8/3/2019 ASKEP APENDICITIS
1/22
7,3
#$&022,,8,2-,::&9,7,$:$0
!&&
,9,70,,3080,9,3207:5,,3,50393/,,20/:5,32,3:8,,3,
47,3203,-,,3080,9,3:39:/73,803/7, 3/503,7:40
-07-,, 1,947 /,39,7,3, ,/,, 54, /:5 ,3 :7,3 -, ,3
2030-,-,347,32028:,9:503,9,380,7:83,/,5,9/.0,,5,-,,/,08,/,7,3/,73/;/:90780-:9%07:9,2,-07:-:3,3/03,3
50203:,3 0-:9:,3 3:978 80-,, 8,7,3, /:5 2,3:8, :39: 9:2-:
909,5 3/;/:.03/07:3:39:203:9,2,3/2,3, 8,,9 3 438:28
2,,3,3 8,3,9 -07,,2 .43943, 2,,3 2,,3,3 ,3 :7,3
203,3/:3 807,9 3 /,5,9 203,/ 503.09:8 503,9 7,/,3 ,5503/8
,9,:8073 /80-:9 ,5503/.98 803, /,5,9203,3: 1:38 4592,
/,788902,8974390893,907:9,2,/:8:8,:8
207, /5077,,3 503/:/: 203/079, ,5503/.98
/03,3 ,8:8 507 47,3 507 9,:3 5503/.98 907,/ 80-,,3
-08,7 ,-,9 2033,93, 438:28 2,,3,3 703/, 807,9 ,/,3,
507,/,3,3 5,/, :203 3, 2479,9,8 ,3 203:-:3,3
425,8 907,/,5 503,9 0- -, /,75,/, 93/,,3 502-0/,,3
3,2479,9,82033,95,/,5,803:8,9,:3907:9,2,,703,
0907,2-,9,3 /,3489 /,3 907,5 !07147,8 /,5,9 907,/ 5,/, :8,
9,:3 /,3 9,:3 02:33,3 ,703, 0907,2-,9,3 /,3488
5503/8 507147,8 ,-:3,3/03,32033,93, ,3,247-/9,8 /,3
2479,9,8 ,,2 50702-,3,33, ,5503/.98 8073 20307,3 47,3
,39,7, :8, 9,:3 $,, 8,9:3, 0- -07,,8,3 :39: 502-0/,,3
/,7:7,9 ,-/4203 5,/, ,3,,3, 9950020/.30.42
#945.92
07/,8,7,3 , / ,9,8, ,320,9,7-0,,3 503:8 203:8:3
50307,5,3 ,8:,3 0507,,9,3 5,/, 5,803 /03,3 ,5503/.98 ,703,
80-,, 507,,9 9, 2020,3 507,3,3 50393 /,,2 :5,, 503.0,,3
425,8,3,,3-07,-,9 0-,3:9/03,3202-07,3503//,3
080,9,3 9039,3 ,, /:5 ,3 80,9 805079 203,3:7,3 :39:
203438:28 2,,3,3 93 807,9 -,3, 23:2 ,7 5:9 ,3,3
8/3/2019 ASKEP APENDICITIS
2/22
7,3
#$&022,,8,2-,::&9,7,$:$0
203,,3 033,3 /010,8 -:,3 ,7 -08,7 , 3 /,5,9 2025070.
907,/3,503,9,5503/.98
%::,3!03:8,3/,5:39::,3503:8,32,,,3,/,,
0309,: /,3 202,,2 ,9,7 -0,,3 503,9 /0138 /,35,941844/,7,5503/.98
03,2-, 503,,2,3 3,9, /,,2 207,,9 /,3 202-07,3 ,8:,30507,,9,35,/,503/079,,5503/.98
02-,3/3,3,39,7,9047/,3,8:8,3,/,/,5,3,3 033,9,302,25:,3/,30907,25,3 /,,2202-07,3,8:,3
0507,,9,3/,5,3,3
094/0!03:8,3/,5:32094/0503:8,3,3/:3,,3/,,2203:8:32,,,
3
$9:/5:89,,0250,,7/,3203,2--0-07,5,907,9:7,3-07:-:3,3/03,3
503,9,5503/.98
$9:/,8:8!03,2,9,3 ,38:3 5,/, 5,803 %3 / 7:,3 $ #$&
$ /03,3 ,5503/.9 8 205:9 ,,3.,7,
,38:3/,320,:,350307,5,3,8:,30507,,9,3
$8902,9,!03:8,3,,2 503:8,3 2,,, 3 503:8 203,, /03,3 ,9,
503,39,7/,3/,19,78/,3:9,3/03,3,-!03/,::,3,3-078
,9,7-0,,39::,3503:8,32094/0503:8,3/,388902,9,503:8,3
02:/,3 ,- %3,:,3 904798 ,3 -078 43805 /,8,7 20/ /,3
43805 ,8:,3 0507,,9,3 8079, 5,9414/,7,2 ,- !03,2,9,3
,8:8 /,3 ,- ' -078 502-,,8,3 ,8:8 /,7 /03,3 ,- '
0825:,3/,3907,257/,19,75:89,,
8/3/2019 ASKEP APENDICITIS
3/22
7,3
#$&022,,8,2-,::&9,7,$:$0
%&%#%$
$!$# 0138
O 5503/.9 8 ,/,, 8:,9: 507,/,3,3 5,/, ,5503/8 ,3207:5,,3 8,:7,3 907802-:3 ,3 202,3,3 /,7 -,,3 /05,3
80:208,
