LICEO DE CAGAYAN UNIVERSITY

COLLEGE OF NURSING
NCM501203

NCM501203
A Care Study

POLYPECTOMY

Submitted to:

AS PARTIAL FULFILLMENT OF THE COURSE REQUIREMENT

FOR NCM501203

Submitted by:
I. Introduction
Overview of the case

II. Health History

Profile of patient

III. Developmental Data

IV. Anatomy and Physiology

V. Pathophysiology

VI. Medical Management

VII. Laboratory Results

VIII. Drug Study

IX. Ideal Nursing Management

X. Actual Nursing Management

XI. Health Teachings

XII. Referrals and Follow up

XIII. Bibliography

I. INTRODUCTION
a. Overview of the Case

A polyp is an abnormal growth of tissue (tumor) projecting from a mucous

membrane. If it is attached to the surface by a narrow elongated stalk it is said to
be pedunculated. If no stalk is present it is said to be sessile. Polyps are
commonly found in the colon, stomach, nose, urinary bladder and uterus. They
may also occur elsewhere in the body where mucous membranes exist like the
cervix and small intestine.

Cervical polyps are fingerlike growths that start on the surface of the
cervix or endocervical canal. These small, fragile growths hang from a stalk
and push through the cervical opening.

The cause of cervical polyps is not completely understood. They may be

associated with chronic inflammation, an abnormal response to increased levels
of estrogen, or clogged cervical blood vessels.

Cervical polyps are relatively common, especially in women over

age 20 who have had children. Only a single polyp is present in most
cases, but sometimes two or three are found. They are rare in females
who have not started menstruating.

Abnormal vaginal bleeding is one of the manifestation in this kind of

condition, especially after intercourse, douching, menopause, and even
abnormal heavy periods (menorrhagia), white or yellow mucous discharge
(leukorrhea)

A pelvic examination reveals smooth, red or purple, fingerlike projections from

the cervical canal. A cervical biopsy typically reveals mildly atypical cells and
signs of infection. Polyps can be removed during a simple, outpatient procedure.
Gentle twisting of a cervical polyp may remove it, but normally a polyp is taken
out by tying a surgical string around the base and cutting it off. Removal of the
polyp's base is done by electrocautery or with a laser.
 Because many polyps are infected, an antibiotic may be given after the
removal, even if there are no or few signs of infection. Although most cervical
polyps are non-cancerous (benign), the removed tissue should be sent to a
laboratory for further examination. Typically, polyps are benign and easily
removed. Regrowth of polyps is uncommon.

II. HEALTH HISTORY

a. Profile of Patient

Patient’s Name:

Birth Date:

Birthplace:

Age: 39 years old

Sex: Female

Status: Married

Religion:

Nationality: Filipino

Address:

Allergy: None

Date of Admission: May 17, 2007

Time of Admission: 8:30 am

Chief Complaints: Vaginal bleeding on and off

Diagnosis: Dysfunctional Uterine Bleeding

III. DEVELOPMENTAL TASK

ERIK ERICKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT

VI. MEDICAL MANAGEMENT

 DOCTOR’S ORDER RATIONALE
May 17, 2007
Admit to Gynecology:
> Temperature
Name of drug
every 4Classification
Date
hours > During this period
Dosage/
of time, potentially
Mechanism of Specific
fatalContraindications Side Effects Nursing
Ordered complications
Frequency may develop
Action Indication Implication
Route
Paracetamol May6,2007 Antipyretic, 1 tab, P.O. Chemical Effect: Reduces fever - Contraindicated Hematologic: - Assess
patient’s pain
(Biogesec) analgesic (prn) May produce in patients hemolytic
or
> Soft diet, NPO > Serves as transition
analgesicto the regular diet; is ahypersensitive to anemia,leucopenia
effect temperature
before and
nutritionally adequate diet;
by blocking is a modification ofdrug.
pain Hepatic: liver
dring therapy.
impulses, by and texture
normal diet in consistency - Use cautiously damage, jaundice. - Assess
patient’s drug
inhibiting in patients with Metabolic:
history.
prostaglandin. history of chronic hypoglycemia - Be alert for
adverse
Therapeutic alcohol abuse. Skin: rash, urticaria
reactions and
> Labs: CBC stat., U/A, FBS, > CBC- leukocytosis
Effect:: usually
Relieves present, although drug
interactions.
Hgb, Ultrasound, Chest X-ray, a low WBC counts may present in viral
pain and reduces

ECG, Alkaline phosphate. infection. fever.

