V.

SYMPTOMATOLOGY
Signs and
Symptoms
Present Absent Rationale

Urine becomes dark
and cloudy


/
Because of the protein and red blood cells
leaked into it.


Facial and
periorbital edema


/





As the colloid osmotic pressure of the blood
drops and soduim and water are retained


BP is elavated
/
Owing to increased renin secretion and decreased
GFR



Flank or back pain




/

As the kidney tissue swells and stretches the
capsule

Sources(Pathophysiology for the health professions. Barbara E. Gould. Third edition)









VI ETIOLOGY OF THE DISEASE

ETIOLOGY ACTUAL SYMPTOMS IMPLICATION
Viruses(RSV viral pathogen,
parainfluenza types 1,2 and 3 and
influenza A or B.
RSV infection occurs in the
witer and early spring.
Parainfluenza type 3
infection occurs in the
spring, and types 1 and 2
occur in the fall. Influenza
occurs in the winter.
Other viruses (adenovirus,
enterovirus, hMPV, rhinovirus, and
coronavirus)
herpesviruses (HSV, VZV, and CMV)

cause pneumonia less
frequently in infants and
young children (adenovirus,
enterovirus, rhinovirus, and
coronavirus). A recent
addition to this list is hMPV,
which causes an illness
similar to RSV and may be
responsible for one third to
one half of non-RSV
bronchiolitis. The
herpesviruses (HSV, VZV,
and CMV) may rarely cause
pneumonia, particularly in
children with impaired
immune systems.

Baterial (S pneumoniae)
H influenzae type B (HiB
S pyogenes, and S aureus.
S pneumoniae is by far the
most common bacterial
cause of pneumonia. H
influenzae type B (HiB)
(very uncommon in
immunized children), S
pyogenes, and S aureus.
Poor Diet


Without the sufficient intake
of vitamins and minerals
that are present in the diet,
the defense mechanism of
the body is weakened;
making it susceptible to
infection and invasion of
possible microorganisms
that are present in the
environment.


Place of residence



his will make the client
susceptible for acquiring a
disease from someone
proximal to him; therefore, a
disease may or may not
develop depending on the
distance of the client from
an infected person and the
virulence of the disease.



Age



factor in which the clients
immunity against possible
diseases is not that
developed in comparison to
adults.



Sex


factor in which the
occurrence of the said
disease in prevalent in
males more it is in females.


http://emedicine.medscape.com/article/967822-overview#aw2aab6b2b2date and
http://nurseslabs.com/pneumonia/ February 24, 2013











ANATOMY AND
PHYSIOLOGY












The gastrointestinal tract (GIT) consists of a hollow muscular tube starting from
the oral cavity, where food enters the mouth, continuing through the pharynx,
esophagus, stomach and intestines to the rectum and anus, where food is expelled.
There are various accessory organs that assist the tract by secreting enzymes to help
break down food into its component nutrients. Thus the salivary glands, liver, pancreas
and gall bladder have important functions in the digestive system. Food is propelled
along the length of the GIT by peristaltic movements of the muscular walls
The functions of the digestive system are:
Ingestion - eating food
Digestion - breakdown of the food
Absorption - extraction of nutrients from the food
Defecation - removal of waste products
The digestive system also builds and replaces cells and tissues that are constantly
dying.

Digestive Organs
The digestive system is a group of organs (Buccal cavity (mouth), pharynx,
oesophagus, stomach, liver, gall bladder, jejunum, ileum and colon) that breakdown the
chemical components of food, with digestive juices, into tiny nutrients which can be
absorbed to generate energy for the body.

The Buccal Cavity
Food enters the mouth and is chewed by the teeth, turned over and mixed with saliva by
the tongue. The sensations of smell and taste from the food sets up reflexes which
stimulate the salivary glands.

The Salivary glands
These glands increase their output of secretions through three pairs of ducts into the
oral cavity, and begin the process of digestion.
Saliva lubricates the food enabling it to be swallowed and contains the enzyme ptyalin
which serves to begin to break down starch.
The Pharynx
Situated at the back of the nose and oral cavity receives the softened food mass or
bolus by the tongue pushing it against the palate which initiates the swallowing action.
At the same time a small flap called the epiglottis moves over the trachea to prevent any
food particles getting into the windpipe.
From the pharynx onwards the alimentary canal is a simple tube starting with the
salivary glands.



The Oesophagus
The oesophagus travels through the neck and thorax, behind the trachea and in front of
the aorta. The food is moved by rhythmical muscular contractions known as peristalsis
(wave-like motions) caused by contractions in longitudinal and circular bands of muscle.
Antiperistalsis, where the contractions travel upwards, is the reflex action of vomiting
and is usually aided by the contraction of the abdominal muscles and diaphragm.

