acute appendicitis & npi_edmalyn gozar

8/14/2019 Acute Appendicitis & NPI_edmalyn Gozar

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BATANGAS REGIONAL HOSPITALBATANGAS REGIONAL HOSPITAL

AppendicitisAppendicitis

CASE STUDYCASE STUDY

In partial Fulfillment of the RequirementsIn partial Fulfillment of the Requirements

In Nursing Care Management 102In Nursing Care Management 102Presented to:Presented to:

Mrs. Annabelle Iturralde RN. MANMrs. Annabelle Iturralde RN. MAN

Presented by:Presented by:

BSN III - 5 Group CBSN III - 5 Group C

Edmalyn GozarEdmalyn Gozar


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I. IntroductionI. Introduction

Acute appendicitis is the inflammation of the appendixAcute appendicitis is the inflammation of the appendix

often cause by obstruction to its narrow opening, fallowed byoften cause by obstruction to its narrow opening, fallowed byswelling and bacterial infection. Acute appendicitis can lead toswelling and bacterial infection. Acute appendicitis can lead torupture of the organ, formation of an abscess or peritonitis.rupture of the organ, formation of an abscess or peritonitis.

Symptoms include abdominal pain (usually in RL abdomen)Symptoms include abdominal pain (usually in RL abdomen)nausea, vomiting and fever. Early surgical removal of thenausea, vomiting and fever. Early surgical removal of theappendix is essential; any abscess requires drainage of pus andappendix is essential; any abscess requires drainage of pus anddelayed removal.delayed removal.

Appendicitis is the most common abdominal emergencyAppendicitis is the most common abdominal emergency

found in children and young adults. One person in 15 developsfound in children and young adults. One person in 15 developsappendicitis in his or her lifetime. The incidence is highestappendicitis in his or her lifetime. The incidence is highestamong males aged 10 to 14. And among females aged 15 toamong males aged 10 to 14. And among females aged 15 to19. More males than females develop appendicitis between19. More males than females develop appendicitis betweenpuberty and aged 25. It is rare in infants and children under thepuberty and aged 25. It is rare in infants and children under the


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the aged of two. In the United States, appendicitis occur in

four out of 1000 children. It occurs in 5 to 6% of its

population.

I chose this case because I want to understand andhave more information about appendicitis. I am very much

curious on how an acute appendicitis developed and what

are the signs and symptoms accompanied it.


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II. ObjectivesII. Objectives

General ObjectivesGeneral Objectives

At the end of the study I will be able to acquire knowledge,At the end of the study I will be able to acquire knowledge,skills and attitude regarding my patients case.skills and attitude regarding my patients case.

Specific ObjectivesSpecific Objectives

My specific objectives are to:My specific objectives are to:

-Give an overview about the disease appendicitis.-Give an overview about the disease appendicitis.-Know the personal data of the client-Know the personal data of the client

-Perform the Physical Assessment-Perform the Physical Assessment

-Familiarize with different laboratory test and its significance-Familiarize with different laboratory test and its significanceto the diseaseto the disease

-Analyze the system that is being affected of this disorder-Analyze the system that is being affected of this disorder

-Know the factors that lead to appendicitis-Know the factors that lead to appendicitis

-Apply interventions that may help clients condition-Apply interventions that may help clients condition

-Know the drugs that the client is taking-Know the drugs that the client is taking

-Know the improvement of clients condition-Know the improvement of clients condition


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III. Patients ProfileIII. Patients Profile

Name:Name:Mrs. XMrs. XAge:Age: 39years old39years old

Sex:Sex: FemaleFemale

Birthday:Birthday: September 13,1969September 13,1969

Civil Status:Civil Status: FemaleFemale

Address:Address: Quilo, Ibaan BatangasQuilo, Ibaan BatangasNationality:Nationality: FilipinoFilipino

Religion:Religion: Iglesia ni CristoIglesia ni Cristo

Date of Admission:Date of Admission: Dec. 9,2008Dec. 9,2008

Physicians Name:Physicians Name: Dr. ReyesDr. ReyesChief Complaint:Chief Complaint: Two days prior to admission theTwo days prior to admission the clientclient

experienced RLQ pain,vomitingexperienced RLQ pain,vomiting fever and loss of appetitefever and loss of appetite

Admitting Diagnosis:Admitting Diagnosis: Acute AppendicitisAcute Appendicitis

Final Diagnosis:Final Diagnosis: Periappendecial abscessPeriappendecial abscess


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IV. ClinicalIV. ClinicalAppraisalAppraisal

On December 9, 2008, Mrs. X, a 39 years old wasOn December 9, 2008, Mrs. X, a 39 years old wasadmitted in Batangas Regional Hospital due to Acuteadmitted in Batangas Regional Hospital due to AcuteAppendicitis.Appendicitis.

A. Past Health HistoryA. Past Health HistoryAccording to Mrs. X, she completed her childhoodAccording to Mrs. X, she completed her childhood

immunization. She has no allergies to drugs, foodsimmunization. She has no allergies to drugs, foodsanimals or any insects bites. Mrs. X didnt experienceanimals or any insects bites. Mrs. X didnt experienceany accident or injury. According to her husband, sheany accident or injury. According to her husband, she

had history of Pulmonary Tuberculosis treated for sixhad history of Pulmonary Tuberculosis treated for sixmonths. Mrs. X experienced common illnesses likemonths. Mrs. X experienced common illnesses likefever, cough and cold. She used over the counter drugsfever, cough and cold. She used over the counter drugslike Paracetamol for fever, Solmux for cough andlike Paracetamol for fever, Solmux for cough andneosep for cold.neosep for cold.


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B. Family History

Mrs. X has 9 siblings and twin sister. She was blessed

with 5 children which are all boys. According to her she and

her relatives has low blood pressure. Her family has nohistory of diabetes, hypertension, heart diseases and asthma.

C. Personal History

Mrs. X was not choosy in her meal, she eat fish, meatspecially vegetables and fruits because it is available in the

farm. Mrs. X daily activities was cleaning the house, washing

clothes and manage their small sari-sari store. She had

enough sleep and resting hours.

D. Social History

Mrs. X and her family is living in a rural area. She finish

elementary and her husband finished high school. Mrs. X is

responsible in managing the house and their small


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sari-sari store, while Mr. X her husband is a farmer. Mrs. X

has a belief not to take a bath during her menstrual period.

According to her, before she was admitted to the hospital shehas a menstruation for 5 days and she didnt take a bath for

the said days. There is a health center available in their

community. She consulted first to their health center before

her husband decided to brought her to BRH.

