NURSING CARE At Mr.

A With
DIGESTIVE SYSTEM
DISORDERS: APPENDICITIS
At MUHAMMADIYAH HOSPITAL
PALEMBANG
 Background
Appendicitis is inflammation of the vermiform appendix and
is the most common cause of acute abdomen. The disease is
aged both men and women.
Appendicitis is the most common cause of acute
inflammation in the lower right quadrant of the abdominal
cavity and is the most common cause for emergency abdominal
surgery (Dorland, 2012)
So we were interested in creating a Nursing Care Report with
the title "Nursing Care for Mr. A with Disorders of the Digestive
System: Appendicitis at the Muhammadiyah Hospital in
Palembang.
Definition of appendicitis

Appendicitis is an
infection and swelling of
the appendix which can
reduce the blood supply
to the wall of the
appendix. This causes
tissue death and
appendicitis to rupture or
explode resulting in
bacteria and feces
entering the stomach
( Cheng, 2014 ).
Anatomy and
Etiology
physiology
The occurrence of acute
appendicitis is generally caused
by bacterial infection. But there
are many trigger factors for this
disease. Among the obstruction
that occurs in the lumen of the
appendix which is usually
caused by the presence of hard
fecal matter (fecalite), lymphoid
tissue hyperplasia, worm
disease, parasites, foreign
bodies in the body, primary
tumors in the wall of the
appendix and strictures.
 Classification of
appendicitis
Classification of appendicitis is divided into two :

Acute appendicitis

Chronic appendicitis
Pathways appendicitis
1. Right lower 2. Nausea vomiting is usually
quadrant abdominal pain in the initial phase

3. Appetite decreases 4. There is constipation

Fever, if there is a complication, if Rovsing sign by palpating the

5. there are no complications, the 6. lower left quadrant which
body is usually not paradoxically causes right
hot. Temperatures usually range
from 37.5 ° C to 38.5 ° C
quadrant pain
(Rukmono,2011)

Clinical manifestation
 Supportive examination of appendicitis

a) Calculate the type of leukocytes with the

results of leukocytosis.
1. Laboratory
b) Urine examination with sediment results
examination
can be normal or there are more
leukocytes and erythrocytes than normal
if the inflamed appendix attaches to the
ureter or vesika.

2. Radiology a) Appendixogram
examination b) Ultrasonography (USG)
Management of Complication of
appendicitis appendicitis
1. Appendicular infiltrates
• Conservative
countermeasures 2. Appendicular abscess
1.
3. Perforation

4. Peritonitis
• Operation
2. 5. Septic shock

6. Peristaltic disorders
• Tertiary 7. Ileus
3. Prevention
 Basic concepts
of nursing care Nursing diagnose
theory
1. Acute pain is associated with
1. Assessment biological injury agents (eg
1) Identity infection, ischemia, neoplasms)
2) Current disease history 2. Hyperthermia is associated with a
3) Past disease history disease
4) Family nursing history 3. Nutritional imbalance: less than the
5) Pattern of health function body's needs associated with eating
a. Pattern of perception and disabilities
management of healthy life 4. Lack of fluid volume associated with
b. Pattern of sleep and rest active fluid loss
c. Activity patterns 5. Constipation associated with
d. Patterns of relationships and insufficient fiber intake.
roles 6. Activity intolerance associated with
e. Sensory and cognitive immobility
patterns 7. The risk of infection with risk
f. Stress management patterns factors for impaired skin integrity
g. Pattern of values ​and beliefs 8. Anxiety is related to threats to
h. Physical examination current status
 Case

A man 19-year-old came to Muhammadiyah Hospital Palembang

with complained of abdominal pain in the right lower quadrant with a
pain scale of 8 from 3 days before entering to the hospital. Pain will
increase when he walk. Patients’ has constipation for 3 days. At
present the diet of patients is irregular and rarely consumes foods
containing fiber. From the results of assessment, the patient has
anorexia and Rovsing's sign. The patient complains that his body
feels hot. The general condition of the patient really looks sick, fever.
Medical diagnostics of the patient is appendicitis. Examination
results obtained BP: 130/80 mmHg, RR: 20 x / min, P: 90 x / min, T:
38.5 C, and Leukocytes: 13,000.
 Developing nursing process
1. Assessment
CURRENT HEALTH
Main complaint: The patient said that his complained of abdominal pain in the right
lower quadrant from 3 days before entering to the hospital
CURRENT HEALTH HISTORY
a. Subjective data:
P= the patient says right lower abdominal pain
Q= the patient says his stomach hurts like a puncture
R= the patient said only right lower abdominal pain for now
S= the patient says the pain score is 8
T= Patients say pain occurs when on the move, especially when walking and feels
more than 3 days
b. Objective data:
the patient looks in pain while holding his right lower abdomen and the patient
looked grimace
BP: 130/80 mmHg, RR: 20 x / min, P: 90 x / min, T: 38.50 C
 Nursing care plan
2. Nursing Diagnose 3. Intervensions
1. Acute pain is associated with Pain Management
biological injury agents: infection 1. Perform comprehensive pain
DS: assessment which includes location,
P= the patient says right lower abdominal characteristics, onset / duration,
pain, frequency, quality, intensity or
Q= the patient says his stomach hurts like a severity of pain and trigger factors.
puncture, 2. Explore patient knowledge and
R= the patient said only right lower knowledge about pain
abdominal pain for now, 3. Teach the principles of pain
S= the patient says the pain score is 8, management
T= Patients say pain occurs when on the 4. Encourage patients to monitor pain
move, especially when walking and feels
and handle the pain appropriately
more
5. Support adequate rest / sleep to help
DO:
reduce pain
the patient looks in pain while holding his
right lower abdomen
weight: 66 Kg
BP: 130/80 mmHg, RR: 20 x / min, P: 90 x /
min, T: 38.50 C Leukocytes: 13,000
Nursing Diagnose Intervensions
2. Hyperthermia is associated with a
disease Fever treatment:
1. monitor the temperature and other
DS:
the patient says his body feels hot vital signs
DO: 2. skin color monitor and temperature
the patient's body temperature is high 3. encourage fluid consumption and
weight: 66 Kg BP: 130/80 mmHg, RR: compresses
20 x / min, P: 90 x / min, T:38.50C
Leukocytes: 13,000