O 5503/.98 ,/,, 31,2,8 ,:9 5,/, :,/7,3 -,, ,3,3 /,7743,,-/42037:3307,3/$://,79,
O 5503/.98 ,/,, 507,/,3,3 5,/, ,5503/8 ;07214728 ,309,3,/0,9,9:5813907 /,39,7, 0:2 :8:8,:8 /,3 80:2
:8:8-08,7,7-,7,,
,81,85503/.98/-,,9,8,9:
, 5503/.98,:9 5503/.98,:914.,8,9,:802039,8
,8,3, ,3, -,,3/89, ,3207,/,3 909,5 80:7: ,349,
,5503/8/89,-0783,3,&39:/,3488,350393,,
/902:,33, 3,3, /,,2 :203 -,,3 9: ,,: 7,/,33,
203,,72,,/,5,9907,/,5503/85:7:039,
5503/.98,:95:7:039,8:55:7,9;,/11:8,8079, 502-039:,3 3,3, ,3 -070-,3 , 7,/,33, 0-
20307,8/,5,9907,/307488/,3502-:8:,3/80-:9,5503/.98
,370348, ,9,: 50024348, !,/, ,5503/.98 ,370348, /,5,9
907,/507147,8,-,93074880/,,2743,507:9/03,3,-,9
50794398
- 5503/.98743 5503/.9874314.,8
$0.,7,2748459,25,1-7488809025,9,3203,7803,
/,5,92030-,-,38903488
5503/.987434-907,9;,
8/3/2019 ASKEP APENDICITIS
4/22
7,3
#$&022,,8,2-,::&9,7,$:$0
%07,/ 1-7488 ,3 :,8 805,3,3 ,5503/ 5,/, ,7 3,3
8:-2:48,/,38:-80748,3,907,/4-907,8,33,:203
907:9,2, / -,,3/89, /03,3203,33, 80,5:9 03/7 5,/,
-,,39:
3,9428445503/8 207:5,,3 47,3 -07-039: 9,-:3 ,3 -:39:
5,3,33, 7,7, .2 -07,3, .2 ,9,: -07::7,3 809,7
,7 033 /,3 -075,3, / 80:2 :2033, 80259 / -,,3
57482, /,3 200-,7 / -,,3 /89, %434,3 ,5503/8 5,/,
3043,9:8 -07-039: 07:.:9 ,3203434 /,7 ,508 80:2 805,3,3
.2 !,/, 2,8, ,3,,3, -,9,8 ,5503/8 /,7 80:2 802,3
0,8 /,3 -070807 0 ,7, /478, 7 !,/, 47,3 /0,8, 5,3,3
,5503/8 7,9,7,9, .2 90709, 548907420/, 80:2 7,7,
.2 310747 /,7 ;,;:, 0480,8 !488 ,5503/8 -8, 7097480,
709740,8:-0,,9,:/50;8202-07,3,2-,7,338,39/,
8,2, !,/, 5488 3472,3, ,5503/8 90709, 5,/, /3/3 ,-/4203
/-,,99.:730/.,7/03,3203,7,78/,7853,,,
8:50747,3,3 0:2-,8 99 903,,78 9: 207:5,,35,3,
,5503/8
:38 ,5503/8 9 /, /09,: ,/,3,/,3 ,5503/
/80-:9 9438 ,-/4203 ,703, /902:,3 -,3, ,73,3 214/
80,397,:9073,70,2,3/,3203.,5,5:3.,3,5,/,7,7,
:2:79,:3,302:/,3203,,2,97418079,57,98203,3
5,/, :8, 9,:3 03,3 -07:7,33, ,73,3 214/ 907,/
1-7488 /,3 5,/, 0-,3,,3 ,8:8 9 2-: 438978 :203 ,9,:
4-907,8 5503/8 203,8,3 03/7 2 507 ,7 03/7 3
80.,7, 3472, /.:7,,3 0 /,,2 :203 /,3 80,3:93, 203,7 0
80:2 5077,,3 ,5503/8 2025:3, 507,3,3 /,,2 20,3820
2:344,3907/,5,9/805,3,38,:7,3.073,9072,8:,5503/8
,, 2:344-:3 9: 8,3,9 01091 80-,,503/:3 907,/,5
31085503/82030:,7,3.,7,3 ,3-0781,9-,8,203,3/:3
,2,80070583/,32:83
8/3/2019 ASKEP APENDICITIS
5/22
7,3
#$&022,,8,2-,::&9,7,$:$0
944!030-,- :9,2,3, ,/,, 4-897:8 ,9,: 503:2-,9,3 ,3
/80-,-,340
0,9 2,88, 1,0808 ,3 5,/,9 ,-,9 438:282,,3,3 703/,807,9
,.35,7,89 3108;7:8.48970594.4..:8 $0-,-,328,9:247-,9: $979:7,703,1-7488,-,9507,/,3,380-0:23, 5075,8,214/
!,9418445503/.98 -,8,3, /80-,-,3 40 503:2-,9,3 :203
,5503/8 40 10,9 -03/, ,83 9:247 3108 ;7:8 5075,8,
214/ /,3 8979:7 ,703, 1-7488 ,-,9 507,/,3,3 80-0:23,
5503/ 2030:,7,3 .,7,3 ,3 -07:5, 80709 2::8 ,-,9
4-897:8503:2-,9,3 :203 90780-:9 2030-,-,3 2::8 ,,3