The Stomach
The stomach lies below the diaphragm and to the left of the liver. It is the widest part of
the alimentary canal and acts as a reservoir for the food where it may remain for
between 2 and 6 hours. Here the food is churned over and mixed with various
hormones, enzymes including pepsinogen which begins the digestion of protein,
hydrochloric acid, and other chemicals; all of which are also secreted further down the
digestive tract.
The stomach has an average capacity of 1 litre, varies in shape, and is capable of
considerable distension. When expanding this sends stimuli to the hypothalamus which
is the part of the brain and nervous system controlling hunger and the desire to eat.
The wall of the stomach is impermeable to most substances, although does absorb
some water, electrolytes, certain drugs, and alcohol. At regular intervals a circular
muscle at the lower end of the stomach, the pylorus opens allowing small amounts of
food, now known as chyme to enter the small intestine.

Small Intestine
The small intestine measures about 7m in an average adult and consists of the
duodenum, jejunum, and ileum. Both the bile and pancreatic ducts open into the
duodenum together. The small intestine, because of its structure, provides a vast lining
through which further absorption takes place. There is a large lymph and blood supply
to this area, ready to transport nutrients to the rest of the body. Digestion in the small
intestine relies on its own secretions plus those from the pancreas, liver, and gall
bladder.

The Pancreas
The Pancreas is connected to the duodenum via two ducts and has two main functions:
1. To produce enzymes to aid the process of digestion
2. To release insulin directly into the blood stream for the purpose of controlling
blood sugar levels
Enzymes suspended in the very alkaline pancreatic juices include amylase for breaking
down starch into sugar, and lipase which, when activated by bile salts, helps to break
down fat. The hormone insulin is produced by specialised cells, the islets of
Langerhans, and plays an important role in controlling the level of sugar in the blood
and how much is allowed to pass to the cells.

The Liver
The liver, which acts as a large reservoir and filter for blood, occupies the upper right
portion of abdomen and has several important functions:
1. Secretion of bile to the gall bladder
2. Carbohydrate, protein and fat metabolism
3. The storage of glycogen ready for conversion into glucose when energy is
required.
4. Storage of vitamins
5. Phagocytosis - ingestion of worn out red and white blood cells, and some
bacteria

The Gall Bladder
The gall bladder stores and concentrates bile which emulsifies fats making them easier
to break down by the pancreatic juices.

The Large Intestine
The large intestine averages about 1.5m long and comprises the caecum, appendix,
colon, and rectum. After food is passed into the caecum a reflex action in response to
the pressure causes the contraction of the ileo-colic valve preventing any food returning
to the ileum. Here most of the water is absorbed, much of which was not ingested, but
secreted by digestive glands further up the digestive tract. The colon is divided into the
ascending, transverse and descending colons, before reaching the anal canal where the
indigestible foods are expelled from the body.
ANATOMY OF THE APPENDIX










The appendix is a wormlike extension of the cecum and, for this reason, has
been called the vermiform appendix. The average length of the appendix is 8-10 cm
(ranging from 2-20 cm). The appendix appears during the fifth month of gestation, and
several lymphoid follicles are scattered in its mucosa. Such follicles increase in number
when individuals are aged 8-20 years.

The appendix is contained within the visceral peritoneum that forms the serosa,
and its exterior layer is longitudinal and derived from the taenia coli; the deeper, interior
muscle layer is circular. Beneath these layers lies the submucosal layer, which contains
lymphoepithelial tissue. The mucosa consists of columnar epithelium with few glandular
elements and neuroendocrine argentaffin cells.
Taenia coli converge on the posteromedial area of the cecum, which is the site of
the appendiceal base. The appendix runs into a serosal sheet of the peritoneum called
the mesoappendix, within which courses the appendicular artery, which is derived from
the ileocolic artery. Sometimes, an accessory appendicular artery (deriving from the
posterior cecal artery) may be found.
Appendiceal vasculature
The vasculature of the appendix must be addressed to avoid intraoperative
hemorrhages. The appendicular artery is contained within the mesenteric fold that
arises from a peritoneal extension from the terminal ileum to the medial aspect of the
cecum and appendix; it is a terminal branch of the ileocolic artery and runs adjacent to
the appendicular wall. Venous drainage is via the ileocolic veins and the right colic vein
into the portal vein; lymphatic drainage occurs via the ileocolic nodes along the course
of the superior mesenteric artery to the celiac nodes and cisterna chyli.

Appendiceal location
The appendix has no fixed position. It originates 1.7-2.5 cm below the terminal ileum,
either in a dorsomedial location (most common) from the cecal fundus, directly beside
the ileal orifice, or as a funnel-shaped opening (2-3% of patients). The appendix has a
retroperitoneal location in 65% of patients and may descend into the iliac fossa in 31%.
In fact, many individuals may have an appendix located in the retroperitoneal space; in
the pelvis; or behind the terminal ileum, cecum, ascending colon, or liver. Thus, the
course of the appendix, the position of its tip, and the difference in appendiceal position
considerably changes clinical findings, accounting for the nonspecific signs and
symptoms of appendicitis.

Physiology of Appendix
The lumen of the appendix communicates with the cecum 3cm (about 1 inch)
before the ileoccal valve, thus making it an accessory organ of the digestive system. Its
functions are not certain, but some biologists believe that the appendix serves as a sort
of breeding ground for some of the nonpathogenic intestinal bacteria thought to aid in
the digestion or absorption of nutrients.

