ang sakit.





Magbigay ng antibiotic.
Ang antibiotic ay mabisang panglaban sa mga bakterya na naipon sa loob ng namamagang appendix





Panatilihin ang integridad ng balat ng pasyente.
Ang maayos na integridad ng balat ng pasyente ay kinakailangan upang maiwasan ang karagdagang impeksyon.