The case study was about a 10 year old girl who came at the emergency department and she was complaining of pain at the right iliac fossa. Appendicitis was then suspected after carrying out further assessment on the patient .The surgery team agreed to perform surgery on Ann so at treat her medical condition. The results after the surgery was a perforated appendix that had peritonitis as well. Ann was then returned to the ward with a nasogastric tube on free drainage .Ann was then subjected to morphine PCA, IV therapy and the triple IV antibiotics. It is recommended that Ann should stay at the hospital for 10 days for IV antibiotics management.
Based on the case study. The patient was suffering from a condition known as acute appendicitis. Acute appendicitis is a medical condition in which there is obstruction of the appendix (Chin & Lim, 2015).The pathophysiology at the organ level begins by obstruction of the appendix. After the obstruction, the appendix becomes filled with a lot of mucus and this causes swelling. Excessive production of the mucus eventually exerts excess pressure in the lining of the walls of the appendix (Puthenpura, Desai, Bauer, & Marshall, 2016). The elevated pressure then leads to thrombosis as well as occlusion of the blood vessels as well as stasis of the flow of the lymphatic fluid.
Once small blood vessels are blocked, recovery is quite difficult. Since there will be continuous obstruction in the blood vessels, the appendix become ischemic and start experiencing ischemia (Hughes & Luu, 2014). Necrosis of the appendix also takes place progressively. Since there is necrosis, there will be a lot of bacteria produced at the site. The bacteria then start leaking out of the dying walls. This leads to formation of pus in the appendix as well as outside (Knox & Mortele, 2015). This condition is described as suppuration (Flum, 2015). The end result is rupturing of the appendix and this leads to peritonitis. Peritonitis on the other hand leads to what is called sepsis. Abdominal pain is the common symptom during all these stages.
There are different causative agents as well as risk factors for appendicitis. The most common causative agents include foreign substances in the body, intestinal worms, and bezoars (Matsushita et al., 2018). The most notable causative agent however is calcified feces which is known as appendicoliths or rather fecoliths.
Developmental milestones generally refer to the development of the child both physically and in terms of behavioral aspects in both the infants and children. There are different categories of behavior and they include cognition, motor coordination, and social interactions and finally adaptive (De Onis, 2017). The most important categories in this particular case study include the cognition and the social interaction. The child in the case study was about a 10 year old girl who was subjected to nasogastric and PCA tubes in situ. This tubes generally derail the development of the child both physically and emotionally.
According to this case study, the patient is 10 years old. At this stage, the child is expected to start admiring older youths besides starting to accept or questioning authority. The child should also be expected to start accepting beliefs by the parent. It is therefore expected that the clinicians should start involving the child by asking her some questions pertaining her health conditions (Øglund, Hildebrand, & Ekelund, 2015). The clinicians should also be braced for questions from the child since it is at this developmental milestone that a child starts questioning any authority. The clinicians should not take the questions from the kid for granted.
At 10 years old, the child is expected to have control of emotions. It is widely expected that hospitalization is likely to contribute to anxiety and stress to the child. It is therefore the role of both the clinician and the family members or the parents to assist the child on how well she can deal with some uncomfortable emotions such as stress and anxiety. It is at this stage that children have the ability as well to sense the emotions of others. Parents should therefore try to control their emotions like stress so that they are not transferred to the hospitalized child.
Family centered care can be defined as the collaboration or the partnership between family members and clinicians towards providing care to the hospitalized child .There are basically four guiding principles under family centered care and they include strength building, collaboration across all the providers, communication and finally respect and dignity. Under respect and dignity the caregiver should respect the culture and religion of each individual should be respected (Coyne, 2013). In this case for example, if the culture does not allow some practices, the family members of the patient should tell the clinician who should abide by their decision or request. Holistic approach should as well form part of the family centered care whereby the clinician should allow the family share encouraging words through the holy books such as the Bible and the Quran. Some family members value holistic approach so much and the clinicians should therefore a supportive and friendly environment to the family members to practice their religious acts when they feel like.
Consent is another conspicuous factor under the family centered care in this case study. The patient in this scenario is just a child with 10 years alone. This therefore means that she does not have the capacity to make any meaningful decisions (Trajkovski, Schmied, Vickers, & Jackson, 2013). It is the parents or the family members that should therefore consent on her behalf. The clinicians will have no otherwise rather than stick with the type of consent provided by the parents.
Communication is necessary at all levels of family centered care. In this case study, the child is still young and therefore majority of the information should be provided by the family members or the parents. However, the healthcare providers and the family members should communicate as well as sharing unbiased information with both the patient and the family members. The information to be shared should be very useful and supportive. Some of the important information include how well to take care of the child once she is discharged from the hospital.
