Polypectomy_cs

LICEO DE CAGAYAN UNIVERSITY COLLEGE OF NURSING NCM501203

NCM501203

A Care Study POLYPECTOMY

Submitted to:

AS PARTIAL FULFILLMENT OF THE COURSE REQUIREMENT FOR NCM501203

Submitted by:

I. Introduction Overview of the case II. Health History Profile of patient

III. Developmental Data IV. Anatomy and Physiology V. Pathophysiology VI. Medical Management VII. Laboratory Results VIII. Drug Study IX. Ideal Nursing Management X. Actual Nursing Management XI. Health Teachings XII. Referrals and Follow up XIII. Bibliography

I. INTRODUCTION

a. Overview of the Case A polyp is an abnormal growth of tissue (tumor) projecting from a mucous membrane. If it is attached to the surface by a narrow elongated stalk it is said to be pedunculated. If no stalk is present it is said to be sessile. Polyps are commonly found in the colon, stomach, nose, urinary bladder and uterus. They may also occur elsewhere in the body where mucous membranes exist like the cervix and small intestine. Cervical polyps are fingerlike growths that start on the surface of the cervix or endocervical canal. These small, fragile growths hang from a stalk and push through the cervical opening. The cause of cervical polyps is not completely understood. They may be associated with chronic inflammation, an abnormal response to increased levels of estrogen, or clogged cervical blood vessels. Cervical polyps are relatively common, especially in women over age 20 who have had children. Only a single polyp is present in most cases, but sometimes two or three are found. They are rare in females who have not started menstruating. Abnormal vaginal bleeding is one of the manifestation in this kind of condition, especially after intercourse, douching, menopause, and even abnormal heavy periods (menorrhagia), white or yellow mucous discharge (leukorrhea) A pelvic examination reveals smooth, red or purple, fingerlike projections from the cervical canal. A cervical biopsy typically reveals mildly atypical cells and signs of infection. Polyps can be removed during a simple, outpatient procedure. Gentle twisting of a cervical polyp may remove it, but normally a polyp is taken out by tying a surgical string around the base and cutting it off. Removal of the polyp's base is done by electrocautery or with a laser.

Because many polyps are infected, an antibiotic may be given after the removal, even if there are no or few signs of infection. Although most cervical polyps are non-cancerous (benign), the removed tissue should be sent to a laboratory for further examination. Typically, polyps are benign and easily removed. Regrowth of polyps is uncommon.

II. HEALTH HISTORY

a. Profile of Patient Patient’s Name: Birth Date: Birthplace: Age:

39 years old

Sex:

Female

Status:

Married

Religion: Nationality:

Filipino

Address: Allergy:

None

Date of Admission:

May 17, 2007

Time of Admission:

8:30 am

Chief Complaints:

Vaginal bleeding on and off

Diagnosis:

Dysfunctional Uterine Bleeding

III. DEVELOPMENTAL TASK

ERIK ERICKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT

VI. MEDICAL MANAGEMENT

DOCTOR’S ORDER May 17, 2007

RATIONALE

Admit to Gynecology: > Temperature every 4Classification hours > During this period of time, potentially fatalContraindications Date Dosage/ Mechanism of Specific

Name of drug

complications Frequency may develop Action

Ordered Paracetamol

May6,2007

(Biogesec)

Antipyretic, analgesic

> Soft diet, NPO

Route 1 tab, P.O. (prn)

Chemical Effect:

Side Effects

Indication

Implication

Reduces fever

May produce

- Contraindicated

Hematologic:

in

hemolytic

patients

> Serves as transition the regular diet; is ahypersensitive to anemia,leucopenia analgesicto effect nutritionally adequate diet; is a modification ofdrug. by blocking pain Hepatic: liver impulses, by and texture normal diet in consistency

- Use cautiously

damage, jaundice.

inhibiting

in patients with

Metabolic:

prostaglandin.

history of chronic

hypoglycemia

Therapeutic

alcohol abuse.

Skin: rash, urticaria

> Labs: CBC stat., U/A, FBS, > CBC- leukocytosis Effect:: usually Relieves present, although Hgb, Ultrasound, Chest X-ray, a low WBC counts may present in viral pain and reduces ECG, Alkaline phosphate. Cefuroxime

May6,2007

Antibiotic

(Zinacef)

> Intake and Output every shift

infection. 400 g every

Chemical effect:

Hinders

- Contraindicated

CNS:

8 hours.

