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Victor, a 10 year old child has been admitted to ER due to increasing pain in abdomen. The pain started around morning and it was in epigastric area which now after 4-5 hours has been changed to right lower quadrant. The pain severity has been increased and it is now sharper than morning which makes him and his parents worry . He lost his appetite and didn't have breakfast or lunch but he deny any vomiting or nausea. He didn't have defecation since morning but passed some gas.
On physical examination the child appears to be in pain but otherwise normal. Vital signs are within normal range and chest examination is normal. In abdominal examination the right lower quadrant is tender and rebound tenderness is apparent.the lab test shows clear leukocytosis with shift to left but urine lab test is completely normal.
The first differential diagnosis is acute appendicitis . which of these actions at this stage is Contraindicated:
1. starting IV fluid therapy2. NPO order3. ordering abdominal x-ray4. ordering laxatives as he didn't have defecation
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