Case Pres Eco Model

8/7/2019 Case Pres Eco Model

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A Case Presentation


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The agent-host-environment model is primarilyused to predict illness rather than to promotewellness, although identification of risk factors thatresult from the interactions of the agent, host, andenvironment helps in promoting and maintaining

health. Because each of agent-host-environmentfactors constantly interact with others, health is an

ever changing state. Health is seen in when allthree elements are in balance, while illness is seenin one when one, two, or three elements are not in

balance.

(Fundamentals of Nursing by Kozier 2004)


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Appendicitis is an inflammation of the inner lining of the vermiform

appendix that spreads to its other parts. It may occur for several reasons, suchas an infection of the appendix, but the primary cause in most cases is the

obstruction of the appendiceal lumen. Appendicitis is a common and urgent

surgical illness with generous overlap with other clinical syndromes, and

significant morbidity, which increases with diagnostic delay. No single sign,

symptom, or diagnostic test accurately confirms the diagnosis of appendiceal

inflammation in all cases.

Obstruction of the appendiceal lumen is the primary cause of

appendicitis. An anatomic blind pouch, obstruction of the appendiceal

lumen leads to distension of the appendix due to accumulated intraluminal

fluid. Ineffective lymphatic and venous drainage allows bacterial invasion of

the appendiceal wall and, in advanced cases, perforation and spillage of pusinto the peritoneal cavity.

Left untreated, appendicitis has the potential for severe

complications, including perforation or sepsis, and may even cause death.

(emedicine.medscape.com

LeBlond RF, DeGowin RL, Brown DD. DeGowin's Diagnostic Examination. 8th ed. McGraw-Hill; 2004:1040.)


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We chose this certain topic for further study under the concept of

Endocrine System & Metabolism. By this, we would be able to gain knowledge

about its etiology and other certain revelations regarding the disease and its

underlying factors. Particularly, statistics report that 1 of 5 cases of appendicitis is

misdiagnosed; however, a normal appendix is found in 15-40% of patients who

have an emergency appendectomy.

We hereby gathered selected data from our patient and also facts from

certain references that would contribute and support the case.


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A. Hypothesis

Acute Appendicitis due to fecalith obstruction of theappendiceal lumen which could lead to bacterialovergrowth and an increase in intraluminal pressure and setsoff an inflammatory process that can lead to infection,thrombosis, necrosis, perforation, and peritonitis.

In our study of the patients condition, we haveperceived that the predisposing factors which contributed tothe occurrence of Acute Appendicitis are the Host and theAgent. There had been no any environmental factor involvedto cause the disease, however, we cannot disregard ordetach it for it is originally a part of the ecologic model.

The predisposing factors together with their componentsare as follows:


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B. Predisposing Factors

1. HostAge: 39 years old

Sex: MaleLifestyle (Nutrition): Low fiber diet

2. Agent

Non-living: Fecaliths


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C. The Lever

Agent

Host

E


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We have chosen the lever ecologic model because it is

used to show the relationship between the host, agent, andenvironment. It is also used to determine if there is animbalance among the three pre-disposing factors or there isone that contributes more than the other, which may lead toan occurrence of the disease.

Since the patient is male & at the age of 39, age is onefactor because Appendicitis could occur in all ages andregarding the gender, there is higher incidence in men thanin women. Due to his nutritional lifestyle which is low fiberdiet, it could also cause Appendicitis because high fiber dietis truly recommended to prevent such disease. And thefecalith, as the agent, initiated the disease process through

obstruction in the appendecial lumen that caused pain inthe right lower quadrant of his abdomen, the client went tothe hospital immediately.