Inhibits cell-wall

kills

in

malaise, dizziness.

synthesis,

susceptible

hypersensitive to

or

> To know if the patient has bacteria. a normal fluiddrug promoting

patients or

other

GI:

headache, nausea,

anorexia,

vomiting,

diarrhea,

glossitis,

instability.

- Use cautiously

abdominal cramps.

Therapeutic

in patients with

Respiratory: dyspnea

effect: Kills

history

of

Skin:

to

urticaria.

functioning and for laboratory purposes.

> Fluids are required susceptibleto replace losses, to sensitivity prevent patient bacteria dehydration. It aids also forpenicillin. mobilization of secretion.

> Meds: - ampicillin 1 IVT every 8° Anst

- Assess patient’s pain or temperature before and dring therapy. - Assess patient’s drug history. - Be alert for adverse reactions and drug interactions.

fever.

osmotic intake and output. To know for normal kidneycephalosporins.

> D5LR I L @ KVO

Nursing

> Kills susceptible bacteria

- famotidine 1 amp IVT every > Decreases gastric acid levels and prevents

rashes,

- Assess patient’s infection before therapy. - Ask patient about previous reactions to cephalosporin - Be alert for adverse reactions and drug interactions.

VIII. DRUG STUDY Name of

Date

drug

Ordered

Tramadol

May6,2007

Classification

Dosage/

Mechanism of

Specific

Frequency

Action

Indication

Contraindications

Side Effects

Nursing Implication

Pharmacologic

Route 300 g IVTT

Chemical

Relieves

- Contraindicated in

CNS:

- Assess patient’s pain

class: opioid

every

effect:

pain.

patients

dizziness,

before

agonist

hours.

Centrally acting

hypersensitive to drug

vertigo,

therapy.

Therapeutic

synthetic

or

headache

-

class:

analgesic

component.

CV:

respiratory status.

analgesic

compound

- Use cautiously in

vasodilation

- Monitor patient for

thought to bind

patients at risk for

EENT: visual

drug dependence.

opioid

seizures or respiratory

disturbances.

Be alert for adverse

receptorsand

depression.

GI:

reaction.

8

any

of

its

nausea,

inhibit reuptake

constipation,

of

vomiting,

norepinephrine

diarrhea

and serotonin. Therapeutic effect: Relieves pain.

starting

Monitor

CV

the and

Name of

Date

drug

Ordered

Ketorolac

May7,2007

(Toradol)

Classification

Dosage/

Mechanism of

Specific

Frequency

Action

Indication

Route mg IV

Pharmacologic

30

class: NSAID

every

Therapeutic:

hours.

6

Chemical effect:

(Zantac)

May7,2007

Relieves May

inhibit

pain

Side Effects

- Contraindicated in and

inflammation.

patients

CNS: drowsiness,

hypersensitive

to

insomnia,

analgesic,

prostaglandins

drug or any of its

dizziness,

anti-

synthesis.

components.

headache.

inflammatory.

Therapeutic

- Not recommend for

CV:

effect:

intrathecal or epidural

hypertension,

administration

palpitations.

and

because of its alcohol

GI:

nausea,

inflammation.

content.

GI

pain,

- Use cautiously in

diarrhea.

patients

Skin:

Relieves

Ranitidine

Contraindications

Antiulcerative

300g

IVTT

every

8

hours.

Chem.

pain

Effect:

Competitively inhibits of

action

H2

at

receptor site. -Relieves discomfort.

GI

Relieves discomfort.

GI

in

the

edema,

Nursing Implication

- Assess patient’s infection before therapy. - Ask patient about previous reactions to cephalosporin - Be alert for adverse reactions and drug interactions.

perioperative period.

sweating.

- Contraindicated in patients hypersensitive to drug or any of its components. Use cautiously in patients with impaired kidney function.

