Meckel’s Diverticulitis final (2)

Meckel’s Diverticulitis

INTRODUCTION

INTRODUCTION•Meckel’s

Diverticulum•3% of infants •no symptoms

Meckel’s DiverticulitisSymptoms:•painless rectal bleeding•Severe abdominal pain, abdominal tenderness, and vomiting•Meckel’s Radionuclide Scan

INTRODUCTION

OBJECTIVES

General Objective To present a useful comprehensive Case study on Diverticulitis that will enhance the knowledge, develop the skills and activities in the actual care and management of patients suffering from the said disease.

General ObjectiveIt is the intention of the presentors to further enhance the Holistic Care approach in handling the case of Mr. JCM. The presentors would like to take the opportunity of gaining and sharing relevant insights in the study of this case.

Specific Objectives: 1.Discuss the pathophysiology of diverticulitis 2.Identify and prioritize Nursing Problems. 3.Discuss the medical management of diverticulitis and its appropriate Nursing responsibilities.

Specific Objectives: 4.Formulate a Comprehensive Nursing Care plan using the nursing process. 5.Evaluate the effectiveness of the care rendered. 6.Provide a continuous Home Care Plan through discharge planning.

PATIENT’S

PROFILE

PATIENT’S PROFILE

Biographical Data:Name : JCMAge : 10 years oldGender : MaleAddress : Manila, PhilippinesBirth date : February 19, 2000Birth place : Manila, Philippines

PATIENT’S PROFILE

Civil Status : SingleReligion : Iglesia Ni CristoNationality : FilipinoDate and time of admission:

July 27, 2010/11:02 amAttending Physician:Santos, Caroline K.

PATIENT’S PROFILE

Chief complaint:“Sumasakit ang sikmura ng anak ko at kanina pa siya suka ng suka.” as

verbalized by the mother.

PATIENT’S PROFILE

History of Present IllnessOne hour prior to

admission, patient noted abdominal pain, epigastric in location, sudden in onset, colicky in character, non-tolerable, continuously felt, non-radiating.

PATIENT’S PROFILE

It was associated with vomiting 6 times of previously ingested food to watery vomitus. No noted fever, cough, colds and loose bowel movement persistence of abdominal pain prompted client’s parents to seek consult hence admission.

PATIENT’S PROFILE

VITAL SIGNS in ER prior to admission:Date: July 27, 2010 Time: 10:00AM ›BP: 110/60

›PR: 100 bpm›RR: 22 cpm›T: 36˚ C›Wt: 32 kg

PATIENT’S PROFILE

Admitting Diagnosis: To consider Appendicitis

Final Diagnosis: Meckel’s Diverticulitis

PATIENT’S PROFILEPast Medical History: (-) Parasitism (-) Tuberculosis (-) Diarrhea (+) Diabetes (mother side) (-) Pneumonia (-) Mumps (-) Measles (+) HPN (both sides) (-) Accidents (-) Epilepsy (-) Chicken Pox (+) Asthma (mother side) (-) Allergies to food and drug (-)Emotional disorders (-)Previous hospitalization

PATIENT’S PROFILEChildhood Immunization: ›BCG (+)* ›DPT 1 (+)*** ›OPV1(+)*** ›Hepa B1 (+)* ›Measles (+)** ›DPT2 (+)**** ›OPV2 (+)**** ›Hepa B2 (+)*** ›DPT3 (+)# ›OPV3 (+)# ›Hepa B3 (+)#

*- Given at birth (Feb 19 2000) ***April 1 2000 ****April 29 2000 **-Nov. 19 2000 #-May 27 2000

GENOGRAM

Paternal MaternalGrandfather

HPNGrandmother

UnknownGrandfather

HPNDM (Type I)

GrandmotherHPN

Asthma

FatherHPN Mother

HPNAsthma

DM (Type I)

GENOGRAM

1st SiblingBrother

2nd SiblingBrotherAsthma

3rd SiblingBrother

4th SiblingBrother

Patient JCMMeckel’s

Diverticulitis

Physical Assessment (July 28.2010)

Physical Assessment (First day Post-op)

General Survey

The client is conscious and coherent with anecteric sclera, pink palpebral conjunctiva symmetric chest expansion without retractions and no heart murmurs.

Physical Assessment (First day Post-op)

General Survey

Flat and soft with tenderness in the epigastric part of the abdomen right lower quadrant and right upper quadrant. He has no edema and not cyanotic. His gait is steady and stable.

Physical Assessment(First day Post-op) Part of

the bodyNorms Actual

FindingsMeasuremen

tsAnalysis

Head Rounded, smooth skull contour

Smooth absence of nodule or massesRounded smooth skull contour

Inspection and palpation

Normal

Scalp The scalp are white and clean no masses or lumps, no lice or nits, no dandruff or lesionNo lump and tenderness of the scalp


Normal

Physical Assessment(First day Post-op)

Hair Evenly distributed, thick , silky and resilient

Uneven distribution of hair, thin hair

inspection Normal

Face Symmetric or slightly asymmetrical facial features; palpebral fissures equal in size

Symmetric facial features, with no skin rash. Absence of nodules

inspection Normal Normal

Part of the body

Norms Actual Findings

Measurements

Analysis



FindingsMeasuremen

tsAnalysis

Eyelids Skin intact, no discharge, no discoloration; approximately 15-20 involuntary blinks per minute; bilateral blinking

Patient can blink normally


Normal

Eyebrows

Symmetrically aligned, equal movement,

Even distribution of hair

Inspection Normal

Eyelashes

Equally distributed, curled slightly outward

Even distribution of eye lashes

Inspection Normal



FindingsMeasuremen

tsAnalysis

Palpebral fissure

Pinkish in color, no lesion or nodules


Normal

Conjunctiva

Shiny, smooth and pink or red

Pinkish in color, no lesion or nodules


Normal

Sclera Appears white(darker or yellowish and with small brown macules in dark skinned client)

Sclera is white in color

Inspection Normal



FindingsMeasuremen

tsAnalysis

Iris Flat and round

Flat and rounded Inspection Normal

Pupils

Black in color, equal in size, round, smooth border

Round equal size pupils that reacts to lights and accommodation

Inspection Normal

Eye movement

Both eyes coordinated, move in unison, with parallel alignment

Both eyes coordination

Inspection Normal



FindingsMeasuremen

tsAnalysis

Visual acuity

Able to read news print

Able to read news print

Inspection Normal

Field vision

When looking straight ahead, client can see objects in the periphery

Client can able to see in the periphery

Inspection Normal



FindingsMeasuremen

tsAnalysis

Ear color same as facial skin, symmetrical auricle aligned with outer cantus of eye

Symmetrically align


Normal

Ear canal Distal third contains hair follicles and and glands.