Cefuroxime May6,2007 Antibiotic 400 g every Chemical effect: Hinders or - Contraindicated CNS: headache, - Assess
patient’s
(Zinacef) 8 hours. Inhibits cell-wall kills in patients malaise, dizziness.
infection
synthesis, susceptible hypersensitive to GI: nausea, before
therapy.
> Intake and Output every shift > To know if the patient has bacteria.
promoting a normal fluiddrug or other anorexia, vomiting,
- Ask patient
osmotic
intake and output. To know for normal kidneycephalosporins. diarrhea, glossitis, about
previous
instability. - Use cautiously abdominal cramps.
functioning and for laboratory purposes. reactions to
Therapeutic in patients with Respiratory: dyspnea cephalosporin
- Be alert for
effect: Kills history of Skin: rashes,
adverse
> D5LR I L @ KVO > Fluids are required
susceptibleto replace losses, to
sensitivity to urticaria. reactions and
drug
prevent patient bacteria
dehydration. It aids also forpenicillin. interactions.
mobilization of secretion.

> Meds:
- ampicillin 1 IVT every 8° Anst > Kills susceptible bacteria

- famotidine 1 amp IVT every > Decreases gastric acid levels and prevents
 VIII. DRUG STUDY

Name of Date Classification Dosage/ Mechanism of Specific Contraindications Side Effects Nursing Implication
drug Ordered Frequency Action Indication
Route
Tramadol May6,2007 Pharmacologic 300 g IVTT Chemical Relieves - Contraindicated in CNS: - Assess patient’s pain
class: opioid every 8 effect: pain. patients dizziness, before starting the
agonist hours. Centrally acting hypersensitive to drug vertigo, therapy.
Therapeutic synthetic or any of its headache - Monitor CV and
class: analgesic component. CV: respiratory status.
analgesic compound - Use cautiously in vasodilation - Monitor patient for
thought to bind patients at risk for EENT: visual drug dependence.
opioid seizures or respiratory disturbances. Be alert for adverse
receptorsand depression. GI: nausea, reaction.
inhibit reuptake constipation,
of vomiting,
norepinephrine diarrhea
and serotonin.
Therapeutic
effect: Relieves
pain.
 Name of Date Classification Dosage/ Mechanism of Specific Contraindications Side Effects Nursing Implication
drug Ordered Frequency Action Indication
Route
Ketorolac May7,2007 Pharmacologic 30 mg IV Chemical Relieves - Contraindicated in CNS: - Assess patient’s
infection before
(Toradol) class: NSAID every 6 effect: May pain and patients drowsiness,
therapy.
Therapeutic: hours. inhibit inflammation. hypersensitive to insomnia, - Ask patient about
previous reactions to
analgesic, prostaglandins drug or any of its dizziness,
cephalosporin
anti- synthesis. components. headache. - Be alert for adverse
reactions and drug
inflammatory. Therapeutic - Not recommend for CV: edema,
interactions.
effect: intrathecal or epidural hypertension,
Relieves pain administration palpitations.
and because of its alcohol GI: nausea,
inflammation. content. GI pain,
- Use cautiously in diarrhea.
patients in the Skin:
perioperative period. sweating.

Ranitidine May7,2007 Antiulcerative 300g IVTT Chem. Effect: Relieves GI - Contraindicated in CNS: vertigo, -Assess patient’s GI
patients
(Zantac) every 8 Competitively discomfort. malaise. condition before
hypersensitive to
hours. inhibits action drug or any of its EENT: starting therapy.
components.
of H2 at blurred vision - Be alert for adverse
Use cautiously in
receptor site. patients with Hepatic: reactions of drug
impaired kidney
-Relieves GI Jaundice. interactions.
function.
discomfort.
VII. LABORATORY RESULTS

DIAGNOSTIC TESTS

URINALYSIS
May 6, 2007

Specimen: Random Sample

Color: Yellow
Appearance: Hazy
Glucose: negative
Protein: negative
Reaction: 6.0 pH
Specific gravity: 1.030

Microscopic
WBC: 0-2
RBC: 0-3
Epithelial Cells: plenty
Pus Cells: 3-7 hpf
Mucus Threads: none seen
Urates: moderate

CHEMISTRY:
Alkaline 160 mg/dl
Creatinine G 0.6 u/l
Glucose- G 79 mg/dl
HEMATOLOGY
May 17, 2007

