Appendicitis/Appendectomy
SKINNY Reasoning
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 by Acute abd. pain, Pain was sudden, not attributed to an MOI,
progressively worse. Localized localized to the area of the appendicitis. He
RLQ. Treated with 400 mpg attempted to treat with an anti inflammatory but it
Motrin continues to progress. He is in a fetal position and
Vomits x 3 cant maintain oral hydration .
RELEVANT Data from Social History: Clinical Significance:
Lives in the inner city, with nformation he has a single mother and 3 siblings.
single mother and 3 siblings. Receiving care needed maybe difficult due to
resources and time.
Plays sports
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
What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEVANT VS Data: Clinical Significance:
100.5 Raised temp: Potential infection
Temp 106 Raised HR: tachycardia from pain, anxiety, infection
Raised respiration: hyperventilating (watch SPO2), due to pain, anxiety
H/R
20 R Pain assessment details characteristics of his pain helping to identify underlying
Pain assessment cause. Because his pain is sharp, continues, provokable, and located in the LQR it
may be appendicitis
1
SKINNY Reasoning
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 by Acute abd. pain, Pain was sudden, not attributed to an MOI,
progressively worse. Localized localized to the area of the appendicitis. He
RLQ. Treated with 400 mpg attempted to treat with an anti inflammatory but it
Motrin continues to progress. He is in a fetal position and
Vomits x 3 cant maintain oral hydration .
RELEVANT Data from Social History: Clinical Significance:
Lives in the inner city, with nformation he has a single mother and 3 siblings.
single mother and 3 siblings. Receiving care needed maybe difficult due to
resources and time.
Plays sports
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
What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEVANT VS Data: Clinical Significance:
100.5 Raised temp: Potential infection
Temp 106 Raised HR: tachycardia from pain, anxiety, infection
Raised respiration: hyperventilating (watch SPO2), due to pain, anxiety
H/R
20 R Pain assessment details characteristics of his pain helping to identify underlying
Pain assessment cause. Because his pain is sharp, continues, provokable, and located in the LQR it
may be appendicitis
1
