Which of the following are common clinical manifestations of appendicitis?

 R.O. is a 12-year-old girl who lives with her family on a farm in a rural community. R.O. has four siblings who have recently been ill with stomach pains, vomiting, diarrhea, and fever. They were seen by their primary care provider(PCP)and diagnosed with viral gastroenteritis. A week later, R.O. woke up at 0200 crying and telling her mother that her stomach “hurts really bad!”she had an elevated temperature of 37.9° C(100.2°F).R.O. began to vomit over the next few hours, so her parents took her to the local emergency department(ed). R.O.'s vital signs, complete blood count, and complete metabolic panel were normal, so she was hydrated with IV fluids and discharged to home with instructions for her parents to call their PCP or to return to the ed if her condition did not improve or if it worsened. Over the next 2 days, R.O.'s abdominal pain localized to the right lower quadrant, she refused to eat, and she had slight diarrhea. On the third day, she began to have more severe abdominal pain, increased vomiting, and fever that did not respond to acetaminophen. R.O. has returned to the ed. Her Vs are 128/78,130,28,39.5°C(103.1°F).

R.O. is guarding her lower abdomen, prefers to lie on her side with her legs flexed, and is crying. IV access is established, and morphine sulfate 2 mgIV is administered for pain. Anabdominal CT scan confirms a diagnos is of appendicitis .R.O.'s white blood count is 12,000 mm3.

1. Which of the following are common clinical manifestations of appendicitis? Select all that apply.

a. Diarrhea

b. Vomiting

c. Leftlowerquadrantabdominalpain

d. Constipation

e. Arthralgia

f. Diffuserash

g. Fever

2. Discuss why R.O.'s presenting clinical manifestations make diagnosis more difficult. Identify two other possible diagnoses.

4. R.O.'s weight is 42kg, and her height is 155cm. Calculate her maintenance fluid needs and discuss how these will be met.

5. R.O.'s parents give informed consent, and R.O. assents to the surgery after the procedure is explained to her.Why is it important for R.O. to provide her assent for the procedure?

What should be included in the preoperative teaching for R.O. and her parents?

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