Salsabila is a 19-year-old college student majoring in physical therapy .Ms.Salsabila arrives at the emergency department at 1:00 A.M.
complaining of general lower abdominal pain that had started the
previous evening. By midnight, the pain was more localized over
the right lower quadrant.She also reports nausea and vomiting.
complaining of general lower abdominal pain that had started the
previous evening. By midnight, the pain was more localized over
the right lower quadrant.She also reports nausea and vomiting.
ASSESSMENT
Hernawati, RN, completes the admission assessment in the emer-
gency department.Ms.Salsabila is complaining of nausea and severe
abdominal pain,stating,“Walking makes my stomach hurt worse.”
Physical assessment findings include:T 100.2°F (37.8°C),P84,R 16,
and BP 110/70; skin warm to touch; abdomen flat and guarded,
with marked tenderness in right lower quadrant. Ms. Salsabila’s com-
plete blood count shows WBC 14,000/mm3
; neutrophils 81.1%;
lymphocytes 12.5%.The diagnosis of acute appendicitis is made,
and Ms. Salsabila is transferred to surgery for a laparoscopic appen-
dectomy.
DIAGNOSIS
The nurses in the short stay unit identify the following nursing di-
agnoses for Ms.Salsabila after surgery.
• Impaired skin integrity, related to surgical incisions
• Pain, related to surgical intervention
• Anxiety, related to situational crisis
Hernawati, RN, completes the admission assessment in the emer-
gency department.Ms.Salsabila is complaining of nausea and severe
abdominal pain,stating,“Walking makes my stomach hurt worse.”
Physical assessment findings include:T 100.2°F (37.8°C),P84,R 16,
and BP 110/70; skin warm to touch; abdomen flat and guarded,
with marked tenderness in right lower quadrant. Ms. Salsabila’s com-
plete blood count shows WBC 14,000/mm3
; neutrophils 81.1%;
lymphocytes 12.5%.The diagnosis of acute appendicitis is made,
and Ms. Salsabila is transferred to surgery for a laparoscopic appen-
dectomy.
DIAGNOSIS
The nurses in the short stay unit identify the following nursing di-
agnoses for Ms.Salsabila after surgery.
• Impaired skin integrity, related to surgical incisions
• Pain, related to surgical intervention
• Anxiety, related to situational crisis
EXPECTED OUTCOMES
The expected outcomes for the plan of care are:
• Incisions will heal without infection or complications.
• Will verbalize adequate pain relief.
• Will verbalize decreased anxiety.
• Returns to preoperative activities.
The expected outcomes for the plan of care are:
• Incisions will heal without infection or complications.
• Will verbalize adequate pain relief.
• Will verbalize decreased anxiety.
• Returns to preoperative activities.
PLANNING AND IMPLEMENTATION
The following nursing interventions are planned
and implemented for Ms.Salsabila.
• Assess pain using a pain scale;provide analgesics as needed.
• Teach pain management following discharge.
• Teach abdominal splinting during coughing,turning,or ambu-
lating as needed.
• Teach home care of incisions.
• Discuss activity limitations as ordered.
• Instruct to report fever or warmth, redness, or drainage from
the incisions.
EVALUATION
On discharge the following evening, Ms. Salsabila is fully ambulatory.
Her appetite has returned, and she is tolerating food and fluids
well.Her temperature is normal.The nurse provides Ms.Salsabila with
written and verbal information on postoperative care following an
appendectomy.
The following nursing interventions are planned
and implemented for Ms.Salsabila.
• Assess pain using a pain scale;provide analgesics as needed.
• Teach pain management following discharge.
• Teach abdominal splinting during coughing,turning,or ambu-
lating as needed.
• Teach home care of incisions.
• Discuss activity limitations as ordered.
• Instruct to report fever or warmth, redness, or drainage from
the incisions.
EVALUATION
On discharge the following evening, Ms. Salsabila is fully ambulatory.
Her appetite has returned, and she is tolerating food and fluids
well.Her temperature is normal.The nurse provides Ms.Salsabila with
written and verbal information on postoperative care following an
appendectomy.
Critical Thinking in the Nursing Process
1. What is the pathophysiologic basis for Ms. Salsabila’s elevated
WBC?
2. How would Ms.Salsabila’s postoperative care and teaching differ
if she had undergone a laparotomy instead of a laparoscopic
appendectomy?
3. Outline a teaching plan to give to clients for home care fol-
lowing an appendectomy.
4. Develop a care plan for Ms. Salsabila for the nursing diagnosis,
Anxiety related to a situational crisis.
1. What is the pathophysiologic basis for Ms. Salsabila’s elevated
WBC?
2. How would Ms.Salsabila’s postoperative care and teaching differ
if she had undergone a laparotomy instead of a laparoscopic
appendectomy?
3. Outline a teaching plan to give to clients for home care fol-
lowing an appendectomy.
4. Develop a care plan for Ms. Salsabila for the nursing diagnosis,
Anxiety related to a situational crisis.
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