CBC
Total WBC 9.7
Hemoglobin 13.0
Hematocrit 37.7
MCV 81.4
MCH 26.8
Platelet Count 265

Differential Count

Lymphocytes 42
Segmenters 58
Basophils 13.5

HBsAg – non reactive

ULTRASOUND

Cervix 3.0 x 2.90 cm

Endometrium 0.77cm
Uterus 5.3 x 5.2 x 4.1 cm
Right ovary 2.3 x 1.50 cm
Left ovary 2.67 x 1.50 cm
CHEST X-RAY

Finding:
There is no evidence of active parenchyma infiltrates.
Heart is not enlarged.
Aorta, trachea, diaphragm and sinuses are unremarkable.
IV. ANATOMY AND PHYSIOLOGY

The cervix (from Latin "neck") is the lower, narrow portion of the uterus
where it joins with the top end of the vagina. It is cylindrical or conical in shape
and protrudes through the upper anterior vaginal wall. Approximately half its
length is visible with appropriate medical equipment; the remainder lies above
the vagina beyond view. It is occasionally called "cervix uteri", or "neck of the
uterus".

Ectocervix

The portion projecting into the vagina is referred to as the portio vaginalis
or ectocervix. On average, the ectocervix is 3 cm long and 2.5 cm wide. It has a
convex, elliptical surface and is divided into anterior and posterior lips.

External Os

The ectocervix's opening is called the external os. The size and shape of the
external os and the ectocervix varies widely with age, hormonal state, and
whether the woman has had a vaginal birth. In women who have not had a
vaginal birth the external os appears as a small, circular opening. In women who
have had a vaginal birth, the ectocervix appears bulkier and the external os
appears wider, more slit-like and gaping.

Endocervical canal

The passageway between the external os and the uterine cavity is referred to as
the endocervical canal. It varies widely in length and width, along with the cervix
overall. Flattened anterior to posterior, the endocervical canal measures 7 to 8
mm at its widest in reproductive-aged women.

Internal Os

The endocervical canal terminates at the internal os which is the opening of the
cervix inside the uterine cavity.

Cervical crypts

There are pockets in the lining of the cervix known as cervical crypts. They
function to produce cervical fluid.[1]

Histology

The epithelium of the cervix is nonkeratinized stratified squamous epithelium at

the ectocervix, and simple columnar epithelium at the cervix proper.[2][3] At certain
times of life, the columnar epithelium is replaced by metaplastic squamous
epithelium, and is then known as the transformation zone.

Nabothian cysts are often found in the cervix.

Functionality

During menstruation the cervix stretches open slightly to allow the endometrium
to be shed. This stretching is believed to be part of the cramping pain that many
women experience. Evidence for this is given by the fact that some women's
cramps subside or disappear after their first vaginal birth because the cervical
opening has widened.

During childbirth, contractions of the uterus will dilate the cervix up to 10 cm in

diameter to allow the child to pass through.

During orgasm, the cervix convulses and the external os dilates. Dr. R. Robin
Baker and Dr. Mark A. Bellis, both at the University of Manchester, first proposed
that this behavior worked in such a way as to draw any semen in the vagina into
the uterus, increasing the likelihood of conception. Later researchers, most
notably Elisabeth A. Lloyd, have questioned the logic of this theory and the
quality of the experimental data used to back it.

IX. NURSING MANAGEMENT

a. Ideal Nursing Management (NCP)

NURSING DIAGNOSIS: Nutrition: imbalanced, risk for less than body

requirements
Risk factors may include
Inability to ingest or digest food or absorb nutrients because of biological,
psychological, or economic factors
Increased metabolic demands
Possibly evidenced by
[Not applicable, presence of signs and symptoms establishes an actual
diagnosis.]

DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL:

Nutritional Status (NOC)
Ingest nutritionally adequate diet for age, activity level, and metabolic
 demands.
Demonstrate stable weight/progressive weight gain toward goal.

ACTIONS/INTERVENTIONS

Nutrition Management (NIC)

Independent
RATIONALE
Identify children at risk for malnutrition (e.g.,
Provides opportunity for early
intestinal surgery, hypermetabolic states,
intervention.
restricted intake, prior nutritional
deficiencies).

Determine ability to chew, swallow, taste;
presence of mechanical barriers; or
conditions such as lactose intolerance,
cystic fibrosis, diabetes, inflammatory bowel
diseases.
These factors can affect ingestion
and/or digestion of nutrients, and
specific dietary choices.

