A Case Study On

Ruptured Appendicitis with Localized Peritonitis

In Partial Fulfillment

In the Course Requirement in Surgical Nursing

Submitted to the Faculty of

San Lorenzo Ruiz College

College of Nursing

Submitted by:

Rita, Chantrea S.

BATCH OSCAR

May 2023
 TABLE OF CONTENTS

I. INTRODUCTION ................................................................................................................ 1

II. OBJECTIVES ......................................................................................................................2

III. NURSING ASSESSMENT .................................................................................................. 3

Personal History ............................................................................................................3

Diagnostic Results .........................................................................................................7

Present Health Profile of Functional Health Patterns ................................................ 11

Pathophysiology and Rationale .................................................................................. 21

IV. NURSING INTERVENTIONS ........................................................................................... 26

NURSING CARE PLAN .................................................................................................. 27

DRUG THERAPEUTIC RECORD .....................................................................................33

SOAPIE ........................................................................................................................ 37

HEALTH TEACHING PLAN ............................................................................................ 38

V. EVALUATION AND RECOMMENDATION ....................................................................... 41

VI. EVALUATION AND IMPLICATION OF CASE STUDY TO: .................................................42

VIII. BIBLIOGRAPHY ............................................................................................................43

I. INTRODUCTION

This case study is based on a patient with Ruptured Appendicitis with Localized
Peritonitis. Through this study, the student nurse will be able to acquire knowledge,
skills, and attitude in caring for a patient with Ruptured Appendicitis with Localized
Peritonitis. The student nurse expects to know the necessary nursing management
needed that is appropriate for the patient’s condition and the factors that may lead to
possible complications of the patient’s current condition.

The student nurse chose this study to discuss the medical history of the patient
and provide data and information about the necessary care or interventions needed for
a patient with Ruptured Appendicitis with Localized Peritonitis and has undergone
Appendectomy. Every nursing student, as well as physicians and nurses who are
continuing education will benefit from this study.

Acute appendicitis is uncommon in older adults. When appendicitis does occur,

classical signs and symptoms can change a lot. There may be some pain or none at all.
Symptoms may be vague, suggesting bowel obstruction or another process. Fever and
leukocytosis may not be manifested. As a result, diagnosis and prompt treatment may
be delayed, causing complications and mortality. The patient may have no symptoms
until the appendix becomes gangrenous or perforates. The incidence of complications is
higher in older adults in light of the fact that these patients do not seek health care as
fast as younger patients.

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II. OBJECTIVES

Student Nurse - Centered

General Objectives:

At the end of 5 days holistic nursing care, the student nurse will be able to gain
more knowledge, skills, and attitude in managing a patient with Ruptured Appendicitis
with Localized Peritonitis and have undergone Appendectomy.

Specific Objectives:

After 8 hours of student nurse - patient and significant others interaction, the
student nurse will be able to:

1. establish rapport with the patient

2. obtain information about the patient’s healthy history and health status
3. Identify the common causes of ruptured appendicitis with localized peritonitis
4. Identify health problems and need of patient
5. State the possible complications of appendicitis
6. Recall the anatomy and physiology of the organ affected by appendicitis
7. Trace the pathophysiology of ruptured appendicitis with localized peritonitis

Patient - Centered

General Objectives:

At the end of 5 days holistic nursing care, the patient and significant others will
be able to gain more knowledge, skills, and attitude in managing a patient with
Ruptured Appendicitis with Localized Peritonitis.

Speciifc Objectives:

After 8 hours of student nurse - patient and significant others interaction, the patient
will be able to:

1. Show interest and trust to the student nurse during interaction

2. Give information about the condition
3. State the common causes of ruptured appendicitis with localized peritonitis
4. State the health problems caused by the current condition
5. Demonstrate a positive attitude to prevent complications by prevent infection
6. Determine behaviors that will improve health condition

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III. NURSING ASSESSMENT

1. Personal History

1.1 Patient’s Profile

Name: Dayondon, Seguindina Matuguina

Age: 66
Sex: Female
Civil Status: Widow
Religion: Catholic
Date of Admission: June 19, 2022
Complaint: Abdominal chills and pain
Diagnosis: Ruptured Appendicitis with Localized Peritonitis
Surgeon: Dr. Rolando E. Cam
Medications
Pre-operative Medications

 Metoclopramide
 Nalbuphine
 Dexketoprofen
 Potassium Chloride

1.2 Family and Individual Information, Social and Health History

Mrs. Villanueva is an 66-year-old, widowed woman, a Catholic, and a Filipino. She has a
daughter. She doesn’t have any bad habits and seeks for checkups when she is in need
of medical care. Prior to her admission, the patient was apparently well although 6 days
PTA had a consultation with AP and ultrasound of the whole abdomen was done, no
significant findings seen, then the reason for her admission was because of a sudden
hypogastric pain radiating towards all quadrants of her abdomen followed by chills. She
has no complains of cough, colds, chest pains, and shortness of breath noted at home.
The patient doesn’t have any other serious illness except for the symptoms she
manifested. She adheres to the doctors recommendations and interventions
appropriate for her current condition.

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1.3 Levels of Growth and Development in Older Adults (65 years old and above)

1.3.1 Normal Development at Particular Stage

Physical Development

Physical function is a dynamic process. It shifts as individuals interact with their

environments. Functional status in older adults includes day-to-day ADL’s involving
activities within physical, psychological, cognitive, and social domains. A decline in
function is often linked to illness or disease and its degree of chronicity. However,
ultimately it is complex relationship among all of these areas that influences older
adult’s functional abilities and overall well-being. During late adulthood the skin
continues to lose elasticity, reaction time slows further, muscle strength and mobility
diminishes, hearing and vision decline, and the immune system weakens.

Physiological Development

Some frequently observed physiological changes in older adults are normal. The
changes are not always pathological processes in themselves, but they make older
adults more vulnerable to some common clinical conditions and diseases. Some older
adults experience these changes, and other experience only few. The body changes
continuously with age; and specific effects on particular older adults depend on health,
lifestyle, stressors, and environmental conditions.

