CASE PRESENTATION I. INTRODUCTION The patient is Mr. V. P. who hailed from Davao City. He is the eldest son of Mr.

And Mrs. F. P. but second sibling among the five children. He is a graduate of Business Management at Ateneo de Davao. He started his business when he was 23 years old. Evidently, his business grows up and now has a branch in Manila. According to him, in every minute of his life as a businessman is so precious like a diamond, in other words he never waste a single minute for nothing. As he grows up older, life changes too and health as well. He is not conscious of his balance diet because he mentioned that as long as the food tastes good it makes no limit until he is full. He was made alarm of his health only when he was diagnosed of DM II when he was 40 years old. Diabetes mellitus, which is simply referred to as diabetes these days, is a metabolic disorder which in particular affects the metabolism of carbohydrates. The condition requires medical treatment and, more often than not, a number of lifestyle changes.He is frequently having a check up for monitoring his glucose. From then on, he was trying to diminish some of his vices such as drinking liquor and cigarette smoking but these are his stress mechanism activities to help him calm towards work problems. At the age of 49, he was diagnosed of acute appendicitis and required for an immediate appendectomy. Appendicitis is a swelling (inflammation) of the appendix. It causes pain in the abdomen (tummy) that gradually gets worse over several hours. It is thought that the most common causes of appendicitis are infection and obstruction (when something gets trapped in the appendix). However, in many cases there is no obvious cause. During appendicitis, the appendix becomes filled with bacteria that produce pus, causing the appendix to swell. Although there is no guaranteed way to prevent appendicitis, it is thought to be less common among people who eat a high-fibre diet. Mr. V. P last words said that Health is wealth. II. OBJECTIVES A. General 1. To be able discuss about Appendicitis and its signs and symptoms. 2. To determine the exact location of each quadrant or where the Appendix is located 3. To actively participate in the discussion about Appendicitis B. Specific

1. To know the appropriate nursing interventions for clients who have diabetes milletus with appendectomy. 2. To determine etiologic factors that causes appendicitis. 3. To respond actively how to prevent appendicitis III. THEORETICAL FOUNDATION The following theorists that that could apply in the study are the following: Florence Nightingales Environmental Theory. The patients environment can contribute to the development of his recovery. Good sanitation such as water, air, food and clean environment can prevent infection that could trigger or alleviate the condition of the patient. Proper ventilation such as air-conditioned room and light that inhibit the production of microorganism and not only that but it makes the patient comfortable and can rest during the period of his recovery as well as calm and quiet surroundings. Another theorist that can be adapted is Hildegard Peplaus Interpersonal Relation Model. This is used as a therapeutic relationship between the nurse and patient such as conducting health teachings and talking to the patient is also helpful in diverting a patient in pain. As a nurse, our roles are teacher and even counsellor to the patients. IV. NURSING HISTORY A. Biographical Data Name: Mr. V. P. Date of Birth: February 18, 1961 Address: 7th Street Guadalupe Vill., Km 7 Bajada, Davao City Birth Place: Bajada, Davao City Occupation: Businessman Sources of Health Assistance: Makati Medical Center St. Lukes Medical Center Davao Medical Center

Source of referral: He had no source of referral. He just had a consultation Emergency Contact Person and Number: Mrs. E. P. 09183452121

B. Reason for seeking health care Chief complaint: Suffering from abdominal pain with elevated body temperature of 39 degree Celsius and nausea and vomiting. C. History of Present Illness Patient came in because of gnawing abdominal pain which started 12 hours prior to consult (after breakfast) associated with nausea and vomiting. He took Malox and Kremel S which afforded temporarily relief of symptoms. Four hours later, pain recurred as epigastric pain time with vomiting 2x about about 50 cc of previously ingested food. He took 1 tablet of buscopan but afforded no relief. Few hours later pain localized at the lower quandrant with intensity of 8 in a scale of 10 prompting consult. Characteristics of a complete: 1. Location : Abdomen 2. Radiation : Epigastric 3. Quality: Gnawing abdominal pain 4. Quantity: 8 in a scale of 10 5. Associated Manifestation: Nausea and vomiting 6. Aggravating factor: more pain if breathing 7. Alleviating factor: none 8. Setting: at home 9. Timing: Before breakfast 10. Meaning and impact: this condition needs an immediate action to relieve the pain. D. Past Health History 1. Medical History

He was hospitalized for 2 weeks because of stab wound at abdomen when he was 25 years. He was first diagnosed of diabetes when he was 40 years old by a private physician with present medication of Metformin and Gliclaside.