Follicles of lymphoid tissue appear in the wall of the appendix shortly a few birth,
become more prominent during the first 10 years of life and then progressively
disappear. The defense or immune system function of lymphatic tissue present in the
appendix of young children is not fully understood.


























PATHOPHYSIOLOGY

Predisposing Factor Precipitating Factor
































Age (23 y/o)




Bowel movement: 3
times a week.
Sedentary Lifestyle
Low Fiber Diet


Obstruction to lumen of
the appendix.

Occlusion/kinking of the
lumen.

Inflammation of the
serosa of the appendix.

Signs and Symptoms:
Acute RLQ Pain of
the Abdomen
Fever
McBurneys Sign
Nausea
Constipation


Intraluminal
pressure.

Muscle Spasm





































Pus Formation as
evidenced by increased
White Blood Cell.

Rupture of the Appendix

If treated:

If not treated:


Medications:
Ranitidine
Ampicillin
Flagyl
Metronidazole

Surgical Procedure:
Appendectomy

Metastasize to the
blood stream and
throughout the organ

Shock


Septicemia


Wellness

Death

PATHOPHYSIOLOGY NARRATIVE

The client was diagnosed of acute appendicitis; she had a
predisposing factor; her age (23 y/o), which is according to research adult
age has the higher risk of incidence. Her gender didnt serve as a factor
because males are more prone to the disease rather than in females.

Prior to admission, she experienced irregularity in her bowel habit;
she only defecates three times a week. Her diet which is low in fiber, high
in cholesterol and protein and her sedentary lifestyle attributed to her
illness.

The two factors: precipitating and predisposing, led to the
obstruction of the lumen of the appendix. As the obstruction was
lengthened, it resulted in the kinking of the lumen, causing her pain. The
occlusion caused an inflammation of the serosa of the appendix which
produced an intraluminal pressure, causing muscle spasm on the client.

The inflammation of the serosa of the appendix was characterized by
signs and symptoms of fever, acute pain in the right lower quadrant of her
abdomen, McBurneys sign, nausea and constipation which causes increase
in the intraluminal pressure thus resulting to muscle spasm.

As there is presence of inflammation, it resulted in presence of pus
formation evidenced by increased in white blood cells to fight against
infection.

Furthermore, if inflammation will not be cured it can result to a
rupture of the appendix. If rupture is to be treated, the client will need
surgery (appendectomy) and medications. If treatment will be successful, it
will lead to wellness of life.

If the rupture is not treated, it would metastasize to the blood stream
and throughout the organ and further complicate to septicemia leading to
shock, which may result to DEATH.












COMPLICATION OF APPENDICITIS












The most frequent complication of appendicitis is perforation. Perforation
of the appendix can lead to a periappendiceal abscess (a collection of
infected pus) or diffuse peritonitis (infection of the entire lining of the
abdomen and the pelvis). The major reason for appendiceal perforation is
delay in diagnosis and treatment. In general, the longer the delay between
diagnosis and surgery, the more likely is perforation. The risk of
perforation 36 hours after the onset of symptoms is at least 15%.
Therefore, once appendicitis is diagnosed, surgery should be done without
unnecessary delay.

A less common complication of appendicitis is blockage of the intestine.
Blockage occurs when the inflammation surrounding the appendix causes
the intestinal muscle to stop working, and this prevents the intestinal
contents from passing. If the intestine above the blockage begins to fill
with liquid and gas, the abdomen distends and nausea and vomiting may
occur. It then may be necessary to drain the contents of the intestine
through a tube passed through the nose and esophagus and into the
stomach and intestine.
A feared complication of appendicitis is sepsis, a condition in which
infecting bacteria enter the blood and travel to other parts of the body.
This is a very serious, even life-threatening complication. Fortunately, it
occurs infrequently.


CLINICAL MANIFESTATION OF APPENDICITIS














The main symptom of appendicitis is abdominal pain. The pain is at first
diffuse and poorly localized, that is, not confined to one spot. (Poorly
localized pain is typical whenever a problem is confined to the small
intestine or colon, including the appendix.) The pain is so difficult to
pinpoint that when asked to point to the area of the pain, most people
indicate the location of the pain with a circular motion of their hand around
the central part of their abdomen. A second, common, early symptom of
appendicitis is loss of appetite which may progress to nausea and even
vomiting. Nausea and vomiting also may occur later due to intestinal
obstruction.

As appendiceal inflammation increases, it extends through the appendix to
its outer covering and then to the lining of the abdomen, a thin membrane
called the peritoneum. Once the peritoneum becomes inflamed, the pain
changes and then can be localized clearly to one small area. Generally, this
area is between the front of the right hip bone and the belly button. The
exact point is named after Dr. Charles McBurney--McBurney's point. If the
appendix ruptures and infection spreads throughout the abdomen, the pain
becomes diffuse again as the entire lining of the abdomen becomes
inflamed.