Determine child’s current nutritional status Identifies individual nutritional

using age-appropriate measurements, needs and provides comparative
including weight and body build, strength, baseline.
activity level, sleep/rest cycles.

Elicit information from child/parent of Baseline information to determine

younger child regarding typical daily food adequacy of intake. Knowledge of
intake, determining foods and beverages child’s specific likes/dislikes may
normally consumed. Note types of snacks. be helpful in meeting child’s
Discuss eating habits and food preferences nutritional needs during a time
(likes and dislikes). when appetite is suppressed or
child has no interest in food.

Determine psychological factors, cultural or Dietary beliefs, such as

religious desires/influences on dietary vegetarianism, can affect
choices. nutritional intake. Ethnic food
choices can improve a child’s
intake when appetite is poor.

Determine whether infant is breastfed or Providing usual and typical

formula-fed and typical pattern of feedings feedings is important to infant well-
during a 24-hr period. Note type and being and early growth.
amounts of solid foods an infant/young
toddler eats.

Auscultate bowel sounds. Note Provides information about

characteristics of stool (color, amount, digestion/bowel function and may
frequency, and so on). affect choice/timing of feeding.

Discuss with parent what types of candy, Identifies what child eats in a
other sweets, snacks, and sodas child typical day. Provides opportunity
eats/drinks. for identifying and providing
healthy snacks.

Emphasize importance of well-balanced, Although nutritious intake is

nutritious intake. Provide information important, arguing over food is
regarding individual nutritional needs and counterproductive. Providing age-
ways to meet these needs within financial appropriate guidelines to children
constraints. Avoid arguing over food intake. as well as to parents/care provider
Provide food without comment.
Review drug regimen, side effects, and
potential interactions with other
medications/over-the-counter drugs.
Clarify family/caregiver access to/use of
resources such as food stamps, budget
counseling, WIC, community food bank,
and/or other appropriate assistance
programs.
Collaborative
Establish a nutritional plan that meets
individual needs incorporating specific food
restrictions, special dietary needs.
Consult dietitian/nutritional team as
indicated.
Review indicated laboratory data (e.g.,
serum albumin/prealbumin, transferring,
amino acid profile, iron, blood urea nitrogen
[BUN], nitrogen balance studies, glucose,
liver function, electrolytes, total lymphocyte
count, indirect calorimetry).
may help them in making healthy
choices.
Timing of medication doses,
interaction with certain foods can
alter effect of medication or
digestion/absorption of nutrients.
May be necessary to improve
child’s intake and/or availability of
food to meet nutritional needs.
Corrects/controls underlying
causative factors (e.g., diabetes,
cancer, malabsorption syndrome,
and anorexia).
Useful in determining individual
nutritional needs and therapeutic
diet.
Indicators of nutritional health and
effects of nutrients in organ
function.
NURSING DIAGNOSIS: Fluid volume, risk for imbalance
Risk factors may include
Lack of adequate intake, increase in fluid needs, e.g. fever
Rapid/sustained loss, e.g., hemorrhage, burns, vomiting, diarrhea, fistulas
Rapid/excessive fluid replacement
Possibly evidenced by
[Not applicable; presence of signs and symptoms establishes an actual
diagnosis.]

DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL:

Hydration (NOC)
Demonstrate adequate fluid balance as evidenced by stable vital signs,
palpable pulses/good quality, normal skin turgor, moist mucous
membranes; individual appropriate urinary output; lack of excessive
weight fluctuation (loss/gain), and absence of edema.
PARENT/CAREGIVER WILL:
Verbalize understanding of child’s fluid needs.
Promote adequate age-appropriate fluid intake.
ACTIONS/INTERVENTIONS

Fluid Management (NIC) RATIONALE

Independent Causative/contributing factors for

Note potential sources of fluid loss/intake, fluid imbalances.
presence of conditions such as diabetes,
burns, use of total parenteral nutrition
(TPN), etc.

Note child’s age, size, weight, and Affects ability to tolerate fluctuations
cognitive abilities. in fluid level and ability to respond to
fluid needs.

Monitor vital signs, mucous membranes, Indicators of hydration status. Note:

weight, skin turgor, breath sounds, urinary Hypotension indicative of developing
and gastric output, amount of blood shock may not be readily observed
draws, hemodynamic measurements. in pediatric patients until very late in
the clinical course.

Review child’s intake of fluids. Children often do not take in enough

oral fluids to meet hydration needs.

