Post appendectomy ncp
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1st Post op NCP Should be continuation of Pre op nursing care plan Purpose of using care plan is to individualize and improve care provided to client Appendectomy is the surgical removal of the appendix Pre op preparations for patient under go surgery are patient history, lab investigation, allergies, NPO, I.V. fluids, preoperative medication, teaching, consent, …….. Post op monitoring include Vital signs, Intake & output, Pain relief, Bowel sounds, Wound healing. continuous patient health education from admission to discharge
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Post appendectomy ncp
- 1. How can I put this lightly? The sooner you come to love nursing care plans, the easier your career as a nurse will be. The relationship that most nurses have with care plans goes something like this: What the hell is a care plan? This seems easy! Agh! Why do they keep telling me my diagnosis is wrong? Screw it! I’ll just Google and copy some random care plan. I’ll never do these again once a graduate. Finally! I graduated . . . goodbye care plans.
- 2. Please take a minute and think positively • What does it mean to you to be accredited by JCI, CABHI? • What do you think which accreditation should come next ? • Are you ready for next challenge? • How it can benefit you? • What do you think you need ?
- 3. Long way Challenges and difficulties Some confusions Beginning The first step The end of successful journey About to arrive Start
- 4. Nursing care plan post appendectomy Jamilah Saad Alqahtani MSN,BSN,RGN EDUCATION DEPARTMENT
- 5. OUTLINES 1 Process of nursing care plan 2 Appendect omy brief review 3 Post appendectom y nursing care plan 4 Post appendect omy Complicati ons 5 Health education 6 Conclusion
- 7. Introduction • Acute appendicitis (AA) is considered as one of the most common causes of surgical emergencies worldwide (1). The gold standard treatment for AA is Appendectomy (2). About 6% of the population during their lifetime, will suffer from acute appendicitis (3,4). • Males suffer from acute appendicitis more than females (8.6% and 6.7% respectively) (5,6). Acute appendicitis rarely causing death; with a mortality rate ranges from zero up to 2.4% (8). However, more attention has been directed for early diagnosis and intervention. 1. Douglas, Charles D., et al. "Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score." Bmj321.7266 (2000): 919. 2. Schwartz SI, Brunicardi FC. Schwartz’s Principles of Surgery. 9thed. New York: McGraw-Hill, Medical Pub. Division; 2010. pp. 1073–1082. 3. Cuschieri, A. "The small intestine and vermiform appendix." Essential surgical practice 3 (1995): 1325-8. 4. Kanumba, Emmanuel S., et al. "Modified Alvarado scoring system as a diagnostic tool for acute appendicitis at Bugando Medical Centre, Mwanza, Tanzania." BMC surgery 11.1 (2011): 1. 5. Von Titte, Sigmond N., Charles J. McCabe, and Leslie W. Ottinger. "Delayed appendectomy for appendicitis: causes and consequences." The American journal of emergency medicine 14.7 (1996): 620-622. 6. England, R. J., and D. C. G. Crabbe. "Delayed diagnosis of appendicitis in children treated with antibiotics." Pediatric surgery international 22.6 (2006): 541-545. 7. Shawana, et al. "CAUSES OF DELAYED PRESENTATION OF ACUTE APPENDICITIS AND ITS IMPACT ON MORBIDITY AND MORTALITY." Journal of Ayub Medical College Abbottabad 27.3 (2015): 620-623. 8. Ohmann,37. Hussain MI, Al-Akeely MH, Alam MK, Al-Qahatani HH, Al-Salamah SM, Al-Ghamdi OA (2012): Management of appendiceal abscess. A 10-year experience in Central Saudi Arabia. Saudi medical journal., 33(7):745-
- 8. Brief View Of Appendectomy • Appendectomy is the surgical removal of the appendix. An inflamed appendix may be removed using a laparoscopic approach with laser. However, the presence of multiple adhesions, retroperitoneal positioning of the appendix, or the likelihood of rupture necessitates an open (traditional) procedure. • Studies indicate that laparoscopic appendectomy results in significantly less postoperative pain, earlier resumption of solid foods, a shorter hospital stay, lower wound infection rate, and a faster return to normal activities than open appendectomy.
- 10. Post appendectomy nursing care plan Nursing care planning and management for patients who underwent appendectomy includes: preventing complications, promoting comfort, and providing information.