-Midline symmetrical and patent internal nares are clean, pinkish with few cilia nasal septum appears straight


Normal Normal



FindingsMeasuremen

tsAnalysis

Hearing acuity

able to hear a whisper spoken 2 feet away

Inspection Normal

Nose Not tender, no lesions

-No discharge or flaring, uniform in color-No tenderness


Normal Normal

Lips Uniform pink color, soft, moist, smooth texture,

-without dryness and cracks


Normal



FindingsMeasuremen

tsAnalysis

Teeth Smooth, shiny tooth enamel, white in color

-all teeth are intact, slightly yellowish in color

Inspection Normal

Tongue -pinkish in color, protrudes symmetrically,(-)swelling,(-)ulcers,(-) ulcers

-pinkish in color, protrudes symmetrically,(-)swelling,(-)ulcers,(-)ulcers

Inspection Normal



FindingsMeasuremen

tsAnalysis

Uvula Position in midline of soft palate

-uvula moves properly upward when the patients says ”ah”-(+) gag reflex when the tongue depressor touches posterior pharynx

Inspection Normal Normal

Soft palate

Light pink, smooth soft palate

-Slightly pink Inspection Normal



FindingsMeasuremen

tsAnalysis

Hard palate

Lighter pink hard palate, more irregular texture

Whitish hard palate

Inspection Normal

Tonsils Pink and smooth, no discharge

No discharge Inspection Normal

Voice Normal voice tone

Normal voice tone

Inspection Normal



FindingsMeasuremen

tsAnalysis

Neck Muscles equal in size; head centered, coordinated, smooth

-(-)unrestrictive range of motion in the neck, no swelling,-no palpable mass noted


Normal Normal

Posterior thorax and anterior thorax

Spine vertically aligned, straight, skin intact

-(-) skin rashes -Costal angel is not widened -no tenderness or masses -no areas of dullness-Normal breath sounds

Inspection, auscultation, percussion and palpation,

Normal Normal Normal Normal



FindingsMeasuremen

tsAnalysis

Breast Breast even with the chest wall; skin uniform in color, skin smooth

-(-)rashes -no tenderness or masses


Normal Normal

Arms Equal size on both sides of the body

-(-)skin rashes -no deformities

Inspection Normal Normal

Arms dorsal surface

(-)rashes No mass

(-)rashes No mass


Normal Normal



FindingsMeasuremen

tsAnalysis

Palms

No abnormalities observed

No abnormalities observed Inspection

Normal

Lower extremities

no gross deformities- symmetrical body parts, -good body alignment, -no involuntary movement,

-no gross deformities- symmetrical body parts, -good body alignment, -no involuntary movement, -smooth gait, full range in motion,-(-)Rashes extending from leg to calf Inspection

NormalNormalNormalNormalNormalNormal

Physical Assessment(July 27, 2010) Part of


FindingsMeasuremen

tsAnalysis

Abdomen

Unblemished skin, uniform color, flat rounded contour

-(-)rashes -(+)flat, soft Normoactive Bowel Sounds -normal tympany - (+)Rebound tenderness - (-) Psoas’ Sign -(-) Obturator Sign

Inspection, palpation, percussion and auscultation

Normal Normal NormalNormalNormal Normal

Physical Assessment (First day Post-op)Part of


FindingsMeasuremen

tsAnalysis

Abdomen

Unblemished skin, uniform color, flat rounded contour

-(+)Hypoactive bowel sounds

-normal tympany -(+)redness at the incision site (RLQ)-mcburney’s incision on the RLQ

Inspection, palpation, percussion and auscultation

Normal Normal NormalNormalNormal Normal

(Activities of Daily Living)

GORDON’S FUNCTIONAL HEALTH

PATTERNJuly 28,2010

FUNCTIONAL

HEALTH PATTERN

BEFORE

HOPITALIZATION

DURING

HOSPITALIZATION

ANALYSIS

Health perception and Health management Is focused on the person’s perceived level of health and well being and on practices for maintaining health.

Patient JCM parents does not often seek medical consultation. Instead, He ignored his condition and sometimes relied on over the counter medicine without prescription. He stated “Natatakot ako pumunta sa doctor kasi baka kung ano gawin sakin. Takot ako sa mga injections.”

Patient JCM is adhering to the therapeutic regimen. He frequently asks his attending physician regarding his condition.

Patient JCM being the youngest in the family at the age of 10 years old. He is afraid to seek any consultation to any professional doctors.Because of his condition. Patient JMC is now being aware that seeking medical consultation is very important and health evaluation is being enhanced.

Elimination is focused on excretory patterns (bowel, bladder, skin)

Patient JMC used to defecate 1 times a day with sometime difficulties. He sometimes force himself not to defecate because he is busy playing with his friends. He stated “pag nagbabawas ako dati minsan nahihirapan ako at minsan pinipigil ko.”

Patient JMC is on Foley Catheter for urine elimination only. He does not defecate because he’ peristalsis in the small intestine has returned.

The patient wants his illness to be cured so he adheres to what the physician ordered

Elimination is focused on excretory patterns (bowel, bladder, skin)

Patient JCM used to defecate 1 times a day with sometime difficulties. He sometimes force himself not to defecate because he is busy playing with his friends. He stated “pag nagbabawas ako dati minsan nahihirapan ako at minsan pinipigil ko.”

Patient JCM is on Foley Catheter for urine elimination only. He does not defecate because he’ peristalsis in the small intestine has returned.

The patient wants his illness to be cured so he adheres to what the physician ordered

Sleep and Rest Is focused on the person’s sleep, rest, and relaxation practices.

He sleeps routinely around 6-7 hours a night. No naps in the afternoon because of busy playing with his friends.