Determine child’s normal pattern of Provides information for baseline

elimination, and whether child is toilet and comparison. If child is in
trained. diapers, output may be determined
by weighing diapers.

Determine whether child has problems Evaluation of these issues is

with urination, such as urine retention, important for determining cause and
bed-wetting, burning, holding. treatment of underlying problem.
Note uses of drainage devices such as May increase fluid and electrolyte
nasogastric tube, wound drain; use of losses.
laxatives, enemas, and suppositories.

Collaborative
Because smaller volumes are
Administer IV fluids via control
administered, close monitoring and
device/pump.
regulation is required to prevent fluid
overload while correcting fluid
balance.

Replace electrolytes as indicated by oral

Oral replacement solutions
route whenever possible.
formulated for children are often
safer and better tolerated when
given orally if time/condition allows.

Monitor laboratory results, e.g.,

Indicators of adequacy of
hemoglobin/hematocrit (Hb/Hct), BUN,
hydration/therapeutic interventions.
urine osmolality/specific gravity.

Arrange with laboratory to combine

Excessive/repetitive blood draws
common tests and draw smallest amount
may markedly reduce Hb/Hct levels
of blood that is necessary to perform
in pediatric patients.
required tests.

NURSING DIAGNOSIS: Infection, risk for (septicemia)

Risk factors may include
Inadequate primary defenses (broken skin, traumatized tissue, altered
peristalsis)
Inadequate secondary defenses (immunosuppression)
Invasive procedures
Possibly evidenced by
[Not applicable; presence of signs and symptoms establishes an actual
diagnosis.]
DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL:
Infection Status (NOC)
Achieve timely healing; be free of purulent drainage or erythema; be afebrile.
Risk Control (NOC)
Verbalize understanding of the individual causative/risk factor(s).

ACTIONS/INTERVENTIONS
Infection Control (NIC)
Independent RATIONALE

Assess vital signs frequently, noting Signs of impending septic shock.

unresolved or Circulating endotoxins eventually
progressing hypotension, decreased produce vasodilation, shift of fluid from
pulse pressure, circulation, and a low cardiac output
tachycardia, fever, tachypnea. state.

Note changes in mental status (e.g., Hypoxemia, hypotension, and acidosis

confusion, stupor). can cause
deteriorating mental status.

Note skin color, temperature, moisture. Warm, flushed, dry skin is early sign of
Monitor urine output. septicemia. Later manifestations
include cool, clammy, pale skin and
cyanosis as shock becomes refractory.
Perform/model good handwashing Reduces risk of cross-
technique. Monitor staff/patient contamination/spread of infection.
compliance.

Monitor/restrict visitors and staff as Reduces risk of exposure to/acquisition

appropriate. Provide protective of secondary infection in
isolation if indicated. immunosuppressed patient.

Collaborative
Obtain specimens/monitor results of Identifies causative microorganisms
serial blood, urine, and helps in
wound cultures. assessing effectiveness of antimicrobial
regimen.

Administer amoebecides e.g., Therapy is directed at anaerobic

Metronidazole. bacteria.

X. Actual Nursing Management (SOAPIE)

S SUBJECTIVE:
“ Sakit akong tiyan diri dapit sa akong kilid ” as verbalized by the
patient.

O - Facial grimace
- Guarding
- Restlessness

A Alteration in comfort pain related to

Distension of intestinal tissues by inflammation

P At the end of 30 minutes of rendering nursing intervention the patient

will be able to verbalize relief/ control of pain.

I Assess pain noting location, characteristics and intensity. (0-10 scale).

- Helps evaluate degree of discomfort.

Provide accurate, honest information to patient/SO. Keep at rest in

semi-Fowler’s position.
- Being informed about progress of situation provides emotional
support, helping to decrease anxiety. Gravity localizes inflammatory
exudate into lower abdomen or pelvis, relieving abdominal tension,
which is accentuated by supine position.

Apply hot or cold compress when indicated.

- Reduces pain

Provide comfort measures e.g. back rub, repositioning the patient.

- Promotes relaxation and may enhance coping abilities.

DEPENDENT:

Administer medications as indicated e.g. narcotics, analgesics.

- Relieves pain enhances comfort and promotes rest.

E At the end of 30 minutes of rendering nursing intervention the patient

was able to verbalized relief/ control of pain.

S SUBJECTIVE:
O - Facial grimace
- Guarding
- Restlessness

A Knowledge, deficient regarding condition,

prognosis, treatment, self-care, and discharge needs related to
Lack of exposure/recall; information misinterpretation

P At the end of 30 minutes of rendering nursing intervention the patient

will be able to verbalize understanding of disease process and potential
complications.