- 11. Post appendectomy nursing care plan Assessment Nursing diagnosis Expected outcome Intervention Evaluation
- 13. Nursing Assessment The identity of the client… Medical/surgical History Physical Examination Investigations Reminder ‘’Purpose of using care plan is to individualize and improve care provided to client’’
- 14. Nursing Diagnosis •Acute pain •Imbalance nutrition: less than body requirements •Impaired skin integrity •Ineffective tissue perfusion: GI •Risk for deficient fluid volume •Risk for infection
- 15. Key outcomes The patient will: Express feeling of comfort and decrease pain Maintain calorie requirement Maintain skin integrity Maintain adequate GI tissue perfusion Maintain normal fluid volume Remain free from signs and symptoms of infection
- 16. Nursing Interventions • Maintain NPO status until surgery is performed • Administer I.V. fluids • Avoid administering analgesic until the diagnosis is confirmed • Avoid administering enemas that may rupture appendix • Place the patient in fowler’s position to decrease pain • NURSING ALERT Never apply heat to the right lower abdomen; this can cause the appendix to rupture • Administer prescribed preoperative medication
- 17. Monitoring After Surgery • Vital signs • Intake & output • Pain relief • Bowel sounds, passing of flatus or bowel movements • Wound healing
- 18. Assistant Tools & Forms Used in AFHSR • Initial assessment Adult • Reassessment evaluation • Care of plan • Pain assessment • Fluid balance • Risk fall assessment
- 19. Health Education For Post Appendectomy Be sure to cover: Disorder, diagnosis and treatment Pre op teaching Possible complications Appropriate wound care Medication administration and possible adverse effects Postop limitations
- 20. Conclusion • 1st Should be continuation of pre op nursing care plan • Purpose of using care plan is to individualize and improve care provided to client • Appendectomy is the surgical removal of the appendix • Pre op preparations for patient under go surgery are patient history, lab investigation, allergies, NPO, I.V. fluids, preoperative medication, teaching, consent, …….. • Post op monitoring include Vital signs, Intake & output, Pain relief, Bowel sounds, Wound healing. • continuous patient health education from admission to discharge
- 22. References 1. Douglas, Charles D., et al. "Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score." Bmj321.7266 (2000): 919. 2. Schwartz SI, Brunicardi FC. Schwartz’s Principles of Surgery. 9thed. New York: McGraw-Hill, Medical Pub. Division; 2010. pp. 1073–1082. 3. Cuschieri, A. "The small intestine and vermiform appendix." Essential surgical practice 3 (1995): 1325-8. 4. Kanumba, Emmanuel S., et al. "Modified Alvarado scoring system as a diagnostic tool for acute appendicitis at Bugando Medical Centre, Mwanza, Tanzania." BMC surgery 11.1 (2011): 1. 5. Von Titte, Sigmond N., Charles J. McCabe, and Leslie W. Ottinger. "Delayed appendectomy for appendicitis: causes and consequences." The American journal of emergency medicine 14.7 (1996): 620-622. 6. England, R. J., and D. C. G. Crabbe. "Delayed diagnosis of appendicitis in children treated with antibiotics." Pediatric surgery international 22.6 (2006): 541-545. 7. Shawana, et al. "CAUSES OF DELAYED PRESENTATION OF ACUTE APPENDICITIS AND ITS IMPACT ON MORBIDITY AND MORTALITY." Journal of Ayub Medical College Abbottabad 27.3 (2015): 620-623. 8. Ohmann,37. Hussain MI, Al-Akeely MH, Alam MK, Al-Qahatani HH, Al-Salamah SM, Al-Ghamdi OA (2012): Management of appendiceal abscess. A 10- year experience in Central Saudi Arabia. Saudi medical journal., 33(7):745-9. https://nurseslabs.com/4-appendectomy-nursing-care-plans/4/ http://www.rncentral.com/nursing-library/careplans/ https://doc-0s-7c-apps- viewer.googleusercontent.com/viewer/secure/pdf/ofkvilh5a7fbgg4k8hmhn0gcum46fuf9/elg9m6m1adqhjrej1sm0ihv25hf7c8ob/1521198075000/gmail/0 5492739580097384208/ACFrOgD7-4pf3jGWqn1ya6LH9rsY0YouITN0Y4ZuegFbcGAHpJcwh7SrZJtb8OwhiQJQyB- GvJ2eraGzx7frEt7wZ0k8gFRq9etJ68fQW9LNJN-XkyQ0BQUQ- DzYlD4=?print=true&nonce=cf5nf7r32n9fu&user=05492739580097384208&hash=of8qlbb5r4rn7sn7aegvm23377cbm2lm
- 23. Charles Heber McBurney, MD Harvard alumni Published first paper on appendicitis in 1889 Introduced the use of rubber gloves during operations to improve aseptic technique Pre dates antibiotics E. Patchen Dellinger, MD Harvard alumni (trained under McBurney) Published his first paper circa 1900 Also uses rubber gloves in the OR (and rubber duckies in the bathtub) Never met an antibiotic he ever liked
Editor's Notes
- If that what came in your mind You need to change In this lecture we by Allah help will guide you to have different way of thinking and analysis of care plan Only if you beattention and share participat you can benefit
