Question

Concept: Assessment 4

Case-Based Experience Prep Work

	Assessment #4 CB: Digestion Scenario
Purpose	To provide students with the opportunity to assess a preoperative patient who is experiencing acute abdominal pain.
Overview	Jamie Carson is an 18-year-old white male with a 24-hour history of right-sided abdominal pain. His primary care physician referred him to the emergency department where he was diagnosed with acute appendicitis. An appendectomy has been scheduled for Tuesday at 2200. The scenario takes place on Tuesday at 1915 just after Jamie has been admitted to the floor.
Skill Review: Please review the following skills.	Abdominal Assessment Medical History Assessment
Pharmacology Review: Please review the following medications.	Sodium chloride; Morphine; Ondansetron
Questions 1: When obtaining subjective data as part of Jamie Carson's focused abdominal examination, what information, other than pain, maybe pertinent?	.
Question 2: Describe involuntary guarding. What would a finding of involuntary guarding indicate in Jamie Carson's case?
Question 3: Describe the iliopsoas test. What findings might you expect if you employed this technique while assessing Jamie Carson?
	Development
What stages of development is Jamie and how will that influence your management of the scenario?

Answer 1

1. Appendicitis is the inflammation of vermiform appendix present at the end of colon. It is a narrow worm like structure which protrudes to the cecum. The pain and severity completely depends on the severity of the inflammation .Ruptured appendix is considered as a medical emergency. Other than pain over the McBurney's point patient may also experience

a. Nausea and vomiting

b. A mild fever which may worsen if the inflammation become severe.

c. Diarrhea in some cases or even constipation in some others.

Since the patient is prescribed with Ondansetron, he may have been experiencing vomiting as Ondansetron is classified as 5-HT 3 receptor antagonists which prevent vomiting by blocking the action of serotonin.

2. Abdominal guarding is the process of tensing of the abdominal muscles to prevent pressure of internal organs which are inflamed and to prevent the pressure over the inflamed organ the muscle tenses.

Involuntary guarding is the tightening of a specific quadrant of abdomen due to inflammation of the specific organ. In the case of Jamie Carson the appendix is inflamed so the right lower quadrant will be tensed while palpation which can give a clue on the diagnosis.

3. Iliopsoas test also known as psoas sign is technique used to find out the irritation of the iliopsoas group of hip flexors in the abdomen. The patient is asked to lie on the back and is asked to flex the right hip towards the physician hand and also patient is asked to lie towards the left side with the legs extended and the physician stretches the right thigh backwards. Pain during this procedure indicates inflammation of the appendix which is underlying the psoas muscle.

4. Mr. Jamie Carson has developed a perforated appendicitis which is caused by the rupture of appendix. The stool present in the appendix is leaked to the peritoneum which causes sepsis and is considered life threatening. Immediate surgery is the only treatment measure which can be taken in this case. Laparoscopic appendectomy is done on patients with non-perforated inflamed appendix