Psychosocial Development

Sociological theories of aging attempt to explain and predict the changes in roles and
relationships in middle and late life,with an emphasis on adjustment.Many of the basic
theories were developed in the 1960s and 1970s and must be viewed within the context
of the historical period from which they emerged. Some of the theories continue to
generate interest and thought, such as modernization and social exchange theories, and
others,such as disengagement theory, are no longer considered relevant. The
disengagement theory states that “old age involves a gradual withdrawal of the
individual from society and of society from the individual. According to this theory,
those happiest in old age have turned their attention inward toward the self and away
from involvement in the outside world. Empirical research has shown, however, that
this mutual withdrawal is not an inevitable component of old age.” This means that
withdrawal from one’s society and community is natural and acceptable for the older
adult and his or her society. The measures of disengagement are based on age, work,
and decreased interest or investment in societal concerns. The theory is seen as
universal and applicable to older people in all cultures, although there are expected
variations in timing and style

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Cognitive Development

Cognitive abilities such as memory may see a decline in late adulthood. Older people
have more difficulty using memory strategies to recall details (Berk, 2007). Working
memory is a cognitive system with a limited capacity responsible for temporarily
holding information available for processing. As we age, the working memory loses
some of its capacity. This makes it more difficult to concentrate on more than one thing
at a time or to remember details of an event. However, people often compensate for
this by writing down information and avoiding situations where there is too much going
on at once to focus on a particular cognitive task.

Moral Development

The older adults lives autonomously in Post Conventional Level and defines moral values
and principles that are distinct from personal identification with group values. Post
conventional morality is the highest stage of morality in Kohlberg's model, in which
individuals have developed their own personal set of ethics and morals that they use to
drive their behavior. He lives according to principles that are universally agreed on and
that the person considers appropriate for life. The social are not the sole basis for
decisions and behaviors because the person believes a higher moral principle applies
such a equality, injustice and due proud.

Spiritual Development

Older adults' level of religious participation is greater than that in any other age group.
For older adults, the religious community is the largest source of social support outside
of the family, and involvement in religious organizations is the most common type of
voluntary social activity—more common than all other forms of voluntary social activity
combined.Many older adults reported that being spiritually present and use religious
coping mechanisms are less likely to develop depression and anxiety and have a greater
sense of psychologic well-being than those who do not. Even the perception of disability
appears to be altered by the degree of religiousness.(Kaplan D.B., 2023). The spiritual
aspect of people’s lives transcends the physical and psychosocial to reach the deepest
individual capacity for love, hope, and meaning. Erickson’s concept of ego integrity and
Maslow’s concept of self-actualization seem closely related to development of a
spiritual self.

1.3.2 The Ill Person at Particular Stage of Patient

At the biological level, aging results from the impact of the accumulation of a wide
variety of molecular and cellular damage over time. This leads to a gradual decrease in
physical and mental capacity, a growing risk of disease, and ultimately, death. But these
changes are neither linear nor consistent, and they are only loosely associated with a
person’s age in years. While some 70 year-olds enjoy extremely good health and

5
functioning, other 70 year-olds are frail and require significant help from others. Beyond
biological changes, aging is also associated with other life transitions such as retirement,
relocation to more appropriate housing, and the death of friends and partners. In
developing a public-health response to aging, it is important not just to consider
approaches that ameliorate the losses associated with older age, but also those that
may reinforce recovery, adaptation and psychosocial growth. Common conditions in
older age include hearing loss, cataracts and refractive errors, back and neck pain and
osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression, and
dementia. Furthermore, as people age, they are more likely to experience several
conditions at the same time. Older age is also characterized by the emergence of several
complex health states that tend to occur only later in life and that do not fall into
discrete disease categories. These are commonly called geriatric syndromes. They are
often the consequence of multiple underlying factors and include frailty, urinary
incontinence, falls, delirium and pressure ulcers.

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2. Diagnostic Results

Name: Dayondon, Seguindina Age: 66

Diagnosis: Ruptured Appendicitis with Localized Peritonitis Sex: Female
Physician: Dr. Rolando Cam

DIAGNOSTIC IMAGING

Sonography of the Whole Abdomen and Appendix

Impression:
- MInimal ascites.
- Minimal fluid in the right iliac of the abdomen.
- Fluid filled stomach and bowel loops with no active peristalsis consider ileus.
- Normal sonographic evaluation of the liver, kidneys, urinary bladder, spleen
and pancreas.
- Intrahepatic and common bile ducts are not dilated.
- No fluid in the posterior cul de sac.
- Unremarkable abdominal aorta.

DIAGNOSTIC TEST NORMAL VALUE RESULT SIGNIFICANCE

1. TROPONIN I (COBAS 0.0 - 0.16 < 0.100 Normal
e 411) QUANTITATIVE
METHOD
2. THYROID PANEL
(COBAS e 411)
TSH 0.270 - 4.20 0.013 LOW -
Hyperthyroidism
3. BLOOD CHEMISTRY
LABORATORY REPORT
Creatinine 53.0 - 97.2 111 HIGH - This may be

7
 a sign of poor
kidney function.
Potassium 3.5 - 5.3 3.09 LOW -
Hypokalemia
HBA1C 4.5 - 6.3 7.2 HIGH - Diabetes
4. COMPLETE BLOOD
COUNT
White Blood Cell 5.0 - 10.0 4.6 LOW - Leukopenia
indicates a higher
risk of infection.
Red Blood Cell 4.2 - 5.4 4.31 Normal
Hemoglobin 12.0 - 16.0 11.4 LOW - Anemia
Hematocrit 37.0 - 47.0 34.9 LOW - Anemia
MCV 80.0 - 96.0 81.0 Normal
MCH 27.0 - 31.0 26.5 LOW -
Hypochromic
anemia
MCHC 32.0 - 36.0 32.7 Normal
RDW 11.0 - 16.0 14.20 Normal
Platelet 150 - 450 120 LOW -
Thrombocytopenia
increases the risk
of bleeding.
5. DIFFERENTIAL
COUNT
Neutrophil 50 - 70 71.8 HIGH -
Neutrophilia
means the body is
under stress.
Lymphocyte 20 - 40 16.5 LOW -
Lymphopenia
indicates a higher
risk of infection.
Monocyte 0-7 11.3 HIGH -
Monocytosis, a
potential sign of
many different
medical conditions.
Eosinophil 1-6 0.2 LOW - This may
indicate excessive
stress, alcohol
misuse, or the
presence of an
underlying