I Identify symptoms requiring medical evaluation, e.g.,

increasing pain; edema/erythema of wound; presence of
drainage, fever.
- Prompt intervention reduces risk of serious
complications, e.g., delayed wound healing, peritonitis.

Encourage progressive activities as tolerated with

periodic rest periods.
- Understanding promotes cooperation with therapeutic
regimen, enhancing healing and recovery process.

Discuss care of incision, including dressing changes,

bathing restrictions, and return to physician for
suture/staple removal.
- Understanding promotes cooperation with therapeutic
regimen, enhancing healing and recovery process.

E At the end of 30 minutes of rendering nursing intervention the patient

was able to verbalized understanding of disease process and potential
complications.

S SUBJECTIVE:
“
O Poor appetite when eating.

A Nutrition: Imbalances, less than body requirements related to poor

appetite.

P At the end of 1 hour, patient will be able to demonstrate good appetite

and verbalized her feelings concerning resumption of diet.

I Encouraged bed rest and limited activity.

- Decreasing metabolic needs aids in preventing caloric depletion and

conserves energy.

Intake and output recorded.

- Useful in identifying specific deficiencies and determining GI response

to foods.

Recommended rest before meals.

-Quiets peristalsis and increase available energy or eating.

Encouraged patient to verbalize feelings concerning resumption of diet.

- Hesitation to eat may result of fear that food will cause exacerbation o
symptoms.

E At the end of 1 hour, patient was able to demonstrate good appetite and
already spoken about her feelings concerning resumption of diet

XI. HEALTH TEACHINGS

Name of Patient: Judy Ann Roque
MEDICATIONS  Advised and encouraged patient
or family to give the patient
paracetamol when she has
fever.
 Do not give patient more than 5
doses in 24 hours unless
prescribed by physician.

EXERCISE  Take some rest to prevent stress

and other complications.

TREATMENT  Maintain clear surroundings.

OUT-PATIENT  Advised the parents to visit the

(Check-up) nearest hospital for further
check-up for their child.
DIET  Diet as to age.
 Increase fluid intake.

XII. REFERRALS AND FOLLOW-UP

To allow continuous monitoring of the patient’s healing progress, patient

was encouraged to consult her doctor 2 weeks after discharge for follow-up
check up of her general condition. This will ensure thorough follow up of her
condition and prevention of potential complications. Apart from this, patient was
advised to increase fluid intake, make sure that proper hand washing is practiced
before and after eating.
XIII. BIBLIOGRAPHY
Black, Joyce M. 1993. Medical-Surgical Nursing- A Psychologic Approach. 4th ed.
W.B Saunders Company: Philadelphia, Pennsylvania,USA.

Smeltzer, Suzanne C.et al.2004. Medical Surgical Nursing. - 10th ed.Lippincott

Williams and Wilkins: Philadelphia

Price, Sylvia A. 1997. Pathophysiology: Clinical Concepts of Disease Processes.

5th ed. Mosby Year Book, Inc: United States of America

Carpenito, Lynda Juall.2000. Nursing Diagnosis: Application to Clinical Practice.

8th ed. Lyndal Juall Carpenito: United States of America.

Pillitteri, Adele. 2003. Maternal and Child Health Nursing.4rth ed.Wolter Kluwer
Company: Hong Kong.

Doenges, Marilynn E.2006.Nurse’s Pocket Guide.F.ADavis Company:

Philadelphia.
www.yahoo.com

V. PATHOPHYSIOLOGY
Predisposing factors:

 Age
 Gender
 Lifestyle

Precipitating factors:

 Infections

Appendicitis

obstruction of the narrow appendiceal lumen.

Obstruction has many sources, including fecaliths, lymphoid hyperplasia (related

to viral illnesses such as upper respiratory infections, mononucleosis, or

gastroenteritis gastrointestinal parasites, foreign bodies, and Crohn's disease

Continued secretion of mucus from within the obstructed appendix results in

elevated intraluminal pressure,

leading to tissue ischemia, over-growth of bacteria, transmural inflammation,

appendiceal infarction, and possible perforation.

Inflammation may then quickly extend into the parietal peritoneum and
adjacent structures.

s/s: epigastric pain, vomiting, anorexia, fever

Complications: wound infections, intra-abdominal abscess,

intestinal obstruction, and prolonged ileus