Chronic Calculous Cholecystitis

8/11/2019 Chronic Calculous Cholecystitis

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Republic of the PhilippinesCAVITE STATE UNIVERSITY

Don Severino de las Alas Ca pusIndan!" Cavite

Colle!e of Nursin!

Chronic Calculous Cholec#stitis

Presented by:

$SN %&' (roup %

Baro, JennylynBraga, Rhodeva JoyCedron, Ariane Rose

Cubillo, Irish JaneDala, Roxanne Jade

Espinelli, Leanna aeLa!son, Leonise JoieLope", Don Ra#ael

asenas, Ayr $ershelilla%ena, Cir%arie $ope

Pastores, &lora AngeliPuedan, Jenivi!

'algado, Janssen

Presented to:

Prof) Nie*el Alarca" RN" +ANProf) Rolando Antonio" RN" +ANProf) Nor idia ,uion" RN" +AN

Clini!al Instru!tors, Level III

Date:

-ctober ./'%

In Partial &ul#ill%ent o# the Re(uire%ent in )*R' + B #or the Degree Ba!helor o# '!ien!e in )ursing

VISION

A premier university inhistoric Caviterecognized for excellencein the development of morally upright and

MISSION

Cavite State University shallprovide excellent, equitable andrelevant educational opportunitiesin the arts, science and technologythrough quality instruction andrelevant research and developmentactivities. It shall provideprofessional, s illed and morally


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TA$0E -1 C-NTENTS

I- DE ./RAP$IC DA0A11111111111111111111111112

II- REA'.) &.R 'EE3I)/ $EAL0$ CARE111111111111111-11-2

III- $I'0.R4 .& PRE'E)0 ILL)E''111111111111111111---112

I5- PA'0 EDICAL $I'0.R411111111111111111111-111-2

5- $ERED.6&A ILIAL $I'0.R41111111111111111111--1-17

5I- DE5EL.P E)0AL $I'0.R41111111111111111111--1-1-8

5II- /.RD.)9' &*)C0I.)AL $EAL0$ PA00ER)'11111111111-11---

5III- A)A0. 4 A)D P$4'I.L./41111111111111111111-11;

I?


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! a g e " iii

I) DE+-(RAP2IC DATA

A) Client3s Na e4 &-J$) Address4 Rosario, CaviteC) A!e4 8D) $irth Date4 June 2;, 2@?7

E) $irth Place4 Cavite1) (ender4 &e%ale() Civil Status4 'ingle2) Reli!ion4 Ro%an Catholi!


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0he !lient stated that GPagnag a alagnat a o at sipon iniinu%an o ngPara!eta%ol o De!olgen- 0u%atagal siya ng %ga 7 to ara , u%iino% din a o ng%ara%ing tubig-H

A!!ording to Publi! $ealth )ursing, a !hild is said to be G&ully I%%uni"ed ChildH

hen a !hild re!eives one dose o# BC/, 7 doses o# .P5 ith an interval bet eendoses o# 8 ee s, 7 doses o# DP0 ith an interval bet een doses o# 8 ee s, 7 doseso# $EPA B ith + ee s interval #ro% 2 st dose to > nd dose and ; ee s interval #ro%>nd dose to 7 rd dose-

V) -$STETRIC&(YNEC-0-(ICA0 2IST-RY

Client had her #irst %enstruation hen she as 2 years old- A!!ording tothe patient she had her %onthly period in the > nd ee o# the %onth- 'he used 7

pads per day and usually last #or 7 to days- 'he has regular %enstrual !y!le-

Patient doesn t #eel any dis!o%#ort or pain during her %enstrual period-

A!!ording to Pilitteri, the average age o# a #e%ale to begin %enstruation is @62?having an interval o# >; days and an average #lo o# >6? days ith the a%ount o# 7 6; %L-

VI) 2ERED-&1A+I0IA0 2IST-RY

A) (EN-(RA+


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Interpretation:

-

V) DEVE0-P+ENTA0 2IST-RY

&RE*D9' P'4C$.A)AL40IC 0$E.R4

Sta!e Specific Tas78s9 Evidences of +ilestoneAchieve ent/enital 'tage It is the last stage o# &reud s Patient JL develops a strong interest

0e!end4

&e%ale

ale

Diseased

Alive and =ell A =


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! a g e " vii

psy!hosexual theory o# personality develop%ent and begins in puberty- It is a ti%e o# adoles!ent sexualexperi%entation, the su!!ess#ul

resolution o# hi!h is settlingdo n in a loving one6to6onerelationship ith another in our > s or so- 'exual instin!t isdire!ted to heterosexual

pleasure, rather than sel# pleasure during the phalli!stage-

in his husband- 'he develops a ell6 balan!ed, ar%, and !aring adult-'he verbali"ed that she as a!tive inter%s o# her sexual li#e-

ERI3'.)9' P'4C$.'.CIAL DE5EL.P E)0

Sta!e Specific Tas78s9 Evidences of +ilestoneAchieve entInti%a!y vsIsolation

During early adulthood %ost people #all in love, get %arriedand start building their o n#a%ily- I# a person is unable todevelop inti%a!y ith others atthis age hether through%arriage or !lose #riendshipsK,they ill probably develop#eelings o# isolation-

Patient JL developed inti%a!y thanisolation in her psy!hoso!ial stage-'he experien!ed to #all inlove andget %arried- 'he already had her o n#a%ily- 0he patient also verbali"edthat she as #eel loved by her husband and her !hildren- Anda!!ording to her she developed astrong bond ith her #a%ily and

!lose #riends-

PIA/E09' 0$ER.4 .& C./)I0I5E DE5EL.P E)0

Sta!e Specific Tas78s9 Evidences of +ilestoneAchieve ent&or%al.perational'tage

0he #or%al operational stage begins at approxi%ately aget elve to and lasts intoadulthood- During this ti%e,

people develop the ability tothin about abstra!t !on!epts-' ills su!h as logi!al thought,dedu!tive reasoning, andsyste%ati! planning also e%ergeduring this stage-

A!!ording to patient JL, she tend tothin very !on!retely -'he also!onsider possible out!o%es andthin the !onse(uen!es o# her a!tionsand de!isions- 'he also has theability to syste%ati!ally solve a

proble% in a logi!al and %ethodi!alay e%erges-

3.$LBER/9' 0$E.R4 .& .RAL DE5EL.P E)0
http://psychology.about.com/od/piagetstheory/p/formaloperation.htmhttp://psychology.about.com/od/piagetstheory/p/formaloperation.htmhttp://psychology.about.com/od/piagetstheory/p/formaloperation.htmhttp://psychology.about.com/od/piagetstheory/p/formaloperation.htmhttp://psychology.about.com/od/piagetstheory/p/formaloperation.htmhttp://psychology.about.com/od/piagetstheory/p/formaloperation.htm


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! a g e " viii

Sta!e Specific Tas78s9 Evidences of +ilestoneAchieve entPost!onventionalLevel

0he !on!ern is so!ial utility or publi! interest- =hile rules areneeded to %aintain so!ial order,

they should not be blindlyobeyed but should be set upeven !hangedK by so!ial!ontra!t #or the greater good o# so!iety- Right a!tion is one that

prote!ts the rights o# theindividual a!!ording to rulesagreed upon by the holeso!iety-

A!!ording to the patient she nothe di##erent so!ial groups ithin aso!iety ill have di##erent values-

'he also pra!ti!ed to !o%%uni!ateand have a better #ello ship ithher neighbourhood- 'he also obeyall rules that ere agreed upon theso!iety and no s her rights as ahu%an-

VI) (-RD-N3S '' 1UNCTI-NA0 2EA0T2 PATTERNS A. Health Perception- Health Management

0he patient verbali"ed that G . ay na%an a o ngayon asinaoperahan na a o, %edyo %agtitiis nalang asi ang da%i na ba alainin-H