CNS: vertigo,

-Assess patient’s GI

malaise.

condition

EENT:

starting therapy.

blurred vision

- Be alert for adverse

Hepatic:

reactions

Jaundice.

interactions.

before

of

drug

VII. LABORATORY RESULTS DIAGNOSTIC TESTS URINALYSIS May 6, 2007 Specimen:

Random Sample

Color:

Yellow

Appearance:

Hazy

Glucose:

negative

Protein:

negative

Reaction:

6.0 pH

Specific gravity:

1.030

Microscopic WBC:

0-2

RBC:

0-3

Epithelial Cells:

plenty

Pus Cells:

3-7 hpf

Mucus Threads:

none seen

Urates:

moderate

CHEMISTRY: Alkaline

160 mg/dl

Creatinine G

0.6 u/l

Glucose- G

79 mg/dl

HEMATOLOGY May 17, 2007 CBC Total WBC

9.7

Hemoglobin

13.0

Hematocrit

37.7

MCV

81.4

MCH

26.8

Platelet Count

265

Differential Count Lymphocytes

42

Segmenters

58

Basophils

13.5

HBsAg – non reactive ULTRASOUND Cervix

3.0 x 2.90 cm

Endometrium

0.77cm

Uterus

5.3 x 5.2 x 4.1 cm

Right ovary

2.3 x 1.50 cm

Left ovary

2.67 x 1.50 cm

CHEST X-RAY Finding: There is no evidence of active parenchyma infiltrates. Heart is not enlarged. Aorta, trachea, diaphragm and sinuses are unremarkable.

IV. ANATOMY AND PHYSIOLOGY The cervix (from Latin "neck") is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall. Approximately half its length is visible with appropriate medical equipment; the remainder lies above the vagina beyond view. It is occasionally called "cervix uteri", or "neck of the uterus".

Ectocervix The portion projecting into the vagina is referred to as the portio vaginalis or ectocervix. On average, the ectocervix is 3 cm long and 2.5 cm wide. It has a convex, elliptical surface and is divided into anterior and posterior lips. External Os The ectocervix's opening is called the external os. The size and shape of the external os and the ectocervix varies widely with age, hormonal state, and whether the woman has had a vaginal birth. In women who have not had a vaginal birth the external os appears as a small, circular opening. In women who

have had a vaginal birth, the ectocervix appears bulkier and the external os appears wider, more slit-like and gaping. Endocervical canal The passageway between the external os and the uterine cavity is referred to as the endocervical canal. It varies widely in length and width, along with the cervix overall. Flattened anterior to posterior, the endocervical canal measures 7 to 8 mm at its widest in reproductive-aged women. Internal Os The endocervical canal terminates at the internal os which is the opening of the cervix inside the uterine cavity. Cervical crypts There are pockets in the lining of the cervix known as cervical crypts. They function to produce cervical fluid.[1] Histology The epithelium of the cervix is nonkeratinized stratified squamous epithelium at the ectocervix, and simple columnar epithelium at the cervix proper.[2][3] At certain times of life, the columnar epithelium is replaced by metaplastic squamous epithelium, and is then known as the transformation zone. Nabothian cysts are often found in the cervix. Functionality During menstruation the cervix stretches open slightly to allow the endometrium to be shed. This stretching is believed to be part of the cramping pain that many women experience. Evidence for this is given by the fact that some women's

cramps subside or disappear after their first vaginal birth because the cervical opening has widened. During childbirth, contractions of the uterus will dilate the cervix up to 10 cm in diameter to allow the child to pass through. During orgasm, the cervix convulses and the external os dilates. Dr. R. Robin Baker and Dr. Mark A. Bellis, both at the University of Manchester, first proposed that this behavior worked in such a way as to draw any semen in the vagina into the uterus, increasing the likelihood of conception. Later researchers, most notably Elisabeth A. Lloyd, have questioned the logic of this theory and the quality of the experimental data used to back it.

IX. NURSING MANAGEMENT a. Ideal Nursing Management (NCP)

NURSING DIAGNOSIS: Nutrition: imbalanced, risk for less than body requirements Risk factors may include Inability to ingest or digest food or absorb nutrients because of biological, psychological, or economic factors Increased metabolic demands Possibly evidenced by [Not applicable, presence of signs and symptoms establishes an actual diagnosis.] DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL: Nutritional Status (NOC) Ingest nutritionally adequate diet for age, activity level, and metabolic

demands. Demonstrate stable weight/progressive weight gain toward goal.