E. Psychological History

According to Mrs. X, Her major stressor s their financial

status. It was very difficult for her to budget their monthly

income to support all their needs. To cope with this problemshe keeps on praying and asking God for more blessings and

assistance.


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F. History of Present Illness

Mrs. X brought to Batangas Regional Hospital last

December 9, 2008 because of experiencing abdominal pain,fever, vomiting and loss of appetite for 2 days. She was

diagnosed of having acute appendicitis and scheduled for

emergency appendectomy.


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V. Physical AssessmentV. Physical Assessment

Done: December 9, 2008; 7:35pmDone: December 9, 2008; 7:35pm

General Appearance StatusGeneral Appearance Status

Mrs. X is a newly admitted client. She is on supineMrs. X is a newly admitted client. She is on supineposition showing anxiety, body weakness, and pain feltposition showing anxiety, body weakness, and pain felt

on the RLQ of her abdomen.on the RLQ of her abdomen.

Vital Signs:Vital Signs:

Temperature: 38.1Temperature: 38.1CC

Pulse Rate: 72 Beats per minutePulse Rate: 72 Beats per minute

Respiratory Rate: 26 Breaths per minuteRespiratory Rate: 26 Breaths per minuteBlood Pressure: 100/60 mmHgBlood Pressure: 100/60 mmHg


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Body PartsBody Parts MethodMethod FindingsFindings AnalysisAnalysis

SkinSkin

HairHair

>Inspection>Inspection

PalpationPalpation

InspectionInspection

>Varies from>Varies fromlight to deeplight to deep

brownbrown>Good skin>Good skinturgorturgor

>Not tender>Not tender

>Short and>Short andblack withblack with

normalnormaldistributiondistribution

>Normal>Normal

>Normal>Normal

>Normal>Normal

>Normal>Normal


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ScalpScalp

HeadHead



>Palpation>Palpation

>Absence of>Absence ofseborrheaseborrhea

>No abrasion>No abrasion

>rounded,>rounded,

smooth skullsmooth skullcontourcontour

>Absence of>Absence of

masses ormasses ornodulesnodules

>Normal>Normal

>Normal>Normal

>Normal>Normal

>Normal>Normal


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FaceFace

NeckNeck

Thyroid GlandThyroid Gland


>Inspection &>Inspection &PalpationPalpation


>facial features>facial features& facial& facial

movements aremovements aresymmetricalsymmetrical

>no>noenlargement ofenlargement of

lymph nodeslymph nodes

>no>noenlargement ofenlargement of

thyroid glandthyroid gland

>Normal>Normal

>Normal>Normal

>Normal>Normal


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Body PartsBody Parts MethodsMethods FindingsFindings AnalysisAnalysis

EyesEyes

>Eyebrow>Eyebrow

>Eyelashes>Eyelashes

>Conjunctiva>Conjunctiva

EarsEars





>symmetrically>symmetrically

alignedaligned>hair evenly>hair evenlydistributeddistributed

>normal>normaldistributiondistribution

>Pink palpebral>Pink palpebral

conjunctivaconjunctiva

>Auricles are>Auricles arefirm & not tenderfirm & not tender

>Normal>Normal

>Normal>Normal

>Normal>Normal

>Normal>Normal

>Normal>Normal

B d P tB d P t M th dM th d Fi diFi di A l iA l i


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Body PartsBody Parts MethodsMethods FindingsFindings AnalysisAnalysis

NoseNose >Inspection>Inspection


>symmetrically>symmetricallyalignedaligned

>no discharges>no discharges

>color of the>color of theauricle is theauricle is thesame as the facesame as the face

>no discharges>no discharges

>symmetrically>symmetricallyalignedaligned

>color is the>color is the

same as the restsame as the restof the faceof the face

>not tender>not tender

>Normal>Normal

>Normal>Normal>Normal>Normal

>Normal>Normal

>Normal>Normal

>Normal>Normal

>Normal>Normal


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SinusesSinuses

MouthMouth

>Lips>Lips

>Tongue>Tongue

>Uvula>Uvula





>Frontal &>Frontal &maxillarymaxillary

sinuses are notsinuses are nottendertender

>uniform pink>uniform pinkcolor, smoothcolor, smoothtexturetexture

>moves freely &>moves freely &at the midlineat the midline

>at the midline>at the midline

>Normal>Normal

>Normal>Normal

>Normal>Normal

>Normal>Normal


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Chest andChest andLungsLungs

HeartHeart

>Inspection and>Inspection andAuscultationAuscultation

>Auscultation>Auscultation

>Equal chest>Equal chestexpansionexpansion

>Quiet, rhythmic>Quiet, rhythmic& effortless& effortlessrespirationrespiration

>Tachypnic 26>Tachypnic 26

bpmbpm

>65 beats per>65 beats perminuteminute

>no murmur>no murmur

>Normal>Normal

>Normal>Normal

>May be normal>May be normalresponse to feverresponse to feverand anxietyand anxiety

>Normal>Normal

>Normal>Normal


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Body partsBody parts MethodMethod FindingsFindings AnalysisAnalysis

AbdomenAbdomen >Inspection>Inspection

>Auscultation>Auscultation

>Percussion>Percussion


>Uniform color>Uniform color

>audible bowel>audible bowel

sound, absencesound, absenceof arterial bruitof arterial bruit

>Tympanic>Tympanicsound heardsound heard

>Flat and not>Flat and nottendertender

>Tenderness on>Tenderness onRLQ notedRLQ noted

>Normal>Normal

>Normal>Normal

>Normal>Normal

>Normal>Normal

>Abnormal. Due>Abnormal. Dueto inflammationto inflammationof the appendix.of the appendix.


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Upper extremitiesUpper extremities

>Hands>Hands

>Pulse>Pulse

>Nails>Nails

Lower extremitiesLower extremities





>Presence of IV>Presence of IVfluidfluid

>distal pulses are>distal pulses arepalpablepalpable

>Pink in color>Pink in color

>Long dirty nails>Long dirty nails

>No edema>No edema

>Abnormal. Fluids>Abnormal. Fluidsare regulated toare regulated topreventpreventdehydration and todehydration and toprovide access forprovide access foradministration ofadministration ofmedication.medication.

>Normal>Normal>Abnormal. Due to>Abnormal. Due topoor hygiene.poor hygiene.