907,2-,9,3,2,2::890780-:92,3 -,3,3,2:3 0,8989,8
/3/3 ,5503/8 2025:3, 0907-,9,8,3 803, 203,-,9,3
500-,7,3 ,5503/8 70889038 80,5:9 03/7 -07:7,3 803,
203,-,9,32:/, 3108 /,3/,7 503:2-,9,3 3 ,2, 0,2,,3
,,3 2030-,-,3 907,/3, 507,/,3,3 5,/, ,5503/ /03,3 9,3/,
/,3 0,,3075,/, 99. :730 85,82049492:, 2:39,/,3
2030-,-,3 3,18: 2,,3 203:7:3 5079072 /,3 0:489488 ,
80708 2::8 907:8 -07,3:9 ,,3 2030-,-,3 5033,9,3 90,3,3
397,:23, 90,3,3 ,3 2033,9 90780-:9 ,,3 203,2-,9 ,7,3
210 ,3 203,-,9,3 0/02, /,50/088 -,907 /,3 :807,8
2:48, !,/, 8,,9 3, 907,/ ,5503/.98 ,:9 14.,8 ,3 /9,3/,
40 307 05 ,897 , 3 :, -, -07,38:3 907:8 ,,3
2030-,-,3 4-897:8 ;03, 0/02, -079,2-, /,3 -,907 ,,3
20302-:8/3/3
!033,9,3 90,3,3 397,:23, ,,3 203,-,9,3 4:8 03/
,7907,5503/:,78803,,7,3/,7,9/,/,5,9203.,5,,5503/
203,/ 548, ,2, 0,2,,3203,/ 802, ,-,9 9742-488 ;03,
397,2:7, ,2, 0,2,,3 203,/ 307488 ,3 ,73, 203,/
8/3/2019 ASKEP APENDICITIS
6/22
7,3
#$&022,,8,2-,::&9,7,$:$0
,3703 /2,3,2:48, 0/02, /,3 90705,8 803, -07-039: 9:,
3/3 ,5503/ 3 ,,3 20358 7,5: /,3 50., ,,3 907,/
,5503/.98 507147,8 , 802:, 574808 / ,9,8 3, 92-: 2,8,
4,,3/80-:93197,9,5503/:,78
!07,/,3,3,5503/890780-:9/9,2-,/03,3/,,9,,39:-:
,3203:7:3202:/,,3907,/3,507147,8$073,507147,83
907,/ /,,2 ,2,574808 3 -07,,3 ,2-,947,347,3/
809,7 0:2 90723,8 80:2 /,3 42039:2 ,,3 202-039: /3/3
2039,7,5503/8803,-07-039:,-808,39074,8,8
%,3/,/,30,,, %,,5,,
07,-/4203307 05,897 ,9,:5:35,/, /,07, :2-:8,3907,/,392-:
:,/,32:39, 02,2
- %,,5507903,,3 #,8, 8,9 203,,7 /,7 /,07, 05,897 0 ,7, 99 .
:730
34708, 008:,3-,/,3907,8,02, %07,/,30,:,34949 $::8:-10-78
. %,,5,:9,3/8079,507147,8 %07,/5033,9,37,8,8,9//,07,99.:730 :39, !033,9,3902507,9:78::3, 4 0,:,3,-/4203 %:3,,3,39/,/,5,9/:7:8,3 0:489488 %,,7/,
%089,3489, 02,944 0:489488 / ,9,8 : 5033,9,3 30:9741
8,25,
8/3/2019 ASKEP APENDICITIS
7/22
7,3
#$&022,,8,2-,::&9,7,$:$0
- % 8.,3 ,-/4203 /,5,9 203:3:,3 907,/3, ,-808 ,5503/,,9,:,5503/.98,:9
. 494 ,-/4203 ,2-,7,3 10,9 , 507147,8 907,/ ,2-,7,3:/,7,-0-,8/,5,9/,9/,7,81494
/ &$/902:,3,2-,7,3,5503/.980 &73,88 3472, 909,5 0:489 /,3 0797489 2:33 ,/, /,,2
:2,80/9
425,8, !07147,8
!07147,8 ,7,3 92-: /,,2 ,2 5079,2, 909,5 2033,9
808:/, ,2 !07147,8 /,5,9 /09,: 570 4507,91 /03,3
,2-,7,338,392-:0-/,7,280,8,95,3,80-
/,7 4 9,25, 948 307 90,3 / 80:7: 507:9 /,3
0:489488,-,9507147,8/,3502-039:,3,-808
- !079439807:5,,3 507,/,3,3 5079430:2 ,3 -07-,,, ,3 8073
907,/,-,95030-,7,33108/,747,347,3,-/420328,3,
,5503/.98 7,3820 ,3 8073 2033108 ,/,, 47,3820
,3/:5//,,2443,9:5,/,,8:87:59:7,,5503/8#0,8
,, 5079430:2 907,/,5 3;,8 40 -,907 ,/,, 0:,73,
08:/,9 1-7348, ,3943,3943 3,3, ,-808 907-039: /,39,7,
5070,9,31-7348,,32030250203,/8,9:/03,35072:,,3
809,73,803,202-,9,83108
. -897:8:8:8,5,9 //0138 ,3 80-,, ,3:,3 ,7,3 3472, 8 :8:8
805,3,38,:7,3:8:8-897:8:8:8/,5,9,:9,9,:7435,78,
