Appendicitis/Appendectomy
SKINNY Reasoning
Suggested Answer Guidelines
John Washington, 14 years old
Primary Concept
Inflammation
Interrelated Concepts (In order of emphasis)
• Pain
• Stress
• Clinical Judgment
• Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
✓ Management of Care 17-23% ✓
✓ Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
✓ Basic Care and Comfort 6-12% ✓
✓ Pharmacological and Parenteral Therapies 12-18% ✓
✓ Reduction of Risk Potential 9-15% ✓
✓ Physiological Adaptation 11-17% ✓
0
, SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
John Washington is a healthy 14-year-old African American male who weighs 150 lbs. (68.2 kg). He came to the
emergency department because he woke up this morning at about 2 am with "excruciating" generalized abdominal pain
around his belly button that has been progressively getting worse over the past several hours. It is now 2 pm. He took
ibuprofen 400 mg PO this morning, which decreased the pain some but is now more painful and uncomfortable. The pain
is now localized to his RLQ. The pain increases with walking and movement but he feels better when he lies down in a
fetal position. He vomited three times after he drank some orange juice for breakfast this morning and has had nothing to
drink since. He continues to feel nauseated but has not had an emesis since this morning.
Personal/Social History:
John lives with his mother and three younger brothers. He is active in athletics and has a strong social network of friends
and family in the inner-city neighborhood where he lives.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
Woke up this morning at about 2 am with Pain is a clinical RED FLAG, especially when there is no prior history.
"excruciating" generalized abdominal pain Sudden onset of pain that is severe and becomes gradually worse makes
the past several hours that has been this complaint even more concerning.
progressively getting worse.
He took ibuprofen 400 mg PO this morning, Took an adequate dose of pain medication that did relieve the pain
which decreased the pain some but is now temporarily.
more painful and uncomfortable.
The pain is now localized to his RLQ.
The pain increases with walking and This is a classic clinical RED FLAG for appendicitis. The appendix is
movement but feels better when he lies down located in the RLQ. Early appendicitis tends to be generalized pain, but
and lies in a fetal position. over time the pain becomes localized and is focused right where the
inflammation is present. There is no one uniform set of symptoms for
appendicitis; however, that migratory pain is a consistent symptom of
acute appendicitis
Inflammation from the appendix causes irritation/inflammation of the
peritoneum. If appendicitis is the present problem, movement of any kind
tends to worsen the pain, while lying quietly relieves the pain.
RELEVANT Data from Social History: Clinical Significance:
He is active in athletics and has a strong No concerns present, but relevant to note that he has a strong social
social network of friends and family in the network to draw strength and support from.
inner-city neighborhood where he lives.
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 100.5 F/38.1 C (oral) Provoking/Palliative: Movement, palpation
P: 106 (regular) Quality: Sharp, cramping
R: 20 (regular) Region/Radiation: Mid abdomen, RLQ
BP: 142/76 Severity: 8/10
O2 sat: 99% RA Timing: Continuous
1
SKINNY Reasoning
Suggested Answer Guidelines
John Washington, 14 years old
Primary Concept
Inflammation
Interrelated Concepts (In order of emphasis)
• Pain
• Stress
• Clinical Judgment
• Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
✓ Management of Care 17-23% ✓
✓ Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12% ✓
Psychosocial Integrity 6-12% ✓
Physiological Integrity
✓ Basic Care and Comfort 6-12% ✓
✓ Pharmacological and Parenteral Therapies 12-18% ✓
✓ Reduction of Risk Potential 9-15% ✓
✓ Physiological Adaptation 11-17% ✓
0
, SKINNY Reasoning
Part I: Recognizing RELEVANT Clinical Data
History of Present Problem:
John Washington is a healthy 14-year-old African American male who weighs 150 lbs. (68.2 kg). He came to the
emergency department because he woke up this morning at about 2 am with "excruciating" generalized abdominal pain
around his belly button that has been progressively getting worse over the past several hours. It is now 2 pm. He took
ibuprofen 400 mg PO this morning, which decreased the pain some but is now more painful and uncomfortable. The pain
is now localized to his RLQ. The pain increases with walking and movement but he feels better when he lies down in a
fetal position. He vomited three times after he drank some orange juice for breakfast this morning and has had nothing to
drink since. He continues to feel nauseated but has not had an emesis since this morning.
Personal/Social History:
John lives with his mother and three younger brothers. He is active in athletics and has a strong social network of friends
and family in the inner-city neighborhood where he lives.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
Woke up this morning at about 2 am with Pain is a clinical RED FLAG, especially when there is no prior history.
"excruciating" generalized abdominal pain Sudden onset of pain that is severe and becomes gradually worse makes
the past several hours that has been this complaint even more concerning.
progressively getting worse.
He took ibuprofen 400 mg PO this morning, Took an adequate dose of pain medication that did relieve the pain
which decreased the pain some but is now temporarily.
more painful and uncomfortable.
The pain is now localized to his RLQ.
The pain increases with walking and This is a classic clinical RED FLAG for appendicitis. The appendix is
movement but feels better when he lies down located in the RLQ. Early appendicitis tends to be generalized pain, but
and lies in a fetal position. over time the pain becomes localized and is focused right where the
inflammation is present. There is no one uniform set of symptoms for
appendicitis; however, that migratory pain is a consistent symptom of
acute appendicitis
Inflammation from the appendix causes irritation/inflammation of the
peritoneum. If appendicitis is the present problem, movement of any kind
tends to worsen the pain, while lying quietly relieves the pain.
RELEVANT Data from Social History: Clinical Significance:
He is active in athletics and has a strong No concerns present, but relevant to note that he has a strong social
social network of friends and family in the network to draw strength and support from.
inner-city neighborhood where he lives.
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 100.5 F/38.1 C (oral) Provoking/Palliative: Movement, palpation
P: 106 (regular) Quality: Sharp, cramping
R: 20 (regular) Region/Radiation: Mid abdomen, RLQ
BP: 142/76 Severity: 8/10
O2 sat: 99% RA Timing: Continuous
1
