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Appendicitis

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by

Lee Zhi Hao

on 26 September 2012

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Transcript of Appendicitis

Appendicitis is inflammation of the vermiform appendix caused by an obstruction attributable to infection, structure, fecal mass, foreign body or tumor. Appendicitis Appendix is a tube like pouch attach to the caecum and when obstructed, it becomes distended and swollen.
Pressure inside appendix increase and become inflamed. Blood supply will be cut off.
Overtime, the appendix will rupture or become gangrene. when this happen, peritonitis and death will occur. Pathology Abdominal exam to detect inflammation
Urine test to rule out a urinary tract infection-Urinalysis
Rectal exam-Barium Enema
Blood test to see if your body is fighting infection-FBC
CT scans and/or ultrasound
Laparoscopy
Abdominal X-Ray Diagnostic test Investigations Surgery to remove the appendix, which is called an appendectomy, is the standard treatment for appendicitis.
If appendicitis is even suspected, doctors tend to be on the side of safety and quickly remove the appendix to avoid its rupture. If the appendix has formed an abscess, you may have two procedures: one to drain the abscess of pus and fluid, and a later one to remove the appendix. Management/Treatment Look out for complication
Teach incisional wound care until stitches are removed.
Avoid physical activity until cleared by doctor
Advise avoid use of laxative Patient Education Mixtard 30 – 10 units pre-breakfast
5 units pre-dinner
Amlodipine 5mg OM
Losartan 50mg OM
Fenofibrate 100 mg OM
Glucosamine 1g OM
Omeprazole 40mg BD
Magnesium Trisilicate Mixture 10 mls TDS
Domperidone 10mg TDS Medication Nursing Care plan Discharge Plan Signs and symptom Loss of appetite
Nausea and/or vomiting soon after abdominal pain begins
Abdominal swelling
Fever
Inability to pass gas
Dull or sharp pain anywhere in the upper or lower abdomen, back, or rectum
Painful urination
Vomiting that precedes the abdominal pain
Severe cramps
Chills
Shivering
Diarrhoea 2 Type
Simple appendectomy
laparoscopy appendectomy Pre-op Management
Obtain patient consent
Bed rest
NBM
IV Hydration
Possible IV antibiotic for prophylaxis
Observe for signs of perforation-Eg Increase pain, absent bowel sound, tachycardia Post-op Care
Incision wound care
Pain management
Fluid balance and maintain adequate nutrition
Relieve anxiety Incision wound care Monitor Vital signs-increase PR and decrease BP indicate signs of shock due to excessive bleeding.
Observe for signs of infection-elevated temperature, redness and swelling, odour and discharges. Check pain score
Administer pain medication
Offer pain relieve such as extra pillow
Diversion Therapy-TV,games, songs Pain management Fluid balance and maintain adequate nutrition Keep NBM after till return of Bowel sound.(usually 24Hr)
When bowel sound return, offer clear feeds and progress to full feeds.
Observe for nausea and vomiting.
Maintain IV Therapy till 2nd/3rd POD.
Monitor IO record. Relieve Anxiety Provide adequate information to patient and family members
Offer supportive care and adopt active listening. IV Intermittent
- Aztreonam Injection
- Clindamycin Injection

Subcutaneous
- Mixtard

PO- Domperidone Tab
- Lactolose Syrup
- Magnesium Trisilicate Mixture [MMT]
- Omeprazole
- Paracetamol Tab
- Sennosides 7.5mg Tab Current Medication Past medication U/E/CR-1.9L/132L/4.6/5.3L
Glucose-9.2H
CRP-240.1H
Alb-27L
TP-64H/C-2.4-16.8 Urea:8-25 mg/dL
Electrolytes:
Sodium (Na+)135-145 mEq/L
Calcium (Ca2+)9.2-10.4 mEq/l
Potassium (K+)3.5-5.0 mEq/L
Magnesium (Mg2+)1.3-2.1 mEq/L
Chloride (Cl-)100-106 mEq/L
Bicarbonate (HCO3-)23.1-26.7 mEq/L
Phosphate (HPO42-)1.4-2.7 mEq/L
Sulfate (SO42-)0.6-1.2 mEq/L
Creatinine0.6-1.5 mg/dL
Glucose:5.6–6.9 mmol/L
C-Reactive protein:<10 mg/L
Albumin:40–50 g/L
Total protein:6.7–8.6 g/dL RFERENCE VALUES FOR LABORATORY TESTS Mental state
- Does the patient seem confused?
- Does the patient avoid answering simple questions?
- Does he or she follow instructions?
- Does he or she seem angry at or fearful of family members?

Housing
- Does the patient live in a house, apartment, condo, farm, board and care facility, or senior citizens housing?
- Is the home one story or are there stairs?
- How close is the bathroom to the bedroom?
- Does the patient share a bedroom with others?
- Who is responsible for laundry, meals, and shopping?

Education
- Will the patient or caregiver need to learn diet, diabetic teaching, crutch training, or other therapy?
- Does the patient seem anxious about or interested in learning?
- Does the patient seem able to learn these skills?

Equipment
- Does the patient express a need for equipment in the home?
- Is the bed at home adequate for current needs?
- Has he or she previously had equipment in the home? * Home with the assistance of full-time live-in help
* Home with home health care and a part-time caregiver
* Skilled nursing facility
* A family member's home
* Board and care residence
* Senior citizens apartments THE END
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