WEEK 14: CASE STUDY ASSIGNMENT CHAPTER 42
The patient is 48 years old and has been admitted to the hospital with severe abdominal pain. Earlier that day she had generalized abdominal pain, followed by a severe pain in the lower right quadrant of her abdomen, accompanied by nausea and vomiting. That evening she was feeling slightly improved and the pain seemed to subside somewhat. Later that night she experienced severe, steady abdominal pain with vomiting. A friend took her to the hospital, where examination demonstrated lower right quadrant tenderness and mild abdominal rigidity. Fever and leukocytosis indicated infection. A diagnosis of acute appendicitis, with possible perforation, was indicated, with immediate surgery.
1. Why is the sequence of pain (location and type of pain) significant in the diagnosis of acute appendicitis? Describe the rational for each type of pain. Does this sequence confirm the diagnosis?
2. Using the pathophysiology, describe the reason for:
The pain subsiding and then recurring
Leukocytosis and fever
Abdominal rigidity
3. Discuss the complications that might arise from rupture of the appendix.
Week 14 Case Study 2
Why is the sequence of pain (location and type of pain) significant in the diagnosis of acute appendicitis? Describe the rational for each type of pain. Does this sequence confirm the diagnosis?
The sequence of pain is important in acute appendicitis. The initial pain that the patient reportedis referred pain. The pain arises from the nerves of the viscera. The localized pain the patient reports is attributed to the involvement of the peritoneum. The peritoneal involvement occurs when the inflammation progresses. The sudden pain the patient reports in the right upper quadrant demonstrates the inflammation of the appendix, hence, the diagnosis (Moris et al., 2021). The accompanying signs include nausea, vomiting, and bloating.
Using the pathophysiology, describe the reason for:
The pain subsiding and then recurring
The pain subsiding after recurring develops due to the progressive appendix obstruction. After sometime, the appendix obstruction is severe that it causes it to rupture, hence, peritonitis. The classic indication of peritonitis is severe pain followed by cessation, and sharp pain afterwards in the abdomen. This explains the patient reporting pain that subsided followed by acute abdominal pain and fever(McCance & Huether, 2018).
Leukocytosis and Fever
Leukocytosis develops due to the inflammatory process and infection following peritonitis. The body releases inflammatory cells such as cytokines in response to the disease process, hence, stimulating the immune system to release white blood cells. The level of white blood cells will rise to protect the body from infection. Fever develops due to an infection attributed to the ruptured appendix(McCance & Huether, 2018).
Abdominal Rigidity
Abdominal rigidity develops from intraabdominal bleeding because of the ruptured appendix. The inflammatory processes also contributed to the rigidity. As a result, the nurse perceives the abdomen to be rigid with rebound tenderness on palpation(McCance & Huether, 2018).
Discuss the complications that might arise from rupture of the appendix.
The complications of rupture appendix include septicemia, anemia, shock, peritonitis, and abdominal abscesses (McCance & Huether, 2018). Complications such as anemia and shock develop from severe blood loss. Septicemia develops from bacterial colonization of the wounds and appendix. Abdominal abscess develops from the infection of the rupture sites.
References
McCance, K. L., & Huether, S. E. (2018). Pathophysiology Online for Pathophysiology (Access Code and Textbook Package): The Biologic Basis for Disease in Adults and Children. Elsevier – Health Sciences Division.
Moris, D., Paulson, E. K., & Pappas, T. N. (2021). Diagnosis and Management of Acute Appendicitis in Adults: A Review. JAMA, 326(22), 2299–2311. https://doi.org/10.1001/jama.2021.20502