Question

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Rapid Reasoning: Appendicitis Chief Complaint/History of Present Illness: Jennifer Anderson is a 42 year old woman who presents to the ED with a chief complaint of abdominal pain. The pain started gradually 12 hours ago shortly after eating dinner. She describes it as a generalized abd. pain that has now become localized in the RLQ. Is nauseated, but has had no emesis. Appears comfortable but is lying in a semi-fetal position. She states that the pain is minimized when in this position. Past Medical History: DVT W/PE... Warfarin (Coumadin) daily . Your Initial VS: WILDA Pain Scale (5h VS) Words: Sharp T: 100.5 (0) P: 92 Intensity: 8/10 R: 20 Location: RLQ abd BP: 130/78 Duration: Continuous since onset 10 hours ago 02 sats: 96% RA Aggreviate: Movement and car ride bumps Alleviate: None Your Initial Nursing Assessment: GENERAL APPEARANCE: resting comfortably in semi-fetal position RESP: breath sounds clear with equal aeration bilat., non-labored CARDIAC: pink, warm & dry, S1S2, no edema, pulses 3+ in all extremities NEURO: alert & oriented x4 GI/GU: Abd soft, active BS in all quads, RLQ has rebound tenderness, voiding without difficulty. Denies painful/burning urination. Remains nauseated. Nursing Interventions: UA (ED standing order) Urine pregnancy test (UPT) (ED standing order) Physician Orders: . Establish PIV Morphine 2-4 mg IV every 30" prn pain Ondansetron (Zofran) 4 mg IV prn every 4 hours nausea Strict NPO CBC, BMP CT abd/pelvis Phytonadione (Vitamin K) 5 mg IV UA Current Fresh Frozen Plasma (FFP) 2 units IV stat Color (yellow) Yellow Prepare for OR/surgical consult Clarity (Clear) Clear Lab/diagnostic Results: Sp. Grav (1.002-1.030) 1.015 Urine Pregnancy: neg Protein (neg) Neg CT abd/pelvis: acute inflammation of appendix consistent w/appe Glucose (neg) Neg Lab Test Current High/Low Ketones (neg) Neg Sodium 138 Blood (neg) Neg Potassium 3.9 Nitrate (neg) Neg Creatinine 0.9 LET (neg) Neg WBC 9.7 RBC'S (0-2) 0 Neut. % 93 WBC's (0-5) 2 Hgb. 14.8 Bacteria (0-few) 0 INR 2.5 Epithelial (O-few) 0 © 2012 Keith Rischer/www.KeithRN.com M

1. What intervention will you initiate based on this priority?

• Pain management
• Fever management
• Preparation for surgery to avoid complications

Nursing Interventions	Rationale	Expected Outcome
1.	1.	1.
2.	2.	2.
3.	3.	3.
4.	4.	4.

2. What can you do to engage yourself with this patient’s experience, and show that they matter to you as a person?

Answer 1

Diagnosis	Nursing interventions (Pain management)	Rationale	expected ooutcome
pain related to appendicitis as evidenced by the patient reactions	assess the level of pain experienced by the patient	this will help us to identify and prioritise the care	pain is reduced to some extent as evidenced by the patients facial expressions.
	provide a comfortable semi fowlers position itself	this will help them to alleviate the pain
	provide a calm environment to the patient	this will help the patient to have a good sleep and can reduce the level of pain
	provide medications like pain killers /	this will help the patient to alleviate the pain
	take the patient to surgery	this will help to come out of the pain

diagnosis	fever management	rationale	expected outcome
Hyperthermia related to disease condition as evidenced by the patient temperature is 100degree	assess the temeprture level of the patient	this will help us to get an idea about the care that is to be given for the patient.	Patient'sd temperature will be decreased to normal
	encourage the patient to take lot of oral fluid	this will help him to prevent dehydration.
	provide a comfortable position to the patient	help the patient to take rest
	do not cover the patient with balnket	covering with blanket will increase the body temperature.
	provide medications to the patient like antipyretic medications	this will help to reduce the temperture

preparation for surgery to avoid complications

• get a detailed history about the patient to have an underline knowledge about the patient
• do a complete physical assessment of the patient to know the exact location of pain a
• check with the partientregarding the severity of pain
• ask about the patients allergic history
• if anything is there, it should be noted immediately
• explain about the surgical procedure to be carried out
• ask the patient to be nil per oral before night itself to prevent complications during the surgery.
• provide premedications needed for the surgery
• on the day of the surgery make the patient to wear the OT gown and clean the area with betadine
• get an informed consent from the patient regarding the procedure
• take all the necessary documents like x-ray, USG while the patient is shifted to operation theatre.

2. To make them feel that we consider them as persons, first of all, we should develop a good interpersonal relationship with the patient and make them feel that they are important to them.

always listen to them about their doubts and anxieties.

provide clear proper explanation to the patient

before doing any procedure on the patient always give a proper information about each and every procedure.

enquire about their culture, customs and beliefs etc to the patient, so that they feel that we are giving comprehensive care to the patient.

always try to respect and fulfill their needs

These are the things that can be done to make them feel that we consider them as person rather than patient