ACTIONS/INTERVENTIONS Nutrition Management (NIC) Independent

RATIONALE

Identify children at risk for malnutrition (e.g., intestinal surgery, hypermetabolic states, restricted intake, prior nutritional

Provides opportunity for early intervention.

deficiencies). Determine ability to chew, swallow, taste;

These factors can affect ingestion

presence of mechanical barriers; or

and/or digestion of nutrients, and

conditions such as lactose intolerance,

specific dietary choices.

cystic fibrosis, diabetes, inflammatory bowel diseases. Determine child’s current nutritional status

Identifies individual nutritional

using age-appropriate measurements,

needs and provides comparative

including weight and body build, strength,

baseline.

activity level, sleep/rest cycles. Elicit information from child/parent of

Baseline information to determine

younger child regarding typical daily food

adequacy of intake. Knowledge of

intake, determining foods and beverages

child’s specific likes/dislikes may

normally consumed. Note types of snacks.

be helpful in meeting child’s

Discuss eating habits and food preferences

nutritional needs during a time

(likes and dislikes).

when appetite is suppressed or child has no interest in food.

Determine psychological factors, cultural or

Dietary beliefs, such as

religious desires/influences on dietary

vegetarianism, can affect

choices.

nutritional intake. Ethnic food choices can improve a child’s intake when appetite is poor.

Determine whether infant is breastfed or

Providing usual and typical

formula-fed and typical pattern of feedings

feedings is important to infant well-

during a 24-hr period. Note type and

being and early growth.

amounts of solid foods an infant/young toddler eats. Auscultate bowel sounds. Note

Provides information about

characteristics of stool (color, amount,

digestion/bowel function and may

frequency, and so on).

affect choice/timing of feeding.

Discuss with parent what types of candy,

Identifies what child eats in a

other sweets, snacks, and sodas child

typical day. Provides opportunity

eats/drinks.

for identifying and providing healthy snacks.

Emphasize importance of well-balanced,

Although nutritious intake is

nutritious intake. Provide information

important, arguing over food is

regarding individual nutritional needs and

counterproductive. Providing age-

ways to meet these needs within financial

appropriate guidelines to children

constraints. Avoid arguing over food intake.

as well as to parents/care provider

Provide food without comment.

may help them in making healthy choices.

Review drug regimen, side effects, and

Timing of medication doses,

potential interactions with other

interaction with certain foods can

medications/over-the-counter drugs.

alter effect of medication or digestion/absorption of nutrients.

Clarify family/caregiver access to/use of

May be necessary to improve

resources such as food stamps, budget

child’s intake and/or availability of

counseling, WIC, community food bank,

food to meet nutritional needs.

and/or other appropriate assistance programs.

Collaborative Establish a nutritional plan that meets

Corrects/controls underlying

individual needs incorporating specific food

causative factors (e.g., diabetes,

restrictions, special dietary needs.

cancer, malabsorption syndrome, and anorexia).

Consult dietitian/nutritional team as

Useful in determining individual

indicated.

nutritional needs and therapeutic diet.

Review indicated laboratory data (e.g.,

Indicators of nutritional health and

serum albumin/prealbumin, transferring,

effects of nutrients in organ

amino acid profile, iron, blood urea nitrogen

function.

[BUN], nitrogen balance studies, glucose, liver function, electrolytes, total lymphocyte count, indirect calorimetry).

NURSING DIAGNOSIS: Fluid volume, risk for imbalance Risk factors may include Lack of adequate intake, increase in fluid needs, e.g. fever Rapid/sustained loss, e.g., hemorrhage, burns, vomiting, diarrhea, fistulas Rapid/excessive fluid replacement Possibly evidenced by [Not applicable; presence of signs and symptoms establishes an actual diagnosis.] DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL: Hydration (NOC) Demonstrate adequate fluid balance as evidenced by stable vital signs, palpable pulses/good quality, normal skin turgor, moist mucous membranes; individual appropriate urinary output; lack of excessive weight fluctuation (loss/gain), and absence of edema. PARENT/CAREGIVER WILL: Verbalize understanding of child’s fluid needs. Promote adequate age-appropriate fluid intake.

ACTIONS/INTERVENTIONS Fluid Management (NIC)

RATIONALE

Independent

Causative/contributing factors for

Note potential sources of fluid loss/intake,

fluid imbalances.

presence of conditions such as diabetes, burns, use of total parenteral nutrition (TPN), etc. Note child’s age, size, weight, and

Affects ability to tolerate fluctuations

cognitive abilities.

in fluid level and ability to respond to fluid needs.

Monitor vital signs, mucous membranes,

Indicators of hydration status. Note:

weight, skin turgor, breath sounds, urinary

Hypotension indicative of developing

and gastric output, amount of blood

shock may not be readily observed

draws, hemodynamic measurements.

in pediatric patients until very late in the clinical course.

Review child’s intake of fluids.

