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Appendicitis/Appendectomy
SKINNY Reasoning
John Washington, 1 4 years old
Primary Concept Inflammation Interrelated Concepts (In order of emphasis)
- Pain
- Stress
- Clinical Judgment
- Patient Education
NCLEX Client Need Categories Percentage of Items from Each
Category/Subcategory
Covered in
Case Study
Safe and Effective Care Environment โ Management of Care 17 - 23% โ โ Safety and Infection Control 9 - 15% Health Promotion and Maintenance 6 - 12% โ Psychosocial Integrity 6 - 12% โ Physiological Integrity โ Basic Care and Comfort 6 - 12% โ โ Pharmacological and Parenteral Therapies 12 - 18% โ โ Reduction of Risk Potential 9 - 15% โ โ Physiological Adaptation 11 - 17% โ
SKINNY Reasoning Part I: Recognizing RELEVANT Clinical Data History of Present Problem: John Washington is a healthy 14 - year-old African American male who weighs 1 5 0 lbs. (68.2 kg). He came to the emergency department because he woke up this morning at about 2 am with "excruciating" generalized abdominal pain around his belly button that has been progressively getting worse over the past several hours. It is now 2 pm. He took ibuprofen 4 00 mg PO this morning, which decreased the pain some but is now more painful and uncomfortable. The pain is now localized to his RLQ. The pain increases with walking and movement but he feels better when he lies down in a fetal position. He vomited three times after he drank some orange juice for breakfast this morning and has had nothing to drink since. He continues to feel nauseated but has not had an emesis since this morning. Personal/Social History: John lives with his mother and three younger brothers. He is active in athletics and has a strong social network of friends and family in the inner-city neighborhood where he lives. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction of Risk Potential) RELEVANT Data from Present Problem: Clinical Significance: RELEVANT Data from Social History: Clinical Significance: Patient Care Begins: What VS data are RELEVANT and must be interpreted as clinically significant by the nurse? (Reduction of Risk Potential/Health Promotion and Maintenance) RELEVANT VS Data: Clinical Significance:
Current VS: P-Q-R-S-T Pain Assessment:
T: 100 .5 F/38.1 C (oral) P rovoking/Palliative: Movement, palpation
P: 106 ( regular) Q uality: Sharp, cramping
R: 20 (regular) R egion/Radiation: Mid abdomen, RLQ
BP: 14 2/76 S everity: 8/
O2 sat: 99% RA T iming: Continuous
Lab Results: Complete Blood Count (CBC) WBC HGB PLTs % Neuts Bands Current: 14 .5 15.2 245 88 0
What lab results are RELEVANT and must be recognized as clinically significant by the nurse?
(Reduction of Risk Potential/Physiologic Adaptation)
RELEVANT Lab(s): Clinical Significance:
Basic Metabolic Panel (BMP) Na K Gluc. Creat. Current: 133 3.5 95 0. What lab results are RELEVANT and must be recognized as clinically significant by the nurse? (Reduction of Risk Potential/Physiologic Adaptation)
RELEVANT Lab(s): Clinical Significance:
. Misc. Lactate CRP Current: 4.1 55 What lab results are RELEVANT and must be recognized as clinically significant by the nurse? (Reduction of Risk Potential/Physiologic Adaptation)
RELEVANT Lab(s): Clinical Significance:
Lab Planning: Creating a Plan of Care with a PRIORITY Lab: (Reduction of Risk Potential/Physiologic Adaptation) **Lab: Normal Value: Clinical Significance: Nursing Assessments/Interventions Required: WBC Value:
Critical Value:**
Part II: Put it All Together to THINK Like a Nurse
1. Interpreting relevant clinical data, what is the primary problem? What primary health-related concepts does this primary problem represent? (Management of Care/Physiologic Adaptation)
Problem: Pathophysiology of Problem in OWN Words: Primary Concept:
Collaborative Care: Medical Management (Pharmacologic and Parenteral Therapies)
2. State the rationale and expected outcomes for the medical plan of care. (Pharm. and Parenteral Therapies)
Care Provider Orders: Rationale: Expected Outcome: Establish peripheral IV 0.9% NS 1000 mL IV bolus Morphine 2 mg IV every 2 hours PRN Ondansetron 4 mg IV every 4 hours PRN nausea Ceftriaxone 1 g IVPB x now Metronidazole 500 mg IVPB every 12 hours General surgeon consult Strict NPO
Education Priorities/Discharge Planning
5. What educational/discharge priorities will be needed to develop a teaching plan for this patient and/or family?
(Health Promotion and Maintenance)
Education PRIORITY:
PRIORITY Topics to Teach: Rationale:
What additional considerations need to be made when teaching the parents of a pediatric patient?