,9,: 949, -897:8 :8:8 743 -,8,3, 20303, 443 80-,,
,-,9/,7,78342,-897:8949,:8:8,:8207:5,,30,/,,3
,,9 ,3 20207:,3 /,3488 /3 /,3 93/,,3 502-0/,,3
/,7:7,9-,503/079,33909,5/:5
8/3/2019 ASKEP APENDICITIS
8/22
7,3
#$&022,,8,2-,::&9,7,$:$0
%07,5/,3!0304,,30/, !704507,8
0/7089:39:4-807;,8/,,2,28090,0:,3 !:,8,.,7,35,703907,,502-0/,,3,38:3/,:,3 %07,5 1,72,4 4 3,749 /3/,7 ,703, /,5,9
203,3,39,3/,/,30,,
39-49:39:203,3:,33108 %7,386:,07:39:80/,8 %:39:2030:,7,3.,7,3,2-:3,/507:,3
,9,9,3 0302, /,3 ,,39, 9/, -40 /-07,3 ,703, /,5,9
2033,9,350789,9:8:8/,32030-,-,3507147,8
!02-0/,,3 5503/.9420 80.05,93, /,:,3 -,//,348,3, 905,9 /,3 9039:3, .,7, /,3 70,8 88902 ,7:8
/507,9,3
- !4894507,8 -807;,8 %%' 907,/3, 507/,7,,3 84 5079072, ,9,:
,3:,35073,1,8,3
!,803/5:,8,,38,25,1:38:8:802-,3472, 02:/,3 -07,323:2 2:, 2,2 80,2, ,2 ,:
3,,3203,/2,20084,3,73,/-07,32,,3,3
8,73/,3,7-07:93,:3,
9;9,8 8,9: ,7 5,8.,4507,8 5,803/,3:7,3:39:/:/:90,/9025,99/:780,2,2039!,/,,70/:,5,803
/,5,9-07/7/,3/:/:/:,7,2,7
39-49/,3,3,088090,548945/-07,3 ,9,3/,3,9,709::
$!$&!#% !03,,3
, !4,5078058/,35020,7,,3080,9,3 !0309,:,39039,35030-,-/,3574808503,9 #,,94507,87,,98,9-07,94-897:89:247 0-,8,,32,,3 703/,807,92,,350/,82,,3,3,38:9
/.073,--,3
8/3/2019 ASKEP APENDICITIS
9/22
7,3
#$&022,,8,2-,::&9,7,$:$0
- !4,3:978209,-4 :, :39, 34708, 02,2
. !4,023,8 43895,8/,70 !03:7:3,3-83:8:8 !07:902-:39/,,/,1,9:8
/!4,,9;9,8/,3,9,3 ,,80 %,,7/9,530, 24-8,8
0 !4,9/:7/,3897,,9 0-,8,,39/:7-07,5,,2, ,3:,39/:7,703,09/,3,2,3,3307
1 !4,5078058/,34391 0:,3 307 5,/, 99. :730 307 90,3 5,/, 99.
:730307/,07,:,4507,8
!4,5078058/,343805/7 02,8,,393/,,3,5503/942 ,3:,3,7,/7
!4,453907,/,589708 !078058503072,,38,9 %,:9.02,8,,393/,,3/,3507,,9,3
,348,0507,,9,3, !70507,8
#084933108-07:-:3,3/03,39/,,/0:,93,889025079,,3,39:-:80-,,,-,9/,757480831,2,8507,/,3,3
07 ,-/4203 -07:-:3,3 /03,3 574808 507,/,3,3 5,/,,5503/
#84 93 0:7,3,3 ;4:20 .,7,3 -07:-:3,3 /03,3507209,-4/02,22:39,
09/,01091,3 2,3,0203 907,50:9 -07:-:3,3 /03,3:7,350309,:,39039,3574808503,9/,35034-,9,3
8/3/2019 ASKEP APENDICITIS
10/22
7,3
#$&022,,8,2-,::&9,7,$:$0
- !489507,8 07-07:-:3,3/03,3388502-0/,,3 #084 93 0:7,3,3 ;4:20 .,7,3 -07:-:3,3 /03,3
502-,9,8,35,8.,4507,85:,8,39,0:7,3
,3:,3 39079 ,8 :9 -07:-:3,3 /03,3 9 3/,,3502-0/,,3
#03.,3,0507,,9,3, !70507,8
! #084 93 3108 -07:-:3,3 /03,3 9/, ,/0:,93,88902 5079,,3,3 9:-: 80-,, ,-,9 /,7 574808
31,2,8507,/,3,3
%/,907,/ 3108/9,3/,/03,38::/,,2-,9,83472,
439079,8:9:9:0:489:
3907;038
43947%%'907:9,2,8::9,5,2# $::2033,9203,3/,,3,/,3,3108
,9,3/,9,3/,50794398/,3,547,38007,-,507:# 0309,:,/,3,425,880507950794398
3/,7502-07,3:3,0302,80-0:24507,8# !03:3,,3 0302,502-07,3 :3, /,5,9 2033,9,3
50789,9:8:8/,32033,9,3784507147,8
07,3/9:3,/,3-,507:-0731:8# !033,9,33:978/,5,9202-,39:2033,9,3/,,9,,3
9:-:
4,-47,8/03,320/502-07,3,39-49# 03.0,31080-:,8
!07-07:-:3,3/03,3574808507,/,3,35,/,,5503/8
07-07:7,38,25,/03,3,3,,9,25,708
3907;038
,/,3.,9,9390389,84,8/,3,2,307# 0309,: 93,9 7,8, 307 -07:3, /,,2 503,,8,3
001091,34-,9
,9,3/,307-,;07-,2,:5:3343;07-,# 072,31,,92030;,:,8307
8/3/2019 ASKEP APENDICITIS
11/22
7,3
#$&022,,8,2-,::&9,7,$:$0
,7,390370,8,88050792,3,82:8,302-:9# 02-,39: :39: 20214:8,3 02-, 507,9 ,3 /,3
202-,39:5,803:39:203,9,83077,8,9/,3,2,3
,7,39033,1,8/,,2/,3-,9:01091# 07 /,5,9 2033,9,3 090,3,3 4949 3,1,8 /,,2 /,3
-,9: 01091 /,5,9 202-,39: 203:7,3 090,3,3 4949
,-/4203
07,35488,33,2,3# !488/,5,9202-,39:203:7,3307
4,-47,8/03,320/502-07,3,3,09# %07,5,3,09/,5,9203:7,3307
! #84 93 0:7,3,3 ;4:20.,7,3 -07:-:3,3 /03,3
507209,-4/02,22:39,
%/, 907,/ 0:7,3,3 ;4:20 .,7,3 /9,3/, /03,3
202-7,32:48,02-,-9:747:90,8989,3/,9,3/,;9,
/,,2-,9,8-,9,83472,0802-,3,339,04:95:9
3907;038
!,39,:9,3/,9,3/,;9,.,9,9,/,3,549038/,39,,7/# 030;,:,8 001091,3 907,5 .,7,3 /,3 708543 5,/,
5034-,9,3
-807;,8202-7,32:48,9:747:9# 3/,9470,/0:,9,387:,8507107/,3/7,8
!,39,:/,3.,9,9.,7,3,30:,7/,32,8:# 0309,:0802-,3,3.,7,3/,3:2,,3/507:,3
3:7,35,803:39:23:2,7,3,9# 7 ,3,9 /,5,9 203:7,3 2:, /,3 2:39, !07,/,3,3
/,5,9 2033,9,3 574808 209,-4 803, /507:,3
.,7,3,3-,3,:39:203:7:3,3/02,2
4,-47,8/03,320/:39:502-07,3.,7,35,703907,# 03,,0802-,3,387:,8.,7,3009749
8/3/2019 ASKEP APENDICITIS
12/22
7,3
#$&022,,8,2-,::&9,7,$:$0
! 09/,01091,3 2,3,0203 907,50:9 -07:-:3,3 /03,3
:7,350309,:,39039,3574808503,9/,35034-,9,3
!,803 /,5,9 202,,2 574808 503,9 /,3 5034-,9,3 /,3
-075,7985,8/,,25747,25034-,9,3
3907;038
,02,25:,3/,350309,:,35,8039039,3574808503,9/,35034-,9,3
# 02-,39: 202-07,3 5030,8,3 ,3 905,9 /,3 808:,
0-:9:,3
0,8,3 05,/, 5,803 20303, 57480/:7 5078,5,3 4507,8805079,9:502-0/,,33:3,3,2,74507,8
# !,803,,30-2:/,2033,9/,30-44507,91
,7,35,803:39:20,93,1,8/,,2/,3,9,34949# 033,9,3503,,7,3/,3,9;9,85,8.,4507,8
- !489507,8!07-07:-:3,3/03,3388-0/,
07-07:7,38,25,/03,3,3,,9,25,708
3907;038
,307390389,84,8/,3,2,3,# 07:3,/,,2503,,8,3001091,35034-,9,3
!079,,3,3897,,9/03,354888021407# 7,;9,8204,8,808:/,90/,,2,-/4203-,,:39:
203:7,3 090,3,3 ,-/4203 ,3 -079,2-, , 5488
907039,3
4743,2-:,8/3# 033,9,3 3472,8,8 1:38 47,3 .4394 207,38,3
50789,9/,30,3.,7,31,9:8
,09/,3,2,3,3,3/80-,-,3548957480/:74507,8# 09/,3,2,3,32:3340388,-,94507,8
4743503:3,,390370,8,8# 005,8,390,3,3024843,/,3494993,9,3507,8,,3
43974
4,-47,8/03,320/:39:2025079,,3,35:,8,
8/3/2019 ASKEP APENDICITIS
13/22
7,3
#$&022,,8,2-,::&9,7,$:$0
# 03:7:3,309/,3,2,3,35,8035,/,50789,9:8:8/3
/,37,8,8907
4,-47,8/03,320/:39:502-07,3,3,09# 03,3,37,8,307
! #084 93 0:7,3,3;4:20.,7,3 -07:-:3,3 /03,3
502-,9,8,35,8.,4507,85:,8,39,0:7,3
%/,907,/0:7,3,3;4:20.,7,3,3/9,3/,/03,3
9,3/,9,3/, ;9, /,,2 -,9,8 3472, 9:747 :9 0,898
202-7,32:48,02-,-39,0/,34:95:9802-,3