> Normal> Normal


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Summary of Physical AssessmentSummary of Physical Assessment

She is a newly admitted client. Physical Assessment wasShe is a newly admitted client. Physical Assessment wasdone by inspection, palpation, percussion anddone by inspection, palpation, percussion and

auscultation. This will serve as a baseline guide for herauscultation. This will serve as a baseline guide for her

progress.progress.

As I assessed her general appearance I noticed herAs I assessed her general appearance I noticed her

weak appearance, feeling anxious and pain felt on herweak appearance, feeling anxious and pain felt on her

abdomen.abdomen.

Her temperature was above normal due to theHer temperature was above normal due to the

inflammation of the appendix. Her respiratory rate wasinflammation of the appendix. Her respiratory rate was

increase it was a normal response to fever and anxiety.increase it was a normal response to fever and anxiety.Upon inspecting I noticed her dirty long nails whichUpon inspecting I noticed her dirty long nails which

indicates poor hygiene. She was tachypniec, it was aindicates poor hygiene. She was tachypniec, it was a

normal response to fever and anxiety.normal response to fever and anxiety.


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Upon palpation tenderness on the RLQ was noted. It

was abnormal because it indicates inflammation of the

appendix. Upon inspecting her hand I noticed that there is apresence of IV fluid on her right hand. It is abnormal

because IV fluid are regulated to prevent dehydration and

provide access for administration of medication.


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Laboratory and Diagnostic TestLaboratory and Diagnostic Test

Urinalysis Done: Dec. 9, 2008Urinalysis Done: Dec. 9, 2008

Color: dark yellowColor: dark yellowSugar: negativeSugar: negative Albumin: Plus 2 (++)Albumin: Plus 2 (++)

Pus Cells: 4-6/hpf Reaction: 6 acidicPus Cells: 4-6/hpf Reaction: 6 acidic

RBC: too numerous to countRBC: too numerous to count

Sp. Gravity: 1.015Sp. Gravity: 1.015

character: slightly turbidcharacter: slightly turbid


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Blood Chemistry Done: Dec. 9, 2008Blood Chemistry Done: Dec. 9, 2008

Description Ref. Value ResultDescription Ref. Value Result AnalysisAnalysis

ErythroctesErythroctes M:4.6-6.28x10/L 2.24M:4.6-6.28x10/L 2.24 decrease. It indicates anemiadecrease. It indicates anemia

F:4.2-5.4F:4.2-5.4 or dietary deficiencyor dietary deficiencyHgbHgb M:140-180g/dl 127.2M:140-180g/dl 127.2 normalnormal

F:120-140F:120-140

HctHct M:0.40-0.54 0.377M:0.40-0.54 0.377 normalnormal

F:0.38-0.47F:0.38-0.47

LeukocyteLeukocyte 4.5-11x10/L 26.004.5-11x10/L 26.00 increase. It indicatesincrease. It indicates

infection or inflammationinfection or inflammation

NeutrophilsNeutrophils 45-65%45-65% 0.8690.869 increase. It indicatesincrease. It indicates

inflammation.inflammation.

Eosinophils 1-3%Eosinophils 1-3% 0.012 decrease. It indicates0.012 decrease. It indicates

increase adrenosteroidincrease adrenosteroid

production.production.

Basophils 0-1%Basophils 0-1% 0.0070.007 decrease in acute phase ofdecrease in acute phase of

infection.infection.

LymphocytesLymphocytes 25-40%25-40% .052.052 decrease. Indicate leukemiadecrease. Indicate leukemia

Monocyte 3-7%Monocyte 3-7% .060.060 decrease may be due to drugdecrease may be due to drug

therapytherapy


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Thrombocyte 150-400x10/L 348 normal

MCH 27-31 pg 29.99 normal

MCV 80-96 f1 88.80 normal

MCHC .32-.36 .34 normalRDW 11.5-14.5 10% normal

Dec. 10, 2008

Sodium 135-148mmol/L 140.3 normal

Potassium 3.5-5.5mmol/L 2.96 decrease. It indicates

hypokalemia.

Dec. 12, 2008

Sodium 135-148mmol/L 150.2 increase. It

indicates hypernatremia.

Potassium 3.5-5.5mmol/L 4.28 normal


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Summary of Diagnostic and Laboratory ResultSummary of Diagnostic and Laboratory Result

As the laboratory result has been released it showsAs the laboratory result has been released it shows

some abnormalities in the blood. The erythrocyte issome abnormalities in the blood. The erythrocyte isdecreased which indicates anemia and dietary deficiency.decreased which indicates anemia and dietary deficiency.

The patients hematocrit and hemoglobin are normal. TheThe patients hematocrit and hemoglobin are normal. The

leukocytes is elevated because it fight infection and defendleukocytes is elevated because it fight infection and defend

the body by the process called phagocytosis. Thethe body by the process called phagocytosis. The

neutrophils which is the most numerous and important typeneutrophils which is the most numerous and important typeof leukocytes in the body's reaction to inflammation suchof leukocytes in the body's reaction to inflammation such

as appendicitis was elevated. Decrease circulatingas appendicitis was elevated. Decrease circulating

eosinophil is usually cause by increase adrenal steroideosinophil is usually cause by increase adrenal steroid

production that accompanies most conditions of bodilyproduction that accompanies most conditions of bodilystress and is associated with Acute bacterial infection withstress and is associated with Acute bacterial infection with

a marked shift to the left. Basophils is decrease in acutea marked shift to the left. Basophils is decrease in acute

phase of infection and may indicate hyperthyroidism.phase of infection and may indicate hyperthyroidism.

Lymphocyte is decrease which indicate leukemia.Lymphocyte is decrease which indicate leukemia.


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The other blood component are normal. The dark yellow

urine may indicate bilirubin in the urine. Slight turbid may

indicate UTI. The Potassium was decrease which indicateelectrolyte imbalance such as hypokalemia. The sodium was

increase which indicate hypernatremia.