2. Surgical History

Explore lap secondary to stab wound at abdomen when he was 25 years old.

3. Medications Metformin Gliclaside

4. Prescription Medication Metformin Gliclaside

5. Allergies No allergies was mentioned because the patient was too much in pain 6. Injuries and Accidents No information given 7. Special needs The patient needs an immediate relieve of pain. 8. Childhood illness immunizations BCG as an evidenced of the scar at the deltoid area E. Family Health History a. Age and health status 49 years old and married b. Spouse Mrs. E. P. c. Children: C. P., 21 years old M. P., 18 years old L. P., 16 years old

A. P. 13 years old D. P. 9 years old d. Siblings Mrs. C. T., 51 years old and married Asthmatic Mr. B. P., 46 years old and married Diabetic Mrs. K. P., 44 years old and married Hypertensive e. Patients Parents Father: Mr. F. P., 75 years old (deceased) Hypertensive Mother: Mrs. Y. P., 72 years old Diabetic F. Social History a. Alcohol use He first tasted liquor when he was third year high school for curiosity only after their JS Prom. He was able to drink 4 bottles of beer and it was unmanageable. He did for a second time when he was in third year college wherein that time almost every weekend and was able to consume for almost 10 bottles of beer and other types of liquor. When he started his business, he likewise started to drink wine and hard liquor for about 5 shots before going to bed. He drank more than 5 shots of hard liquor whenever he is with his business associates. b. Drug use He never engage himself to prohibited drugs c. Tobacco use He started smoking when he was first year college for an initial of 5 sticks a day until he was in second year college. After that, unnoticeably he can consumed half of a

pack of the cigarette until he became change smoker until he was 40 years old. When he was diagnosed of DM, cigarette smoking was decreased to 2-3 sticks a day. d. Sexual practice He has no permanent extramarital affair but with occasional sexual encounter with professional prostitute. e. Travel History He travels a lot for local such Davao, Metro Manila, Bohol and Cebu and international such as Hongkong, Singapore, Thailand, Malaysia, Macau and United States of America. f. Work environment He works in a very convenient, comfortable and well ventilated office. g. Home environment He has a good, clean and comfortable place to live in with complete amenities. h. Physical environment i. Psychosocial environment He is an active member of the Mason fraternity and business associations. j. Hobbies and Leisure Activity He watches television with his family and dine out side to divert his time during his free day as his bonding moments with the family. He still gives values on close family ties. k. Stress The sources of his stress are internal stress because of his health condition and work problems. His stress management is to go for bar hopping and sometimes at comedy bar because he believe that laughter is the best medicine. l. Education Bachelor of Science in Business Management m. Economic status, religion, ethnic background

He is financially stable that can suffice all of their needs. He is a Roman Catholic and does not belong to any minority group. n. Roles and relationship He is the head of the and father of the family of 2 kids V. IMMUNIZATION/ EXPOSURE TO COMMUNICABLE DISEASE BCG FLU HEPA A Vaccine is given through a shot. It is approved for use in children (age 1 year and older), teens, and adults. Given by an injection into the muscle of the upper arm for adults and older children and in the thigh muscle of toddlers. killed influenza virus single dose of 0.5 ml of liquid injected through the skin into muscle (intramuscular or IM) birth or anytime after birth 1 dose Route & dosage,Site : ID, 0.05 ml Right arm

VI. ALLERGIES No drug and food allergies VII. HOME MEDICATION/ ALTERATIVE MEDICINE Metformin 500mg 3 times a day Glicaside 30mg 1 times a day VIII. DEVELOPMENTAL LEVEL Not applicable

IX. PSYCHOSOCIAL HISTORY Alcohol use: The patient states that he moderately drinks alcoholic beverages;. He and his wife is a member of couples for Christ and they attend meetings every weekend. He usually goes with his friends and drinks oftentimes. He is a person easy to go with and

approachable as his friends and workmates told him. And every night he arrives home he always tell his wife what happened to his day. He assures that even he has hectic schedule in his work he still provide family bonding with his wife and children.

Drug use: He has no history of drug use Caffeine use: Every morning he drinks coffee before or sometimes in his office. Often times he drinks soft drinks when he feels to and whenever he eats at fast food chain. X. OBSTETRICAL HISTORY Menarche: For Pregnant Client: OB Score (GPFPALM): LM: EDC: AOG: XI. PEDIATRIC HISTORY Developmental Milestone XII. ANATOMY and PHYSIOLOGY

The appendix sits at the junction of the small intestine and large intestine. Its a thin tube about four inches long. Normally, the appendix sits in the lower right abdomen.