Patient JCM has an altered sleeping pattern due to RLQ pain where the operation done. He is awake at night and sleeps sometime in daytime. “pero minsan tinitiis ko na lang ang sakit hanggang umaga” he stated.

Pain alters the sleeping pattern of the client contributes to irritability and moods changes of the client

Roles and Relationship Is focused on the person’s roles in the world and relationships with others.

Patient JCM is dependent on his parents regarding in any situations in his life.

Patient JCM is being more dependent on the people around him especially to the health care providers. He feels resentment because his friends don’t visit him in the hospital.

As the youngest among the brood of four, the parent’s attentions are focus mainly at the client except from his friends. He is afraid to be rejected because of his illness.

Nutrition

Patient JCM stated that “minsan nakakalimutan ko na kumain.” He used to take 1-2 meals a day with junk foods anytime. He ate Pork, beef, rice and he doesn’t like vegetables. He didn’t drink enough water because of his lifestyle.

Patient JCM is NPO. Due to his condition, he usually avoids to eat food and drink.

Before admission. Patient JCM has no control over what he eats and took less water. On admission, he adheres that he must avoid food and water this time w/o his physicians order.

Self perception and Self concept Is focused on the person’s attitudes toward self, including identity, body image, and sense of self worth.

Patient JCM described himself as an optimistic person who can adapt well to any challenges he encounters in his everyday life.

Patient JCM remains to be optimistic despite of his condition. He maintains a positive outlook to overcome his illness. He looks after the unconditional love and support from his family.

Patient JCM stands by his principle to stay focus in giving a solution to his present illness.

Cognition and Perception Is focused on the ability to comprehend and use information and on the sensory functions.

Patient JCM displayed good comprehension on different conditions surrounding him. He has good hearing status, speaks clearly and accurately, and responds well to questions asked.

During interviews, the patient often demonstrates inability to focus in answering questions. Although he maintains his optimism to be free from his illness.

Patient JCM has good awareness and coordination. But his present illness gives him anxiety which can be contributory factor to a decrease in cognitive perception of an individual and the inability to focus.

Activity and Exercise Is focused on the activities of daily living requiring energy expenditure, including self care activities, exercise, and leisure activities. The status of major body systems involved with activity and exercise is evaluated.

He played basketball and video games with his friends or watched television programs when he wanted to.

While Patient JCM is in the ward, He is on optimal rest periods with television viewing privileges.

The patient is advised to avoid strenuous activities and restricted within the hospital premises except for consultation and diagnostic procedure outside or inside FUMC. Lifestyle modifications including light exercises are advice.

Values and Belief Is focused on the person’s values and beliefs (including spiritual beliefs), or on the goals that guide his or her choices or decisions.

Patient JCM went to church regularly with his family but sometimes he attended bible study irregularly.

Patient JCM is still rooted in his faith that he will be cured with his strong belief in the power of the almighty. He stated “Sa tuwing nag pe-pray kami ni mama at papa mas napapalapit ako kay god dahil alam kong tutulungan niya ako gumaling

Keeping a strong faith helps an individual survive in any challenges and trial that may come in a person’s life. It is power of the mind and the power of faith that overcomes unwillingness to be healed.

DEVELOPMENTAL TASK(Erik Erickson’s Psychosocial Theory of Development)

Industry vs. Inferiority• Optimistic

• Perseverance

• Confident• Brave

• Initiative

LABORATORY AND DIAGNOSTIC RESULTS

DATE PROCEDURE NORMS RESULT INTERPRETATION ANALYSISJuly 27, 2010 WBC 5-10x10^9/L 13.2 High Associated with

infection and inflammation

Neutrophil 0.40-0.60 0.79 High Infection and some inflammatory states

Lymphocyte 0.20-0.40 0.16 Low (+) Lymphopenia

Monocyte 0.02-0.08 0.03 Normal Normal Eosinophil 0.01-0.03 0.01 Normal Normal Basophil 0-0.02 0.01 Normal Normal Hemoglobin M: 140-175 ml/L

F: 123-159 ml/L138 Low Possible anemia

or hemorrhage Hematocrit M: 0.42-0.48

F: 0.37-0.420.40 Low Possible anemia

or hemorrhage RBC M: 5.5-6.5x10^12/L

F: 4.5-5.5x10^12/L5.44 Normal Normal

MCV 88-96 74 Low Cells are microcytic

MCH 25.3 25.3 Normal Normal MCHC 330-360 g/L 343 Normal Normal Platelet 150-450x10^9/L 340 Normal Normal

CBC WITH APC RESULTDATE PROCEDUR

E NORMS RESUL

TINTERPRETATION

ANALYSIS

July 27, 2010

WBC 5-10x10^9/L 13.2 High Associated with infection and inflammation


Lymphocyte

0.20-0.40 0.16 Low (+) Lymphopenia

Monocyte 0.02-0.08 0.03 Normal Normal Eosinophil 0.01-0.03 0.01 Normal Normal Basophil 0-0.02 0.01 Normal Normal


DATE PROCEDURE NORMS RESULT INTERPRETATION ANALYSISJuly 27, 2010 WBC 5-10x10^9/L 13.2 High Associated with

infection and inflammation


Lymphocyte 0.20-0.40 0.16 Low (+) Lymphopenia

Monocyte 0.02-0.08 0.03 Normal Normal Eosinophil 0.01-0.03 0.01 Normal Normal Basophil 0-0.02 0.01 Normal Normal Hemoglobin M: 140-175 ml/L

F: 123-159 ml/L138 Low Possible anemia

or hemorrhage Hematocrit M: 0.42-0.48

F: 0.37-0.420.40 Low Possible anemia

or hemorrhage RBC M: 5.5-6.5x10^12/L

F: 4.5-5.5x10^12/L5.44 Normal Normal


MCH 25.3 25.3 Normal Normal MCHC 330-360 g/L 343 Normal Normal Platelet 150-450x10^9/L 340 Normal Normal

CBC WITH APC RESULT

DATE PROCEDURE

NORMS RESULT INTERPRETATION

ANALYSIS

July 27, 2010

Hemoglobin M: 140-175 ml/LF: 123-159 ml/L

138 Low Possible anemia

Hematocrit M: 0.42-0.48F: 0.37-0.42

0.40 Low Possible anemia

RBC M: 5.5-6.5x10^12/LF: 4.5-5.5x10^12/L

5.44 Normal Normal


MCH 25.3 25.3 Normal Normal

MCHC 330-360 g/L 343 Normal Normal

Platelet 150-450x10^9/L 340 Normal Normal


DATE PROCEDURE NORMS RESULT INTERPRETATION ANALYSISJuly 27 2010 Microscopic

Examination:

