Case study about post appendectomy

LisaRn21 · Jan 10, 2006

Depending on how the appendectomy is performed (lappy or old fashion cut) which depends on if it was perfed or not depends on the outcome.

A lap appy usually has small incisions one on the right and left of the abdomen and one in the umbilicus. These are usually covered with steristrips. Pt is started on a clear diet if bowel sounds audible or pt passing gas. Then progressed to a regular diet as tolerated. Meds are usually unasyn or amp but can be any antibiotic. I have seen so many different ones used. Pt usually gets 3 doses of toradol for pain within 24 hours and then tylenol. If tylenol isn't helping with pain they may go home with some tylenol #3 prescription.

A perfed appy is a little different. They usually make a small incision about 3-4 inches on the right lower side of the abdomen. sometimes they use steristrips to close and sometimes stitches...depends on the patient... more than likely steristrips though. Depending on how well they can clean out the infection they patient may require to have a NGT salem sump or something in that order hooked up to low wall suction for a day or two then to gravity. While the NGT is hooked to suction the patient is NPO. After a day or two the pateint will be started on clears and advanced as tolerated. They will also be given antibiotics IV. I have seen some patients get a picc line placed if they are a hard stick so that they aren't constatly getting replacement IV's. I have also seen them on clear diet and put on HAL and LIPIDs for a week or so to get them back up to normal.

Either way both patients will be on IVF while they are NPO or if they aren't tolerating any kind of diet. Usually D5 1/2 NS with 20K but it could be anyhting.

Hope this helps!

coolcomic · Jan 10, 2006

Depending on how the appendectomy is performed (lappy or old fashion cut) which depends on if it was perfed or not depends on the outcome.
A lap appy usually has small incisions one on the right and left of the abdomen and one in the umbilicus. These are usually covered with steristrips. Pt is started on a clear diet if bowel sounds audible or pt passing gas. Then progressed to a regular diet as tolerated. Meds are usually unasyn or amp but can be any antibiotic. I have seen so many different ones used. Pt usually gets 3 doses of toradol for pain within 24 hours and then tylenol. If tylenol isn't helping with pain they may go home with some tylenol #3 prescription.
A perfed appy is a little different. They usually make a small incision about 3-4 inches on the right lower side of the abdomen. sometimes they use steristrips to close and sometimes stitches...depends on the patient... more than likely steristrips though. Depending on how well they can clean out the infection they patient may require to have a NGT salem sump or something in that order hooked up to low wall suction for a day or two then to gravity. While the NGT is hooked to suction the patient is NPO. After a day or two the pateint will be started on clears and advanced as tolerated. They will also be given antibiotics IV. I have seen some patients get a picc line placed if they are a hard stick so that they aren't constatly getting replacement IV's. I have also seen them on clear diet and put on HAL and LIPIDs for a week or so to get them back up to normal.
Either way both patients will be on IVF while they are NPO or if they aren't tolerating any kind of diet. Usually D5 1/2 NS with 20K but it could be anyhting.
Hope this helps!

thanks you very much mam.it helps a lot on my study

Daytonite, BSN, RN · Jan 10, 2006

Your case study should start with a statement of the case (I assume this is what you were given by your instructor.) You then follow the steps of the nursing process. First, begin with all the data you are going to need to collect, so you want to go back to the pathophysiology of an appendicitis and list out the signs and symptoms. Those signs and symptoms will be what the doctor is going to aim his treatment at. So, you will want to match up lab tests, x-rays, medications and surgery with them. Everything must logically follow. By far, the most you need to collect is the data. That will include all the patient's symptoms and treatments and meds being ordered for him. Not until you have all that will you be able to decide what nursing interventions (nursing care) needs to be done. Remember to present this in the order of the steps of the nursing process.

Here is a link to a nice, concise list of the pathophysiology, differential diagnosis and treatment of appendicitis. Be forwarned that it is coming from a site for physicians, but there is still very good, useable information for you, the nurse, there. You can also use the way it is outlined as a guide for the information you might want to include in your case study. You will have to use your nursing textbooks to supply the nursing interventions.

http://www.fpnotebook.com/SUR43.htm