The appendix is a narrow, dead-end tube about three-to-four inches long that hangs off of the cecum (the beginning of the large intestine).

PHYSIOLOGY The appendix has no known function. It is believed that it may have a role in the immune system. The appendix secretes antibodies into the gut and so plays a role in the body's immune system, though it is not a vital one, as patients survive perfectly well following removal of the appendix. One theory is that the appendix acts as a storehouse for good bacteria, rebooting the digestive system after diarrheal illnesses. Other experts believe the appendix is just a useless remnant from our evolutionary past. Surgical removal of the appendix causes no observable health problems. Appendix has a physiologic function, it is probably related to the presence of lymphoid follicles. Reports of a statistical relationship between appendectomy and subsequent carcinoma of the colon and other neoplasms in humans are not supported by controlled studies.

XIII. PATHOPHYSIOLOGY

XIV. GORDONS FUNCTIONAL PATTERN

Health Perception

He said that his health was good

Now his not good because of his disease

Nutritional Gordons Functional Pattern Elimination

He loved to eat durian as his favorite fruit. He Before Hospitalization ate vegetables, meat and fish without a limit. He urinate 4 times a day with no discomfort and Defacate once a day His routinary activities were in the office the whole day for iffice works and meeting with his client

They are different because he has been admitted to hospital because of his condition. He controls food that He is health conscious can trigger his aliment now escaping food During Hospitalization Analysis trigger his such as rice and all that are can fatty and sweet foods ailment. He cannot go to toilet always because he feels restless There are difference and it affects his elimination because now he is always on bed to get rest unlike before. They are difference because it affects his daily activity when he was been admitted to hospital

Activity

He just sleep and eat the whole day.

Exercise

His exercise before is walking within 15 min.

His exercise before is walking within 15 min.

Sleep

His sleeping pattern Now, his sleeping before was 3 to 4 hours pattern was he sleep 8 hours.

Cognitive Self Perception

He can be able to read and write. He described his own self as a good person and has a self confidence. His role in the family

He can be able to read and write. He described his own self as a good person and has a self confidence. His role in the family

Role Relationship

They are the same even though his been admitted to hospital his exercise does not affected because his exercise is only walking within 15 min. They are difference because before, he wants to go at the bar to meet girls every night and sleep 3 to 4 hours. Now he was been admitted, he cannot do it anymore because his at the hospital. They are the same even though he was at the hospital They are the same even though he was at the hospital. He is very kind to hospital staff. They are the same

XV. PHYSICAL ASSESSMENT (abnormal finding only) Body Parts General Survey: Appearance Findings Upon admission he is restless Analysis Nursing Alert Give client crackers so that he does not feel Nausea & Vomiting Control blood sugar level Hydrate the client Digestive health and patient safety.

Eye Skin Abdomen

Because he feels Nausea & Vomiting. After several hours he vomit twice. Sudden blurred of Because of diabetic vision lens osmosis or diabetic retinopathy Dry Because of fluid volume deficit Presence of pain upon Because of irritating palpation at of the lining of McBuneys point the peritoneum at the (located half way place where the between the umbilicus peritoneum comes & anterior spine of the into contact with the illium). appendix.

XVI. DIAGNOSTIC/ LABORATORY EXAMINATIONS

XVII. MEDICAL DIAGNOSIS Dyspepsia, urinary tract infection, std, acute appendicitis

XVIII. DRUG STUDY GENERIC NAME INDICATI ACTION ON CONTRAINDIC ATION ADVER SE EFFECT >abdomi nal pains NURSING CONSIDERA TION > Monitor known or suspected alcoholics carefully for decreased liver function.

METFORMIN

BRAND NAME : Fortamet, Glucophage, Glumetza, Riomet

Type 2 diabetes inadequate ly controlled by diet & exercise alone.

CLASSIFICAT ION: Antidiabetic Agents

This medication works by helping to restore your body's proper response to the insulin yo u naturally produce, and by decreasing the amount of sugar that your liver makes and that your stomach/intes tines absorb.