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VII. AnatomyVII. AnatomyandandPhysiologyPhysiology
http://rds.yahoo.com/_ylt=A0S020yFoUhJWAkA5r.JzbkF;_ylu=X3oDMTBpZTByOGFiBHBvcwMyBHNlYwNzcgR2dGlkAw--/SIG=1in3s1eoq/EXP=1229583109/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Ffr2%253Dsg-gac%2526sado%253D1%2526p%253Dappendix%2526fr%253Dyfp-t-501%2526ei%253Dutf-8%2526x%253Dwrt%26w=400%26h=320%26imgurl=www.walgreens.com%252Flibrary%252Fgraphics%252Fimages%252Fen%252F1128.jpg%26rurl=http%253A%252F%252Fwww.walgreens.com%252Flibrary%252Fcontents.jsp%253Fdocid%253D000170%2526doctype%253D10%26size=17.2kB%26name=1128.jpg%26p=appendix%26type=JPG%26oid=6a999e78ec30699c%26no=2%26tt=417,775%26sigr=125g17i34%26sigi=11l4gin10%26sigb=135huq01v


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The appendix (orvermiform appendix; also cecal

(or caecal) appendix; also vermix) is a blind ended tube

connected to the cecum (or caecum), from which it develops

embryologicallly. The cecum is a pouch-like structure of thecolon. The appendix is near the junction of the small intestine

and the large intestine.The term "vermiform" comes from

Latin and means "worm-like in appearance".

The appendix averages 10 cm in length, but can range

from 2 to 20 cm. The diameter of the appendix is usually

between 7 and 8 mm. The longest appendix ever removed

measured 26 cm in Zagreb, Croatia. The appendix is located

in the lower right quadrant of the abdomen, or morespecifically, the right iliac fossa. Its position within the

abdomen corresponds to a point on the surface known as

McBurney's point. While the base of the appendix is at a

fairly constant location, 2 cm below the ileocaecal valve,


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the location of the tip of the appendix can vary from being

retrocaecal (74%) to being in the pelvis to being extra

peritoneal. In rare individuals with situs inversus, the

appendix may be located in the lower left side.


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VIII. PathophysiologyVIII. Pathophysiology

Non Modifiable Factor Modifiable

Obstruction of the lumen

ACUTE APPENDICITIS

Diet

Obstruction of the outflow of the secretion

Increase mucosal secretions Increase intraluminal pressure

Distention of the appendix

Inflammation of the appendix

Localized Peritonitis

Periappendiceal Abscess

Abdominal pain

Tenderness on RLQFever, vomiting

Loss of appetite

Age Gender


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Summary of PathophysiologySummary of Pathophysiology

Appendicitis is the most common cause emergency,Appendicitis is the most common cause emergency,

abdominal surgery. It develops when the lumen of theabdominal surgery. It develops when the lumen of the

appendix becomes obstructed, usually by fecalith, foreignappendix becomes obstructed, usually by fecalith, foreign

body or tumors. The obstructed lumen does not allowbody or tumors. The obstructed lumen does not allow

drainage of the appendix and the mucosal secretionsdrainage of the appendix and the mucosal secretions

continues, intraluminal pressure increases. The resultantcontinues, intraluminal pressure increases. The resultantincrease pressure decreases mucosal blood flow and theincrease pressure decreases mucosal blood flow and the

appendix becomes hypoxic. The obstructed appendixappendix becomes hypoxic. The obstructed appendix

become distended because of continued secretion of mucusbecome distended because of continued secretion of mucus

by the lining cell. Typically acute appendicitis progressesby the lining cell. Typically acute appendicitis progressesfrom obstruction of the lumen and distention of the appendixfrom obstruction of the lumen and distention of the appendix

to spreadto spread


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Of the inflammation beyond the appendix. The inflammatoryOf the inflammation beyond the appendix. The inflammatory

process increases intraluminal pressure, initiating aprocess increases intraluminal pressure, initiating a

progressively severe generalized or upper abdominal painprogressively severe generalized or upper abdominal pain

which within a few hours becomes localized in the RLQ ofwhich within a few hours becomes localized in the RLQ ofthe abdomen. The pain is usually accompanied by a lowthe abdomen. The pain is usually accompanied by a low

grade fever, nausea and often vomiting. Local tenderness isgrade fever, nausea and often vomiting. Local tenderness is

noted when pressure is applied and loss of appetite isnoted when pressure is applied and loss of appetite is

common.common.Initially there is a localized peritonitis confined to theInitially there is a localized peritonitis confined to the

area of the appendix. If unrecognized and untreated, thisarea of the appendix. If unrecognized and untreated, this

may lead to rupture and abscess.may lead to rupture and abscess.


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IX. Nursing Care ProcessIX. Nursing Care Process

AssessmentAssessment Nursing DiagnosisNursing DiagnosisS> Parang nahihiwa ang tyanS> Parang nahihiwa ang tyanko ko

O>facial grimace connotesO>facial grimace connotespain.pain.

>weak appearance>weak appearance

>pain scale 6/10>pain scale 6/10

>provokes pain when moving>provokes pain when moving>dull pain>dull pain

>RLQ of the abdomen>RLQ of the abdomen

>intermittent>intermittent

Acute pain related to surgicalAcute pain related to surgicalincision.incision.


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Scientific ExplanationScientific Explanation PlanningPlanning

Usually a recent onset associates aUsually a recent onset associates aspecific injury, acute pain indicates thatspecific injury, acute pain indicates that

cause pain may heal spontaneously orcause pain may heal spontaneously ormay require treatment. The systemmay require treatment. The systeminvolved in the perception of pain isinvolved in the perception of pain isreferred to as nociceptal system. Thereferred to as nociceptal system. Thesensitivity of this system component cansensitivity of this system component canbe affected by several factors and maybe affected by several factors and may

differ among individuals. A stimulus maydiffer among individuals. A stimulus mayresult on pain at one time but not inresult on pain at one time but not inanother. Pain receptors are free nerveanother. Pain receptors are free nerveendings in the skin that respond only toendings in the skin that respond only tointense potentially damaging stimuli. Aintense potentially damaging stimuli. Anumber of algogenic substances that affectnumber of algogenic substances that affectthe sensitivity of nociceptors are releasedthe sensitivity of nociceptors are releasedinto the extra cellular tissue as a result ofinto the extra cellular tissue as a result oftissue damage. (Medical Surgical Nursingtissue damage. (Medical Surgical NursingSmeltzer et. al pp. 264)Smeltzer et. al pp. 264)

After 2 hours of nursingAfter 2 hours of nursingintervention the client levelintervention the client level

of pain from 6/10 will beof pain from 6/10 will beminimized into tolerableminimized into tolerablelevel.level.


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Nursing InterventionsNursing Interventions RationaleRationale

> V/s taken and recorded.> V/s taken and recorded.

> Noted location of surgical> Noted location of surgicalprocedure.procedure.