3. Nutritional imbalance: less than the

body's needs associated with eating
disabilities
Eating disorder management:
DS:
The patient says his diet is irregular and dry 1. Encourage clients to discuss the
of mucouse foods they like together with
DO: nutritionists
the patient looks tired, weak, and anxious 2. teach and support the concept of
weight: 66 Kg BP: 130/80 mmHg, RR: 20 good nutrition with clients
x / min, P: 90 x / min, T: 38.50 3. monitor client behavior related to
CLeukocytes:13,000 diet

Nursing Diagnose
4. Constipation associated
with insufficient fiber intake
DS:
the patient said that having difficulty
defecating for more than 3 days
DO:
the patient appears bloated in his stomach
weight: 66 Kg
BP: 130/80 mmHg, RR: 20 x / min, P: 90
x / min, T: 38.50 C Leukocytes:
Intervensions
Gastrointestinal management :
1. Monitor defecation including
frequency, constitution, shape,
volume, and color, in the right way
2. Monitor bowel sounds
3. Monitor for signs and symptoms of
diarrhea, constipation, and
impaction
4. Teach patients regarding certain
foods that help support regularity
(activity) of the intestine
 Evaluation
1. Acute pain is associated with biological injury agent: infection
S= the patient says there is still right lower abdominal pain, the patient said the pain
in his stomach did not stab again, the patient said only right lower abdominal pain
for now , the patient says the pain score is 6, & the patient said when walking pain
was felt
O= the patient does look sick when walking
A= the problem has not been resolved
P= intervention continued

2. Hyperthermia is associated with a disease

S= the patient says his body feels warm
O= the patient's body temperature is average T: 380 C
A= the problem has not been resolved
P= intervention continued
 Evaluation
3. Nutritional imbalance: less than the body's needs associated
with eating disabilities
S= the patient said he still lacked appetite
O= the patient looks tired, weak, and dry of mucouse
A= the problem has not been resolved
P= intervention continued

4. Constipation associated with insufficient fiber intake

S= the patient said he still difficult defecating
O= the patient looks uncomfortable with his digestion
A= the problem has not been resolved
P= intervention continued
 discussion
1. Acute pain is associated with biological injury agent: infection

According to the nursing journal written by ( Sugeng Triyani and

Theresia Eugenie, 2018 ) that pain management given to clients can be
reduced by using compresses and relaxation. Warm compresses can
cause several therapeutic effects such as reducing pain, increasing
blood flow, reducing stiffness and reducing muscle spasms.
While for relaxation is an effective method to reduce the pain of clients
who experience pain or maintain so that no more severe pain occurs.

2. Hyperthermia is associated with a disease

According to the nursing journal written by ( Sri Purwanti, 2012 )

that warm compresses lower the temperature of the kill more than cold
water compresses, With warm compresses causing the temperature of the
body to be warm so that the body will interpret that the temperature is quite
hot, the body will reduce temperature control in the brain so as not to
increase body temperature, with warmer temperatures that make the blood
vessels dilated and vasodilated so that the skin pores will open and facilitate
heat dissipation. So that there will be changes in body temperature .
3. Nutritional imbalance: less than the body's needs associated with
eating disabilities

According to the journal of nursing written by (Nurdin Rahman, 2016) that

the nutritional knowledge is someone’s understanding about the
food ber balanced nutrition, which in the age to adulthoodis an age that
requires the intake of nutrients are balanced and in accordance with the needs
of children to help achieve optimal growth and development. consumtion
nutritious foods and comprehended that the food is closely related to
health and a persons growth and development is one of a persons nutritional
processes fulfilled.
4. Constipation associated with insufficient fiber intake

According to the nursing journal written by ( M. Kusharto, 2006 )

that Adequacy of fiber intake is now recommended to be higher, given the
many benefits that are beneficial to health, adequate intake (AI) for dietary
fiber as a reference to maintain the health of the digestive tract dietary
fibers, especially those consisting of cellulose, hemicellulose and lignin, are
largely indestructible by enzymes and bacteria in the digestive tract. This
dietary fiber will absorb water in the colon, so that the volume of stool
becomes larger and will stimulate nerves in the rectum, giving rise to a
desire for defecation.
Thank You