Appendicitis case study

Case Study
Appendicitis

difficulty: Advanced

setting: Hospital

index Words: appendicitis, assessment, developmental care, differential diagnosis, maintenance fluid calculations, discharge teaching, legal aspects, outcomes management, preoperative care, postoperative care

giddens Concepts: Clinical Judgment, development, Inflammation, Pain, Tissue Integrity

Hesi Concepts: Advocacy/ethical/Legal Issues, Assessment, Clinical decision Making—Clinical Judgment, developmental, Inflammatory, Pain, Tissue Integrity

R.O. is a 12-year-old girl who lives with her family on a farm in a rural community. R.O. has four siblings who have recently been ill with stomach pains, vomiting, diarrhea, and fever. They were seen by their pri- mary care provider (PCP) and diagnosed with viral gastroenteritis. A week later, R.O. woke up at 0200 cry- ing and telling her mother that her stomach “hurts really bad!” she had an elevated temperature of 37.9 ° C (100.2 ° F). R.O. began to vomit over the next few hours, so her parents took her to the local emergency department (ed). R.O.’s vital signs, complete blood count, and complete metabolic panel were normal, so she was hydrated with IV fluids and discharged to home with instructions for her parents to call their PCP or to return to the ed if her condition did not improve or if it worsened. Over the next 2 days, R.O.’s abdominal pain localized to the right lower quadrant, she refused to eat, and she had slight diarrhea. On the third day, she began to have more severe abdominal pain, increased vomiting, and fever that did not respond to acetaminophen. R.O. has returned to the ed. Her Vs are 128/78, 130, 28, 39.5 ° C (103.1 ° F).

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scenario

R.O. is guarding her lower abdomen, prefers to lie on her side with her legs flexed, and is crying. IV access is established, and morphine sulfate 2 mg IV is administered for pain. An abdominal CT scan confirms a diagnosis of appendicitis. R.O.’s white blood count is 12,000 mm3.

1. Which of the following are common clinical manifestations of appendicitis? Select all that apply.

a. Diarrhea

b. Vomiting

c. Left lower quadrant abdominal pain

d. Constipation

e. Arthralgia

f. Diffuse rash

g. Fever

2. Discuss why R.O.’s presenting clinical manifestations make diagnosis more difficult. Identify two other possible diagnoses.

Part 2 Pediatric, Maternity, and WoMen’s HealtH cases

598

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12 Pediatric Disorde