The patient presented with stomach pain, vomiting and loss of appetite for 1 day. Ultrasound showed a dilated and tender appendix. The patient was diagnosed with appendicitis and underwent an appendectomy. Post-surgery, the patient was prescribed medications including pantoprazole to decrease acid, ondansetron for nausea, cefaperazone/sulbactam and metronidazole for infection treatment, and diclofenac for pain. The patient's vital signs and lab tests were monitored daily and found to be stable and within normal ranges.

3. PAST MEDICAL HISTORY ;-
• NILL
PAST MEDICATION HISTORY ;-
• NILL
ON EXAMINATION :-
VITALS DAY1 DAY2 DAY3 UNITS
B.P 110/70 110/70 110/70 mmofHg
P.R 82 72 78 BPM
SPO2 98 97 96 %
TEMPERATUR
E
98 98 98 ‘F

4. LABORATORY INVESTIGATIONS :-
CBP OBSERVED VALUE NORMAL VALUE
Hb 13.8 mg/dl 13.5-15.5 g/dl
WBC 18,000cells/cu mm 4000-- 11000cells/cu mm
RBC 4.5 million cells / cu mm 4.5-6.0million cells/ cu
mm
BLOOD UREA 18 mg/dl 5-20 mg/dl
S.CREATININE 1.3 mg/dl 0.7-1.35 mg/dl
BLEEDING TIME 1.0 minute 1-3 minutes
CLOTTING TIME 1.45seconds 3-7minutes

5. DIAGNOSIS ;-
Ultra sound abdomen is performed
Impression :-
Dilated tender appendix with loss
of compressibility is seen

6. SOAP NOTES :-
Subjective findings :-
• Stomach pain at night since 1day
• Vomitings of 2 episodes
• Loss of appetite
Objective findings :-
Ultra sound abdomen ; dilated appendix with loss of
compressibility is seen
Assesment :-
From subjective and objective findings the case is diagnosed as
appendicitis

7. TREATMENT :-
Appendectomy is done
• Inj.Pantop 40mg
• Inj.Zofer 2mg/ml
• Inj.Xylocaine 20mg/ml
• Inj.Sulcef 1.5gm
• Inj.Metrogyl 500mg /100ml
• Inj.Diclo 25mg/ml

8. DRUG CHART :-
DRUG
NAME
CATEG
ORY
MOA USE
ROA
FRE
QUE
NCY
DAYS
D1 D2 D3
Inj.pantop
[pantaprazol
e]
H+/k+
inhibotor
It inhibit final
step in gastric
acid production
Decrease
acid
secretion
IV OD + + +
Inj.zofer
[ondansetro
n]
5HT3
antagonist
It inhibits
seratonin
To treat
nausea
vomitings
IV BD + + +
Inj.xylocain
e[lidocaine]
Local
anesthetic
It blocks
VGSCs
Used to
numb an
area
IV OD + - -
Inj.sulcef
[cefaperazo
ne
salbactum
Cephalos
porin
&beta
lactamase
inhibitors
Inhibits cell
wall synthesis
To treat
bacterial
infections
IV BD + + +
Inj.metrogyl
[metronidaz
ole]
nitroimid
azole
It inhibits
protein
synthesis
Bacterial&
parasitic
infections
IV BD + + +

9. Disease information on appemdicitis:-
Definition;-
Appendicitis is the inflammation of the vermiform
appendix that develops most commonly in adolescents
and adults
Epidemiology;-
• Appendicitis is the most common acute surgical
condition of the abdomen
• Approximately 7% of the population will have
appendicitis in their life time
• With the peak incidence occuring between ages of 10
to 30 years

10. Etiology;-
Obstructive causes;-
• Fecalith that acculde the lumen of the appendix
• Swelling of the bowel wall
Non obstructive causes;-
• Haematogenous spread of infection
• Vascular occlusion
• Diet lacking fibres
• Less water intake

11. Pathophysiology;-
Due to etiologic factors
Obstruction of appendix
[due to fecalith ,tumor]
Increased intraluminal pressure
Results in severe pain[appendicitis]

12. SIGNS AND SYMPTOMS ;-
• Abdomial pain
• Nausea & vomiting
• Anorexia
• Constipation
• Diarrhea
• Fever

13. DIAGNOSIS;-
• CT scan
• Ultra sound-visualise tubular structure & cysts
• MRI

14. TREATMENT ;-
• Appendicectomy-It is a surgical procedure to
remove the appendix from the abdomen .It can be
performed with a small incision on the abdomen or
laproscopically
MEDICAL MANAGEMENT ;-
• Antibiotic therapy
• Anti inflammatory drugs
• Analgesics
• Fluid therapy

15. CRITICAL EVALUATION ;-
• Clinical condition --- Appendicitis
• Drug of choice --- surgery
• Dose --- Appropriate
• Dosage forms --- Appropriate
• Frequency --- appropriate
GUIDLINES;-
World Journal of Emergency Surgery

16. LIFE STYLE MODIFICATION ;-
• Avoid spicy foods
• Take plenty of water
• Improving posture of the body after the surgery

17. PATIENT COUNSELLING;-
REGARDING DISEASE;-
It is an inflammation of the vermiform appendix
REGARDING MEDICATION;-
• Inj.Pantop 40mg---to decrease acid level in stomach
• Inj.Zofer 2mg/ml—to treat vomitings and nausea
• Inj.Xylocaine 20mg/ml—to cause numbness during surgery
• Inj.Sulcef 1.5gm--- to treat bacterial infections
• Inj.Metrogyl 500mg /100ml---to treat bacterial &parasitic
infections
• Inj.Diclo 25mg/ml ----to treat pain

18. REFERENCE;-
Harsha mohan
WWW. Drugs.com