3907;038
-807;,89,3/,9,3/,;9,%#$!# 549038 9,,7/ 5033,9,3 5073,1,8,3
203/0391,8,30:7,3,3;4:20.,7,3
!,39,:39,0/,34:95:9.,7,3/,3.,9,9,73,:730# !03:7:3,3 4:95:9 :730 ,9,: 4380397,8 :730 50,9
203/0391,8,3 /0/7,8 202-:9:,3 5033,9,3
.,7,3
,9,92:,/,32:39,# :, ,3 907,/ 80,2, ,2 5,8., 4507,8 :2:23,
,703,010,3,8908
-807;,8 202-7,3 2:48, 9:747 :9 8:: :9 /,3 5,5,8507107.,5,7701920
# :9 /3302-,- /03:9 507107 02, 2033/,8,3
503:7:3,387:,8507107
4,-47,8/03,320/:39:502-07,3.,7,35,703907,# ,7,3 5,703907, /,5,9 202-,39: 0-:9:,3 .,7,3 ,3
/-:9:,39:-:
! ,3:,3 39079,8 :9 -07:-:3,3 /03,3 9 3/,,3
502-0/,,3
:,,9,3-0789/,,/,9,3/,9,3/,3108
3907;038
,/,07,809,7:,,5,,,/,5:8,9,:,9,3-,8,# 0908,,,907,/,3:,3/,,257480850302-:,3
8/3/2019 ASKEP APENDICITIS
14/22
7,3
#$&022,,8,2-,::&9,7,$:$0
,,:,,9,3909,5073/,3-078# 03:7,370843108
:3,,3903,80598,,9207,,9:,,9,3# 03.0, .7488 3108 /,3 203.0, 97,3828 3108
-,907,5,/,:,,9,3
!07,9,339,03:97803# !0393:39:202507.05,950302-:,3:,
!0703.,3,,3!:,3, 4-8,8-079,,5808:,02,25:,3- ,,:,4507,8909,5-078/,3073. !07,9,3 54, 2,,3 80,7,7 2,,3 93 807,9 8,3,9 -,
/438:28:7,32,,3,350/,8/9/93,9,3-079,,5-:-:7
8,73-:-:7-,8,3,892:3,
/ 3:24-,9808:,3897:8439740/49070 $007,0#$-,,/,9,3/,9,3/,31085,3,8207,307
8/3/2019 ASKEP APENDICITIS
15/22
7,3
#$&022,,8,2-,::&9,7,$:$0
5503/.9420
!07
!#089;4.,7,3!07:8,,339079,8:9
!%#0,9.,.331084$970594.4..:8
-897:8:203
!03:2-,9,35030:,7,3807092::8
!00-,7,3,5503/8
#088903880,5:903/7-07:7,3
:/,3108
!07,/,3,3/3/3
,5503/8
!02-039:,32::8
!033,9,390,3,3397,:23,
:803/,7907,5503/:,78
548,,73,3
802,,-,99742-488;03,397,2:7,
07488
,3703
,9,8/3/3,5503/820358
!07147,8
!0794398
!09/,01091,32,3,0203907,50:9
!02-,9,8,3
.,7,3:,2:39,
07
:,2:39,
$::0790,399.
:7300:489488
!#0893108
!07
!#089;4.,7,3
:48,0/02,/,3/,5,990705,8
803,-07-039:9:,
:,2:39,
%GG$4
89038,-/4203
0790,380:7:,-/4203!#084933108
8/3/2019 ASKEP APENDICITIS
16/22
7,3
#$&022,,8,2-,::&9,7,$:$0
!%$&$
!03,2,9,3 ,8:8 /,:,3 5,/, %3 :2:7 9,:3 ,,2, 8,2
7,,9 / 7:,3$, ,2,7 9,3,20,:$&
$ ,348, 2,8: /03,3 5503/.98 ,:9 /,3 97,
-7,8 !,803 2,8: /03,3 0:,3 307 ,-/4203 5,/, :,/7,3 ,3,3
-,,507:9 907,8, 90,32:,!,8032027,,9503,9 5079038/7,,9/#$&$,703,807,3,3507903880,
,7,3,:/,320,:,35034-,9,3/03,3/490757,90
!,/,8,,9503,,39,3,0,/,,3:2:25,8039,25,
8,9 80/,3 08,/,7,3 .42548 20398 !,803 203,9,,3 0:,3 307
,-/4203 / :,/7,3 ,3,3 -,, -07:7,3 390389,8 2:, 9/, ,/,
-807;,89,3/,9,3/,;9,%222039#2039
$4!2039!,/,5,8039075,8,3;0314314:39:308'
!,803 203/,5,9 -,9,8,3 .,7,3 .. ,2 ,8 ,- 9,3,
02,944,8, 5749742-3 /09 !%% /090:489
:$020321489-/2,4-:3/
%49,/!481,9,80,,:40890742/&73,8,
#,8&$-/420303,55503/202-08,7
50789,9 3472, 08,3 5072:,,3 ,5503/.98 ,8 1494 947,
08,3 80;070 .,7/420, /03,3 01:8 50:7, -,907, 7 0- -,3,
/-,3/3,3 ,3,3 47,,3 ;,8:07 ,8,7 / 0/:, 50707 ,8