>Used pain rating scale for>Used pain rating scale foraged/cognition. (6/10)aged/cognition. (6/10)

>Accepted client description>Accepted client descriptionof pain. (dull)of pain. (dull)

> To establish baseline data.> To establish baseline data.(NANDA, Doenges et. Al)(NANDA, Doenges et. Al)

>This can influence the amount>This can influence the amountof postoperative painof postoperative painexperienced.experienced. (NANDA Doenges et. Al)(NANDA Doenges et. Al)

>It assist the patients perception>It assist the patients perceptionof pain.of pain.(NANDA Doenges et al)(NANDA Doenges et al)

> Pain is subjective and cannot> Pain is subjective and cannot

be felt by others.be felt by others. ( NANDA Doenges( NANDA Doengeset al)et al)


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Provided comfort measuresProvided comfort measuressuch as therapeutic touchsuch as therapeutic touch

and repositioning.and repositioning.

Administered painAdministered painmedication as ordered.medication as ordered.

KotorolacKotorolac

Tromethamine 30 mg IV q8.Tromethamine 30 mg IV q8.

Adminisred IV fluid asAdminisred IV fluid asordered.ordered.

>>Promotes relaxation and mayPromotes relaxation and mayenhance patients coping abilitiesenhance patients coping abilities

by refocusing attention.by refocusing attention. ( NCP 6th( NCP 6thedition Doenges et al)edition Doenges et al)

>Reduce metabolic rate and>Reduce metabolic rate andintestinal irritation from circulating/intestinal irritation from circulating/

local toxins, which aids in painlocal toxins, which aids in painrelief and promotes healing.relief and promotes healing.(NANDA Doenges et al)(NANDA Doenges et al)

>>Maintain Hydration and providesMaintain Hydration and provides

access for administration ofaccess for administration ofmedications.medications.(Delmar's Critical Care NCP(Delmar's Critical Care NCPSheree Comer)Sheree Comer)


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> placed the patient in high> placed the patient in highfowler position.fowler position.

>This position reduces the>This position reduces thetension on the incision andtension on the incision and

abdominal organs helping toabdominal organs helping toreduce pain.reduce pain.(Medical Surgical(Medical SurgicalNursing Smeltzer et al)Nursing Smeltzer et al)


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EvaluationEvaluationThe clients level of pain was minimized asThe clients level of pain was minimized as

evidence by pain scale of 4/10.evidence by pain scale of 4/10.


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AssessmentAssessment Nursing DiagnosisNursing Diagnosis

S> Kinakabahan ako dahilS> Kinakabahan ako dahil

operasyon ko na mamaya.operasyon ko na mamaya.

O>voice quiveringO>voice quivering

>anxious>anxious

>restless>restless>poor eye contact>poor eye contact

>increase respiration>increase respiration

Anxiety related toAnxiety related to

preoperative procedure.preoperative procedure.


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Vague uneasy feeling ofVague uneasy feeling of

discomfort or drieddiscomfort or driedaccompanied by anaccompanied by anautonomic response (theautonomic response (thesource often non specific orsource often non specific orunknown to the individual); aunknown to the individual); a

feeling of apprehensionfeeling of apprehensioncaused by anticipation ofcaused by anticipation ofdanger. It is an altering signaldanger. It is an altering signalthat warns of impendingthat warns of impendingdanger and enables thedanger and enables the

individual to take measures toindividual to take measures todeal with treat. (NANDAdeal with treat. (NANDADoenges et al)Doenges et al)

After an hour of nursingAfter an hour of nursing

intervention the clients anxietyintervention the clients anxietywill be lessened in a tolerablewill be lessened in a tolerablelevel.level.


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V/s taken and recorded.V/s taken and recorded.

Provided accurateProvided accurateinformation about the situation.information about the situation.

Observed behaviors.Observed behaviors.

To identify physicalTo identify physicalresponses associated withresponses associated with

both physical and emotionalboth physical and emotionalconditions.conditions. (NANDA Doenges et al)(NANDA Doenges et al)

Helps client to identify what isHelps client to identify what isreality based.reality based.(NANDA Doenges et(NANDA Doenges etal)al)

Can point the client level ofCan point the client level ofconsciousness.consciousness.(NANDA Doenges(NANDA Doengeset al)et al)


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>Stayed with client,>Stayed with client,maintaining a calm, confidentmaintaining a calm, confident

manner.manner.

> Provided preoperative> Provided preoperativeeducation. Discuss routineeducation. Discuss routine

procedures that frightenedprocedures that frightenedthe patient.the patient.

> To decrease anxiety and> To decrease anxiety andprovide comfort.provide comfort. (NANDA Doenges et(NANDA Doenges et

al)al)

>Can provide reassurance and>Can provide reassurance andalleviate patients anxiety as wellalleviate patients anxiety as well

as provide information foras provide information forformulating intraoperative care.formulating intraoperative care.(NANDA Doenges et al)(NANDA Doenges et al)


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EvaluationEvaluationThe clients anxiety was lessened asThe clients anxiety was lessened as

evidenced by being able to communicate herevidenced by being able to communicate herfeeling to her significant others.feeling to her significant others.


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AssessmentAssessment Nursing DiagnosisNursing Diagnosis

O>T: 38.1 CO>T: 38.1 C

>warm to touch>warm to touch>weak>weak

>teary eyed>teary eyed

Elevated body temperatureElevated body temperaturerelated to inflammation of therelated to inflammation of theappendix.appendix.

S i ifi E l i Pl i


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Inflammation is a local andInflammation is a local andnon specific defensivenon specific defensive

response of the tissues to anresponse of the tissues to aninjurious or an infectiousinjurious or an infectiousagent. It is an adaptiveagent. It is an adaptivemechanisms that destroys ormechanisms that destroys ordilutes a injurious agent,dilutes a injurious agent,

prevents further spread of theprevents further spread of theinjury, and promotes the repairinjury, and promotes the repairof damage tissue. Theof damage tissue. Theinflammatory process causesinflammatory process causes

elevation of the bodyelevation of the bodytemperature to fight infection.temperature to fight infection.(Fundamentals of Nursing,(Fundamentals of Nursing,Kozier et al page 634)Kozier et al page 634)..

After 2 hour of nursingAfter 2 hour of nursingintervention the clients bodyintervention the clients body

temperature will decrease totemperature will decrease tonormal range.normal range.

N i I t ti R ti l


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>Monitored the client>Monitored the clienttemperature.temperature.

>Provided tepid sponge bath.>Provided tepid sponge bath.

> Monitored use of Hypothermia> Monitored use of Hypothermiablanket and wrap extremitiesblanket and wrap extremitieswith bath towels.with bath towels.