- So tell me start thronging some questions to you in order to keep you focus the whole journey of nursing care plan Let me share with you very important fact that nursing care plan the evidence that we have or can how professional is nursing as it stated long time that nursing is art and sciences the art showing throughout our skills and sciences show though out our thinking and professional writing
- Now I will take you to beautiful journey through out the nursing care plan
- Care plan consist of 5 things assessment, diagnosis, outcome identification, planning accordingly implement your planning than evaluate what have plan and implement if your desire outcome met or not met if not again go around the circle assess the needs if something is missing and so on A nursing care plan provides direction on the type of nursing care the individual/family/community may need.[1] The main focus of a nursing care plan is to facilitate standardised, evidence-based and holistic care.[2] Nursing care plans have been used for quite a number of years for human purposes and are now also getting used in the veterinary profession.[2] A care plan includes the following components: assessment, diagnosis, expected outcomes, interventions, rationale and evaluation Objective[edit] To promote evidence-based nursing care and to provide comfortable and familiar conditions in hospitals or health centers.[1] To promote holistic care which means the whole person is considered including physical, psychological, social and spiritual in relation to management and prevention of the disease.[1] To support methods such as care pathways and care bundles. Care pathways involve a team effort in order to come to a consensus with regards to standards of care and expected outcomes while care bundles are related to best practice with regards to care given for a specific disease.[1] To record care.[1] To measure care.[1] History The function of nursing care plans has changed drastically over the past several decades. In 1953, care planning was not believed to be within the nursing scope of practice.[3] In the 1970s, care planning was activity based.[3] Patients were listed according to the procedures they were having done, which determined their plan of care.[3] Care provided was passed on by word of mouth, dressing books, and work lists.[3] These forms of communication all focus on activities the nurse performed instead of focusing on the patient.[3] Today, nursing care plans focus on the individuals unique set of needs and goals.[3] Care plans are individualized to create a patient-centered approach to care.[4] Therefore, nurses must perform a physical assessment prior to planning a patients care
- A cross-sectional study was conducted to assess the relationship between appendicitis and lifestyle ; dietary and hygiene in Saudi Arabia. This study showed defects in Dietary life style for acute appendicitis patients including, low consumption of water, a significant decrease in the containment of fiber at the usual food.
- Risk factors : adolescent male Incidence Occure at any age howover majority of cases ages between 11 to 20 Affects both both sexes equally however between puberty and age 25 more prevent male
- Causes: Foregion body, neoplasm (abnormal growth), mucous ulcerations, fecal mass , stricture(adhersions), barium ingestion viral infection
- Current medical history ; complaints of pain in postoperative wound appendectomy, nausea, vomiting, increased body temperature, increased leukocytes Physical Examination Cardiovascular System: To determine vital signs, presence or absence of jugular venous distension, pallor, edema, and abnormal heart sounds. Hematologic System: To determine whether there is an increase in leukocytes is a sign of infection and bleeding, nosebleeds splenomegaly. Urogenital System: Whether or not the tension of the bladder and lower back pain complaints. Musculoskeletal System: To determine whether there is difficulty in movement, pain in bones, joints and there is a fracture or not. The immune system: To determine whether there is lymph node enlargement. Investigations Routine blood tests: to determine an increase in leukocytes is a sign of infection. Abdominal examination photo: to know the existence of post-surgical complications.
- Patient information for the day of the surgery. The perioperative RN should instruct patients: • To contact the surgeon’s office if they develop cold or flu-like symptoms • About NPO restrictions and medications as ordered • To bring a valid ID, insurance card, Medicare or Medicaid care • Not to wear jewelry, makeup, powder, or deodorant • To leave all valuables at home • Arrive at _______ (insert time) • Park at ________ (insert) • Check in at _________ (insert) • Eat or drink nothing after _________ (insert time) and take _________ (insert medications as ordered by the physician) at _________ (insert time) •That an anesthesia professional will contact them to discuss their care and answer their questions •That the patient’s pain will be addressed by the physicians and nurses