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Beth Downing, MSN, RN-BC, ONC Anna Gordon, MSN, RN.

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Presentation on theme: "Beth Downing, MSN, RN-BC, ONC Anna Gordon, MSN, RN."— Presentation transcript:

1 Beth Downing, MSN, RN-BC, ONC Anna Gordon, MSN, RN

2  Utilize the nursing process to plan culturally competent developmentally appropriate care for a client diagnosed with appendicitis.  Outline perioperative nursing concepts related to an appendectomy.

3  6 yr old male recently moved to the US from Mexico with his mother, 7 yr old sister Carle, & 14 yr old brother Juan to join his father who works for a metal recycling company.  Except for Juan no one speaks English.  Jose’s parents are excited to have their family together.  Jose & his siblings enjoy playing with neighborhood children who mostly speak English.  The family attends the local Hispanic Catholic Church.

4  What is the priority concern based on this information?

5  kg, cm  No previous hospitalizations  No surgical history  Current with immunizations  Attends 1 st grade  Lives with parents & siblings in a nonsmoking household  Maternal grandmother – DM  Paternal grandfather - HTN

6  Jose presents with sharp abdominal pain, not feeling well & woke up crying at The pain went away for a while at school this a.m., but came back. Now the pain is constant between his umbilicus & right iliac crest. He is complaining of feeling cold. Jose began vomiting after he entered the ER and is now lying on left side with his right leg flexed.

7  Lungs clear, HRR w/o murmur  Pain with guarding of the RLQ  VS (ax) – 125 – 35 – 119/79 – 98%  Labs:  WBC – 17,500  HgB -  HcT -  UA - negative  CT Abdomen – acute appendicitis

8  Does this clinical picture coincide with a diagnosis of appendicitis?  Are vital signs normal for a child this age? Why the changes?  Jose’s pain suddenly stops what is your priority?

9  Admit to Pediatrics  Bedrest  NPO  Consent for laparoscopic appendectomy  D5 ½ NS with 10 meQ 70 mL/hr  Gentamicin 45 mg IV on call to OR  Morphine Sulfate 2 mg IV q 1-2 hr prn pain

10  SBAR report from the ED nurse to the pediatric nurse to prepare Jose for surgery.  How do you get the consent signed? By whom? In what language?  Discuss issues/concerns regarding the use of translators – what is appropriate & what is not?

11  The OR has called and it is time for Jose to go to surgery. His parents escorted to the holding room with him.

12  What should be sent with Jose or communicated to the OR/holding room nurse?  What is the role of the holding room/OR nurse?

13  Jose is brought into the operating room, after receiving oral midazolam hydochloride (Versed) in the holding room. A timeout is completed prior to beginning the surgery.

14  What type of anesthesia is used for this procedure?  How should the anesthesia be administered to Jose?  Why would other types be inappropriate?

15  As the circulating nurse what would your duties include during this procedure?  As the scrub nurse what would your duties include during this procedure? Review sterile technique  What are the principles of surgical asepsis?

16  Jose arrives in the PACU, extubated, arousable when spoken to. His parents are notified and brought in to comfort Jose.  His Aldrete score on admission is 6 (Activity – 2, Respiration – 1, Circulation – 1, Consciousness – 1, O2 Saturation – 1).  Oucher Pain Rating is 8  VS – 99.0 – 120 – 30 – 114/70 – 96% on O2 2L

17  What are the priority assessments that should be completed in PACU?  What patient/family teaching should occur at this time?

18  VS – 99.1 – 114 – /68 – 98% O2 2L  Jose’s Aldrete Score is 8  Oucher Pain Rating is 3

19  Based on this information is Jose ready to leave PACU?  What information should be passed on in report from the PACU RN to the Pediatric RN?

20  Routine VS  D5 ½ NS w/ 20 mEq 75 mL/hr  HL when taking fluids  Gentamicin 45 mg IV q8 hr  Unasyn 900 mg IV q 6 hr  Morphine 1 mg IV q 1 hr prn pain  Acetaminophen 240 mg q 4 hr for T > 99.5 F  Clear liquids, advance as tolerated if no nausea  IS 10 times/hr while awake  OOB to chair this p.m.  Notify MD T >  CBC, Chem 14 in a.m.

21  Alert & oriented  Lungs clear  HR – 110 Regular  Bowel sounds hypoactive  Oucher pain rating – 3  Abdominal drsg dry & intact  IVF infusing in RA at 75 mL/hr  Denies nausea  Due to void

22  What other assessment & laboratory data should the nurse monitor? Why?  Priority nursing diagnoses  Potential complications? How do you assess for them?  If Jose’s appendix had ruptured how would his care be different – what additional assessment findings should be seen?

23  Jose is recovering without complications. He has been advanced to a full liquid diet and his parents have questions about why he can not eat solid foods yet  Encouragement is needed for Jose to ambulate & use the IS  Surgical dressing remains in place  Antibiotics are being continued

24  How is this postoperative teaching completed?  Anything else that needs to be taught??

25  Jose is now being discharged home with his parents. He is tolerating a regular diet without nausea, had a bowel movement yesterday. His incision is well approximated with the staples intact, no drainage present. Pain is tolerable with prn acetaminophen (Tylenol).

26  What teaching needs to be included at discharge?

27  Ricci, S. and Kyle, T. (2008). Maternity and Pediatric Nursing. Lippincott, Williams & Wilkins.  Smeltzer, S., Bare, B., Hinkle, J., Cheever, K. (2010). Brunner and Suddarth’s Medical Surgical Nursing. 12 th ed. Lippincott, Williams & Wilkins.


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