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CONTENTS
1 Acknowledgement
3 Appendix
4 Appendicitis
5 Clinical investigation
6 Appendectomy
7 Record of operation
8 Medication
9 Clinical progress note
1 Nursing diagnosis
0
1 Reference
1
ACKNOWLEDGEMENT
PATIENTS PROFILE
NAME : CHUAH CHEONG KIN
Age : 19/yrs
Sex: Male
Physician : Mr Liew Fah Kong
Room : Mawar 10/2
Diagnosis : Acute appendicitis
25/7/08(2000)
C/O abdomen pain since 23/7/08 9(RIF pain) fever since
morning
-no vomiting
-no diarrhea
-rebound tenderness
In emergency room
Temperature:38.3
Pulse:88
BP:130/90
ORDERED
Full blood count
BUSE
RBS
Urine FEME
IV Hartmans over 2 hour
Then D/Saline 1 pint 4 hour,
D/Saline alternate D5% 1 pint over 6 hour
4 hly observation
Nil by mouth
25/7/08(2310)
Seen by Mr Liew , noted pain at right iliac fossa. No nausea
and vomiting. Temperature high
tenderness
CLINICAL MANIFESTATION OF
APPENDICITIS
Ultrasound
Barium Enema
Laparoscopy
Urinalysis
Urinalysis is a microscopic examination of the urine that detects red
blood cells, white blood cells and bacteria in the urine. Urinalysis
usually is abnormal when there is inflammation or stones in the
kidneys or bladder. The urinalysis also may be abnormal with
appendicitis because the appendix lies near the ureter and bladder. If
the inflammation of appendicitis is great enough, it can spread to the
ureter and bladder leading to an abnormal urinalysis. Most patients
with appendicitis, however, have a normal urinalysis.
The right fallopian tube and ovary lie near the appendix. Sexually
active women may contract infectious diseases that involve the tube
and ovary. Usually, antibiotic therapy is sufficient treatment, and
surgical removal of the tube and ovary are not necessary.
Right-sided diverticulitis.
Kidney diseases.
The right kidney is close enough to the appendix that
inflammatory problems in the kidney-for example, an abscess-
can mimic appendicitis.
Meckel's diverticulitis.
CLINICAL INVESTIGATION
INVESTIGATION RESULTS UNIT REFERENCE
RANGE
FULL BLOOD
COUNT
Red Cell Count 5.57 x10^12/L ( 4.5 - 6.0 )
Haemoglobin 17.9 g/dL ( 13.7 - 18.0 )
Haematocrit 52 % ( 40 - 54 )
MCV 94 fL ( 82 - 100 )
MCH 32 pg ( 27 - 32 )
MCHC 34 g/dL ( 32 - 36 )
RDW 13.2 % ( 4.0 - 11.0 )
Platlet count 235 x10^9/L ( 150 - 400 )
White cell count* 21.2 x10^9/L ( 4.0 - 11.0 )
APPENDECTOM
Y
During an appendectomy, an incision two to three inches in length is
made through the skin and the layers of the abdominal wall over the
area of the appendix. The surgeon enters the abdomen and looks for
the appendix which usually is in the right lower abdomen. After
examining the area around the appendix to be certain that no
additional problem is present, the appendix is removed. This is done
by freeing the appendix from its mesenteric attachment to the
abdomen and colon, cutting the appendix from the colon, and sewing
over the hole in the colon. If an abscess is present, the pus can be
drained with drains that pass from the abscess and out through the
skin. The abdominal incision then is closed.
Newer techniques for removing the appendix involve the use of the
laparoscope. The laparoscope is a thin telescope attached to a video
camera that allows the surgeon to inspect the inside of the abdomen
through a small puncture wound (instead of a larger incision). If
appendicitis is found, the appendix can be removed with special
instruments that can be passed into the abdomen, just like the
laparoscope, through small puncture wounds. The benefits of the
laparoscopic technique include less post-operative pain (since much
of the post-surgery pain comes from incisions) and a speedier return
to normal activities. An additional advantage of laparoscopy is that it
allows the surgeon to look inside the abdomen to make a clear
diagnosis in cases in which the diagnosis of appendicitis is in doubt.
If the appendix is not ruptured (perforated) at the time of surgery, the
patient generally is sent home from the hospital after surgery in one
or two days. Patients whose appendix has perforated are sicker than
patients without perforation, and their hospital stay often is prolonged
(four to seven days), particularly if peritonitis has occurred.
Intravenous antibiotics are given in the hospital to fight infection and
assist in resolving any abscess.
Occasionally, the surgeon may find a normal-appearing appendix and
no other cause for the patient's problem. In this situation, the surgeon
may remove the appendix. The reasoning in these cases is that it is
better to remove a normal-appearing appendix than to miss and not
treat appropriately an early or mild case of appendicitis
COMPLICATION OF
APPENDECTOMY
1. Lanz Incision
2. Specimen sent for HPE
3. Appendectomy done
Post Op Order
-nil orally
-2 pint D/saline alt 2 pint D5% 24 hour
-IV Zinacef 750mg 8 hour
-IV Flagyl 500mg 8 hour
-IM pethidine 3cc 6 hour and PRN
MEDICATION
IV Zinacef 750mg
Generic Name : Cefuroxime Na
Group : Antibiotic
Indication ;
Resp, ENT, GUT, soft tissue, OnG, bone and joint
infection, gonorrhea, septicemia,meningitis, surgical
prophylaxis.
IV Flagyl 500 mg
Group : antibiotic
IM Pethidine 3cc
26/7/08(0910)
Seen by Mr Liew temperature high, abdomen soft noted
dressing dry and intact.
Ordered
IV Netromycin 300mg stat and daily
BUSE
27/7/08
Seen by Mr Liew . dressing inspected ordered to
change dressing clean with normal saline and cover
with gauze and tegaderm. Sign off same said patient
can go back , ordered STO on the 5/8/08.
Nursing diagnosis