Minimizing the Perils of Appendicitis Written by Joan Della Rocca - Essay Example

Article Review-Appendicitis 20 November 2009 Introduction The article “Minimizing the Perils of Appendicitis” written by Joan Della Rocca that was published in the January 2007 issue of Nursing Vol. 37, Issue No. 1 is an eye-opener of sorts. More importantly, it outlined the steps that a nurse should take when confronted with a patient who is suspected to have appendicitis because this medical condition is potentially deadly when misdiagnosed. Appendicitis can easily be mistaken for another acute condition because the signs and symptoms are often similar to other disorders and often vary widely. It is incumbent upon nursing practitioners that they can also diagnose it correctly when a patient presents with the symptoms and act quickly based on the information. Any delay can be life threatening because a ruptured appendix leads to septicemia (bacteremia) or even lead to sepsis (whole body inflammation). Speed has to be combined with accuracy by the use of differential diagnosis because it is easy to mistake it for other conditions especially among women (who may present with pelvic inflammatory disease or PID, ectopic pregnancy, etc.) and aged people who had an altered perception of pain (high pain tolerance levels) and delay seeking immediate treatment (Rocca 2007, p. 1). This takes knowledge and practice. The ease with which appendicitis is misdiagnosed is shown by the fact that up to 20% of all patients who undergo emergency abdominal surgery appeared to have a normal result or findings regarding their appendixes but only upon closer pathological examination was their condition known. This excellent article discusses the common symptoms of appendicitis, the procedures for both pre-operative and post-operative care of appendicitis patients and all other additional steps to be taken with regards to preparations for discharge towards early recovery. Summary Appendicitis is the most common acute medical condition that necessitates abdominal surgery. Its classic symptom is abdominal pain accompanied by same signs and symptoms of other medical conditions which is why it is often misdiagnosed. But the danger of appendicitis cannot be overemphasized because if left untreated, it can lead to rupture in which bacteria is released to the bloodstream leading to bacteremia (blood poisoning) and worse, causes sepsis. Abdominal pain usually starts near the navel (belly button area) and gradually spreads to the lower right side of the belly (WebMD, April 28, 2009). Even if belly pain is moderate but persists for more than four hours, it is best to seek professional medical help. If belly pain gets worse, then go to a hospital immediately because the situation can get pretty real bad in a short period of time. Abdominal pain is caused by an appendix getting inflamed due to a block on its opening caused by a hardened fecal mass (called a fecalith) or due to ulceration of the mucosa (membrane or lining) but there are other symptoms of appendicitis discussed below. The second most reliable sign of appendicitis is rebound tenderness. This is pain felt when slight pressure is applied a bit farther away from the actual point of pain and released quickly that leads to severe pain. Other symptoms are anorexia (loss of appetite), nausea and vomiting. Additional signs are elevated temperature and white blood count of 10,000 or more. Other signs are constipation and back pain before an actual rupture occurs. When an appendix is ruptured, signs are vastly different now such as a WBC count of 20,000/mm3 or more, a rigid abdomen and a body temperature of 39° C (102° F or higher). It usually takes 24 hours or less from the first signs of appendicitis to the medical emergency that happens when it becomes ruptured and bacteria starts to spread into the bloodstream. The article by Ms. Rocca strongly recommends patients suspected to have appendicitis be closely monitored at the hospital in preparation for surgery as treatment is easier if there is no rupture. Evaluation This article was good in pointing out the necessity of correctly diagnosing appendicitis because it presents with signs and symptoms similar to other medical conditions. Due to this similarity, appendicitis carries a higher risk because it can turn into a medical emergency quite quickly if not acted upon immediately; consequences can be life-threatening and even fatal. If viewed from a knowledge point, this article is extremely useful because detecting appendicitis is often difficult even with the use of laboratory diagnostic tools like X-rays, imaging studies and ultrasound methods. However, appendicitis can be diagnosed when patient history and the correct physical examination will rule out other possible medical conditions. The article could have devoted more space to what temporary emergency measures can be taken by people who has a friend or relative who has a ruptured appendix but cannot be brought to a hospital immediately for one reason or another. This can definitely save lives. Additionally, the article should have discussed too how to avoid appendicitis in the first place. The short article will be very useful to nurses who need to know how to diagnose appendicitis correctly from other conditions with confusingly similar signs and symptoms. Further, people at greater risk of appendicitis (those who may have it but exhibit no outward signs) like young children (3 years or below), older people and pregnant women should read this article. Conclusion This article was very short but compact and generally complete in the sense that it had covered all the important points regarding appendicitis. It was able to discuss all various signs and symptoms associated with it, the necessary pre-operative and post-operative procedures to be followed to ensure fast recovery. Likewise, the article included two special sections which I found to be particularly interesting and useful which are special care in cases of perforation or abscess and also on the two common appendectomy techniques used today. Reference List Rocca, J. D. (January 2007). “Minimizing the Perils of Appendicitis.” Hospital Nursing, 37 (1). pp. 1-3. Retrieved from CINAHL Plus with Full Text database. WebMD (April 28, 2009). “Appendicitis Symptoms.” Accessed November 20, 2009 