>provide information about the>provide information about theeffectiveness of care.effectiveness of care. (NANDA(NANDA

Doenges et al)Doenges et al)

>To increase heat loss through>To increase heat loss throughconduction.conduction. (Fundamentals of(Fundamentals ofNursing 8th edition Kozier et al)Nursing 8th edition Kozier et al)

>To minimize shivering.>To minimize shivering.(NANDA(NANDADoenges et al)Doenges et al)

N i I t tiN i I t ti R ti lR ti l


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>Reduced physical activity.>Reduced physical activity.

>Maintained and regulated IV>Maintained and regulated IVfluid as ordered.fluid as ordered.

D5 LR 1L@30 gtts/minD5 LR 1L@30 gtts/min

>Administered antipyretic>Administered antipyreticmedicine as ordered.medicine as ordered.

Paracetamol 300 mg IV q6.Paracetamol 300 mg IV q6.

>To limit heat production.>To limit heat production.(Fundamentals of nursing 8(Fundamentals of nursing 8thth editioneditionKozier et al)Kozier et al)

>To met the increase>To met the increasemetabolic demand and preventmetabolic demand and preventdehydrationdehydration.. (Fundamentals of(Fundamentals ofnursing 8nursing 8thth edition Kozier et al)edition Kozier et al)

> May relieve fever through> May relieve fever throughcentral action to thecentral action to thehypothalamic regulatinghypothalamic regulatingcenter.center.(Nursing 2008 Drug Handbook(Nursing 2008 Drug Handbook

Williams and Wilkins)Williams and Wilkins)


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EvaluationEvaluationThe clients body temperature back toThe clients body temperature back to

normal range.normal range.


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X. Drug StudyX. Drug Study

Drug NameDrug Name Classification and MechanismClassification and Mechanismof Actionof Action

Generic Name:

Cefoxitine Sodium

Dose:1g

Route:

Through IV

Frequency:

q8

Anti-infective DrugsAnti-infective Drugs

Second generationSecond generationcephalosporins that inhibitscephalosporins that inhibitscell wall synthesis, promotingcell wall synthesis, promotingosmotic instability: usuallyosmotic instability: usuallybactericidal.bactericidal.


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IndicationIndication Adverse ReactionAdverse Reaction

>Perioperative prevention. CNS: feverCNS: fever

CV: hypotentionCV: hypotentionGI: nausea and vomotingGI: nausea and vomoting

Hematologic:Hematologic:

Thrombocytopenia, transientThrombocytopenia, transient

neutropenia, eosinophilia,neutropenia, eosinophilia,hymolitic anemia, anemiahymolitic anemia, anemia

Respiratory: DyspneaRespiratory: Dyspnea


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ContraindicationContraindication Nursing ResponsibilitiesNursing Responsibilities

>Contraindicated in

patients hypersensitive todrugs and othercephalosporin's.

>Use cautiously in patientshypersensitive to penicillin

because of possibility odcross sensitivity to withother beta lactamantibiotics.

>Tell the patient to report>Tell the patient to report

adverse reactions and s/s ofadverse reactions and s/s ofsuper infection.super infection.

>Instructed the patient to>Instructed the patient toreport discomfort at IV site.report discomfort at IV site.

>Advise patient to notify>Advise patient to notifyprescriber about loose stoolsprescriber about loose stoolsor diarrhea.or diarrhea.


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Monitoring ParametersMonitoring Parameters>May increase alkaline phosphate, ALT,

AST,bilirubin and LDH levels. May decreasehemoglobin level.

> May increase eosiniphil count. May decreaseneutrophil and platelet count.

Drug NameDrug Name Classification & Mechanism of actionClassification & Mechanism of action


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gg

Generic Name:Generic Name:

Acetaminophen (APAPAcetaminophen (APAP

Paracetamol)Paracetamol)

Dose:Dose:

300mg300mg

Route:Route:

IVIV

Frequency:Frequency:q6q6

Nonophioid AnalgesicsNonophioid Analgesicsand antipyreticsand antipyretics

Thought to produceThought to produceanalgesia by blocking painanalgesia by blocking painimpulses by inhibiting synthesisimpulses by inhibiting synthesisof prostaglandin in the CNS orof prostaglandin in the CNS orof other substances thatof other substances that

synthesize pain receptors tosynthesize pain receptors tostimulation. The drug maystimulation. The drug mayrelieve fever through centralrelieve fever through centralaction in the hypothalamicaction in the hypothalamicregulatory center.regulatory center.

IndicationIndication Adverse ReactionAdverse Reaction


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d cat o d e se eact o

>Mild pain or fever>Mild pain or fever Hematologic: hymolitic anemia,Hematologic: hymolitic anemia,leukopenia, pancytophenia.leukopenia, pancytophenia.

Hepatic: jaundiceHepatic: jaundiceMetabolic: hypoglycemiaMetabolic: hypoglycemia

CC t i di ti


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ContraindicationContraindication

>Contraindicated to patients hypersensitive to drugs.>Contraindicated to patients hypersensitive to drugs.

>Use cautiously in patient with long term alcohol use>Use cautiously in patient with long term alcohol usebecause therapeutic dose can cause hepatotoxicity inbecause therapeutic dose can cause hepatotoxicity inthese patients.these patients.

Nursing ResponsibilitiesNursing Responsibilities Monitoring ParametersMonitoring Parameters


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g pg p gg

> Advice patient and> Advice patient andcaregiver that many OTCcaregiver that many OTCproducts containproducts containacetaminophen and shouldacetaminophen and shouldbe counted when calculatingbe counted when calculatingtotal daily dose.total daily dose.

> Tell patient not to used for> Tell patient not to used for

marked fever (temperaturemarked fever (temperaturehigher than 103 F.higher than 103 F.

>Warn patient that high>Warn patient that highdoses or unsupervised longdoses or unsupervised longterm used can cause liverterm used can cause liverdamage. Excessive alcoholdamage. Excessive alcoholused may increase the risk ofused may increase the risk ofliver damage.liver damage.

>May decrease glucose and>May decrease glucose andhgb levels and hct.hgb levels and hct.

>May decrease nuetrophils,>May decrease nuetrophils,WBC, RBC, and platelet count.WBC, RBC, and platelet count.

Drug NameDrug Name Classification & Mechanism ofClassification & Mechanism of


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ggactionaction

Generic Name:Generic Name:

KetorolacKetorolac

Dose:Dose:

30mg30mg

Route:Route:

Through IVThrough IV

Frequency:Frequency:q8q8

Nonsteroidal InflammatoryNonsteroidal InflammatoryDrugs (NSAIDs)Drugs (NSAIDs)

May inhibit prostaglandinMay inhibit prostaglandinsynthesis, to produce anti-synthesis, to produce anti-inflammatory, analgesics andinflammatory, analgesics andanti pyretic effects.anti pyretic effects.

