acute appendicitis — HA W9 R2
Type of document Essay
1 Page Double Spaced
Subject area Nursing
Academic Level Master
Style APA
References 2
Order description:
Jessica Martin’s Main Post Week 9
COLLAPSE
Based on the information provided in the scenario, this patient may be suffering from acute appendicitis. However, much more information is needed to confirm this diagnosis. Time of onset of symptoms would need to be known, in addition to which PRN medications she has taken for her symptoms. A list of current medications is needed. A more thorough exam is needed, including a thorough gastrointestinal examination checking for rebound tenderness and bowel patterns. Appendicitis is the third most common indication for abdominal surgery in the elderly patient. Patients with appendicitis typically present with right lower quadrant pain, fever, anorexia, or leukocytosis. The use of CT scan is necessary to make this diagnosis in a timely fashion. A differential diagnosis for this patient may be diverticulitis, in which the patient typically presents with fever, nausea, change in bowel regimen, and LLQ pain. However, patients may present with RLQ pain if the right colon is predominantly involved. CT scan is recommended to diagnose this problem, as it is highly sensitive and specific for this disease (Spangler et al., 2014). Another potential diagnosis may be peritonitis, which can be caused by a perforated ulcer, appendix, or diverticulum. Patients with peritonitis often present with severe abdominal pain, rigid abdomen, rebound tenderness, absent bowel sounds, hypovolemic shock, fever, vomiting, tachycardia, and tachypnea. She may also be experiencing inflammatory bowel disease, including ulcerative colitis and Chron’s disease. Signs and symptoms include abdominal pain, lethargy, nausea, vomiting, fever, tachycardia, diarrhea, and signs of shock (“Chapter 10: Gastrointestinal emergencies,” 2016). For a patient presenting with abdominal pain, common blood tests needed include CBC, CMP (to assess electrolytes and kidney function), Liver panel, CRP and CK to determine inflammation. A lactate level may be used for evaluation of overall status and intestinal ischemia. Blood cultures would be needed as well to look for bacteremia. A urinalysis should also be obtained to rule out urinary tract infection, which may also be another potential diagnosis for this patient (Mayumi et al., 2016).
Subjective
HPI: 70-year-old white female nursing home resident c/o sharp pain in LRQ of abdomen, worse after meals, associated with nausea and vomiting. Time of onset is not clear.
PMH: HTN, Type 2 DM, obesity, arthritis of knee (unclear which knee)
ROS:
Abdomen: Reports sharp pain in LRQ, worse after meals, and associated with N&V. Pain unrelieved with PRN medications (unclear which PRN medications she is taking). Onset of pain is unclear.
Current medications unknown
Objective
Physical exam:
General: Awake, alert, and oriented elderly female in no apparent distress or pain resting quietly in bed
Skin: Warm and dry
Lungs: Clear to auscultation
Heart: No murmurs or other abnormalities auscultated.
VS: T 102; P 84; BP 150/88; R 23
Assessment
This patient is likely experiencing acute appendicitis.
Problem list:
Appendicitis
Plan
- Appendicitis: appendectomy
References
Chapter 10: Gastrointestinal emergencies (2016). Oxford: Oxford University Press, UK. Retrieved from https://prx-herzing.lirn.net/login?url=https://search-proquest-com.prx-herzing.lirn.net/docview/2031253443?accountid=167104
Mayumi, T., Yoshida, M., Tazuma, S., Furukawa, A., Nishii, O., Shigematsu, K., . . . Hirata, K. (2016). The practice guidelines for primary care of acute abdomen 2015.Japanese Journal of Radiology, 34(1), 80-115. doi:http://dx.doi.org.prx-herzing.lirn.net/10.1007/s11604-015-0489-z
Spangler, R., Van Pham, T., Khoujah, D., & Martinez, J. P. (2014). Abdominal emergencies in the geriatric patient. International Journal of Emergency Medicine (Online), 7doi:http://dx.doi.org.prx-herzing.lirn.net/10.1186/s12245-014-0043-2
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