ANSWER
Appendicitis Case Study
advanced difficulty
hospital setting
Index Appendicitis, assessment, developmental care, differential diagnosis, maintenance fluid calculations, discharge teaching, legal aspects, outcomes management, preoperative care, and postoperative care are some terms used in this article.
Clinical judgment, development, inflammation, Pain, and tissue integrity are all Giddens concepts.
Advocacy/ethical/Legal Issues, Assessment, Clinical Decision Making—Clinical Judgment, Developmental, Inflammatory, Pain, and Tissue Integrity are all Hesi Concepts.
R.O. is a 12-year-old girl who lives on a farm in a rural community with her family. R.O. has four siblings who have recently experienced stomach pains, vomiting, diarrhea, and fever. Their primary care provider (PCP) examined them and diagnosed them with viral gastroenteritis. R.O. awoke a week later at 0200, crying and telling her mother that her stomach “hurts bad!” She had a temperature of 37.9 ° C (100.2 ° F). R.O. began vomiting within the next few hours, so her parents took her to the nearest emergency room (ed). R.O.’s vital signs, complete blood count, and complete metabolic panel were all typical, so she was hydrated with IV fluids and sent home with instructions for her parents to contact their primary care physician or return to the emergency department if her condition did not improve or worsen. R.O.’s abdominal Pain became localized to the right lower quadrant over the next two days, she refused to eat, and she had mild diarrhea. She began to experience more severe abdominal Pain, increased vomiting, and a fever that did not respond to acetaminophen on the third day. R.O. has returned to the classroom. Her Vs. are 128/78, 130, 28, and 39.5 degrees Celsius (103.1 degrees Fahrenheit).
case study
R.O. is crying and guarding her lower abdomen. She prefers to lie on her side with her legs flexed. For Pain, IV access is established, and morphine sulfate 2 mg IV is administered. A CT scan of the abdomen confirms the diagnosis of appendicitis. R.O. has a white blood cell count of 12,000 mm3.
1. Which of the following clinical manifestations of appendicitis is most common? Choose all that apply.
a. Constipation
b. Nausea
c. Abdominal Pain in the left lower quadrant
d. Indigestion
d. Arthralgia
f. Widespread rash
h. A fever
2. Explain why R.O.’s clinical manifestations make diagnosis more difficult. Determine two more possible diagnoses.
Part 2: Cases in Pediatrics, Maternity, and Women’s Health
598
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12 Pediatric Illnesses
Case Study Development
An abdominal C.T. scan confirms R.O.’s appendicitis. The ed doctor has written orders.
3. Indicate whether the orders are appropriate or inappropriate and explain why.
View of a Chart
Orders from the Emergency Department (E.D.)
ORDER WITH US AND GET FULL ASSIGNMENT HELP FOR THIS QUESTION AND ANY OTHER ASSIGNMENTS (PLAGIARISM FREE)
a. Create a patient NPO
b. Insert a peripheral IV and start D512NS at 80 mL/hr.
c. Immediately administer Fleet Enema to rule out impaction.
d. For Pain, give 2 mg morphine sulfate IV every 2 hours.
e. Obtain the patient’s surgical consent.
f. Give cefotaxime (Claforan) IVPB at 150 mg/kg/day every 6 hours.
4. R.O. weighs 42 kg and stands 155 cm tall. Determine her maintenance fluid requirements and discuss how they will be met.
5. R.O.’s parents provide informed consent, and R.O. agrees to the surgery after hearing about it. Why is it critical that R.O. give her consent to the procedure?
6. What should be included in R.O.’s and her parents’ preoperative education?
Case Study Development
R.O. has an appendectomy because his appendix has ruptured. The peritoneum is inflamed, and abscesses near the colon and small intestine are visible. R.O. is admitted to the surgical unit; she is NPO and has an NGT, a Foley catheter, an IV line, an abdominal dressing, and a Penrose drain.
7. Determine the most critical nursing considerations. Choose all that apply.
a. Impaired bowel function
b. Pain
c. Alterations in skin integrity
d. Changes in cardiac output
e. Modified family processes
f. Possible hypothermia
g. Potential electrolyte and fluid imbalance
Case Study Development
R.O. is doing well on postoperative day two and can tolerate ice chips. Her breathing is clear, and she is performing pulmonary hygiene. NGT has minimal drainage. Her urine output is adequate now that the Foley catheter and Penrose drain have been removed. Her IV line has been saline-locked. There is no drainage or redness around the incision. Her pain level is 4 to 6 out of 10, and she takes pain medication every 4 hours. Later that evening, your examination reveals that R.O. is pale and listless; there are no bowel sounds; the abdomen is distended and tender to the touch; and the NGT is draining an increased amount of dark, greenish-black fluid. Her lung sounds are moist on both sides, and her temperature has risen to 40.2 ° C (104.4 ° F).
On room air, O2 saturation is 97%. She rates her Pain as a 10 out of 10 and is having difficulty taking deep breaths due to the Pain, which she describes as “hurting all over my stomach.”
8. How would you proceed?
9. How would you communicate with the surgeon using SBAR?
10. What factors will you consider in your nursing management of R.O.’s Pain?
Case Study Development
R.O. is evaluated by the surgeon, who orders an immediate return to the operating room. R.O. returns to the operating room for adhesion lysis, necrotic bowel removal, and abscess drainage. Her abdominal wound has been left open by the surgeon, who has ordered wound packing changes twice daily and abdominal irrigation with normal saline. When you go to perform the procedure, R.O. cries and becomes agitated.
11. As you help R.O. prepare for the procedure, which of the following Pain and coping concepts would you question?
a. R. may be concerned about losing control during the dressing change.
b. R. may be afraid of being separated from family members during painful experiences.
c. R. is concerned about his privacy while changing his clothes.
To prepare for the dressing change, prior coping strategies can be used.
12. In advance of R.O.’s discharge, identify the expected outcomes that must be met before he is released from the hospital.
Case Study Development
R.O. still meets expectations after a week, with her wound healing well. Her discharge from the hospital is scheduled for the following day. You provide R.O. and her parents with discharge instructions.
13. Which of the following statements indicates that more instruction is required?
a. “We must return if R.O. vomits again or develops a fever.”
b. “R.O. should take a week off from her gymnastics program.”
c. “We will keep the incision clean and notify you if there is any redness or drainage.”
d. “R.O. can progress her diet to the regular foods she enjoys eating.”
Case Study Result
R.O. is released and returns home with her parents after a quick recovery. She has a follow-up appointment with the surgeon in two weeks.
QUESTION
Please provide complete, thorough, and detailed answers to all questions in the case study. Multiple choice answers should include the correct choice and rationale for that choice and/or rationale why other choices are incorrect.