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 condition.
Basophil 0-2 0.2 Normal
6. RANDOM/CAPILLARY 70-110 156 HIGH - Diabetes
BLOOD SUGAR
7. PROTHROMBIN TIME 10 - 14 seconds 10.7 Normal
DETERMINATION
8. BLOOD TYPING N/A A - POSITIVE N/A
9. URINALYSIS
MACROSCOPIC
EXAMINATION
Color Pale yellow to Yellow Normal
amber and is clear
Transparency Light yellow that is Slightly Cloudy This may be caused
transparent by dehydration, a
UTI, kidney stones,
diabetes, and
others.
CHEMICAL
EXAMINATION
pH 4.6 - 8.0 5.0 Normal
Sp. Gravity 1.005 - 1.030 1.020 Normal
Leukocytes N/A 2+ HIGH - This
indicate an
infection in the
urinary system.
Blood < 0.6 Negative Normal
Sugar 0 - 0.8 Negative Normal
Nitrite 0 Positive This is a sign of a
UTI.
Protein < 150 Negative Normal
Urobilinogen < 1.0 Negative Normal
Ketone < 0.6 Negative Normal
Bilirubin 0 Negative Normal
MICROSCOPIC/URINE
FLOWCYTOMETRY
Pus Cells 0 - 17 99.5 HIGH - Pyuria, the
most common
cause is UTI.
Red Cells 0 - 11 2.9 Normal
Epithelial Cells 0 - 17 35.1 HIGH - This may
indicate UTI.
Bacteria 0 - 278 6783.1 HIGH - UTI
Cast 0-1 0.3 Normal

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10. FECALYSIS
Color All shades of Brown Normal
brown and even
green
Consistency Firm and soft Watery This is a common
sign of an intestinal
infection.
Blood Absent Negative Normal
Mucus Few to Absent Positive This may be caused
by an intestinal
infection.
Adult Parasite Absent Negative Normal
Fat Globules Few to Absent Negative Normal
Starch Granules Absent Negative Normal
Vegetables Cells Absent Negative Normal
Yeast Cells Absent Negative Normal
Pus Cells 0-4 2-3 Normal
Red Cells <2-3 0-2 Normal
Ova of Parasites Absent Negative Normal
Amoeba:
Cyst Absent None seen Normal
Trophozoite Absent None seen Normal

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3. Present Health Profile of Functional Health Patterns

3.1 Health Perception / Health Management Pattern

Prior to Admission: The patient makes sure that she does not miss her regular checkup
and always takes her prescribed medications. She does not take over-the-counter drugs
and follows religiously the orders of the doctors. Does not take any herbal drugs and
performs passive ROM exercise.

During Hospitalization: The patient is still complaint with the orders of the doctor. Takes
medications on time and performs passive ROM exercise as tolerated by the patient.

3.2 Nutritional / Metabolic Pattern

Prior to Admission: The patient is not picky when it comes to her diet. She eats fish,
meat, vegetable, and fruits. She eats 3 meals per day and snacks in between. She
consumes about 2 liters of water a day.

During Hospitalization: The patient is on NPO pre-operatively, and DAT post-operatively.

No changes in food preference after the surgery and still eat the same foods that she
likes before. She adheres in restoring fluid intake. She has no known allergies.
3.3 Elimination / Urinary Pattern

Prior to Admission: The patient does not always need assistance in doing activities of
daily living. The patient did not confirm pain felt during urination and defecation.15

During Hospitalization: Patient urinate freely in her diaper. Bowel movement noted
once daily.

3.4 Activity / Exercise Pattern

Prior to Admission: The patient has a sedentary lifestyle. Passive ROM is done at least
every other day and when she wants to do it. The patient do walking either in the early
morning or afternoon. She can do household chores without assistance.

During hospitalization: The patient ambulates as tolerated or when pain does not hinder
her movements and needs assistance post operatively.

3.5 Cognitive / Perceptual Pattern

Prior to Admission: The patient is responsive to external stimuli. The patient responds
when asked questions. The patient wears can read without eyeglasses. She is oriented
to time, people, and place. The patient has no problem in standing and walking.

11
During Hospitalization: Prior to Admission: The patient is responsive to external stimuli.
The patient responds when asked questions. The patient wears can read without
eyeglasses. She is oriented to time, people, and place. The patient needs asisstance in
standing and walking post operatively.

3.6 Rest / Sleep Pattern

Prior to Admission: The patient sleeps 7 hours a day including naps. There are times that
her sleeping time is disrupted by distractions such as loud noises, but most of the time
she is asleep at home. After lunch time she will take a nap, and 3 hours after dinner at
around 10 o’clock in the evening, she will go to bed and fall asleep.

During Hospitalization: The patient does not have any problem with her sleeping pattern
in the hospital.No problems in her sleep and wake pattern but sometimes distracted
due to administration of medications.

3.7 Self - Perception / Self - Concept Pattern

Prior to Admission: The patient manages health by seeking medical assistance with her
daughter.

3.8 Role - Relationship Pattern

Prior to Admission: The patient at home finds time to talk with friends, neighbors and
relatives. She lives with her daughter at home. Her daughter supports her financially
with her basic and medical needs.

During Admission: The patient is assisted by her daughter during ambulation post
operatively.

3.9 Sexuality / Reproductive Pattern

Prior to Admission: The patient is widowed and a mother to her daughter. She has no
history of sexually transmitted diseases or any disease affecting genitals prior to
admission. She has not performed any breast self-examination in the past years. She
have not used contraceptives during her younger years.

During Hospitalization: The patient does not have any problems affecting her sexuality.

3.10 Coping / Stress Tolerance Pattern

Prior to Admission: The patient lives with her daughter. The patient verbalizes that she
misses her husband at times but was able to accept the loss.

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During Admission: The patient’s coping mechanism to the new environment is talking
with her daughter and sleeping.

3.11 Value - Belief Pattern

Prior to Admission: The patient’s religion is catholic. She verbalizes that she prays every
day and continues to practice religious practices at home such as praying the holy rosary.

During Admission: The patient has no religious restrictions in care given by health care
providers. Hospital procedures does not interfere with the spiritual practices of the
patient.

