lOMoARcPSD|5967629
lOMoARcPSD|5967629
John Washington Appendicitis
Nursing (Northwest Arkansas Community
College)
Appendicitis/Appendectomy
INFOL Reasoning
John Washington, 14 years old
Primar Conce t
Inflammation
Interrelated Conce ts In order of em hasis
Pain
Stress
Clinical Judgment
Patient Education
Communication
NCLEX Client Need Categories Percentage of Items from Each Covered in
Cate or /Subcate or Case Stud
, lOMoARcPSD|5967629
Safe and Effective Care Environment
Management of Care 17-23%
Safet and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Ps chosocial Inte it 6-12%
Ph siolo ical Inte •t
Basic Care and Comfort 6-12%
APPENDICITIS CASE
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 Problem: Clinical Significance:
- Progressive "excruciating" - Pain progressed from been general on the Abd zone and around
generalized abdominal pain around belly button to be local on the RLQ.
belly area. - Physical movement aggravates pain, rest alleviates it.
- Pt took ibuprofen 400 mg PO, reduced pain. - Pt had no drink or solid food since morning due to emesis earlier.
- Pain located on RLQ zone
- no more emesis but nauseous.
- Pain worsening with movement, relieves
with laying down on fetal position.
- Pt vomited orange juice, no drinks since
morning.
- nauseous.
RELEVANT Datta from social Clinical Significance:
- Lives in the city with 3 younger - pt may have a low income, may need assistance with health bill
brothers and mother. and treatment due to one parent income and 3 siblings.
- He is very social and active in athletics - pt is social , good network support.
-pt is physically active
Patient Care Begins:
Current VS: P:Q-R-S-T Pain Assessment:
T: 100.5 F/38.1 C (oral) Provoking/Pa11iative: Movement, palpation
P: 106 (regular) Quality: Sharp, cramping
R: 20 (regular) Region/Radiation: Mid abdomen, RLQ
BP: 142/76 Severity: 8/10
02 sat: 99% RA Timing: Continuous
lOMoARcPSD|5967629
John Washington Appendicitis
Nursing (Northwest Arkansas Community
College)
Appendicitis/Appendectomy
INFOL Reasoning
John Washington, 14 years old
Primar Conce t
Inflammation
Interrelated Conce ts In order of em hasis
Pain
Stress
Clinical Judgment
Patient Education
Communication
NCLEX Client Need Categories Percentage of Items from Each Covered in
Cate or /Subcate or Case Stud
, lOMoARcPSD|5967629
Safe and Effective Care Environment
Management of Care 17-23%
Safet and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Ps chosocial Inte it 6-12%
Ph siolo ical Inte •t
Basic Care and Comfort 6-12%
APPENDICITIS CASE
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 Problem: Clinical Significance:
- Progressive "excruciating" - Pain progressed from been general on the Abd zone and around
generalized abdominal pain around belly button to be local on the RLQ.
belly area. - Physical movement aggravates pain, rest alleviates it.
- Pt took ibuprofen 400 mg PO, reduced pain. - Pt had no drink or solid food since morning due to emesis earlier.
- Pain located on RLQ zone
- no more emesis but nauseous.
- Pain worsening with movement, relieves
with laying down on fetal position.
- Pt vomited orange juice, no drinks since
morning.
- nauseous.
RELEVANT Datta from social Clinical Significance:
- Lives in the city with 3 younger - pt may have a low income, may need assistance with health bill
brothers and mother. and treatment due to one parent income and 3 siblings.
- He is very social and active in athletics - pt is social , good network support.
-pt is physically active
Patient Care Begins:
Current VS: P:Q-R-S-T Pain Assessment:
T: 100.5 F/38.1 C (oral) Provoking/Pa11iative: Movement, palpation
P: 106 (regular) Quality: Sharp, cramping
R: 20 (regular) Region/Radiation: Mid abdomen, RLQ
BP: 142/76 Severity: 8/10
02 sat: 99% RA Timing: Continuous
