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Programme Course Topic Group No of students Venue Date Duration Method of teaching Av aids
: Bsc(N) : Medical Surgical Nursing : APPENDICITIS : Bsc(N) -II : 50 : Lecture hall- 5 : 22/10/2009 : 1 hrs : Lecture cum discussion : black board, OHP. Chart. : Radhika. A.B. year
Central objectives: At the end of the class the students will be able to gain in-depth knowledge on Appendicitis & develop desirable skill & attitude while taking care of Appendicitis patients Specific objectives: At the end of the class the students will be able to Define Appendicitis Discuss the incidence of Appendicitis List down the types of Appendicitis Enumerate the causes of Appendicitis Describe the pathophysiology of Appendicitis. Explain the clinical manifestation of Appendicitis Identify the diagnostic investigation of Appendicitis Elaborate the management of Appendicitis.
SL NO
TIME
SPECIFIC OBJECTIVE
CONTENTS APPENDICITIS
TEACHERS ACTIVITIES
LEARNERS ACTIVITIES
AV.AIDS
EVALUATION
5min
- introduce INTRODUCTION the topic to Appendicitis is a common the students. condition that affects 7% of the population, according to the American Academy of Family Physicians. Persons of any age may be affected, with the highest incidence occurring during the second and third decades of life. Rare cases of neonatal and prenatal appendicitis have been reported. Increased vigilance in recognizing and treating potential cases of appendicitis is required for the very young and old who have a higher rate of complication.
Writes the topic on the black board. & Introduces the topic by narration.
Listens
Black board
5min
- enumerate MEANING the meaning The appendix is a narrow tubular Explains the of pouch attached to the intestines. When the meaning of Appendicitis appendix is blocked, it becomes inflamed Appendicitis . and results in the condition known as appendicitis. If the blockage continues, the inflamed tissue becomes infected with bacteria and begins to die from a lack of blood supply, which finally results in the
Black board
What is Appendicitis?
appendix bursting (perforated appendix). 5min -describe the CAUSES causes of There is no clear cause of Appendicitis appendicitis. Fecal material is thought to be one possible obstructing object. Bacteria, viruses, fungi, and parasites can be responsible agents of an infection that leads to swelling of the tissues of the appendix wall, including Yersinia species, adenovirus, cytomegalovirus, actinomycosis, Mycobacteria species, Histoplasma species, Schistosoma species, pinworms, and Strongyloides stercoralis. Also, swelling of the tissue from inflammatory bowel diseases such as Crohn's disease may cause appendicitis. It appears that appendicitis is not hereditary or transmittable from person to person.
OHP
5min
-To describe in PATHOPHYSIOLOGY detail about pathophysiolo The appendix becomes inflamed and gy of edematous Appendicitis The appendix becomes kinked or occluded by a fecalities ,tumor,or foreign body.
Chart
5min
-To explain SIGNS AND SYMPTOMS in detail Appendicitis typically begins with a about signs vague pain in the middle of the & symptoms abdomen often near the navel or of "belly button" (umbilicus). Appendicitis The pain slowly moves to the right
Black board
lower abdomen (toward the right hip) over the next 24 hours. In the classic description, abdominal pain is accompanied with nausea, vomiting, lack of appetite, and fever. All of these symptoms, however, occur in fewer than half of people who develop appendicitis. More commonly, people with appendicitis have any combination of these symptoms. Symptoms of appendicitis may take 4-48 hours to develop. During this time, someone developing appendicitis may have varying degrees of loss of appetite, vomiting, and abdominal pain. Some may have constipation, diarrhea, or there may be no change in bowel habits. Early symptoms are often hard to separate from other conditions including gastroenteritis (an inflammation of
the stomach and intestines). Many people admitted to the hospital for suspected appendicitis leave the hospital with a diagnosis of gastroenteritis; true appendicitis is often mis-diagnosed as gastroenteritis initially. Children and the elderly often have fewer symptoms, which makes their diagnosis less obvious and the incidence of complications more frequent. DIAGNOSTIC TESTS Lab work: Although no blood test can -To enumerate confirm appendicitis, a blood sample is In detail about sent for laboratory analysis to check the Diagnosis of white blood cell count, which is Appendicitis . typically elevated in an individual with appendicitis. However, normal levels can be present with appendicitis, and elevated levels can be seen with other conditions. A urine test may be performed to exclude urinary tract infection (or pregnancy) as the cause of the symptoms. Imaging tests: Appendicitis is diagnosed