Color Yellow Yellow Normal Normal Transparency Clear Slightly Turbid Not normal Possible

infection sediment or high levels of urinary proteins

Specific Gravity 1.005-1.025 1.025 Normal Normal Pus cells 1.1/hpf 1.3/hpf Not normal Possible

infection Bacteria None Few Not normal Indicate the

need for urine culture to determine the presence of UTI

RBC 0.2/hpf 0.1/hpf Normal Normal

URINALYSIS RESULTDATE PROCEDURE NORMS RESULT INTERPRETATIO

NANALYSIS

July 27 2010

Microscopic Examination:

Color Yellow Yellow Normal Normal Transparen

cyClear Slightly

TurbidNot normal Infection

sediment or high levels of urinary proteins

Specific Gravity

1.005-1.025 1.025 Normal Normal

Pus cells 1.1/hpf 1.3/hpf Not normal Infection Bacteria None Few Not normal Indicate the

need for urine culture to determine the presence of UTI

RBC 0.2/hpf 0.1/hpf Normal Normal


Anatomy and Physiology



Pathophysiology

PathophysiologyPredisposing

Factor: Precipitating Factor:Congenital -Irregular bowel

movement-Low fiber Diet

Vitilline duct fails to

disappear completely

during fetal life

Increase intraluminal pressure in the small

intestine during defecation

Formation of Meckel’s

DiverticulitisSmall intestine opens

widely into the ascending colon

Intussusception of the ileocecal valve

Lumen Obstruction

inflammation of the ileocecal

junctionStrangulation of

blood supply

Neutrophil 0.9

(July 27 2010)

Leukocytosis(July 27 2010)

Cyanosis of ileocecal junction

(July 27 2010)Congestion of the appendix(July 27 2010)

Colicky abdominal pain(July 27 2010)

Vomiting 6 times of previously ingested food(July 27 2010)

Course in the ward

July 27, 2010 (Tuesday) The client was admitted at the FUMC in ER due to vomiting and abdominal pain. Routine admission care was done also the diagnostic tests like CBC with APC, Urinalysis and Chest X-ray, Physical Assessment was also done. The client was examined by the doctor with orders handed and should be carried out. The client was received from the ER and instructed to be in temporary NPO by the attending physician with orders to referrals to surgery. The client was seen and examined by the anesthesiologist. The client was endorsed to OR nurse on duty for the plan of appendectomy.

Course in the ward

The client was received in the OR on the wheel chair accompanied by the nurse on duty. The consent for operation was completely signed. The operation was started by the attending physician. The surgeon found that the intestine was twisted. The mother was informed of the findings. When the operation ended, insertion of NGT was done by the anesthesiologist. Routine post operation care was done, specimen was sent to laboratory, care of clerk in charge for examination.The client is then brought to the surgery ward via stretcher accompanied by OR nurse on duty and relatives safely continue current management as ordered by the physician.

Course in the ward

July 28, 2010 (Wednesday) First day post-op The client was awake on bed with on going IV fluids, with NGT and foley catheter connected to urobag. He was seen and examined by the attending physicians and instructed to sit up and dangle feet bedside with assistance from the relative if tolerated and instructed to have deep breathing exercise. The foley catheter was removed as ordered and the client may have sips of water.

Course in the ward

July 29, 2010 (Thursday) Second post-op The client was awake on bed with on going IV fluids, with NGT connected to bedside bottle. The nurse instructed the relative to have the client sips of water and may have sit and dangle feet with assistance from the relative and may stand at the bedside.

Course in the ward

Nursing Care Plan

Nursing Care Plan

Assessment:

Facial grimace discomfort and irritability.

Diagnosis: Acute pain related to abdominal surgical incision as manifested by facial grimace, discomfort and irritability.

Nursing Care Plan

Nursing Care PlanBackground of the study

Abdominal surgical incision

Tissue injury

Pain

Nursing Care Plan

Planning

STG: After 30 minutes of nursing intervention the client will verbalize relief in pain

Nursing Care PlanInterventionIndependent:

Position the client to comfortable position as he chooses.

Rationale:Positioning is the best nursing

intervention that may alleviate pain felt.


Ask the patient to rate pain using the faces pain scale.

Rationale:Pain rating measure the

outcome of pain felt


Place the client to a quiet and comfortable room.

Rationale:A quiet environment aids in the

alleviation of pain felt.


Divert the attention of the client in watching TV, listening to music , reading comic books.

Rationale:To divert his attention from pain.

Nursing Care PlanInterventionDependent:

Administer as prescribe such as Diclofenac Sodium.

Rationale:To relieve pain felt.

Nursing Care PlanEvaluation

STG: After 30 minutes of nursing intervention the client verbalized relief in pain

The goal was MET.

ASSESSMENT DIAGNONSIS BACKGROUND OF THE STUDY

PLANNING INTERVENTION RATIONALE EVALUATION

OBJECTIVE:Facial grimaceDiscomfort Irritability

Acute pain related to abdominal surgicalincision as manifested by facial grimace, discomfort and irritability.

Abdominal Surgical Incision

Tissue Injury

Pain

STG:After 30minutes of Nursing intervention the client will verbalized relieve inpain.

INDEPENDENT:-Position the client tocomfortable position as he chooses. -Ask the patient torate pain using the faces pain scale.(smiling(0) no pain)(crying (5)worst) -Place the client to a quiet and comfortable room. -Divert the attention of the client through watching TV, listening to music, reading comic books. DEPENDENT:administer as prescribe, such as Diclofenac Sodium (volteran) 25mg TIV as prescribed for untolerable pain.

-Positioning is the best nursing intervention that may alleviate pain felt. -Pain rating measures the outcome of pain felt. -A quiet environment aids in the alleviation of pain felt. -To divert his attention from pain. -To relieve pain felt.