97, 890348897, -7,85,/,'/,3' %07,5 ,3//,5,9
7, ,743 9,-09,78 9,-090943, 2 $2,7.2
9,-09%,79 9,-09,72,.74 ..0381429,-09
$:5548947,,/0 8:552308$49,9,25'9,23
,25,9,7,78,259:3,
,8,, 0507,,9,3,3/902:,35,/,5,803 ,/,,#084 93
503:7:3,3 .:7, ,39:3 -07:-:3,3 /03,3 ,3:,3 43/:8 ,39:3
07 -07:-:3,3 /03,3 574808 507,/,3,3 5,/, ,5503/8 39407,38
,9;9,8-07:-:3,3/03,309/,802-,3,3,39,7,8:5,480324.,7/
/03,3 0-:9:,3 02,8 -07:-:3,3 /03,3 574808 507,,9,3 /,3
5034-,9,3 89,9:8 080,9,3 #03.,3, 93/,,3 ,3 /,:,3 ,/,,
8/3/2019 ASKEP APENDICITIS
17/22
7,3
#$&022,,8,2-,::&9,7,$:$0
20214:8,35,/,0:,3,3/7,8,,35,803202-07,3503::,3/,3
20,8,3,,35747,220/ !0,8,3,,3/,:,3 808:,2,8,, ,3,/,
/,3 0;,:,8 /,:,3 :39:20309,: 93,90-07,8,3 507,,9,35,/,
5,803
8/3/2019 ASKEP APENDICITIS
18/22
7,3
#$&022,,8,2-,::&9,7,$:$0
'
!$$&$
$090, 503:8 20,:,3 503,2,9,3 ,8:8 2,, //,5,9,3
5078,2,,3/,3507-0/,,3,39,7,9047/,3,8:8,39,7,,3
!03,,3$090, /,:,3 503,,3 20303, 9047 /,9,,3 -,,
5030-,-/,7,5503/.98,/,,10,9,9:2,8,10808,35,/,9,3
/80-,-,3 ,703, :7,3 2,,3 2,,3,3 ,3 203,3/:3 807,9
!030-,-3808:,5,/,,8:8/2,3,5,/,54,5078058080,9,35,803
9/, 8:, 2,,3 2,,3,3 ,3 203,3/:3 807,9 805079 8,:7,3 /,3
/9,2-,,3 ,7,323:2,75:9%,3/,/,30,, ,3/,,25,803
80, ,7 ,3 ,: 5,803 2030: 307 / -,,3 ,-/4203 ,3,3
-,, /,3 507:9 907,8, 90,3 ,/, 2:, 909,5 5,/, 8,,9 20,:,3
503,,3 307 / ,-/4203 ,3,3 -,, -07:7,3 390389,8 2:,
9/,,/,9,3/,/,30,,38,2,/03,39047,3,3,80/,7,5:9
/,,2 /,7, /-:9,3 /03,3 ,8 ,-47,947:2 9,3, :89:8
//,5,9 0:489 : /,3 /,9,,3 ,/,3, ,5503/.98 /,7 ,8
&$ 9,3, :89:8 08,3 5072:,,3 ,5503/.9 8 ,703,
,5503/ 202-08,7 50789,9 3472, 0,, .05,9 0, //,5,9 5,/,
,8:8,703,5,803,/,7,,98,9,39:380,9,:3,3,:909,5
0:,3 808, /,3 307 /,/, 8:/, 9/, ,/, !,/, 9,3,
//,5,9,8297,890348897, 1-7,85,/,'/,3',9: /8792,
,3 /80-,-,3 40 ,3:,3 502-039:,3 25:8 ,8 1494 947,
9,3,08,3$0;070.,7/420,/03,301:850:7,-,907,7
0--,3,/-,3/3,3,3,3.47,,3;,8:07,8,7/0/:,50707
, 3 02:33,3 ,-,9 502-08,7,3 ,97:2 ,-,9 08 ,9:5 ,39:3
,3 203.0, ,97:2 2034843,3 83, 80.,7, ,/0:,9 0 /,,2
;03970!,803203/,5,9-,9,8,3.,7,3..,202:33,3,,7
2025073,307, ,39:3!,803 :,203,,2.02,8,703,-07,9,3
/03,3507,,9,3/,35034-,9,3,3 80,7:83, ,,3 /,:,34507,8
8/3/2019 ASKEP APENDICITIS
19/22
7,3
#$&022,,8,2-,::&9,7,$:$0
,5503/8 909,5 ,703, -,, 9/, ,/, /,3 02:33,3 /9:3/, ,703,
7084907,/,5503,9,39:33,
,348,0507,,9,3,348, 0507,,9,3 ,3 503:8 902:,3 5,/, 5,803 ,/,,
7084 93 503:7:3,3 .:7, ,39:3 -07:-:3,3 /03,3 ,3:,3
43/:8 ,39:3 /,348, 3 /,3,9 ,703, ,/,3, ,8 /03,3
97,8903488,97,1-7,85,/,'/,3',348,0,/,,307
-07:-:3,3 /03,3 574808 507,/,3,3 5,/, ,5503/8 /,348, 3
/,3,9,703,5,803203,9,,330790,32:,-07:7,3390389,8
/,3 ,8 &$ ,/,3, 5072:,,3 ,5503/.98 ,348, 0 ,/,,
39407,38 ,9;9,8 -07:-:3,3/03,309/,802-,3,3 8:5, 4803
24,7//03,30-:9:,3,703,5,803203,9,,3.05,90,#
39!239,8947,149480;070.,7/420,/03,301:850:7,