'he has sedentary li#estyle- Patient said that she doesn9t doanything to be healthy li e not doing exer!ise or eat healthy #oods- 'heusually eat #ried #oods and buy #oods at G!arenderiaH-xxxxxxxxxxx

. Nutritional-Metabolic Pattern

!ay "#eptember $%&$'"3

!ay$#eptember 3'&$'"3

!ays 3(ctober "&$'"3

rea) ast 3pcs. Pandesal co ee

$ slices loa bread co ee

$pcs. Pandesal co ee

+unch ,ried ish"ser ing egetable" cup rice

+itson )a ali" cup rice

Adobo/ cup rice

!inner ,ried chic)en" cup rice

,ried chic)en" cup rice

,ish" cup rice

Water 0nta)e 3 glasses ater1$'ml

3 glasses ater 1$'ml

3 glasses ater 1$'ml

2222222222222-interpretation .. urther elaborate.. t.y


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! a g e " x

6#apat naman ang tulog )o )ahit gabi na a)o umuu i galing sa trabaho& tanghali na rin namana)o nagigising7& as erbali;ed by patient. Client &-J #eels relaxed and does not #eel anydis!o%#ort upon a ing up-

During hospitali"ation the patient is satis#ied about her sleeping pattern- 'he stated that

G)a a atulog na%an a o ditto ng %aayos sa hospital-H-

,. 4ogniti e-Perceptual Patient &J

Si ple Descriptive Pain Intensit# Scale

*according to Health Assessment in Nursing 3 rd edition Janeth Weber and Jane Kelley

; days and an average #lo o# >6? days iththe a%ount o# 7 6; %L-

J. 4oping #tress

#o !ain $ild !ain $oderate !ain Severe !ain %ery Severe!ain &orst

!ossible!ain


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=hen patient got stressed she usually !ope up by eating a lot o# #oods-'o%eti%es she shares her proble% ith her partner-

=henever there is a proble% !a%e they solved it together-

K. =alue- elie A!!ording to the patient she seldo% go to !hur!h- But she verbali"ed thatG'ye%pre nanini ala parin na%an a o sa Diyos ahit na hindi a onagsisi%ba tu ing linggo-H Patient &J does not believe in anysuperstitious belie#s-

VII) ANAT-+Y AND P2YSI-0-(Y

DI(ESTIVE SYSTE+


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! a g e " xii

0he hu%an digestive syste% is a !o%plex series o# organs and glands that pro!esses #ood-In order to use the #ood e eat, our body has to brea the #ood do n into s%aller %ole!ules that it!an pro!essM it also has to ex!rete aste- ost o# the digestive organs li e the sto%a!h andintestinesK are tube6li e and !ontain the #ood as it %a es its ay through the body- 0hedigestive syste% is essentially a long, t isting tube that runs #ro% the %outh to the anus,

plus a #e other organs li e the liver and pan!reasK that produ!e or store digestive !he%i!als-

T2E DI(ESTIVE PR-CESS


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! a g e " xiii

The start of the process & the outh40he digestive pro!ess begins in the %outh- &ood is partly bro en do n by the pro!ess o# !he ing andby the!he%i!al a!tion o# salivary en"y%es these en"y%es are produ!ed by the salivary glands and brea don star!hesinto s%aller %ole!ulesK-

-n the 5a# to the sto ach4 the esopha!us6 A#ter being !he ed and s allo ed, the #ood enters the esophagus- 0he esophagus is a longtubethat runs #ro% the %outh to the sto%a!h- It uses rhyth%i!, ave6li e %us!le %ove%ents !alled

peristalsisK to #or!e #ood #ro% the throatinto the sto%a!h- 0his %us!le %ove%ent gives usthe ability to eat or drin even hen e re upside6do n-

In the sto ach6 0he sto%a!h is a large, sa! 6li e organ that !hurns the #ood and bathes it in a very strong a!idgastri! a!idK- &ood in thesto%a!h that is partly digested and %ixed ith sto%a!h a!ids is !alled!hy%e-