STG:After 30minutes of Nursing intervention the client verbalized relieve inpain. THE GOAL WAS MET

Nursing Care PlanASSESSMENT DIAGNONSIS BACKGROUND

OF THE STUDY


OBJECTIVE:Facial grimaceDiscomfort Irritability

Acute pain related to abdominal surgicalincision as manifested by facial grimace, discomfort and irritability.

Abdominal

Surgical Incision

Tissue Injury

Pain

STG:After 30minutes of Nursing intervention the client will verbalized relieve inpain.

INDEPENDENT:-Position the client tocomfortable position as he chooses. -Ask the patient torate pain using the faces pain scale.(smiling(0) no pain)(crying (5)worst) -Place the client to a quiet and comfortable room.-Divert the attention of the client through watching TV, listening to music, reading comic books. DEPENDENT:administer as prescribe, such as Diclofenac Sodium (volteran) 25mg TIV as prescribed for untolerable pain.

-Positioning is the best nursing intervention that may alleviate pain felt. -Pain rating measures the outcome of pain felt. -A quiet environment aids in the alleviation of pain felt. -To divert his attention from pain. -To relieve pain felt.

STG:After 30minutes of Nursing intervention the client verbalized relieve inpain. THE GOAL WAS MET

Nursing Care Plan

Assessment: Subjective

“Hindi ko maiwasang hawakan ang inopera sakin.” As verbalized by the patient.

Nursing Care Plan

Assessment: Objective

(+) continuous palpation of the client to the incision site with barehands

Diagnosis: Knowledge deficit

related to post operative abdominal incision as manifested by continuous palpation of the incision site with bare hands.

Nursing Care Plan


Palpation of the Operative site with bare hands

Bacterial contamination of the wound

Infection

Nursing Care PlanPlanning

STG: After 30 minutes of nursing intervention the client will verbalize the importance of keeping the operative wound


STG: clean and free of infection by not touching it when in pain or just out of curiosity.


Demonstrate the importance of proper hand washing to the client.

Rationale:Hand washing is the most

effective method of keeping the wound free from infection.


Do proper wound care by practicing the aseptic technique principle to prevent infection.

Rationale:proper wound care contributes

less risks for further infection.


Assess the incision site, it’s color, warm, and other discharges that may indicate infection process.

Rationale:inspecting the incision site is

crucial to detect early signs of complications of infection.


Monitor Vital signs especially the temperature.

Rationale:to establish baseline data for

further evaluation and to monitor for signs of infection.


STG: After 30 minutes of nursing intervention the client verbalized the importance of keeping the operative wound


STG:clean and free of infection by not touching it when in pain or just out of curiosity.

The goal was MET.

ASSESSMENT DIAGNONSIS BACKGROUND OF THE STUDY


SUBJECTIVE:“hindi ko maiwasang Hawakan ang inoperaSakin”. As verbalized By the patient. OBJECTIVE:(+) continuousPalpation of the clientTo the incision site w/barehands

Knowledge deficit r/tPost operativeAbdominal incision as manifested by Continuous palpation of the incision site with bare hands.

Palpation of theOperative site withBare hands


Infection

STG:After 30 mins. Of Nursing interventionThe client will -verbalize theImportance ofKeeping the operativeWound clean and freeOf infection by notTouching it when in Pain or just out ofcuriosity

INDEPENDENT:-demonstrate theImportance ofProper hand washingTo the client -do proper woundCare by practicingThe aseptic techniquePrinciple to preventThe infectionTo get worse. -assess the incisionSite, it’s color, warm, and other discharges. That may indicate the Infection process. -monitor vital signsEspecially the Temperature throughAxillary route. -encourage theClient to eat a Balance diet Consisting of greenLeafy vegetable foods,Citrus food, andIncrease intakeOf protein whichIncrease woundHealing. -teach the client toAvoid touching theIncision siteUnnecessarily DEPENDENT:-administer painReliever likeNalbuphine IV asPrescribed when Pain arises. -administer and Recommend Responsible use ofAntibioticsEspecially Cefuroxime IV asPrescribed.

-hand washing is the Most effectiveMethod in keepingThe wound free fromInfection andPrevent it’s furtherSpread. -proper wound careContributes less risksFor furtherInfection andTissue damagesMade by infectiousagents -inspecting the incision site is crucialTo detect early signsOf complications ofInfection may ariseDuring wound healing. -to establish baselineData for furtherEvaluation and toMonitor. For the signsOf infection progress.Axillary route in taking the temperature is non invasive, so, it’s the Safest route toApply it -balanced diet contributes to wellness of the client,Aids in wound healingAnd aids in his Recovery. -educating the clientAbout not touchingThe wound areaContributes to lessRisk for infection. -pain contributes to touching the site so, pain reliever may aid to alleviate pain felt by the client which results to less palpation of the incision site. -to prevent the resistance of the infectious bacteria and promote wound healing.

STG:After 30 mins. Of Nursing interventionThe client: -verbalized theImportance ofKeeping the operativeWound clean and freeOf infection by notTouching it when in Pain or just out ofCuriosity. THE GOAL WAS MET

Nursing Care PlanASSESSMENT DIAGNONSIS BACKGROUND

OF THE STUDY


SUBJECTIVE:“hindi ko maiwasang Hawakan ang inoperaSakin”. As verbalized By the patient. OBJECTIVE:(+) continuousPalpation of the clientTo the incision site w/barehands

Knowledge deficit r/tPost operativeAbdominal incision as manifested by Continuous palpation of the incision site with bare hands.

Palpation of theOperative site withBare hands


Infection

STG:After 30 mins. Of Nursing interventionThe client will -verbalize theImportance ofKeeping the operativeWound clean and freeOf infection by notTouching it when in Pain or just out ofcuriosity

INDEPENDENT:-demonstrate theImportance ofProper hand washingTo the client

-do proper woundCare by practicingThe aseptic techniquePrinciple to preventThe infectionTo get worse. -assess the incisionSite, it’s color, warm, and other discharges. That may indicate the Infection process.

-monitor vital signsEspecially the Temperature throughAxillary route. -encourage theClient to eat a Balance diet Consisting of greenLeafy vegetable foods,Citrus food, andIncrease intakeOf protein whichIncrease woundHealing. -teach the client toAvoid touching theIncision siteUnnecessarily DEPENDENT:-administer painReliever likeNalbuphine IV asPrescribed when Pain arises. -administer and Recommend Responsible use ofAntibioticsEspecially Cefuroxime IV asPrescribed.

