Appendicitis is the inflammation of the vermiform appendix caused by an obstruction and/or infection.
- The 34-Year-Old Patient Evaluation & Management Plan Appendicitis is the inflammation of the vermiform appendix caused by an obstruction and/or infection. It is the most common cause of acute right lower quadrant (RLQ) abdominal pain requiring surgical intervention. One question that should be asked is if the patient is experiencing anorexia, because this is the first symptom and principal indicator of appendicitis. Another important question is asking about where the abdominal pain is because inflammation of the visceral peritoneum usually progresses to the parietal peritoneum, presenting with migratory pain, which is a classic sign of appendicitis. Additionally, ask about presence of fever and vomiting because these are results of inflammation, and if the patient is having menstruation now to rule out other etiologies of abdominal pain (Snyder et al., 2018). The diagnosis of acute appendicitis is made clinically and is based primarily on the patient’s history and physical exam. The historical presentations of signs and symptoms are important keys to prompt diagnosis and treatment; therefore, it is important to obtain a thorough and accurate account of the events. A rectal exam can be performed, but it is open to greater subjective interpretation. Patients with appendicitis will normally perceive greater tenderness and fullness on the right than on the left during the rectal exam. The provider must keep in mind that both the bowel and the appendix are mobile organs; they can shift posteriorly or suprapubic, causing altered exam findings (Dunphy et al., 2019). Bowel sounds are a nonspecific finding they may be present, absent, or decreased in patients with appendicitis. Other physical exam findings can include alterations in vital signs consistent with increased pain, such as tachycardia or elevated blood pressure. Patients may be reluctant to take a deep breath for fear they will cause themselves pain (Talan & Di Saverio, 2021). If there is perforation of the appendix, there may be a sudden cessation of the pain, which is considered an emergency. Findings consistent with peritonitis include diffuse abdominal tenderness with rigidity. The patient may exhibit signs of septic shock, with marked leukocytosis, fever, and hemodynamic instability (Snyder et al., 2018). The differential diagnoses of appendicitis include a host of problems, which include, but are not limited to, urinary tract infection, ectopic pregnancy, ovarian cyst, pneumonia, gastroenteritis, Crohn’s disease, diverticulitis, mesenteric adenitis, pancreatitis, PID, and cholelithiasis. Laboratory findings are not diagnostic and are nonspecific, so they must be used in combination with data from the history and physical exam. The complete blood count usually reveals a mild to moderate leukocytosis (white blood cell count 10–20,000 mcg/L) with a left shift (Talan & Di Saverio, 2021). Urinalysis shows microscopic hematuria or pyuria in 25% of patients. Women should have a urine human chorionic gonadotrophin test completed to rule out (ectopic) pregnancy. The lack of laboratory findings should not preclude the diagnosis of appendicitis (Dunphy et al., 2019). A computed tomography scan of the abdomen is helpful in ruling out other diagnostic possibilities, as well as determining if there has been perforation of the appendix or development of a peri-appendiceal abscess. An abdominal ultrasound helps to visualize the inflamed appendix and is also useful in ruling out other potential diagnoses. Diagnostic laparoscopy may be considered in female patients to rule out ectopic pregnancy, tub-ovarian processes, or pelvic inflammatory disease (PID). The treatment of appendicitis is surgical; therefore, once a definitive diagnosis is made, prompt referral to a surgeon should follow. ReferencesDunphy, L. M., Winland-Brown, J. E., Porter, B.O., & Thomas, D. J. (2019). Primary care: The art and science of advanced practice nursing-an interprofessional approach (5th ed.). Philadelphia: F.A. Davis. ISBN-13: 978-0-8036-3801-3Snyder, M. J., Guthrie, M., & Cagle Jr, S. D. (2018). Acute appendicitis: efficient diagnosis and management. American family physician, 98(1), 25-33.Talan, D. A., & Di Saverio, S. (2021). Treatment of acute uncomplicated appendicitis. New England Journal of Medicine, 385(12), 1116-1123.Module 5 Discussion .docx ReplyReply to Comment
17 hours ago
please disregard the previous msg
17 hours ago
Evaluation and Management Plan
The case study focuses on a 34-year-old lady who goes to the emergency room complaining of sudden, severe back pain and pointing to her right side. She gives the anguish the maximum possible score of 10 on a scale from 1 to 10. In addition to her pain, she is feeling nauseous. She asserts that this is the first instance of its sort and that the pain gradually subsides. This paper discusses additional questions to ask the patient, physical exam, diagnostic testing, differential diagnosis, and patient management.