Children often do not take in enough oral fluids to meet hydration needs.

Determine child’s normal pattern of

Provides information for baseline

elimination, and whether child is toilet

and comparison. If child is in

trained.

diapers, output may be determined by weighing diapers.

Determine whether child has problems

Evaluation of these issues is

with urination, such as urine retention,

important for determining cause and

bed-wetting, burning, holding.

treatment of underlying problem.

Note uses of drainage devices such as

May increase fluid and electrolyte

nasogastric tube, wound drain; use of

losses.

laxatives, enemas, and suppositories. Collaborative Administer IV fluids via control device/pump.

Because smaller volumes are administered, close monitoring and regulation is required to prevent fluid overload while correcting fluid balance.

Replace electrolytes as indicated by oral route whenever possible.

Oral replacement solutions formulated for children are often safer and better tolerated when given orally if time/condition allows.

Monitor laboratory results, e.g., hemoglobin/hematocrit (Hb/Hct), BUN, urine osmolality/specific gravity. Arrange with laboratory to combine common tests and draw smallest amount of blood that is necessary to perform required tests.

Indicators of adequacy of hydration/therapeutic interventions.

Excessive/repetitive blood draws may markedly reduce Hb/Hct levels in pediatric patients.

NURSING DIAGNOSIS: Infection, risk for (septicemia) Risk factors may include Inadequate primary defenses (broken skin, traumatized tissue, altered peristalsis) Inadequate secondary defenses (immunosuppression)

Invasive procedures Possibly evidenced by [Not applicable; presence of signs and symptoms establishes an actual diagnosis.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Infection Status (NOC) Achieve timely healing; be free of purulent drainage or erythema; be afebrile. Risk Control (NOC) Verbalize understanding of the individual causative/risk factor(s).

ACTIONS/INTERVENTIONS Infection Control (NIC) Independent

RATIONALE

Assess vital signs frequently, noting

Signs of impending septic shock.

unresolved or

Circulating endotoxins eventually

progressing hypotension, decreased

produce vasodilation, shift of fluid from

pulse pressure,

circulation, and a low cardiac output

tachycardia, fever, tachypnea.

state.

Note changes in mental status (e.g.,

Hypoxemia, hypotension, and acidosis

confusion, stupor).

can cause deteriorating mental status.

Note skin color, temperature, moisture.

Warm, flushed, dry skin is early sign of

Monitor urine output.

septicemia. Later manifestations include cool, clammy, pale skin and cyanosis as shock becomes refractory.

Perform/model good handwashing

Reduces risk of cross-

technique. Monitor staff/patient

contamination/spread of infection.

compliance.

Monitor/restrict visitors and staff as

Reduces risk of exposure to/acquisition

appropriate. Provide protective

of secondary infection in

isolation if indicated.

immunosuppressed patient.

Collaborative Obtain specimens/monitor results of

Identifies causative microorganisms

serial blood, urine,

and helps in

wound cultures.

assessing effectiveness of antimicrobial regimen.

Administer amoebecides e.g.,

Therapy is directed at anaerobic

Metronidazole.

bacteria.

X. Actual Nursing Management (SOAPIE)

S

O

SUBJECTIVE: “ Sakit akong tiyan diri dapit sa akong kilid ” as verbalized by the patient. - Facial grimace - Guarding - Restlessness

A

Alteration in comfort pain related to Distension of intestinal tissues by inflammation

P

At the end of 30 minutes of rendering nursing intervention the patient will be able to verbalize relief/ control of pain.

I

Assess pain noting location, characteristics and intensity. (0-10 scale). - Helps evaluate degree of discomfort. Provide accurate, honest information to patient/SO. Keep at rest in semi-Fowler’s position. - Being informed about progress of situation provides emotional support, helping to decrease anxiety. Gravity localizes inflammatory exudate into lower abdomen or pelvis, relieving abdominal tension, which is accentuated by supine position.

Apply hot or cold compress when indicated. - Reduces pain Provide comfort measures e.g. back rub, repositioning the patient. - Promotes relaxation and may enhance coping abilities. DEPENDENT: Administer medications as indicated e.g. narcotics, analgesics. - Relieves pain enhances comfort and promotes rest. E

At the end of 30 minutes of rendering nursing intervention the patient was able to verbalized relief/ control of pain.