IndicationIndication Side EffectsSide Effects


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Short term management ofShort term management ofmoderately severe, acutemoderately severe, acute

pain for single dose treatmentpain for single dose treatment

CNS: headache, dizziness,CNS: headache, dizziness,drowsiness, sedationdrowsiness, sedation

CV: arrythmias, edema,CV: arrythmias, edema,hypertension, palpitationshypertension, palpitations

GI: dyspepsia, GI pain, nausea,GI: dyspepsia, GI pain, nausea,constipation, diarrhea,constipation, diarrhea,flatulence, peptic ulceration,flatulence, peptic ulceration,vomiting, stomatitisvomiting, stomatitis

Skin: rash, pruritis, diaphoresisSkin: rash, pruritis, diaphoresis

Hematologic: decreasedHematologic: decreasedplatelet adhesion, prolongedplatelet adhesion, prolonged

bleeding time, purpurableeding time, purpuraOther: pain in the injection siteOther: pain in the injection site



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Contraindicated in patientsContraindicated in patientshypersensitive to drugs andhypersensitive to drugs and

in those with active pepticin those with active pepticulcer disease and recent GIulcer disease and recent GIbleedingbleeding

Contraindicated asContraindicated asprophylactic analgesic beforeprophylactic analgesic beforemajor surgery ofmajor surgery ofintraoperatively whenintraoperatively whenhemostasis is criticalhemostasis is critical

Use cautiously in patientsUse cautiously in patients

who are elderly or havewho are elderly or havehepatic or renal impairmenthepatic or renal impairment

Correct hypovolemiaCorrect hypovolemiabefore givingbefore giving

Dont give epidurallyDont give epidurallybecause of alcohol contentbecause of alcohol content

NSAIDs may mask signNSAIDs may mask signand symptoms of infectionand symptoms of infection

because of their antipyreticbecause of their antipyreticand anti inflammatoryand anti inflammatoryactionsactions

Serious GI toxicitySerious GI toxicityincluding bleeding and pepticincluding bleeding and peptic

ulcers, can occur in patientsulcers, can occur in patientstaking NSAIDs, despite lacktaking NSAIDs, despite lackof symptomsof symptoms


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ContraindicationContraindication Nursing ResponsibilitiesNursing Responsibilities Contraindicated to childrenContraindicated to childrenyounger than age of two andyounger than age of two andin patients with history ofin patients with history of

peptic ulcer disease, pastpeptic ulcer disease, pastallergic reactions to aspirinallergic reactions to aspirinand during labor and deliveryand during labor and deliveryor breastfeedingor breastfeeding

Carefully observe patientsCarefully observe patientswith coagulopathies and thosewith coagulopathies and thosetaking anticoagulantstaking anticoagulants


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Monitoring ParametersMonitoring Parameters

May increase ALT and AST levelMay increase ALT and AST level

May increase bleeding timeMay increase bleeding time


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XI. PrognosisXI. Prognosis

After four days of confinement at Batangas RegionalAfter four days of confinement at Batangas Regional

Hospital the client prognosis is good because the patientHospital the client prognosis is good because the patient

was recovering well after the surgery. According to thewas recovering well after the surgery. According to the

doctor the patient will be discharge after three moredoctor the patient will be discharge after three more

days.days.


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XII. Discharge PlanningXII. Discharge Planning

M- Instructed the significant others to continue giving theM- Instructed the significant others to continue giving thepatients medications as ordered.patients medications as ordered.

1. Paracetamol 30 mg as necessary for fever.1. Paracetamol 30 mg as necessary for fever.

2. Ketorolac 30 mg three times a day2. Ketorolac 30 mg three times a day

3. Metronidazole 500 mg three times a day3. Metronidazole 500 mg three times a day

E- Advised the client to exercise in moderation with aE- Advised the client to exercise in moderation with agradual build up in intensity. Explained to the client that hergradual build up in intensity. Explained to the client that hernormal activity can be resumed after 2 to 4 weeks.normal activity can be resumed after 2 to 4 weeks.

T-Instructed the significant others to cleanse and change theT-Instructed the significant others to cleanse and change thedressing of the client wound regularly.dressing of the client wound regularly.

H-Instructed the significant others to always bath the patientH-Instructed the significant others to always bath the patient

but avoid soaking the wound in the water.but avoid soaking the wound in the water.


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Advised the patient to always cut the nails. InstructedAdvised the patient to always cut the nails. Instructed

the significant others to provide clean and safethe significant others to provide clean and safe

environment for the clients early recovery.environment for the clients early recovery.

O- Instructed the patient to have a follow up check up toO- Instructed the patient to have a follow up check up to

Dr. Reyes after one week for the removal of the sutures.Dr. Reyes after one week for the removal of the sutures.

D- Instructed to eat foods rich in protein and Vit. C.D- Instructed to eat foods rich in protein and Vit. C.

S- Advised the client to strengthen her faith in GOD.S- Advised the client to strengthen her faith in GOD.

Because Jesus is the only source of healing.Because Jesus is the only source of healing.

S- Provided health teaching of sexual responsibility.S- Provided health teaching of sexual responsibility.

A k l d t


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AcknowledgementAcknowledgement

I would like to extend my deepest andI would like to extend my deepest and

heartfelt gratitude to all those people who helpedheartfelt gratitude to all those people who helped

and supported me while Im doing this study.and supported me while Im doing this study.

First of all to our Almighty God for theFirst of all to our Almighty God for the

strength ,knowledge and wisdom He gave me whilestrength ,knowledge and wisdom He gave me while

I doing this study.I doing this study.To my parents who always there for me andTo my parents who always there for me and

supported me emotionally and financially.supported me emotionally and financially.

To my dear clinical instructor, Mrs. AnnabelleTo my dear clinical instructor, Mrs. Annabelle

Iturralde for sharing us her knowledge and guidingIturralde for sharing us her knowledge and guidingus in the clinical area.us in the clinical area.

To the staff of the IMC, for allowing me toTo the staff of the IMC, for allowing me toborrow books and use their internet.borrow books and use their internet.


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To all my friends, classmates, and group mates for all

the ideas and advices you shared to me.

To all of you THANK YOU SO MUCH ANDGODBLESS.