In the s all intestine6 A#ter being in the sto%a!h, #ood enters the duodenu%, the #irst part o# the s%all intestine- Itthen enters the FeFunu%and then the ileu% the #inal part o# the s%all intestineK- In the s%allintestine, bile produ!ed in the liver and stored in the gall bladderK,pan!reati! en"y%es, and other digestive en"y%es produ!ed by the inner all o# the s%all intestine help in the breadon o# #ood-

In the lar!e intestine6 A#ter passing through the s%all intestine, #ood passes into the large intestine- In the largeintestine, so%e o# the ater and ele!trolytes !he%i!als li e sodiu%K are re%oved #ro% the #ood-any %i!robes ba!teria li e Ba!teroides, La!toba!illus a!idophilus, Es!heri!hia !oli, and3lebsiellaK in the large intestine help in the digestion pro!ess- 0he #irst part o# the large intestineis !alled the !e!u% the appe ndix is !onn e!ted to the !e!u %K- &ood then trave ls up ardin the as!endin g !o lon - 0 he #oo d trave ls a!ross the abd o%en in the transverse !olon, goes

ba! don the other side o# the body in the des!ending !olon, and then through the sig%oid !olon-

The end of the process6 'olid aste is then stored in the re!tu% until it is ex!reted via the anus

DI(ESTIVE SYSTE+ (0-SSARY

Anus 6 the opening at the end o# the digestive syste% #ro% hi!h #e!es asteK exits the body-Appendi: 6 a s%all sa! lo!ated on the !e!u%-


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ascendin! colon 6 the part o# the large intestine that run upardsM it is lo!ated a#ter the !e!u%-$ile 6 a digestive !he%i!al that is produ!ed in the liver, stored in the gall bladder, and se!reted into the s%allintestine-Cecu 6 the #irst part o# the large intestineM the appendix is !onne!ted to the !e!u%-Chi e 6 #ood in the sto%a!h that is partly digested and %ixed ith sto%a!h a!ids- Chy%e goes on to the s%all

intestine #or #urther digestion-Descendin! colon 6 the part o# the large intestine that run donards a#ter the transverse !olon and be#ore thesig%oid !olon-Duodenu 6 the #irst part o# the s%all intestineM it is C6shaped and runs #ro% the sto%a!h to the

FeFunu%-Epi!lottis 6 the #lap at the ba! o# the tongue that eeps !heed #ood #ro% going do n the indpipe to thelungs- =hen you sallo , the epiglottis auto%ati!ally !loses- =hen you breathe, the epiglottis opens so that air !an go in and out o# the indpipe-Esopha!us 6 the long tube beteen the %outh and the sto%a!h- It uses rhyth%i! %us!le %ove%ents !alled

peristalsisK to #or!e #ood #ro% the throat into the sto%a!h-(all bladder 6 a s%all, sa!6lie organ lo!ated by the duodenu%- It stores and releases bile a digestive !he%i!al

hi!h is produ!ed in the liverKinto the s%all intestine-Ileu 6 the last part o# the s%all intestine be#ore the large intestine begins- ;e


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0he Cir!ulatory 'yste% is designed to deliver oxygen and nutrients to all parts o# the body and pi! up aste %aterials and toxins #or eli%ination- 0his syste% is %ade up o# the heart, the veins, thearteries, and the !apillaries-

Cir!ulation is a!hieved by a !ontinuous one6 ay %ove%ent o# blood throughout the body- 0henet or o# blood vessels that #lo through the body is so extensive that blood #lo s ithin !lose

proxi%ity to al%ost every !ell-

As blood begins to !ir!ulate, it leaves the heart #ro% the le#t ventri!le and goes into the aorta- 0heaorta is the largest artery in the body- 0he blood leaving the aorta is #ull o# oxygen- 0his isi%portant #or the !ells in the brain and the body to do their or - 0he oxygen ri!h blood travelsthroughout the body in its syste% o# arteries into the s%allest arterioles-