-hand washing is the Most effectiveMethod in keepingThe wound free fromInfection andPrevent it’s furtherSpread. -proper wound careContributes less risksFor furtherInfection andTissue damagesMade by infectiousagents -inspecting the incision site is crucialTo detect early signsOf complications ofInfection may ariseDuring wound healing. -to establish baselineData for furtherEvaluation and toMonitor. For the signsOf infection progress.Axillary route in taking the temperature is non invasive, so, it’s the Safest route toApply it -balanced diet contributes to wellness of the client,Aids in wound healingAnd aids in his Recovery. -educating the clientAbout not touchingThe wound areaContributes to lessRisk for infection. -pain contributes to touching the site so, pain reliever may aid to alleviate pain felt by the client which results to less palpation of the incision site. -to prevent the resistance of the infectious bacteria and promote wound healing.

STG:After 30 mins. Of Nursing interventionThe client: -verbalized theImportance ofKeeping the operativeWound clean and freeOf infection by notTouching it when in Pain or just out ofCuriosity. THE GOAL WAS MET

Nursing Care Plan

Assessment: Objective

Lack of interest in food like fruits and vegetables

Lack of information about what he eats.

Wt.: 32Kgs.

Diagnosis: Altered Nutrition less than body requirements related to lack of basic nutritional knowledge

Nursing Care Plan

Diagnosis: as manifested by lack of interest in food particularly green leafy vegetables and fruits.

Nursing Care Plan


Lack of nutrition

Compromised health status

illness


STG: Within 1hour of nursing intervention the patient will understand importance of nutritious foods.


Determine patient’s ability to meet nutritional needs.

Rationale:To gauge the clients capability

to modify his diet according to condition.


Assess his diet by interviewing him personally or his significant others Rationale:

To identify potential problems that pre-disposes the client to keep him from eating nutritious foods.


Encourage intake of nutritious foods like vegetables and fruits that can alleviate condition.Rationale:

To convince the client that diet modification contributes greatly in treatment of his condition


Encourage increase fluid intake not less than 2liters of clear fluid a day. Rationale:

To maintain proper hydration and promote good bowel movement


STG: After 1hour of nursing intervention the patient understand importance of nutritious foods.

The goal was MET.

ASSESSMENT DIAGNOSIS BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION Objective: Lack of interest in food like fruits and vegetables Lack of information about what he eats Wt. 32 kgs

Altered nutrition less than body requirements related to lack of basic nutritional knowledge as manifested by lack of interest in food particularly green leafy vegetables and fruits

Lack of nutrition

Compromised Health Status

Illness

STG: Within 1 hr of Nursing intervention the patient will understand importance of nutritious foods

INDEPENDENT: Determine patient’s ability to meet nutritional needs that are necessary to his conditionAssess his diet by interviewing him personally or his significant others to determine his diet practices Encourage intake of nutritious foods like vegetables and fruits that can alleviate his condition specifically the high intake of fiber rich foods to promote peristaltic pattern of the intestine and good bowel movement Encourage increase fluid intake not less than 2 liters of clear fluid ad day Restrict sodium rich foods like processed meats and junk foods DEPENDENT: Refer to Dietitian for further evaluation

To gauge the clients capability to modify his diet according to condition To identify potential problems that pre-disposes the client to keep him from eating nutritious foods To convince the client that diet modification contributes greatly in treatment of his condition specifically his Gastro Intestinal Problems To maintain proper body hydration and promote good bowel movement To prevent fluid retention To improve diet modifications and work up

STG: After 1 hr of Nursing intervention the patient will understand importance of nutritious foods THE GOAL WAS MET

Nursing Care PlanNursing Care PlanASSESSMENT DIAGNOSIS BACKGROUND PLANNING INTERVENTION RATIONALE EVALUATION Objective: Lack of interest in food like fruits and vegetables Lack of information about what he eats Wt. 32 kgs

Altered nutrition less than body requirements related to lack of basic nutritional knowledge as manifested by lack of interest in food particularly green leafy vegetables and fruits

Lack of nutrition

Compromised Health Status

Illness

STG: Within 1 hr of Nursing intervention the patient will understand importance of nutritious foods

INDEPENDENT: Determine patient’s ability to meet nutritional needs that are necessary to his conditionAssess his diet by interviewing him personally or his significant others to determine his diet practices Encourage intake of nutritious foods like vegetables and fruits that can alleviate his condition specifically the high intake of fiber rich foods to promote peristaltic pattern of the intestine and good bowel movement Encourage increase fluid intake not less than 2 liters of clear fluid ad day Restrict sodium rich foods like processed meats and junk foods DEPENDENT: Refer to Dietitian for further evaluation

To gauge the clients capability to modify his diet according to condition To identify potential problems that pre-disposes the client to keep him from eating nutritious foods To convince the client that diet modification contributes greatly in treatment of his condition specifically his Gastro Intestinal Problems To maintain proper body hydration and promote good bowel movement To prevent fluid retention To improve diet modifications and work up

STG: After 1 hr of Nursing intervention the patient will understand importance of nutritious foods THE GOAL WAS MET

Drug Study

Name of Drug

Classification

Mechanism of Action

Indication/ Dosage given

Contraindication

Adverse effect Drug to Drug Interaction

Nursing Consideration

Plain Lactated Ringer's solution

Isotonic solution

for fluid resuscitation after

a blood loss due to

trauma, surgery. Previously, it was used to induce urine

output.

Given Dosage: Fast drip

500cc

Solutions containing dextrose may be

contraindicated in

patients with known allergy to

corn or corn products

May cause fluid overload if not

monitored closely

No drug to drug interaction

Because this fluid expands the IV space the patient with HPN in heart

failure should be monitored for the signs.

Drug StudyName of

DrugClassifica

tionMechani

sm of Action

Indication/

Dosage given

Contraindication

Adverse effect

Drug to Drug

Interaction


Plain Lactated

Ringer's

solution

Isotonic

solution

for fluid resuscitation

after a

blood loss due to

trauma,

surgery.