Bibliograph


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Bibliography

Delmar's Critical Care NCP Sheree ComerDelmar's Critical Care NCP Sheree Comer

Essentials Anatomy and Physiology by Seeley, Tate & Stephens

Fundamentals of Nursing, Kozier et alFundamentals of Nursing, Kozier et al

Laboratory and Diagnostic Test with Nursing Implication;7th edition by Joyce Lefever Lee

Medical Surgical Nursing 7th edition by Joyce Black & Jane Hokanson

Medical Surgical Nursing 8th edition by Brunner & Suddarths

Medical Surgical Nursing Smeltzer et. alMedical Surgical Nursing Smeltzer et. al

NCP 6th edition Doenges et alNCP 6th edition Doenges et alMIMS17th edition2005

NANDA Doenges et al

Nursing Care Plan 7th edition by Marilynn Doenges et.al

Nursing Drug Handbook 28th edition

Nursing 2008 Drug Handbook Williams and WilkinsNursing 2008 Drug Handbook Williams and Wilkins

Electronic References

www.yahoo.com


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Nurse Patient InteractionNurse Patient Interaction

Therapeutic CommunicationTherapeutic Communication

>it promotes understanding and helped establish a>it promotes understanding and helped establish aconstructive relationship between the nurse and theconstructive relationship between the nurse and the

client.client.

>Unlike the social relationship, where there may not>Unlike the social relationship, where there may not

be a specific purpose or direction, the therapeuticbe a specific purpose or direction, the therapeutic

helping relationship is client and goal oriented.helping relationship is client and goal oriented.

Therapeutic communications technique


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Therapeutic communications technique

1.Using silence Accepting pauses or silences that may extend for several

seconds or minutes without interjecting any verbal response.

Ex. Sitting quietly and waiting attentively until the client is able toput thoughts and feelings into words.

2.Providing general leads Using statements or questions that encourage

the person to verbalize , choose a topic of conversation and facilitate

continued verbalization.Ex. Can you tell me how it is for you?

Perhaps you would like to talk about

And then what.

3.Being specific and tentative Making statements that are specific ratherthan general and tentative rather than absolute.

Ex. Rate your pain on a scale of 0-10. (specific statements)

Are you in pain? (general statements)

4.Using open ended question asking broad questions that lead or invite


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the client to explore thoughts and feelings.

Ex. Id like to hear more about that.

Tell me about

How have you been feeling lately?

5.Using touch providing appropriate form of touch to reinforce caring

feelings.

Ex. Putting an arm over the clients shoulder. Putting your hand

over the clients hand.

6.Restating or paraphrasing Actively listening to the clients basic

message and then repeating those thoughts or feeling in similar words.

Ex. Client: I couldn't manage to eat any dinner last night not

even the dessert.

Nurse: You had difficulty eating yesterday.

7. Seeking clarification A method of making a clients broad overall

meaning of the message more understandable.

Ex. Im puzzled.

Im not sure I understand that.

8.Perception checking or seeking conceptual validation A method similar


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p g g p

to clarifying that verifies the meaning of specific words rather than the

overall meaning of the message.

Ex. Client: My husband never gives me any present

Nurse: You mean he has never given you a present for yourbirthday or Christmas?

9.Offering Self Suggesting ones presence, interest or wish to understand

the client without making any demands or attaching conditions that the

client must comply with to receive the nurses attention.Ex. Ill stay with you until your daughters arrives.

Ill helped you to dress to go home if you like.

10.Giving Information Providing in a simple and direct manner , specific

factual information the client may or may not request.

Ex. Your surgery is scheduled for 11 am tomorrow.

11.Acknowledging Giving recognition , in a non judgmental way, of a

change of behavior, an effort the client has made, or a contribution to a

communication.

Ex. You trimmed your beard and mustache and washed your hair.

12 Cl if i ti H l i th li t l if t


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12. Clarifying time or sequence Helping the client clarify an event,

situation or happening in relationship to time.

Ex. Client: I vomited this morning.

Nurse: Was that after breakfast?

13. Presenting Reality Helping the client to differentiate the real from the

unreal.

Ex. The telephone ring came from the television.

14Focusing Helping the client expand on and develop a topic of

importance.

Ex. Client: My wife says she will look after me, but I dont think she

can, what with the children to take care of, and theyre

always after her about something- clothes, homework,whats for dinner that night.

Nurse: Sounds like you are worried how she can manage.

15. Reflecting Directing ideas, feelings, questions, or content back to


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g g g q

clients to enable them to explore their own ideas and feelings about the

situation.

EX. Client: What can I do?

Nurse: What do you think would be helpful?

16. Summarizing and planning Stating the main points of a discussion to

clarify the relevant points discussed.

EX. During the past half hour we have talk about

Tomorrow afternoon we will explore this further.

Attentive listening


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Attentive listening

It is listening actively using all the senses, as

opposed to listening passively with just the ear. It is

probably the most important technique in nursing and is

basic to all other techniques. Attentive listening is an

active process that requires energy and concentration. It

involves paying attention to the total message, both verbal

and nonverbal, and noting whether this communication iscongruent . Attentive listening means absorbing both the

content and the feeling the person is conveying, without

selectivity.

The Helping Relationship

Nurse-client relationship are referred to by some as

interpersonal relationships, by others as therapeutic

relationships,


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Phases of helping relationship


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1. Preinteraction phase

>it is similar to the planning stage before the interview.

>the nurse has information about the client before the

first face to face meeting. Such information may

include, the clients name, address, age, medical

history and social history.

2.Inroductory Phase>also referred to as the orientation phase or the

prehelping phase.

>it is important because it sets tone to the relationship.

>the client and the nurse closely observed each otherand form judgments about the others behavior.

>getting to know each other and developing a degree

of trust.


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3. Working Phase

>the nurse and the client begin to view each other as

unique individuals, they begin to appreciate this uniqueness

and care about each other . Caring is sharing deep and

genuine concern about the welfare of another person.

4. Termination Phase>often expected to be difficult and filled with

ambivalence.

>the client generally has a positive outlook and feels

able to handle problems independently.>it is natural to expect some feeling of loss, and each

person needs to developed a way of saying goodbye.


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Developing a Helping Relationship

1.Listen actively.

2.Help to identify what the person is feeling.

3.Put yourself in the other persons shoes.

4.Be honest.

5.Be genuine and credible.6.Use your ingenuity.

7.Be aware of cultural differences that may affect meaning and

understanding.

8.Maintain client confidentiality.9.Know your roles and your limitations.

acute appendicitis & npi_edmalyn gozar

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