.n its ay ba! to the heart, the blood travels through a syste% o# veins- As it rea!hes the lungs,the !arbon dioxide a aste produ!tK is re%oved #ro% the blood and repla!e ith #resh oxygen thate have inhaled through the lungs-


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VIII) C-+PRE2ENSIVE P2YSICA0 E=A+INATI-N

A) Vital Si!ns

.!tober 7, > 27

Ti e $P Te pC>RR cp

PR bp

?4// a "''>?' 3@.$ $? @$'.4// nn ""'>1' 3@.? $@ ?$

.!tober 8, > 27

Ti e $P Te p RR PR ?4// a ""'>1' 3@.? $? ?''.4// nn ""'>1' 3@.? $@ ?$

$) Anthropo etric Data$eight: 8922H=eight: +- gB I:

C) (eneral Appearancei. ody built and height eight proportionality

A 8 years old #e%ale has an endo%orph type o# the body- 'he has round body built and has obvious signs o# distress or illness-

ii. Posture and gait

iii. ( er all Hygiene and


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At #irst, the patient doesn9t ant to ans ers (uestions due to surgi!al pro!edurespe!i#i!ally !hole!yste!to%y- But eventually the patient responded to hat as as ed-

ii. Attitude0he patient as having di##i!ulty in tal ing, but hen e established our rapport

the patient be!a%e !ooperative-

iii. A ect>Mood appropriateness o responsesPatient &J !an appropriately respond over a !onversation-

i2. Buality and Buantity o speech0he patient9s (uality o# spee!h is in!o%prehensible-

2. :ele ance and organi;ation o thoughts0he organi"ation o# thoughts as pre!ise-

D) 1ocused Assess ent


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! a g e " xix

$od# PartE:a ined

Actual 1indin! Nor al 1indin! Clinical Si!nificance

Inte!u entS7in

2air @ Scalp

Inspection46 Pale6 no lesions6no %asses

Palpation4 6=ar% te%perature6 6Poor ' in 0urgor 6Dry s in

Inspection46bla! in !olor 6thin dry hair 6 no parasites6e(ually distributed6Dry s in o# s!alp6Presen!e o# dandru##

O!olored s in tonesithout or pro%inentdis!olorationsOs in rebounds anddoes not re%ainintended hen

pressure is released-OA lesion does not#luores!e-

Os in pin!hes easilyand i%%ediatelyreturns to its original

position-O' in is nor%allyar% te%perature,

and slightly %oist-Os in rebounds anddoes not re%ainintended hen

pressure is released-

OCan be bla! , bro nOevenly distributed!overs the holes!alp no eviden!e o# Alope!iaK,Ono parasites and thea%ount are variable-

A!!ording to =eber and 3elly6 $ealthAssess%ent in

)ursingM 7rd ed-Paleness o# the s in!an also be !aused byenviron%ental anddietary #a!tors, su!has !old te%peratures,#rostbite, dehydration,s!urvy, or la! o# sunexposure


)ursingM 7rd ed-6' in %ay be dry

be!ause o# insu##i!ient#luid inta e-6Poor s in turgor happens be!ause o# #luid loss that !ano!!ur #ro% !o%%on!onditions su!h asdiarrhea or vo%iting-


)ursingM 7rd ed-6Dull, dry hair %ay beseen ithhypothyroidis% and%alnutrition-6Poor hygiene %ay


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Nail

Palpation46rough and dull6Properly distributed

Inspection46round nail ith 2+degree nail base6it is hard and #ine intexture6Plate shape is longand un!ut6nails are dirty6Pale !olor o# nail

O'!alp is !lean anddry- 'parseDandru## %ay bevisible-

Ohair is s%ooth and#ir%, so%e hatelasti!- $o ever, as

people age, hair #eels

!oarser and drier-O5arying a%ounts o# ter%inal hair !over the s!alp,axillary, body,and pubi! areasa!!ording to