Some additional questions to ask the patient include; When did the pain begin? What aggravates the pain? Where does the pain radiate? Have you tried to use any painkillers? And Is there any underlying medical condition? It is necessary to know the onset of pain to assess its severity to make a differential diagnosis. To make a final diagnosis, the healthcare practitioner must know the aggravating and alleviating factors of the pain (Fontenelle et al., 2020). Pain normally originates in one part of the body and radiates to another. This may be indicative of a serious medical condition that results from it. Knowing whether the patient uses painkillers or not would aid in making a final diagnosis.
In the physical examination, the back is palpated to detect lumps, kyphosis, and lordosis. Additionally, the back should be palpated to detect soreness. The physical examination should also include observations and measurements of the back (Fontenelle et al., 2020). In addition, palpation of the legs for discomfort, joint alignment, pulse examination, and certain tests, such as the straight leg test, should be performed (Rule et al., 2020).Kidney stones, flank discomfort, and lower back pain may be potential differential diagnoses. Renal calculi, commonly known as kidney stones, nephrolithiasis, or urolithiasis, are hard mineral and salt deposits inside the kidneys (Rule et al., 2020). Kidney stones may be brought on by several things, such as a poor diet, being overweight, having a medical condition, or using specific supplements or drugs. Extreme lower back pain, blood in the urine, nausea, vomiting, dizziness, a high body temperature, chills, and a foul odor or hazy appearance in the urine are among the symptoms you may experience (Rule et al., 2020). Pain in the lower back’s flanks is common, and it manifests on either side of the spine between the pelvis and the ribs. Various illnesses and traumas may cause pain in the flanks. Common causes of flank discomfort include kidney stones, infection, and muscular strains. Rest, pain medication and antibiotics are all possible treatments for flank discomfort, depending on the underlying reason.
Blood tests, urine testing, and imaging are some of the most important diagnostics for diagnosing kidney stones. Blood testing might suggest excessive calcium or uric acid levels. The results of a blood test assist the doctor in monitoring the condition of your kidneys and may urge them to evaluate you for further problems. (Rule et al., 2020).The 24-hour urine test may indicate too many or too few stone-preventative substances. This patient will have two urine samples taken on two consecutive days. In the urinary system, imaging scans may detect kidney stones. Computerized tomography (CT) at high speeds or with dual energies may detect even the smallest stones (Fontenelle et al., 2020). Because simple abdominal X-rays might overlook tiny kidney stones, they are used less often. Ultrasound, a noninvasive test that is rapid and simple to do, provides an additional imaging tool for diagnosing kidney stones.
Patients with kidney stones may be treated with analgesics, medicinal medication, and encouragement to consume large quantities of water. Pain medicines such as ibuprofen (Advil, Motrin IB,and naproxen sodium (Aleve) are advised for the treatment of minor pain (Rule et al., 2020). Alpha-blockers are often recommended for the treatment of kidney stones. The mechanism of action for alpha-blockers is that they relax the muscles in your ureter, facilitating the quicker, less painful transit of kidney stones. The medication combination dutasteride and tamsulosin are examples of alpha-blockers. The patient must be instructed to drink plenty of water.
In conclusion, flank discomfort affects the region between the pelvis and the ribs on each side of the lower back. Several ailments, diseases, and traumas may cause pain in the flanks. Kidney stones are hard salt and mineral deposits inside the kidneys. The physical examination should also include observations and measurements of the back. Blood tests, urine tests, and imaging are some of the most important diagnostics for diagnosing kidney stones. Computerized tomography (CT) at high speeds or with dual energies may detect even the smallest stones. Patients with kidney stones may be treated with analgesics, medicinal medication, and encouragement to consume large quantities of water.