Given Dosag

e: Fast drip

500cc

No contraindication

No Advers

e effect

No drug to

drug interact

ion

Because this fluid

expands the IV space the patient with

HPN in heart failure

should be monitored

for the signs.

http://www.answers.com/topic/bleeding

http://www.answers.com/topic/bleeding

http://www.answers.com/topic/surgery

Name of Drug

Classification

Mechanism of Action

Indication/ Dosage

given

Contraindication Adverse effect Drug to Drug

Interaction Nursing Consideration

D5 0.3 NACL

Isotonic solution

Expands ECF

volume

1 Liter

17gtts/min

In fluid resuscitation this solution cannot be

used. Because hyperglycemia can result.

May cause fluid overload if not

monitored closely

No drug to drug interaction

Should not be used if the client is at risk for

increase ICP

Drug Study

Name of

Drug

Classificatio

n

Mechanism

of Action

Indication/

Dosage given

Contraindication

Adverse effect

Drug to Drug

Interaction

Nursing Considerati

on

D5 0.3 NAC

L

Isotonic solution

Expan

ds ECF

volume

1 Liter17gtts/min

No

contraindicati

on

No

Adverse

effect

No drug to drug interacti

on

Should not be used if the client is at risk

for increase

ICP

Name of Drug

Classification

Mechanism of Action

Indication/

Dosage given

Contraindication



Diclofenac Sodium

Analgesic (nonopiod

)

Anti-inflammat

ory

Antipyretic

NSAIDs

Inhibits prostagl

andin synthesi

s to cause

antipyretic and anti-

inflammatory

effects; the

exact mechani

sm is unknow

n

Acute or long term treatment of mild to moderate

pain

Given dosage: 25mg IV (-) ANST

q8

Contraindicated with

allergy to NSAIDs

Use cautiously

with impaired hearing, allergies,

hepatic, CV, GI

conditions, and in elderly patient

CNS: headache, dizziness, insomnia, fatigue, tiredness, ophthalmic effects

GI: nausea and dyspepsia, GI pain

GU: dysuria, renal impairment

CNS: headache, dizziness, lethargy

Increase risk of bleeding with anti-

coagulants

Monitor patient closely

Assessment: skin color, lesions, reflexes,

Ophthalmologic and audiometric

evaluation , renal function test, impaired

hearing

GI bleeding, renal insufficiency

Teaching point: take only the prescribed dosage, take it after meal, report for sore

throat, swelling in ankles or fingers, changes in vision, black, tarry stools

Drug StudyName of

DrugClassific

ationMechanism

of Action

Indication/

Dosage given

Contraindication



Diclofenac

Sodium

Analgesic

(nonopiod)

Anti-inflammatoryAntipyr

eticNSAIDs

Inhibits

prostaglandi

n synthesis to

cause antipyretic and anti-

inflammator

y effects;

Given dosage: 25mg IV (-) ANST

q8

No

contraindication

No Adverse

effect

No drug to

drug interaction

Assessment: skin color,

lesions, reflexes,

Teaching point: take only the

prescribed dosage, take it

after meal, report for sore throat, swelling

in ankles or fingers,

changes in vision, black, tarry stools

Name of Drug

Classification

Mechanism of

Action

Indication/

Dosage given

Contraindication



Cefuroxime

antibiotic Bactericidal: inhibits synthesis

of bacterial cell wall, causing

cell death

Given dose:750mg IV (-) ANST q8

Contraindicated with allergy

to cephalosporin

or penicillin

GI: nausea, vomiting, diarrhea, anorexia,

abdominal pain, hepatotoxicity

GU: nephrotoxicity

Hypersensitivity

Increased nephrotoxicity with amino glycosides

Increase risk of bleeding with anti-

coagulants

Risk of disulfiram-like reaction with

alcohol

Hepatic and renal impairment skin status,

sensitivity test

Culture infection and arrange for sensitivity test before and during the therapy if expected

response not seen

Have Vit K available in case

hypoprothrombinemia occurs

Discontinue if hypersensitivity occurs

Drug StudyName

of DrugClassificatio

n

Mechanism

of Action

Indication/ Dosa

ge given

Contraindication

Adverse effect

Drug to Drug

Interaction


Cefuroxime

Antibio--tic

Bactericidal

: inhibit

s synthesis of bacterial cell wall,

causing cell death

Given dose:750mg IV (-)

ANST q8

No

contraindication

No

Adverse effect

No drug to

drug interaction

Culture infection and arrange for

sensitivity test before and during the therapy if expected

response not seen

Have Vit K available in

case hypoprothrombinemia occursDiscontinue if hypersensitivit

y occurs

Name of Drug

Classification

Mechanism of

Action


Contraindication

Adverse effect

Drug to Drug Interaction


Nalbuphine

(Nubain)

Opioid Agonist

Agonist at specific opioid

receptors in the CNS

top produce

analgesia

Relief of moderate to severe pain,

pre-operative

analgesia, as a

supplement to surgical anesthesia

Given Dosage:

Slow IV 5mg q8

Contraindicated in patients

hypersensitive to the drug or

sulfites present in some

preparations of drug

CNS: Confusion,

crying, delusions, headache,

hallucinations, vertigo

EENT: Blurred vision

GI: Bitter taste,

constipation, cramps

GU: Urinary urgency

Skin: Burning, itching,

sweating, clammy feeling

Potentiation of effects with barbiturate

anesthetic or other CNS

depressants

For direct IV injection through an IV line with the compatible infusing

solution give drugs slowly-no more than 10mg over 3-5 mins.

Inject into free flowing NS, D5W or LR solution

Drug StudyName of

DrugClassifica

tionMechanism of Action

Indication/

Dosage given

Contraindication

Adverse effect

Drug to Drug

Interaction


Nalbuphine(Nuba

in)

Opioid Agonis

t

Agonist at speci

fic opioid receptors

in the CNS top

produce

analgesia

Given Dosage: Slow IV 5mg

q8

No

contraindication

No

Adverse

effect

No drug to drug interacti

on

For direct IV injection

through an IV line with the compatible

infusing solution give drugs slowly-no more than 10mg over 3-5 mins. Inject

into free flowing NS, D5W or LR

solution

Name of Drug

Classification

Mechanism of Action


Contraindication



Omeprazole

(Losec)

Proton pump

inhibitor/ anti- ulcer

Gastric acid

pump inhibitor

To treat gastroesophageal reflux

disease (GERD) without

esophageal lesion, to prevent erosive

esophagitis.