-,907, 7 0- -,3, /-,3/3,3 ,3,3 .47,,3 ;,8:07 ,8,7 /
0/:, 50707 ,348, 0 ,/,, .02,8 -07:-:3,3 /03,3 574808
507,,9,3 /,3 5034-,9,3 ,703,5,803203,9,,3207,8, -0-,3 ,703,
-,, 9/, ,/, :39: 4507,8 33 .05,9 5:,3 ,348, ,3 ,3
-07:-:3,3 /03,3 ,5503/.98 5,/, 9047 9/, /,3,9 ,703, 808:,
/03,343/85,803
!0703.,3,,3!0703.,3,,3,3/,:,3 5,/,!/14:8,35,/, 502,39,:,3
9,3/,9,3/,;9,907:9,2,3,/#8:,7,7,2,,39:34-,94-,9,3/03,3
-,9,8,3 .,7,3 ! /14:8,3 5,/, .,7, 203,9,8 307 /03,3 903
70,8,8/,3203, 307 390389,8! /14:8,35,/, 503::,3
9039,3 503933, 897,,9 /,3 9,3/,9,3/, ;9, 8090, 20,:,3
,9;9,8 ! /14:8,3 5,/, 503/,253,3 907,/,5 453 ,3
/:3,,35,803
8/3/2019 ASKEP APENDICITIS
20/22
7,3
#$&022,,8,2-,::&9,7,$:$0
!0,8,3,,3!0,8,3,,3,3/,:,3808:,/03,3703.,3,,390,/-:,9
,9: 5,/, ! 202,39,: 9,3/,9,3/, ;9, 907:9,2, # 7,2,
170:038 203, 0:,3 5,803 805079 307 /,/, 202-07,3 907,5
4-,94-,9,3808:,3897:88079,202,39,:.,7,3!,/,!03,/,3
203.,9,9 390389,8 4,8 307 2034-807;,8 %%' % # ! $
203,,7,3 903 70,8,8/,3202-07,3 907,5 !,/,!02-07
5030,8,3 20303, ,9;9,8 ,3 -40 /,:,3 203, 9,3/,9,3/,
9/, 9407,38 907,/,5 ,9;9,8 ! 03,, 5,803 -07/8:8 ,,7
203:7,37,8,.02,8/,3203,001091,34535,803
;,:,8;,:,8 /,:,3808:,/,348, ,3,/,3,2:3 802:,2,8,,
,3 ,/, 5,/, 5,803 -0:2 /,5,9 907,9,8 !,/, 5 0:,3 0, ,8
/,7 /,3 9,3/,9,3/, ;9, 202:33,3 7084 503:7:3,3 .:7,
,39:3!,8&$/,3,-47,947:28079,0:,3307,-,9574808
507,/,3,3 5,/, ,5503/ ! :39: ,9;9,8 2,8 /-,9,8 ,,7 9/,
202507-07,9 07, ,39:3 ! 0.02,8,3 2,8 ,/, 803, 2,8
/-:9:,3/::3,30:,7,:39:5,803
8/3/2019 ASKEP APENDICITIS
21/22
7,3
#$&022,,8,2-,::&9,7,$:$0
'
$!&
$090, 20,:,3 503,2,9,3 /,3 502-,,8,3 ,8:8 2,, /,5,9
/,2-0825:,3-,,5,/,5,803907/,5,9/:,2,8,,,9:,5503/.98
/,3 ,97, 1-7,8 5503/.98 ,/,, 507,/,3,3 ,5503/ :39: 5030-,-
/,7 ,5503/.98 ,/,, ,/,3, 10,9 3108 ;7:8 /03,3 9,3/, /,3 0,,
3075,/,/,07,,-/4203,3,3-,,/,5,9/8079,2:,
97, 1-7,8 /80-,-,3 ,703,,3:,3502-039:,3 25:8,9:
502-08,7,3 ,97:2 ,-,9 08 ,9:5 ,39:3 ,3 203.0, ,97:2
2034843,383,80.,7,,/0:,90/,,2;039700,703,9:808:,
/03,343/85,8032,,0-20257479,8,3,3203,3.,2,909,5
9/,203,-,,30,,,3,3
,,2 , 3 54, /:5 ,3 8,, 207:5,,3 1,947 ,3 /,5,9
203,-,9,3 907,/3, 503,9 ,5503/.980,703, 9:507,350393
507,,9 809, /::3,3 /,7 0:,7, 8,3,9 /-:9:,3 40 5,803 2,,
507:3,503::,35,/,2,8,7,,9/,,2,203,9:754,/:5,3-,
,,7907,,080,9,33,
8/3/2019 ASKEP APENDICITIS
22/22
7,3
#$&022,,8,2-,::&9,7,$:$0
%#!&$%
,7-,7, 43 0/., $:7., :783 $9 4:8 ' 48-
425,3
7:3307,3/$://,790507,,9,30/,0/,'4-,,8,
43.,8907/8,,79,
433, 3,9,;.:8 0/., $:7., :783 $,:3/078
425,3!,/05,
4.0 ,. 0/., $:7., :783 3., ,3,02039 147
4393:941,7019/943$,:3/078425,3!,/05,
08 $,743 ,39 0/., $:7., :783 880882039 ,3/
,3,02039413.,!74-028884:748-3.
:.2,33 ,3/ $47038038 0/., $:7., :783
!8.45844.5574,.4:790/943
,733403408 :783 ,70!,3/943 !,/05,
,;8425,3
$405,72,3$,7434,85,/::,72:!03,9,,2/
!0307-9&,,79,