3.12 HEAD - TO - TOE ASSESSMENT

Name: Dayondon, Seguindina Age: 66

Diagnosis: Ruptured Appendicitis with Localized Peritonitis Sex: Female
Physician: Dr. Rolando Cam

PHYSICAL ASSESSMENT
Body Part Inspection Palpation Percussion Auscultation
HEAD Symmetrical, Hard and N/A N/A
midline, and smooth
round without
lesions
HAIR Evenly Smooth, N/A N/A
distributed, a bit symmetrically
of white grayish distributed
hairs
SCALP No dandruff, no Symmetrical N/A N/A
lesions
FOREHEAD Symmetrical Strong N/A N/A
temporal
pulse
FACE Symmetrical Smooth, no N/A N/A
nodules noted
EYES No sinking, no No lumps N/A N/A
edema, around
symmetrical preorbital
with equal size area, no eye
and shape bumps, no
inflammation
EYEBROWS Coarse, hair is No nodules N/A N/A
evenly and no rashes

13
 distributed present
EYELASHES Present on both N/A N/A
eyelids, evenly
distributed
EYELIDS No nodules, no No bumps, no N/A N/A
lesions, no edema noted
edema noted
Upper No nodules No nodules
noted noted
Lower No nodules
noted No nodules
noted
SCLERAE White in color N/A N/A N/A
and the
palpebral
conjunctiva
appears pink
CORNEA Lustruos surface N/A N/A N/A
and crystal
clear, allowing a
crisp and lucid
view of the iris
IRIS Round, similar N/A N/A N/A
black - brown
color where
pupil is centrally
located
PUPIL PERRLA N/A N/A N/A
MUSCLE Both eyes with N/A N/A
FUNCTION coordinated
movements,
with parallel
alignment
MUSCLE Eyes aligned N/A N/A N/A
BALANCE with
coordinated
movements
when looking
upward and
downward
VISUAL ACUITY No lenses, able N/A N/A N/A
to read
newsprint or

14
 magazine
PERIPHERAL When looking N/A N/A N/A
VISION straight ahead,
patient can see
objects in the
periphery
conforms to
face
NOSE External nose is No pain noted, N/A N/A
symmetrical firm and
with no stable
discoloration, structures, no
swelling, or hard masses
malformations, or lumps
no polyps noted palpated, no
Nasal mucosa is foreign bodies
pinkish red with noted
no discharge or Patient can
bleeding breath
through the
nose normally
when the
opposite nares
is occluded
FRONTAL No swelling and No pain N/A N/A
SINUSES no reported upon
malformations palpation, no
noted tenderness, no
masses noted
MAXILLARY No swelling and No pain N/A N/A
SINUSES no reported upon
malformations palpation, no
noted tenderness, no
masses noted
MOUTH Symmetrical, No pain N/A N/A
slightly pink in reported upon
color, smooth, palpation, no
and slightly dry lumps, no
inflammation
noted
LIPS Symmetrical, No growths, N/A N/A
slightly pink, no no lumps, no
lesions, no discoloration

15
 swelling noted of tissue noted
GUMS Pink in color No swelling, N/A N/A
no gingivitis,
no pain noted
TEETH The patient has N/A N/A N/A
no dentures, 28
teeth noted
TONGUE Midline, pink The patient N/A N/A
and moist, can protrude
smooth, lateral tongue
margins, no straight out
lesions, raised with no
papillae deviation
noted, pink in
color, smooth
texture, no
abnormal
tissue growth
noted
FRENULUM Midline, moist, No lesions or N/A N/A
pink in color masses noted
HARD PALATE White in color, Firm towards N/A N/A
firm texture, the anterior
and irregular and lateral to
transverse the midline
rugae while more
compressible
towards the
posterior and
medial to the
apices of the
teeth
SOFT PALATE Slightly less N/A N/A N/A
vascular than
the oropharynx,
reddish pink in
color
UVULA No redness Using a tongue N/A N/A
noted, not blade pressed
swollen, light down on the
pink in color, patient’s
smooth, and tongue, uvula
upwardly in midline and

16
 movable rise along the
soft palate
TONSILS No swelling or N/A N/A N/A
lesions noted
EARS Equal in size, No masses, no N/A N/A
ear canal is skin-
nodules at the
colored, and hasback of the
small few hairs ears and pinna
noted
EXTERNAL No odor or Recoils easily, N/A N/A
discharge noted no tenderness,
no lumps
INTERNAL Small amount of N/A N/A N/A
cerumen noted
AUDITORY The patient N/A N/A N/A
ACUITY correctly replies
to words
through whisper
test
NECK No deformities Lymph nodes N/A N/A
noted on the are palpable,
neck and back, round,
skin is light movable, and
brown in color not enlarged
or tender
LYMPH NODES Assymetric and Movable, N/A N/A
not enlarged enlarged, and
not tender
TRACHEA Midline, correct N/A N/A N/A
position
THYROID GLAND N/A Rises freely N/A N/A
with
swallowing,
and no
enlargement
noted
CHEST ANTERIOR Elevated No pain Resonance Good air entry,
respiratory rate reported, no heard equal
noted, regular tenderness throughout bilaterally, no
rise and fall of noted lungs on adventitious
chest, regular anterior sounds
breathing thorax throughout all
without distress lobes on

17
 anterior thorax
LUNGS No visible No pain , no Resonance Equal bilateral
deformities tenderness heard air entry, no
such as a barrel throughout adventitious
chest, regular lungs on sounds
rise and fall of anterior
chest, elevated thorax
respiratory rate
noted
HEART No cardiac No vibratory Dullness to Elevated heart
impulses sensation percussion rate and rhytm
observed from the without
against the sternum to murmur
chest wall approximately
6 cm lateral to
the left of the
sternum
CHEST Regular No pain, Equal tactile Good air entry,
POSTERIOR breathing temperature is fremitus bilaterally
without distress warm to equal, no
touch, adventitious
bilaterally sounds audible
equal, no throughout all
moisture, no lobes
masses, no
swelling
DIAPHRAGMATIC Normal No masses/ The rest of the No
EXCURSION diaphragmatic nodules and lung fields are hyperresonace
excursion ( 5 - 6 no tenderness resonant
cm), no noted
hyperinflation,
no difficulty of
movement of
the thoracic
diaphragm
during
breathing
ABDOMEN Light brown in Abdomen is Dullness over No altered
color, no visible symmetrical, the stomach, bowel sounds
lesions or scars, positive epigastric area
vague sharp Rovsing’s sign, and tympany
pain that begins and rebound over upper
around the tenderness midline

18
 navel and noted
moves to the
right lower
quadrant are
reported by the
patient and
noted
LIVER No gross No Dullness Dullness
asymmetries tenderness, no
across the guarding
abdomen movement,
edge of the
liver palpable
just below the
costal margin
SPLEEN Not palpable Dullness
KIDNEY Laboratory Not palpable N/A N/A
analysis of
patient
(urinalysis
indicates
presence of
urinary tract
infection)
UPPER Asymmetric, no No N/A N/A
EXTREMITIES tremors, tenderness, no
atraumatic in masses, no
appearance contractures
without (the patient
tenderness or was able to
deformity, no flex and
swelling or extend wrist
erythema, slight without
weakness due difficulty
to age to
perform full
ROM
MUSCLE TONE No contractures N/A N/A N/A
on both hands
(the patient can
flex and extend
wrist and
elbows without