)or%al gender distribution-

Othere is nor%ally2+ degree angle

bet een the nail baseand the s inOnails are hard and

basi!ally i%%obileOpin tones should

be seen- 'o%elongitudinal ridging

have indi!ate a need#or !lient tea!hing or assistan!e itha!tivities o# dailyliving-

6Dry s in o# s!alp !an!ause s!aly #la es andit lead to havingdandru##-


)ursingM 7rd ed- 0hatthe #inding in !lient is

nor%al-6$irsutis% #a!ial hair on #e%alesK is a!hara!teristi! o# Cushing9s disease andresults #ro%an i%balan!e o# adrenal hor%ones, or it %ayBe a side e##e!t o# steroids-

6 Dull, dry hair %ay be seen ithhypothyroidis% and%alnutrition- And it%ight be !ause by drys in o# s!alp-


)ursingM 7rd ed-Paleness %ay o!!ur

by itsel# or, dependingon the underlying!ause, %ay o!!ur ithother sy%pto%s, su!has di""iness, #ainting,


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! a g e " xxii

,acial ,eatures

5yes

Inspection :6&a!e is sy%etri!ith an oval andround-

6 Periorbital ede%a6 hollo under theeyes6sun en eyes

Othe #a!e issy%%etri! ith around, oval,elongated or s(uareappearan!e-O)o abnor%al

%ove%ents noted-

Ono ede%a and nohollo ness #ound

!ondition o!!urs henthere is a shortage o# ater and other essential #luids in the

body-


)ursingM 7rd ed-*nusual proportionsshort palpebral#issures, thin lipes,

and ide and #lat philtru%, hi!h is thegroove above theupper lipK %ay behereditary or they%ay indi!ate spe!i#i!syndro%es su!h asDo n9s syndro%e and#etal al!oholsyndro%e- *ne(ual%ove%ent %ay in

di!ate #a!ial nerve paralysis-


)ursingM 7rd ed-Ede%a o!!urred

be!ause o# Ele!trolytei%balan!e-6 'un en eyes is a!ondition hi!h%ainly appears ithaging and !an happendue to %any reasons,hi!h !an be externalli e stress, tension or


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! a g e " xxiii

5yesEyebro s

5yelashes

Palpations46 no nodules6 no %asses

Inspection46evenly distributed6$as a nu%erous'e!retions

6li%ited %ove%ents

6 eyelashes are long!olor is bla!

Ono nodulesOno lu%ps anddepression #eltduring palpation-

O$air evenlydistributedM s ininta!t-OEyebro s

sy%%etri!allyalignedM e(ual%ove%ent, absen!eo# pi%ples anddandru##, %aybe

bla! bro n or blonddepending on ra!e-

OE(ually distributedM!urled slightlyout ard and bla! in!olor

internal li e la! o# sleep, dehydration or i%proper diet-


)ursingM 7rd ed- 0hatthe #inding in !lient isnor%al-


)ursingM 7rd ed-0he i%%obility and

a!!u%ulation o# #oreign substan!esthat !auses %u!ousse!retions-


)ursingM 7rd ed-'parseness o# lashes!ould indi!ate s indisease-


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! a g e " xxv

I=) DIA(N-STIC TESTS

A) Non&Invasive

SpecificTest

DateTi e ofTest

Actual 1indin! Nor al 1indin! Clinical Si!nificance

Plain

Abdo%en 27

=ith /aseous

distention o# the bo els=ith pau!ity o# has inthe presa!ral region

)o organo%egaly

)o organo%egaly Consider ileus ith

peritoneal irritation

=holeAbdo%enC0 '!anith!ontrast

?6>+627 u!osal =all: 8hic)and irregular ith

slight enhancement. ,at stands noted Liver: normal si;e&

smooth contour& nomass lesions orcalci ication.Paren!hy%al density:homogenousIntrahepati! biledu!ts: Not dilated /all bladder: Normal

u!osal =all: 8hinand regular in shape&no at stands isibleLiver: normal si;e&

smooth contour& no

mass lesions orcalci ication.Paren!hy%al density:homogenousIntrahepati! bile du!ts:

Not dilated /all bladder: Normalin si;e

Consider In#la%%ationin#e!tious pro!essinvolving the ter%inalileu% and !e!u%, ith

surrounding #atstranding-


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! a g e " xxvi

in si;ePan!reas: Normal in

si;e'pleen: Normal in

si;e

Adrenal glands: Normal in si;e3idneys: Normal in

si;e& no mass lesionor lithiasisPelvo!aly!eal syste%and ureters: Normal&no hydronephrosis*rinary Bladder:

physiologicallydistended& not

thic)ened all& nomass lesion orlithiasis*terus: Normal

Pan!reas: Normal in si;e'pleen: Normal in si;eAdrenal glands:

Normal in si;e

3idneys: Normal in si;e& no mass lesion orlithiasisPelvo!aly!eal syste%and ureters: Normal& nohydronephrosis*rinary Bladder:

physiologicallydistended& notthic)ened all& nomass lesion or lithiasis

*terus: Normal

Chest +

Potassiu%: 3.@ C D.Dmmol>+

Potassiu% is ithinnor%al level-

?62@627 Potassiu%: 3."@mmol>+'odiu%: 27+-8 mmol>+Chloride: 2 ?-+ mmol>+

Potassiu%: 3.@ C D.Dmmol>+ 'odiu%: "3D-"E?mmol>+Chloride: %?-"'@mmol>+

Potassiu% is belonor%al level hileChloride ex!eeds-$ypo ale%ia happenshen inta e isde!reased that !ausesdehydration resultingto in!rease !hloride


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! a g e " xxvii

seru%-?6>2627 Potassiu%: 3."E

mmol>+Potassiu%: 3.@ C D.Dmmol>+

Potassiu% is belonor%al level-$ypo ale%ia happenshen inta e is

de!reased-?6>>627 Potassiu%: 3.3Emmol>+


Potassiu% is belonor%al level-$ypo ale%ia happenshen inta e isde!reased-

?6>7627 B*): ".$" mmol>+

Creatinine: 3?.E"mmol>+

B*): $."E-1."Emmol>+Creatinine:: +>62 + mmol>+&9 EE-?' mmol>+

Lo !reatinine levelindi!ates de!reased%us!le %ass hilelo B*) indi!ateslo protein inta e-

?6>7627 Potassiu%: 3."@mmol>+ Potassiu%: 3.@ C D.Dmmol>+ Potassiu% is belonor%al level-$ypo ale%ia happenshen inta e isde!reased-

?6>8627 Potassiu%: 3.%@mmol>+


Potassiu% is ithinnor%al level-

;6 2627 /lu!ose &astingK:D.$? mmol>+0otal Protein: [email protected]%

g>+

Albu%in: E1.?' g>+/lobulin: $?.@' g>+A / Ratio: '.@?

/lu!ose &astingK:E.""- D.?% mmol>+0otal Protein: @E-%3

g>+

Albu%in: 3D-D$ g>+/lobulin: $3-3D g>+A / Ratio: "."-$.D

/lu!ose level, 0otalProtein, Albu%in and/lobulin are ithinnor%al range- Belo

nor%al level o# A /ratio is !onsidered tohave intestinal or renal disorders due tolo absorption o# nutrients-

;6 2627 Potassiu%: E."Dmmol>+'odiu%: 277-; mmol>+Chloride: 2 ;-2

mmol>+

Potassiu%: [email protected]>+ 'odiu%: "3D-"E?mmol>+Chloride: %?-"'@

mmol>+

In!reased !hloride isasso!iated ith loss o# ele!trolyte6#ree #luidspure ater lossK dueto #ever or

dehydration-;628627 0otal Protein: 1@."$ g>+Albu%in: 3'.?' g>+/lobulin: ED.3' g>+A / Ratio: '.@?