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D. AnalysisAppendicitis is the inflammation of the vermiform appendix,

usually acute, that if undiagnosed leads rapidly to perforationand peritonitis. The inflammation is caused by an obstructionsuch as a hard mass of feces or a foreign body in the lumen ofthe appendix, fibrous disease of the bowel wall, an adhesion, or

parasitic infestation. The most common symptom is constant painin midabdomen. Extreme tenderness occurs over the right rectusmuscle. Appendicitis is also characterized by vomiting, a lowgrade fever of 99 to 102 F, an elevated white blood count,rebound tenderness, a rigid abdomen, and decreased or absent

bowel sounds. Treatment is appendectomy within 24 to 48 hoursof the first symptom because delay usually results in rupture andperitonitis as fecal matter is released into the peritoneal cavity.

(Mosbys Pocket Dictionary of Medicine, Nursing, & Health

Professions p.1

06)


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E. Conclusion

We therefore conclude that our hypothesis is correctbecause the patient had acute appendicitis due to fecalithobstruction to the lumen of the vermiform appendix affectedby the patients age, gender, and lifestyle. It was manifestedby atypical symptom of the right lower quadrant which wasthe reason why the client immediately went and reported to

the hospital. It was also the reason why the client hadundergone appendectomy within 24 hours of the firstsymptom because delay or when left untreated, it usuallyresults in rupture, peritonitis , or even death.


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F. RecommendationsThe best way to prevent Appendicitis is to eat plenty of

raw, fresh vegetables and fruits, whole grains and at leasteight glasses of liquid a day will provide the fiber needed toprevent constipation and minimize the risk of the appendixbecoming infected. However, if there are symptoms ofappendicitis already, there are some herbs that have beenknown to help reduce the effects. These herbs include:detoxifying and fever-reducing herbs (Flos lonicerae, Fructus

forsythiae, Herba taraxaci, Patrinia scabioseafolia, Gypsumfibrosum), circulation-enhancing herbs (Semen persicae,Radix paeoniae rubra, Squama manitis, Spina gleditsiae),and laxatives (Rhizoma rhei, Mirabilitum depuratum).Belladonna and Bryonia are classic homeopathic remediesoften used for an inflamed appendix with symptoms.


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F. Recommendations (continuation)Eat lactic acid fermented foods such as natural,

unsweetened yogurt to keep the bacterial culture in thecolon healthy. Exercise regularly to help prevent fecal matterfrom lodging and hardening in the colon.

If surgery has been performed, Vitamin E supports woundhealing and Vitamin C prevents infection and supports theimmune system. Bioflavonoids work naturally with Vitamin C.These vitamins are excellent during any infection, and

Vitamin C can be taken in high dosages if necessary. The Bvitamins can be added to the regimen to provide the bodywith the extra strength needed for the stress of the surgeryand illness.

(Dr. Eddy's Clinic Integrated Medicine - Web Journal )

www.dreddyclinic.com


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F. Recommendations (continuation)Treatments for Acute Appendicitis

The list of treatments mentioned in various sources forAcute Appendicitis includes the following list. Always seekprofessional medical advice about any treatment or changein treatment plans.

Emergency hospitalization

Appendectomy

Laparoscopic appendectomy

Paracetamol

Panadol

Ibuprofen

Diclofenac


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F. Recommendations (continuation) Buscopan

Over the counter pain medications

Treatment depends on underlying cause Call emergency services in case of acute pain

Appendecectomy

Antibiotics

(www.wrongdiagnosis. com)


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F. Recommendations (continuation)

The most important factor in your recovery after surgery is

following the full course of treatment ordered by yourhealthcare provider, including taking all of any prescribedantibiotics. To feel better as soon as possible you should:

Rest. Get plenty of sleep but avoid staying in bed for longperiods of time during the day.

Eat foods high in protein while you are healing if your providersays it is OK.

Eat small frequent meals.

Gradually increase your walking and activity as directed byyour provider.

Keep your sutures clean.


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F. Recommendations (continuation)

Wash your hands before and after changing the dressing on

your incision(s), and after disposing of the dressing.

Keep taking prescribed medicine until it is finished.

Contact your provider if the following signs of woundinfection appear:

redness or warmth at the suture site

yellow or green drainage from the wound

fever.

(www.med.umich.edu.com)

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