Renal impairment, CHF requiring pharmacologic treatment, acute or chronic metabolic acidosis

>chest pains

>indiges tion

> Monitor

cardiopulmona ry status throughout of >vomitin course therapy; g cardiopulmona ry insufficiency >diarrhe may predispose to a lactic acidosis >blurred vision

GENERIC NAME

INDICAT ION

ACTION CONTRAINDIC ATION

ADVERSE EFFECT

NURSING CONSIDERA TION > Patient who are NPO may need to have their dose held to avoid hypoglycemia

GLICLAZIDE for control of hyperglyc emia in BRAND gliclazide NAME: responsiv Diamicron e diabetes mellitus of stable, mild, nonketosis CLASSIFICA prone, TION: maturity onset or Antidiabetic adult type Agents which cannot be controlled by proper dietary managem ent and exercise, or when insulin therapy is not appropriat e

an improve ment in insulin secretion from the functioni ng beta cells of the pancreas. It potentate s the insulin release, improves the dynamic s of insulin.

Type 1 diabetes, ketoacidosis, diabetic precoma, severe renal or hepatic impairment.

Hypogly cemia

Gastroin testinal disturbance (reported)

Skin reactions (rare)

Hematol ogical disorders (rare)

Hepatic enzyme rises (exceptional

XIX. MEDICAL/ SURGICAL MANAGEMENT

Closely monitor vital signs to avoid complications. Pain medication may also be administrated if necessary. Most individuals will be offered clear liquids the day after the surgery and then progress to a regular diet when the intestines start to function properly. It is highly recommended that patients sit up on the edge of the bed and walk short distances for several times a day. Moving is mandatory and pain medication may be given if necessary. Full recovery from appendectomies takes about 4 to 6 weeks but it can prolong to up to 8 weeks if the appendix had ruptured.

XX. NURSING CARE PLAN ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective:

Masakit ang tiyan ko as verbalized by patient.

Acute pain related to inflammation of tissues.

Objective: Facial mask of pain. Guarding behavior. Rebound tenderness. V/S taken as follows: T: 39

After 30 minutes of nursing interventions, the patient will demonstrate use of relaxation skills, other methods to promote comfor

Independent:

- Changes in location or - Investigate pain intensity are reports, noting not location, duration, uncommon intensity (0-10 but may scale), and reflect characteristics developing (dull, sharp, complications. constant). - Reduces abdominal distention, - Maintain semithereby fowlers position. reduces - Move patient tension. slowly and - Reduces deliberately. muscle - Provide comfort tension or measure like back guarding, rubs, deep which may breathing. Instruct help minimize in relaxation or pain of visualization movement. exercises. Provide - Promotes diversional relaxation and activities. may enhance - Provide frequent patients oral care. Remove coping noxious abilities by environmental refocusing stimuli. attention. - Reduces nausea and vomiting, which can increase intraabdominal

- After 30minutes of nursing interventions, the patient was able to demonstrate use of relaxation skills, other methods to promote comfor

Collaborative:

- Administer

analgesics as prescribed.

presspain. - Reduce metabolic rate and aids in pain relief and promotes healingure or

XXI. DISCHARGE PLAN MEDICATIONS Advise the patient to take exact dose of medicine such as: Metformin 500 mg 3 times a day and Glicaside 30 mg 1 times a day and follow the instruction given by the physician. Inform the patient about the side effect of the medication used, contraindication of the drug that prescribed by the physician. EXERCISE The exercise lowers blood glucose by increasing the uptake of glucose by the body muscles and providing insulin utilization. Exercise improves circulation and muscle tone. The patient may do some simple exercise like walking and deep breathing to promote good respiratory circulation. TREATMENT The treatment of diabetes mellitus with appendectomy usually involves keeping the patient comfortable while the illness runs its course. Emphasized supportive care includes bed rest, drinking extra fluids, and drugs as prescribed by the physician. Oral fluids are usually given when they can be tolerated unless the patient has been dehydrated; food may be given as desired on the days of operation, if the patients condition permits. HYGIENE Maintain proper hygiene like: cleaning the wound or incision everyday for the immediate recovery and morning care to prevent mouth and body odor. OPD Instruct the patient to check for follow- up check up and to take the drugs prescribed by the physician. If there are unwanted signs and symptoms persist consult the physician. DIET Advise the patient to eat nutritious food and avoid eating food high in glucose and dinks high in sugar. Diet and weight control constitute the foundation of diabetes management these are: provision of all essential food constituents like vitamin and mineral, achievement and maintenances of ideal weight, meeting energy needs, prevention of wide daily variations in the blood glucose level as close to normal as is safe and practical and decrease of blood lipids levels, if elevated. SPIRITUAL

Always pray to God for help because only God can provide us enough courage to survive all struggles and challenge in life.