19
 assistance)
MUSCLE Full ROM Smooth N/A N/A
STRENGTH without coordinated
assisstance movement
REFLEXES Relaxed arms, The patient N/A N/A
reflexes are not extends arms
difficult to elicit with the palms
up and eyes
closed
Firm,
sustained grip
LOWER No visible No N/A N/A
EXTREMITIES deformity, no tenderness,
swelling, and slight
slight weakness weakness due
due to age to age, ROM
without
assistance
MUSCLE TONE No visible ROM without N/A N/A
deformity or assistance, no
swelling tenderness
MUSCLE ROM without ROM without N/A N/A
STRENGTH assistance assistance, no
tenderness
REFLEXES Dorsiflexion and Flexion of all N/A N/A
plantar flexion toes are
of toes are present
present
GAIT, BALANCE, No difficulty of No tenderness N/A N/A
AND standing and and no masses
COORDINATION walking, no
assistive device
used

20
4. Pathophysiology and Rationale

4.1 Anatomy and Physiology of the Organs / Systems Affected

McBurney point

The McBurney point is midway between the umbilicus and the right superior iliac

spine of the coxal bone. This is the specific point of the right lower abdomen where

sudden abdominal pain is felt.

Cecum

The cecum is a sac that extends inferiorly about 6 cm past the ileocecal junction.

This is the part of the large intestine where the appendix is attached.

Appendix

The appendix is a tube that is about 9 cm long. Appendicitis is an inflammation of

the appendix that usually occurs because of an obstruction; therefore, they accumulate

causing enlargement and pain.

21
4.2 Schematic Diagram of the Pathophysiology of the Condition
PATHOPHYSIOLOGY OF RUPTURED APPENDICITIS WITH LOCALIZED PERITONITIS
PRECIPITATING FACTORS PREDISPOSING FACTORS
- Obstruction in the appendix - Age (66 years old)
- Digestive tract infection - Older adult
- Abdominal trauma - Vague abdominal pain

Appendix blocked by either feces or a foreign object

Lumen obstruction and continued secretion of mucus

Distention of the wall of the appendix, inflammation

Ischemia to the wall of the appendix

Appendix wall necrosis

Appendix rupture

Bacterial invasion

Ruptured Appendicitis with Localized Peritonitis

Signs and Symptoms

 Vague periumbilical pain progresses to right lower quadrant pain
 Nausea
 Low - grade fever
 Local tenderness at McBurney point when applied with pressure
 Rebound tenderness
 Rovsing sign
 Pain consistent with peritonitis
 Constipation

Management
Nursing Management Medical- Surgical Management
 Prepare the patient for surgery.  Antibiotics, antipyretics, analgesics and IV
 After surgery, place the patient in a High fluids
Fowler position.  Appendectomy
 Auscultate for the return of bowel sounds.
 Monitor the urinary output.
 Encourage the patient to ambulate the day of
the surgery.

22
4.3 Disease Process and Its Effects on Different Organs / Systems

The appendix is a small out - pouching from the beginning of the ascending colon.

Formally called the vermiform appendix because it was thought to be worm-like. It sits

in the right lower quadrant of the abdomen. During childhood, the appendix works in

the immune system, which helps the body to fight disease. When a person gets older,

the appendix stops doing this and other parts of the body takes over to help fight

infection.

The appendix can get infected. If not given immediate intervention, it can

rupture. Appendicitis can happen as soon as 2 to 3 days after the symptoms are felt.

Appendicitis happens when the inside of the appendix is obstructed. It may be caused

by various infections such as virus, bacteria, or parasites in the digestive tract. Other

cause of this is when the appendix is obstructed by feces. Tumors can also cause

appendicitis.

The appendix then becomes inflammed. The blood supply to the appendix

reduces and eventually stops. With ischemia, the appendix will necrotize. This will result

to a rupture of the appendix if appendectomy is not immediately done. This will then

allow feces, mucus, and infection to pass through. This will then cause a secondary

peritonitis. Peritonitis can be life-threatening if not managed immediately.

23
4.4 Comparison Between Clinical and Classical Symptoms of the Disease

CLASSICAL SYMPTOMS CLINICAL SYMPTOMS RATIONALE

Vague periumbilical pain Manifested
progresses to right lower Cues: Visceral pain that is poorly
quadrant pain The patient reported localized and parietal pain
abdominal pain that is that is sharp, discrete, and
poorly localized. Pain is well localized are early
significantly felt in the right signs of ruptured
lower quadrant. appendicitis.
Nausea Manifested
Cues: Appendicitis can cause
The patient verbalized that nausea as the patient loses
she losses appetite and feel appetite and feels like they
like vomiting ever since she cannot eat.
suffered abdominal pain.
Low - grade fever Manifested
Cues: Appendicitis causes a fever
The patient experienced between 37.2 degrees
fever 3 days before her celsius to 38 degrees
appendectomy and 2 days celsius. In a ruptured
thereafter. appendicitis, the resulting
infection is the cause of a
rise in fever. A fever greater
than 38.3 degrees celsius
and an increased heart rate
may mean that the
appendix has ruptured.
Local tenderness at Manifested
McBurney point when Cues: McBurney point refers to
applied with pressure The patient reported that the point on the right lower
pain is intense on the right quadrant of the abdomen
lower quadrant of her at which tenderness is
abdomen when the area is maximal in cases of acute
applied with pressure. appendicitis.
Rebound tenderness Manifested
Cues: Rebound tenderness is
The patient felt more pain often indicative of general
when pressure on the right peritonitis.
lower quadrant of the
abdomen is released.
Rovsing sign Manifested
Cues: A positive Rovsing’s sign is

24
 The patient verbalized the result of acute
sudden pain in the right appendicitis.
lower quadrant when
pressure is applied into the
left lower quadrant of the
patient’s abdomen.
Pain consistent with Manifested
peritonitis Cues:
The patient verbalized that The early clinical
she is experiencing manifestations of
abdominal pain that gets peritonitis frequently are
worse with any motion. the signs and symptoms of
the disorder causing the
condition. At first, pain is
diffuse but then becomes
constant, localized, and
more intense over the site
of the pathologic process.

Constipation Not Manifested If the patient has difficulty

passing gas, constipation
can occur with appendicitis.

