Amoxicillin (penicillins) 300mg TID PO with food (safe)

Morphine (opiate agonists) HCL 2-6mg Q3-4 PRN PO (safe)

Acetaminophen (analgesics and antipyretics) 330mg Q4H PRN PO (safe)

Ceftriaxone sodium (cephalosporins) 1000mg Q24 IV (Safe, not therapeutic (1100))

Metronidazole (antibiotic) 150mg Q8H IV (safe)

Dimenhydrinate (antiseptics) 25mg Q8H PRN IV (safe)

Ibuprofen (non-steroidal anti-inflammatory NSAID) 220mg Q6H PRN PO (safe)

Ondansetron (antiemetics) 4mg (safe)

Post-op day 1

Abdomen quite tender in the right lower quadrant

3 lap sites on abdomen

No BM since surgery

Language deficits, patient has selective communication with speaking only Punjabi with his mother and using non-verbal responses (head nodding and shaking head) or answering in yes or no responses to writer.

Using urinal frequently from bed

Patient voiding limited amounts

3 lap sites on abdomen overed with gauze dressing and tegaderm, right abdominal and mid umbilical dressing no drainage noted but left abdominal dressing has pea sized area of serosange drainage noted.

Mom at bedside all day

Dad works during the day but visits frequently

Younger sister at home

Grandparents at home that are a big help in care with children

Parents are knowledgeable about care, Mom knows to keep up with dressing care to keep them dry and clean. She mentions the need to watch out for signs of infections like drainage Orr inflammation.

Mom is very active in patients care, she advocates for patient by making needs known and asking for help when needed.

Patient is able to express needs tactically by using the FACES scale, patient clearly points to where he is feeling on the scale

Neutrophils - High (10.8)

WBC - High (12.1),

Lymphocytes - Low (0.6)

CRP - High (15.0)

Minimal intake both fluid and food

Eriksons: At 6 years old he is transitioning into the Industry vs inferiority stage (5-11 years), focusing on developing and mastering new skills. He demonstrates autonomy by using the FACES scale to point to the face that matches his discomfort, indicating his pain and identifying its location, shows his ability to understand and communicate his experiences.  

Piaget: in the preoperational stage (2-7), his cognitive abilities are still developing and he engages in more imaginative thinking. He shows early signs of logical thinking especially in understanding pain and healing. As he nears 7 is just entering the concrete operational stage, where he’ll grasp cause and effect relationships. His use of the FACES scale and pain localization shows development of handling more abstract concepts.

Physical development: Expected development in this stage of life that he has reached is he has He’s lost a few baby teeth, and his fine and gross motor skills are improving, allowing him to eat and dress independently. Post-appendectomy, he may need some encouragement and support in resuming tasks like chores and dressing as he recovers.

Language: M.S prefers to communicate in Punjabi with his mother

Family involvement: Extended family in this case grandparents play a significant role in caregiving

Family is connected with a local Temple