S

SUBJECTIVE:

O

- Facial grimace - Guarding - Restlessness

A

Knowledge, deficient regarding condition, prognosis, treatment, self-care, and discharge needs related to Lack of exposure/recall; information misinterpretation

P

At the end of 30 minutes of rendering nursing intervention the patient will be able to verbalize understanding of disease process and potential complications.

I

Identify symptoms requiring medical evaluation, e.g., increasing pain; edema/erythema of wound; presence of drainage, fever. - Prompt intervention reduces risk of serious complications, e.g., delayed wound healing, peritonitis. Encourage progressive activities as tolerated with periodic rest periods. - Understanding promotes cooperation with therapeutic regimen, enhancing healing and recovery process. Discuss care of incision, including dressing changes, bathing restrictions, and return to physician for suture/staple removal. - Understanding promotes cooperation with therapeutic regimen, enhancing healing and recovery process.

E

At the end of 30 minutes of rendering nursing intervention the patient was able to verbalized understanding of disease process and potential complications.

S

SUBJECTIVE: “

O

Poor appetite when eating.

A

Nutrition: Imbalances, less than body requirements related to poor appetite.

P

At the end of 1 hour, patient will be able to demonstrate good appetite and verbalized her feelings concerning resumption of diet.

I

Encouraged bed rest and limited activity. - Decreasing metabolic needs aids in preventing caloric depletion and conserves energy. Intake and output recorded. - Useful in identifying specific deficiencies and determining GI response to foods. Recommended rest before meals. -Quiets peristalsis and increase available energy or eating. Encouraged patient to verbalize feelings concerning resumption of diet. - Hesitation to eat may result of fear that food will cause exacerbation o symptoms.

E

At the end of 1 hour, patient was able to demonstrate good appetite and already spoken about her feelings concerning resumption of diet

XI. HEALTH TEACHINGS Name of Patient: Judy Ann Roque

MEDICATIONS

 Advised and encouraged patient or family to give the patient paracetamol

when

she

has

fever.  Do not give patient more than 5 doses

in

24

hours

unless

prescribed by physician. EXERCISE

 Take some rest to prevent stress and other complications.

TREATMENT

 Maintain clear surroundings.

OUT-PATIENT

 Advised the parents to visit the

(Check-up)

nearest

hospital

for

further

check-up for their child.  Diet as to age.

DIET

 Increase fluid intake. XII. REFERRALS AND FOLLOW-UP To allow continuous monitoring of the patient’s healing progress, patient was encouraged to consult her doctor 2 weeks after discharge for follow-up check up of her general condition. This will ensure thorough follow up of her condition and prevention of potential complications. Apart from this, patient was advised to increase fluid intake, make sure that proper hand washing is practiced before and after eating. XIII. BIBLIOGRAPHY

Black, Joyce M. 1993. Medical-Surgical Nursing- A Psychologic Approach. 4th ed. W.B Saunders Company: Philadelphia, Pennsylvania,USA. Smeltzer, Suzanne C.et al.2004. Medical Surgical Nursing. - 10th ed.Lippincott Williams and Wilkins: Philadelphia Price, Sylvia A. 1997. Pathophysiology: Clinical Concepts of Disease Processes. 5th ed. Mosby Year Book, Inc: United States of America Carpenito, Lynda Juall.2000. Nursing Diagnosis: Application to Clinical Practice. 8th ed. Lyndal Juall Carpenito: United States of America. Pillitteri, Adele. 2003. Maternal and Child Health Nursing.4rth ed.Wolter Kluwer Company: Hong Kong. Doenges,

Marilynn

E.2006.Nurse’s

Philadelphia. www.yahoo.com

V. PATHOPHYSIOLOGY

Pocket

Guide.F.ADavis

Company:

Predisposing factors:  Age  Gender  Lifestyle Precipitating factors:  Infections Appendicitis obstruction of the narrow appendiceal lumen. Obstruction has many sources, including fecaliths, lymphoid hyperplasia (related to viral illnesses such as upper respiratory infections, mononucleosis, or

gastroenteritis gastrointestinal parasites, foreign bodies, and Crohn's disease

Continued secretion of mucus from within the obstructed appendix results in elevated intraluminal pressure,

leading to tissue ischemia, over-growth of bacteria, transmural inflammation, appendiceal infarction, and possible perforation.

Inflammation may then quickly extend into the parietal peritoneum and adjacent structures. s/s: epigastric pain, vomiting, anorexia, fever Complications: wound infections, intra-abdominal abscess, intestinal obstruction, and prolonged ileus