References
Fontenelle, L. F., & Sarti, T. D. (2019). Kidney stones: treatment and prevention. American family physician, 99(8), 490-496.
Rule, A. D., Lieske, J. C., & Pais, V. M. (2020). Management of kidney stones in 2020. JAMA, 323(19), 1961-1962.
17 hours ago
The 34-year-old Patient Evaluation and Management Plan
- What additional questions should you ask the patient and why?
Additional questions to ask the patient in order to make a probable diagnosis include asking about the onset of the pain, its characteristics, such as whether it is sharp, dull, or throbbing, what the patient was doing before the pain started, her history of back injuries, any other symptoms aside from nausea such as fever or blood in urine, and whether she has taken any painkillers for the pain.
- What should be included in the physical examination at this visit?
Following the taking of the patient’s history, a physical examination should be carried out. This includes taking the patient’s vital signs to check for fever, examining the patient’s general appearance and posture, feeling for CVA tenderness, performing an abdominal exam that includes palpation, percussion, and auscultation to check for organomegaly and the degree of pain, performing the straight leg raising test, and performing a heel-toe walk to evaluate range of motion, leg strength, and sensation.
- What are the possible differential diagnoses at this time?
The patient’s symptoms can be used to make a range of differential diagnoses, including urinary calculi, and urinary tract infection. Renal calculi, or kidney stones, are hard deposits consisting of minerals and salts that develop inside the kidneys (Stanford et al., 2020).Diet, too much body fat, and certain illnesses are the main causes of kidney stones. Minerals crystallize and adhere to one another in concentrated urine, which causes kidney stones to form. Severe side and back discomfort, back pain that comes in waves and varies in severity, and nausea, are being displayed by the patient. Pain or a burning sensation while urinating, fever or cloudy, foul-smelling urine are other signs of kidney stones. An infection of the kidneys, ureters, bladder, or urethra is referred to as a urinary tract infection (UTI) ( Yuan et al., 2018). The bladder and urethra make up the lower urinary tract, which is where most UTIs occur. In the patient’s situation, the kidneys may have a urinary tract infection. Back or side pain, as well as nausea, are signs of a kidney urinary tract infection that the patient is experiencing. High fever, nausea, and chills are further signs of a kidney infection (UTI).
- What tests should you order and why?
A basic metabolic panel to assess the kidney’s function is one test that can be performed on the patient. A complete blood count should also be performed on the patient to check the number of white blood cells suggestive of an infection. Another test that should be carried out on the patient to assess for excessive excretion of stone-forming materials, blood, pus, or bacteria is a urine test. To check for kidney stones, their size, and their shape, computed tomography or ultrasound should be done.
- How should this patient be managed?
The patient needs an alpha blocker like tamsulosin (Flomax) to help relax the muscles in her ureter, which will help her pass the kidney stone more swiftly and painlessly. The patient should be given a prescription for painkillers such as ibuprofen (Advil, Motrin, or naproxen sodium) to treat her discomfort. The patient needs to be made aware of how important it is to drink enough water in order to keep her urine diluted and avoid the development of kidney stones. The patient should be encouraged to keep a healthy weight by working out frequently and being active to reduce the risk of developing kidney stones.
References
Stanford, J., Charlton, K., Stefoska-Needham, A., Ibrahim, R., & Lambert, K. (2020). The gut microbiota profile of adults with kidney disease and kidney stones: a systematic review of the literature. BMC Nephrology, 21(1), 1-23. https://doi.org/10.1186/s12882-020-01805-w
Yuan, X., Liu, T., Wu, D., & Wan, Q. (2018). Epidemiology, susceptibility, and risk factors for acquisition of MDR/XDR Gram-negative bacteria among kidney transplant recipients with urinary tract infections. Infection and Drug Resistance, 11, 707. https://doi.org/10.2147%2FIDR.S163979
Edited by Bocanegra, Jessica on Sep 21 at 10:07am
17 hours ago
please send me the peer responses to review the answer
thank you
Answer preview to Appendicitis is the inflammation of the vermiform appendix caused by an obstruction and/or infection.
APA
296 words