Given Dosage: Children 20mg IV

Contraindicated in patients

hypersensitive to the

drug or any of its

components

CNS: Agitation, dizziness

EENT: Anterior ischemic optic

neuropathy. Optic atrophy or neuritis

ENDO: Hypoglycemia

GI: Abdominal pain, constipation,

diarrhea, dyspepsia, nausea and pancreatitis

MS: Back pain

Respi: Cough

Increased serum levels and potential increase in toxicity of benzodiazepines

phenytoin, warfarin; if these combinations are

used monitor patients closely

Assist if the patient is hypersensitivity to the

drug

Drug StudyName of

DrugClassificati

on

Mechanism of Action


Contraindicatio

n

Adverse effect

Drug to Drug

Interaction


Omeprazole(Losec

)

Proton pump inhibitor/

anti-

ulcer

Gastric

acid pum

p inhibi

tor

Given Dosage: Children 20mg IV

No

contraindication

No

Adverse effect

No

drug to

drug interaction

Assist if the patient is

hypersensitivity to the

drug

Name of Drug

Classification

Mechanism of Action

Indication/ Dosage

given

Contraindication

Adverse effect



Diphenhydramine

(Diphenadryl)

Anti - histamine

Interferes with

histamine 1

receptor site: CNS

depressant and

anti-choliner

gic

Allergy symptoms caused by histamine

release (including anaphylaxis, seasonal

and perenial allergic rhinitis,

and allergic

dermatoses); nausea,

vertigo

Given Dosage: 32mg

through IV

Hypersensitivity to the drug

CNS: drowsiness, dizziness, headache, paradoxical stimulation

EENT: Blurred vision, tinnitus

GI: Diarrhea, constipation,

dry mouth

GU: Dysuria, urinary

frequency or retention

Possible increase and prolonged anti cholinergic effects

Risk for increase sedation with alcohol, CNS

depressant, avoid this combination

Check compatibility before using with other

drugs

Drug StudyName of

DrugClassific

ationMechanism

of Action

Indication/

Dosage given

Contraindication

Adverse effect



Diphenhydramine(Diphenadr

yl)

Anti - histam

ine

CNS depressant

and anti-cholinerg

ic

Given Dosag

e: 32mg through IV

No

contraindication

No

Adverse effect

No drug to

drug interaction

Check compatibilit

y before using with

other drugs

Name of Drug

Classification

Mechanism of Action


Contraindication



Magnesium

aluminum

hydroxide

(MAALOX)

Antacid Causes gas

bubbles to

coalesce and

allows gas to pass

through GI tract

via belching

or passing of flatus

Silicone antifoam spreads

on surface

of aqueous liquids

forming a film of

low surface tension

that causes foam

bubbles to

collapse

Excess gas in GI tract

after surgery or from air

swallowing, dyspepsia, peptic ulcer

or diverticulitis

Given Dosage:

15mg/cc PO

Hypersensitivity to drug

Intestinal perforation

or obstruction

GI: Rebound hyperacidity,

diarrhea, constipation

Metabolic: Decrease

absorption of fluoride and

accumulation of an aluminum in serum,

bone, CNS ( aluminum maybe

neurotoxic, specially in patient with renal failure);

alkalosis; hypermagnesemia

and toxicity in patient with renal

failure

Do not administer other oral drugs within 1 to 2 of

antacid administration;

change in gastric pH may interfere with absorption of

oral drugs

History assessment: Allergy to magnesium or aluminum products, renal

insufficiency, gastric outlet obstruction

Physical Assessment: Bone and muscle

strength; abdominal examination, bowel

sounds; renal function test, serum magnesium

as appropriate

Monitor patient on long term therapy for signs of aluminum accumulation:

bone pain, muscle weakness, malaise. Discontinue drug as

needed

Drug StudyName of

DrugClassific

ationMechanism of Action


Contraindication

Adverse effect Drug to Drug

Interaction


Magnesium aluminum

hydroxide

(MAALOX)

Antacid

Causes gas

bubbles to coalesce and

allows gas

to pass through GI tract via

belching or passing of flatus

Excess gas in GI

tract after surgery or from air

swallowing,

dyspepsia, peptic

ulcer or diverticulit

isGiven

Dosage: 15mg/cc

PO

No

contraindication

No Adverse

effect

No drug to drug

interaction

Monitor patient on long term therapy for

signs of aluminum

accumulation: bone pain,

muscle weakness, malaise.

Discontinue drug as needed

DISCHARGE PLANNING

M- Medications: Encourage daily intake of laxative as prescribed, such as Metamucil which helps to propel feces to the colon, stool softeners are also prescribed to decrease straining ad stool which decrease intestinal pressure.

DISCHARGE PLANNING

E- Exercise: Passive ROM exercises if the client is ready for mild ambulatory activities and should be assisted. If the client is ready for ambulation encourage walking and stretching in a short course to prevent injury to the surgical site that can cause further complications. Exercise promotes good blood circulation and oxygenation to promote healing of the wound and for a better well being.

DISCHARGE PLANNING

T- Treatment: Administer pain reliever or analgesic as prescribed by the physician to relieve the pain of the surgical site and anti-spasmodic agents to decrease intestinal spasm.

DISCHARGE PLANNING

H- Health Teaching: Establish a scheduled time for defecation and to assist in identifying habits that may have suppressed the urge to defecate.

DISCHARGE PLANNING

O- OPD-follow up check up and further evaluation of the clients condition if the medical and nursing managements are effective and additional interventions to be rendered.

DISCHARGE PLANNING

D- Diet: Increase oral fluid intake not less than 2 liters of clear fluid a day to promote proper hydration and evacuation of feces. : Encourage food intake of fiber rich foods such as green leafy vegetables to promote regulate peristaltic pattern of the intestine and for regulation of bowel movement.

: Restrict excessive sodium intake

DISCHARGE PLANNING

S- Support System: Remind the patient and family about the importance of continuing health promotion and screening problem.

DISCHARGE PLANNING

Thank You…

Presented by: BSN 3A2-7

Documents

Meckel’s Diverticulitis final (2)