0otal Protein: @E-%3 g>+Albu%in: 3D-D$ g>+/lobulin: $3-3D g>+A / Ratio: "."-$.D

De!reased bloodalbu%in levels %ayo!!ur hen your bodydoes not get or absorbenough nutrients, su!has lo protein diet or a#ter surgery- $igh


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! a g e " xxviii

globulin value !anindi!ate in#e!tions,in#la%%ations andrenal disorders- Belonor%al level o# A /

ratio is !onsidered tohave intestinal or renal disorders due tolo absorption o# nutrients-

$e%atology ?62@627>:> p%

=BC: "".D% "'F3u+RBC: D."% "'F@ u+

$!t: E".?G

$gb: "E$.'

C5: ?'.D +

C$: $1.E M4H49 3E.'

Platelet: E$% "'F3u+

)eutrophil: ?%.1 G

Ly%pho!yte: D.1G

ono!yte: E."GEosinophil: '.EGBasophils: '."GP5: 2 -

=BC: D.' C "' "'F3u+RBC:

M9 E.1-@." "'F@ u+ ,9 E.'- D.D "'F@ u+$!t:

M9 E$.'-D$.'G ,9 $1.' C E1.'G$gb:

M9 "3D-"?' ,9 "$'- "@'C5:

M9 ?'-%E + ,9 ?"-%% +C$: $1.' C 3".'C$C: 33.'-31.'

g>d+

Platelet: "D' -ED'"'F3 u+

)eutrophil: D'.'-1'.'GLy%pho!yte: $D.'-E'Gono!yte: 3.'-"".'GEosinophil: ".'-E.'GBasophils: '.'- ".'GP5: ?->622-2 #L

=BC in!reases henin#e!tion or in#la%%ation are

present- De!reasedC5 !ells %ayindi!ate %i!ro!yti!

ane%ia- Ly%pho!ytede!reases due to renal%al#un!tion related toi%balan!e body #luids!aused bydehydration- Anin!reased neutrophiland de!reasedeosinophil are signs o# stress response o# the

body a#ter the surgery-

;6 26278: p% =BC: D.$% "'F3 u+RBC: E.EE "'F@ u+

$!t: 31."G

=BC: D.' C "' "'F3u+RBC:

M9 E.1-@." "'F@ u+ ,9 E.'- D.D "'F@ u+$!t:

M9 E$.'-D$.'G ,9 $1.' C E1.'G

In!reased C$C andEosinophil %ayindi!ate ironde#i!ien!y ane%ia-$igh platelet values%ay be seen ith

bleeding, ironde#i!ien!y, so%e


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=) C-NCEPT +APS

PAT2-P2YSI-0-(Y

+odifiable 1actors4 $istory o# Appendi!itis

Identi#ied etastati! Adeno!ar!ino%a

Non& odifiable 1actors4 Age

alignant epithelial !ells on the intestinallining

0u%or on the large intestine

Protein se!reted by the tu%or

Protein %i%i!s the Anti6diureti! hor%oneIn!reased Anti6diureti! hor%one level


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In!reased Anti6diureti! hor%one in the blood

Anti6diureti! hor%one travels to the

.pen up the ater pores in the tubules

Reabsorption o# ater .s%osis

Allo s )a 3 A0Pase

Reabsorbed ater %oves to high sodiu%

In!reased potassiu% !hannels in thelu%inal border

In!reased potassiu% se!retion

In!reased potassiu% level in the urine

De!reased potassiu% level in the blood

$ypo ale%ia

'igns and sy%pto%s

&atigue

Anorexia

)ausea

5o%iting

us!le ea ness

Leg !ra%ps

De!reased bo el %otility

Paresthesias

Dysrhyth%ias

In!reased sensitivity to digitalis


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=I) CASE +ANA(E+ENT

') +edical +ana!e enta) Phar acolo!ic Intervention

u e ur ne

Ex!essive thirst

De!reased %us!le strength

0endon re#lexes


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Chronic Calculous Cholecystitis

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