25
IV. NURSING INTERVENTIONS

CARE OF CLIENT WITH RUPTURED APPENDIX WITH LOCALIZED PERITONITIS

 Prepare the patient for surgery

Perform IV infusion to replace fluid loss and promote adequate renal function,

antibiotic therapy to prevent infection, and administration of analgesic agents for pain.

 After surgery, place the patient in a high Fowler position

This position reduces the tension on the incision and abdominal organs, helping

to reduce pain. It also promotes the thoracic expansion, diminishing the work of

breathing, and decreasing the likelihood of atelectasis.

 Auscultate for the return of bowel sounds

The nurse queries the patient for passing of flatus. This indicates that the patient

is allowed to eat as as desired and tolerated.

 Monitor the urine output

This is to ensure that the patient is not hampered by postoperative urinary

retention and to ensure that hydration status is adequate.

 Encourage the patient to ambulate the day of surgery

This reduce risks of atelectasis and venous thromboemboli formation.

26
Name: Dayondon, Seguindina Age: 66
Diagnosis: Ruptured Appendicitis with Localized Peritonitis Sex: Female
Physician: Dr. Rolando Cam Date: June 22, 2022

NURSING CARE PLAN 1

Assessment Nursing Diagnosis Scientific Basis Objectives of Care

Subjective Cues: Acute pain related Appendicitis may be After 8 hours of
“Sakit kaayo ako to ruptured suggested if the deliberate nursing
tiyan ma’am.” As appendicitis with pain begins near the interventions, the
verbalized by the localized peritonitis navel and moves to patient will be able
patient. as evidenced by the right lower to report pain is
patient’s reports of quadrant, becomes relieved.
Objective Cues: pain worse upon moving,
- Reports of severe walking, or Desired Outcomes:
abdominal pain. Status: sneezing, and 1. appears relaxed,
- Positioning to ease Actual Nursing occurs abruptly. able to sleep, and
pain Diagnosis rest appropriately
- Restless due to
pain Functional Health 2. follow prescribed
- Elevated vital signs Pattern: medications
Cognitive -
Vital SIgns: Perceptual Pattern 3. verbalize
T: 38 degree celsius nonpharmacological
P: 105 bpm methods that
R: 28 cpm provide relief
B/P: 100/ 60 mmhG
Sa02: 98%

Pain Score: 9

Nursing Action Rationale Evaluation

Independent: After 8 hours of deliberate
1. Assess pain, noting 1. Useful in monitoring the nursing interventions, the
location, characteristics, effectiveness of medication patient was able to report
and severity ( 0 to 10 scale). and progression of healing. pain is relieved.
Investigate and report Changes in characteristics
changes in pain, as of pain may indicate GOAL IS MET.
appropriate. developing abscess or
peritonitis, requiring
prompt medical evaluation
and intervention.

2. Provide accurate, honest 2. Being informed about

27
information to patient / progress of situation
significant other. provides emotional
support, helping to
decrease anxiety.

3. Keep at rest in semi - 3. Gravity localizes

Fowler’s position. inflammatory exudate into
lower abdomen or pelvis,
relieving abdominal
tension, which is
accentuated by supine
position.

4. Encourage early 4. Promotes normalization

ambulation. of organ function;
stimulates peristalsis and
passing of flatus, reducing
abdominal discomfort.

5. Provide diversional 5. Refocuses attention,

activities. promotes relaxation, and
may enhance coping
abilities.

Dependent:
1. Administer analgesics, as 1. To maintain “acceptable”
indicated, to maximum level of pain.
dosage, as needed.

2. Evaluate and document 2. Increasing or decreasing

patient’s response to dosage, stepped program
analgesia. helps in self - management
of pain.

Collaborative:
1. Keep NPO and maintain 1. Decreases discomfort of
NG suction initially. early intestinal peristalsis
and gastric irritation or
vomiting.

2. Place ice bag on 2. Soothes and relieves pain

abdomen periodically through desensitization of
during initial 24 to 48 nerve endings.
hours, as appropriate.

28
Name: Dayondon, Seguindina Age: 66
Diagnosis: Ruptured Appendicitis with Localized Peritonitis Sex: Female
Physician: Dr. Rolando Cam Date: June 22, 2022

NURSING CARE PLAN 2

Assessment Nursing Diagnosis Scientific Basis Objectives of Care

Subjective Cues: Impaired skin During an open After 8 hours of
“Magkatol og integrity related to appendectomy, an deliberate nursing
hapdos ako samad abdominal incision incision about 2 to 4 interventions, the
usahay nurse.” As as evidenced by inches long is made patient will be able
verbalized by the patient’s report of in the lower right to participate in
patient. pain and itching on quadrant of the infection prevention
the incision area abdomen. The measures and
Ojective Cues: ruptured appendix treatment.
- Reports of pain Status: is taken out through
and itching on the Actual Nursing the incision. Desired Outcomes:
incision area DIagnosis 1. Identify individual
- Redness of wound risk factor
- Elevated vital signs Functional Health
Pattern: 2. display timely
Vital SIgns: Nutritional - healing of wounds
T: 38 degree celsius Metabolic Pattern without
P: 103 bpm complication
R: 25 cpm
B/P: 100/ 60 mmHg
Sa02: 98%

Pain Score: 5

Nursing Action Rationale Evaluation

Independent: After 8 hours of deliberate
1. Determine if wound is 1. Which affects healing nursing interventions, the
acute or chronic. time. patient was able to
participate in infection
2. Determine patient’s level 2. To clarify intervention prevention measures and
of discomfort. needs and priorities. treatment.

3. Perform routine skin 3. Systemic inspection can GOAL IS MET.

inspections. identify developing
problems and promotes
early intervention.

4. Encourage early 4. Promotes circulation and

29
ambulation. reduces risks associated
with immobility.

5. Provide optimum 5. To provide a positive

nutrition, including nitrogen balance to aid in
vitamins and protein. skin and tissue healing and
to maintain good general
health.

6. Keep surgical area clean 6. To assist body’s natural

and dry, carefully dress process of repair.
wounds, support incision.

7. Apply appropriate 7. For wound healing.

dressing.

Dependent:
1. Administer medication as 1. To assist in wound
prescribed. healing.

2. Obtain specimen from 2. To determine

draining wounds when appropriate therapy.
appropriate for culture and
sensitivities.

Collaborative:
1. Consult with wound 1. To assist with developing
specialist, as indicated. plan of care for cases of
wound infection.