from http://www.webmd.com/a-to-z-guides/appendicitis-symptoms Clients Name Professors Name Article Review-Musculoskeletal Journal 22 November 2009 Introduction The article written by Nicola L. Judge entitled “Assessing and Managing Patients with Musculoskeletal Conditions” is a big help to nursing practitioners. This is because the role of nurses have evolved and even expanded that it had merged with the duties of other health care team members. This article was published in July 20, 2007 by the Nursing Standard, Volume 22, No. 1 and contains a wealth of information and practical advice for the examination of patients who present with musculoskeletal complaints. This is timely due to the increasing number of seniors today from the general ageing of the population and complaints like these are fairly common nowadays specially among elderly people. The article discussed common ailments that are associated with the skeletal structure of the body and included both anatomy and physiology of the musculoskeletal system as well for better understanding. A few aspects of history taking and physical examination were likewise included to improve knowledge. Summary More and more adults today are affected with musculoskeletal-related ailments. They are very common in acute and primary care settings like clinics and the emergency rooms of most hospitals. Adults who seek treatment are usually those who experience increasing levels of pain and decreasing levels of functional activity that had adversely affected their activities of daily living (ADLs). Besides hyperactive kids and active adolescents who often suffer from accidents, the other adult group most seen in these settings are athletes who complain of some soft-tissue injuries and over-use injuries. However, a majority of those seeking treatment are people who suffer from the most common diseases associated with ageing and lifestyles. Perhaps a most common musculoskeletal complaint is arthritis which is inflammation of the joints. Although there are about a hundred different forms of arthritis identified today by medical science, the two most common are osteoarthritis (OA) and rheumatoid arthritis or RA. Osteoarthritis can be caused by several causative factors such as trauma, infection to the joint or due simply to old age. Rheumatoid arthritis, on the other hand, is primarily due to a systemic inflammation of the joints. It affects the synovial membrane in which joints become warm, swollen, tender and range of motion (ROM) is reduced. Being systemic, RA means it affects several joints simultaneously; it has no known etiology although familial or genetic and environmental factors are suspected to be involved in the development of the disease. The two ailments are progressive and have no known treatment but pain can be alleviated. Also common is osteoporosis in which there is significant and continued bone loss. It results if bone resorption is faster than bone formation and is a primary cause of pathologic fractures (the bone breaks due to loss of bone density). Other causes of fractures are accidents (falling down the stairs) or trauma due to sports injuries. In all cases, the level of care is the same. There are many types of bone fractures but the management principles are applicable to all situations which are to reduce the fracture, hold the ends to let them unite again during the healing process and moderate exercise to retain joint functions (Judge 2007, p. 53). The nurse should take a comprehensive history when a patient presents with problems related to musculoskeletal functioning. This history-taking activity helps the nurse assess the patient initially based on what a patient says about the start of pain (whether traumatic or not) and information can then be used in the actual physical examination, going from the general to the specific areas of pain. Questions to be asked include onset of pain, degree of pain felt, any deformities seen, weakness or numbness and lastly, functional difficulties. Answers that are also needed are about past medical history, drug history, family history and social history. Critical part during history-taking is pain assessment so the physical examination can be conducted with extreme care and not add to the distress of the patient. Only inspection and palpation are required and these should be done away from the area of pain. The nurse is also to observe the patients ambulation, gait, posture and functional ability to have a general idea of the condition. This will be followed by a regional joint examination (specific area) and then assess the ROM of the affected joint/s. The common methods for ROM should be used to know if there are excess fluids or loose bodies within the joint like when crepitus is observed; it will also help whether it is a joint problem or a soft-tissue problem. Evaluation This article was excellent in explaining the signs and symptoms of the more common musculoskeletal conditions especially now that there are older people in the overall general population due to demographic trends. It had discussed in outline form some of the common pathology of these medical conditions, what a nurse should look out for, how to do it and the steps to be taken to minimize pain among the sufferers. An important section of this article was the one dealing with possible complications of this condition such as developing some peripheral neurovascular deficits which I did not know about before reading this article. The article, however, did not mention preventive measures to avoid these conditions. It was also fairly lengthy such that too much information is conveyed and important points are lost. Conclusion The article is very useful for nursing practitioners today because they are often in the first line of contact with patients who present in primary care and urgent care settings today. More people are now being affected by OA and RA due to their lifestyles and this article is helpful also to those with musculoskeletal conditions so they understand what is happening to them, avoid certain foods and to improve their own chances of recovery if they are admitted. Reference List Judge, N. L. (July 20, 2007). “Assessing and Managing Patients with Musculoskeletal Conditions.” Nursing Standard, 22 (1). pp. 51-57. Retrieved from CINAHL Plus with Full Text database. Read More