5min
chart
by the classic symptoms and the physical exam (the doctor's examination of the patient's abdomen). Imaging tests are used when the diagnosis is not readily apparent. Most medical centers now use a CT scan of the abdomen and pelvis to help evaluate abdominal pain suspected of being caused by appendicitis. Ultrasound scanning is currently commonly used in small children to test for appendicitis. APPENDICITIS TREATMENT 10min -To discuss Self-Care at Home in detail There is no home care for about the appendicitis. treatment If the condition is suspected, contact modalities of a doctor or go to an emergency Appendicitis. department. Avoid eating or drinking as this may complicate or delay surgery. If the person is thirsty, he/she may rinse their mouth with water. Do not take (or give your child)
OHP
laxatives, antibiotics, or pain medications because these may cause delay in diagnosis that increases the risk of rupture of the appendix or mask the symptoms, which makes diagnosis more difficult. Surgery The best treatment for appendicitis requires surgery to remove the appendix (the operation is called an appendectomy) before the appendix opens or ruptures. While awaiting surgery, the patient will be given IV fluids to keep hydrated. The patient will not be allowed to eat or drink because doing so may cause complications with the anesthesia during surgery. Surgery is commonly done laparoscopically (through small incisions using a camera in the abdominal cavity). However, in some cases it may be necessary to do an open abdominal procedure to take the appendix out. Up to 20% of surgeries for
appendicitis reveal a non-inflamed appendix (negative appendectomy). The difficulty in making a definite diagnosis of this medical problem and the risk of missing the acutely inflamed appendix (and the patient becoming very ill due to perforation) makes a certain rate of misdiagnosis inevitable. Women in particular have a high rate of negative appendectomy as ovarian and uterine problems make the diagnosis more difficult. CT scanning prior to surgery has been shown to decrease this percentage to closer to 7%-8% in women. 5min -explains about the follw-up and prevention of Appendicitis Follow-up After an uncomplicated appendectomy, the patient may gradually resume a normal diet with a restriction in physical activity for at least two to four weeks. The doctor will check the incision the following week to look for possible wound infection.
listens
Black board
5min
Prevention There is no way of predicting when appendicitis will occur. It cannot be prevented. Write nursing care plan on appendicitis
3min
NURSING MANAGEMENT OF APPENDICITIS Provide comfortable position. Give more oral fluids. Administer medication as per prescription. Prepare the patient for appendicectomy. SUMMARY Appendicitis is a common condition that affects 7% of the population, according to the American Academy of Family Physicians. Persons of any age may be affected, with the highest incidence occurring during the second and third decades of life. The appendix is a narrow tubular pouch attached to the intestines. When the appendix is blocked, it becomes
2min
inflamed and results in the condition known as appendicitis. The treatment choice for appendicitis is appendicectomy. 3min CONCLUSION At the end of the class the student have gain knowledge about appendicitis and its types, risk factors, clinical features, diagnosis, and its management EVALUATION Short answer question 5 x 3 = 15. 1) What is appendicitis? 2) Management of patient with appendicitis. 3) Treatment and nursing management of appendicitis. 2min ASSIGNMENT Write an assignment on nursing care plan on appendicitis BIBLIOGRAPHY 1. Students bibliography Brunner and suddarths, TEXT BOOK OF MEDICAL SURGICAL NURSING, 10TH edition, Lippincott Williams and
2min
Wilkins. Lippincott, MANNUAL OF NURSING PRACTICE, 8th edition, Lippincott Williams and Willkins.
2. Teachers bibliography Brunner and suddarths, TEXT BOOK OF MEDICAL SURGICAL NURSING, 10TH edition, Lippincott Williams and Wilkins. Lippincott, MANNUAL OF NURSING PRACTICE, 8th edition, Lippincott Williams and Willkins. Long & Phipps -Medical Surgical Nursing Luckman &Sorenson -Medical Surgical Nursing