30
Name: Dayondon, Seguindina Age: 66
Diagnosis: Ruptured Appendicitis with Localized Peritonitis Sex: Female
Physician: Dr. Rolando Cam Date: June 22, 2022

NURSING CARE PLAN 3

Assessment Nursing Diagnosis Scientific Basis Objectives of Care

Subjective Cues: Hyperthermia A fever greater than After 8 hours of
“Kasagaran takigan related to ruptured 38.3 degree celsius deliberate nursing
ko labi na og gabii appendicitis with is a sign of a interventions, the
tungod sa ako localized peritonitis ruptured appendix. patient will be able
hilanat.” As as evidenced by to maintain core
verbalized by the body temperature temperature within
patient. at 38.5 degree normal range.
celsius
Objective Cues: Desired Outcomes:
- Status: 1. be free of
Actual Nursing complications
Diagnosis
2. identify
Vital SIgns: Functional Health importance of
T: 38.5 degree Pattern: treatment, as well
celsius Nutrional - as signs/ symptoms
P: 106 bpm Metabolic Pattern of wound infection
R: 24 cpm that requires
B/P: 100/ 60 mmHg further intervention
Sa02: 98%
3. demonstrate
Pain Score: 5 behaviors to
promote
normothermia

4. be free of seizure
activity

Nursing Action Rationale Evaluation

Independent: After 8 hours of deliberate
1. Identify underlying 1. Hyperthermia is a nursing interventions, the
cause. common sign of ruptured patient was able to
appendix and peritonitis. maintain core temperature
within normal range.
2. Monitor core 2. Tympanic temperatures
temperature by most closely approximate GOAL IS MET.

31
appropriate route. Note the core temperature.
presence of temperature
elevation.

3. Monitor and record all 3. Which can potentiate

sources of fluid loss. fluid and electrolyte losses.

4. Discuss the importance 4. To prevent dehydration.

of adequate fluid intake.

5. Review signs and 5. This indicates a need for

symptoms of hyperthermia. prompt intervention.

Dependent:
1. Administer medications. 1. To control shivering and
seizures.

2. Administer antibiotics. 2. To treat infection.

Collaborative:
1. Administer replacement 1. To support circulating
fluids and electrolytes. volume and tissue
perfusion.

2. Provide high - calorie 2. To meet increased

diet. metabolic demands.

32
 DRUG THERAPEUTIC RECORD 1

Drug/ Dose/ Classification/ Indications/ Nursing

Frequency/ Route Mechanism of Contraindications/ Considerations
Action Adverse Reactions
Drug: Classification: Indications: - Assess for
Metoclopramide Dopamine receptor Prevent/ treat dehydration.
antagonist nausea/vomiting
Dose: after surgery. - Assess for nausea,
1 amp Mechanism of vomiting,
Action: Contraindications: abdominal
Frequency: Stimulates motility - Hypersensitivity to distention, bowel
Enroute to OR of the upper GI metoclopramide. sounds
tract. Blocks
Route: dopamine/ - Concurrent use of - Monitor for
IVTT serotonin receptors medications likely anxiety,
in chemoreceptor to produce restlessness,
trigger zone. extrapyramidal extrapyramidal
Enhances reactions. symptoms during IV
acetylcholine administration.
response in upper Adverse Reactions:
GI tract; increases Neuroleptic - Monitor daily
lower esophageal syndrome has been pattern of bowel
sphincter tone. reported. activity, stool
consistency.

- Assess skin for

rash.

Evaluate for
therapeutic
response from
gastroparesis.

Monitor renal
function, B/P, heart
rate.

33
 DRUG THERAPEUTIC RECORD 2

Drug/ Dose/ Classification/ Indications/ Nursing

Frequency/ Route Mechanism of Contraindications/ Considerations
Action Adverse Reactions
Drug: Classification: Indications: - Obtain vital signs
Nalbuphine Opioid agonist, Relief of moderate before giving
antagonist to severe pain, medication.
Dose: preop analgesia,
1/2 A Mechanism of adjunct to - If respirations are
Action: anesthesia. 12/min or less,
Frequency: Agonist of kappa withhold
STAT opioid receptors Contraindications: medication, contact
and partial Hypersensivity to physician.
Route: antagonist of mu nalbuphine.
IVTT opioid receptors - Assess onset, type,
within CNS, Adverse Reactions: location, duration of
inhibiting ascending - Abrupt withdrawal pain.
pain pathways. after prolonged use
may produce - Effect of
symptoms of medication is
narcotic withdrawal reduced if full pain
recurs before next
- Overdose results dose.
in severe
respiratory - Monitor for
depression, skeletal changes in
muscle flaccidity, respirations, B/P,
cyanosis, extreme rate/ quality of
drowsiness pulse.
progressing to
seizures, stupor, - Monitor daily
coma. pattern of bowel/
activity, stool
- Tolerance to consistency.
analgesic effect,
physical - Assess for clinical
dependence may improvement,
occur with chronic record onset of
use. relief of pain.

- Consult physician
if pain relief is not
adequate.

34
 DRUG THERAPEUTIC RECORD 3

Drug/ Dose/ Classification/ Indications/ Nursing

Frequency/ Route Mechanism of Contraindications/ Considerations
Action Adverse Reactions
Drug: Classification: Indications: - Monitor for
Dexketoprofen NSAID Moderate to severe tinnitus, hearing
acute pain. impairment, and
Dose: Mechanism of visual disturbance,
20 mg Action: Contraindications: especially during
The S-(+) Hypersensitivity to prolonged or high-
Frequency: enantiomer of dexketoprofen, dose therapy.
Enroute to OR / PRN ketoprofen, is a aspirin, or other
q6h for pain propionic acid NSAIDs. - Monitor for signs
derivative with and symptoms of GI
Route: analgesic, anti- Adverse Reactions: ulceration
IVTT inflammatory, and Nausea, vomiting,
antipyretic diarrhea, abdominal
properties. It is an pain, dyspepsia, dry
NSAID that reduces mouth, gastritis,
prostaglandin constipation,
synthesis by flatulence,
inhibiting the hematemesis.
cyclooxygenase
pathway.

DRUG THERAPEUTIC RECORD 4

Drug/ Dose/ Classification/ Indications/ Nursing

Frequency/ Route Mechanism of Contraindications/ Considerations
Action Adverse Reactions
Drug: Classification: Indications: - Assess for
Potassium Chloride Electrolyte Treatment, hypokalemia.
prevention of
Dose: Mechanism of hypokalemia. - Monitor serum
10 mcg in 90 mL Action: potassium.
PNSS Necessary for Contraindications:
multiple cellular Renal failure, - Be alert to
Frequency: metabolic hyperkalemia, decreased urinary
To run for 1 -2 hrs x processes. Primary conditions in which output.
3 cycles action is potassium retention
intracellular. is present. - Monitor daily
Route: pattern of bowel

35
IVTT Adverse Reactions: activity, stool
Hyperkalemia consistency.
manifested as
paresthesia, feeling - Assess I&O
of heaviness in diligently during
lower extremities, diuresis, IV site for
cold skin, grayish extravasation,
pallor, hypotension, phlebitis.
confusion,
irritability, flaccid - Be alert to
paralysis, cardiac evidence of
arrythmias. hyperkalemia.

36
 SOAPIE

Name of Patient: Dayondon, Seguindina Matuguina

Address: Brgy. Salvacion, Ormoc City

S- Subjective Cues
“Sakit kaayo ako tiyan ma’am.”

O- Objective Cues
- Reports of severe abdominal pain.
- Positioning to ease pain
- Restless due to pain
- Elevated vital signs

A- Assessment

Acute pain related to ruptured appendicitis with localized peritonitis as

evidenced by patient’s reports of pain

P- Planning

After 8 hours of deliberate nursing interventions, the patient will be able to

report pain is relieved.

I- Intervention
1. Assess pain, noting location, characteristics, and severity ( 0 to 10 ) scale.
Investigate and report changes in pain, as appropriate.
2. Provide accurate, honest information to patient/ significant other.
3. Keep at rest in semi- Fowler’s position.
4. Encourage early ambulation.
5. Provide diversional activities.

E- Evaluation
After 8 hours of deliberate nursing interventions the goal is met. The patient was
able to report pain is relieved.

37
 HEALTH TEACHING PLAN

GENERAL CONTENT METHODOLOGY TIME EVALUATION

OBJECTIVES
After 8 hours of
deliberate
student nurse -
patient/
significant other
interaction, the
patient/
significant other
will be able to
acquire
knowledge, skills,
and attitude in
caring for a
patient who have
undergone
appendectomy.

Specific
Objectives:
After 1 hour of After 1 hour of
student nurse - student nurse -
patient/ patient/
significant other significant other
interaction, the interaction, the
patient/ patient/
significant other significant other
will be able to: was able to:

1. enumerate the  Obstruction in - lecture 10mins. enumerate the

common causes the appendix - visual aids common causes
of ruptured  Digestive tract - dialogue of appendicitis
appendicitis with infection
localized  Abdominal
peritonitis trauma
 Ruptured
appendicitis

2. identify  Antibiotics, - informal 20 identify

treatment antipyretics, discussion mins. treatment
modalities for analgesics and modalities for

38
ruptured IV fluids - question and appendicitis
appendicitis with  Appendectomy answer
localized
peritonitis

3. identify  Maintain fluid - lecture 20 identify

different ways to balance. - visual aids mins. different ways
prevent  Adherence to - dialogue to prevent
postoperative medications to postoperative
complications prevent post - complications
following operative following
appendectomy infection. appendectomy
 Investigate any
reports of
unusual pain
that is
unrelieved by
analgesics.
 Keep the
incision clean
and dry and
apply
appropriate
dressing.
 Encourage
ambulation.
 Do deep
breathing
exercises.
 Avoid strenuous
activities and
lifting for about
2 weeks or as
recommended
by the
physician.

4. enumerate  Wash the area - discussion 15 enumerate

ways of proper with warm, - visual aids mins. ways of proper
incision care soapy water 24 - question and incision care
to 48 hrs. after answer
the surgery. Pat
the area dry
 Keep the

39
 incision clean
and dry. Change
the bandage
daily.

5. show - question and 10 Show

awareness of answer mins. awareness of
current condition current
condition

40
V. EVALUATION AND RECOMMENDATION

PROGNOSIS OF PATIENT

The four nursing care plans in this case study namely acute pain, impaired skin

integrity, and hypothermia progressed to positive results of the desired outcomes for

the patient. In addition, nursing care plans for the patient will make it possible to

provide continuity of holistic nursing care. The health teaching plan presented also

provides ways for the caregiver or significant other to know how to care for the patient

following an appendectomy to prevent post - operative complications.

RECOMMENDATIONS

Based on the 5 days student nurse - patient and significant others interaction,

the following are recommended:

1. Maintain fluid balance.

2. Adherence to medications to prevent post - operative infection.

3. Investigate any reports of unusual pain that is unrelieved by analgesics.

4. Keep the incision clean and dry and apply appropriate dressing.

5. Encourage ambulation.

6. Do deep breathing exercises.

7. Avoid strenuous activities and lifting for about 2 weeks or as recommended by the

physician.

41
VI. EVALUATION AND IMPLICATION OF CASE STUDY TO:

Nursing Practice

This case study aids the health care providers and nursing students in

representing appropriate care and interventions to prevent complications in individuals

who had ruptured appendicitis with localized peritonitis and had undergone

appendectomy.

Nursing Education

This case study benefits the nursing students in understanding more about the

system affected by ruptured appendicitis with localized peritonitis and be able to

provide proper management. Complications can also be identified in the study and can

therefore prepare the nursing student for the appropriate intervention.

Nursing Research

This case study provides the nurse and nursing students ways to provide

interventions appropriate for the condition and ways to prevent its complications.

VII. REFERRAL AND FOLLOW - UP

Discharge instructions were given by the nurse before the patient’s discharge from

the hospital. Proper explanation were provided to the patient and significant others to

avoid confusion and misunderstanding. Medication is also important and was

emphasized, and in case of any unusualities or adverse reactions while on medication

therapy, a follow - up care was advised to treat and prevent further complications.

42
VIII. BIBLIOGRAPHY

Books:

Doenges Moorhouse and Murr; Nurses’s Pocket Guide; 14th Edition; Diagnoses,
Prioritized Interventions and Rationales; F.A. Davis

Hinkle & Cheever; Brunner and Suddarth’s Textbook of Medical Surgical Nursing; 14th
edition; Wolters Kluwer

Saunders Nursing Drug Handbook; Elsevier; 2019

Internet Sources:

https://www.hopkinsmedicine.org/health/conditions-and-
diseases/appendicitis#:~:text=Appendicitis%20happens%20when%20the%20inside,bloc
ked%20or%20trapped%20by%20stool

https://www.msdmanuals.com/professional/geriatrics/social-issues-in-older-
adults/religion-and-spirituality-in-older-adults

https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

43