Presenting children to health facilities has several effects on either the child as well as the parents or the family at large. According to several studies, it has been established that psychosocial effects are the leading in terms of affecting the wellbeing of both the child and the parents. Studies have out that early presentation of children to health facilities lead to stress among children. Subjecting the child at 10 years old on the Nasogastric tube and the PCA in situ also affects the physical development of the child since she cannot move around freely and play with others.
Sickness as well as hospitalization are some of the most critical events that a child is subjected to. This act is known to be associated with a lot of stress on the family members. The most affected people in this case are the parents (Fredman, Baucom, Boeding, & Miklowitz, 2015). Stress as well as anxiety form the parents can affect the ailing child in two different ways. First of all, the stress is transferred to the child and secondly, it also affects the ability of the parents to take care of the child. However, several countries have come to appreciate the importance of family centered care and they nowadays allow one of the family members to be present at the bedside of the child during treatment. The family member also takes part in providing care to the child.
Studies have established that stress as well as anxiety is due to the lack of proper information on the diseases as well as the medical procedures that are to be undertaken. Stress and pain in the child and the parents is also due to some of the crude treatment models subjected to the child as well as being unfamiliar with some of the rules and regulations of the hospital (Coyne, Hallström, & Söderbäck, 2016). Unfriendly staff was also according to some studies, found to be one of the contributing factors to stress among the parents and the hospitalized children since they are afraid of asking any questions or seeking clarifications.
Environmental factors, socio economic factors and managerial factors have also shown to be some of the leading factors in causing stress among the parents of the hospitalized children. According to some studies, some parents go through a period of stress whenever they spend so much money on their hospitalized child yet there is little or no improvement at all .There are different effects of hospitalizing a child to the child himself and the parents. Some of the effects include stress and anxiety. Hospitals should appreciate the importance of family centered care and implement it at the hospitals so as to reduce the incidences of stress and anxiety among both the parents and the hospitalized child.
Conclusion:
Appendicitis is a condition in which there is obstruction of the appendix and this leads accumulation of mucus that leads to swelling of the appendix. Inflammation then leads to damage of smaller blood vessels and stasis in the flow of the lymphatic fluids. Necrosis then sets in and the bacteria leak outside and there is formation of pus within and around the appendix a condition called suppression. In this case study, there was a child of 10 years who was suffering from appendicitis. The nurses have a critical role to play to ensure recovery of the child .The nurses have to consider issues like developmental milestones .Developmental milestones are key in nursing interventions especially when dealing with children. Other considerations include family centered care and finally the effects of hospitalization on the child and the parents. Family centered care includes the collaboration between the parents or the family members and the clinicians. There should be communication and respect as well. Issues of consent also need to be adhered to by the clinicians and the parents .Hospitalization is known to cause stress and anxiety to both the child and the parents. The clinicians should therefore come up with strategies to counter such emotions.
References:
Chin, C. M., & Lim, K. L. (2015). Appendicitis: Atypical and Challenging CT Appearances:Resident and Fellow Education Feature. RadioGraphics, 35(1), 123-124. doi:10.1148/rg.351140122
Coyne, I. (2013). Families and health-care professionals’ perspectives and expectations of family-centred care: hidden expectations and unclear roles. Health Expectations, 18(5), 796-808. doi:10.1111/hex.12104
Coyne, I., Hallström, I., & Söderbäck, M. (2016). Reframing the focus from a family-centred to a child-centred care approach for children’s healthcare. Journal of Child Health Care, 20(4), 494-502. doi:10.1177/1367493516642744
De Onis, M. (2017). Child Growth and Development. Nutrition and Health in a Developing World, 119-141. doi:10.1007/978-3-319-43739-2_6
Flum, D. R. (2015). Acute Appendicitis — Appendectomy or the “Antibiotics First” Strategy. New England Journal of Medicine, 372(20), 1937-1943. doi:10.1056/nejmcp1215006
Fredman, S. J., Baucom, D. H., Boeding, S. E., & Miklowitz, D. J. (2015). Relatives’ emotional involvement moderates the effects of family therapy for bipolar disorder. Journal of Consulting and Clinical Psychology, 83(1), 81-91. doi:10.1037/a0037713
Hartwich, J., Luks, F. I., Watson-Smith, D., Kurkchubasche, A. G., Muratore, C. S., Wills, H. E., & Tracy, T. F. (2016). Nonoperative treatment of acute appendicitis in children: A feasibility study. Journal of Pediatric Surgery, 51(1), 111-116. doi:10.1016/j.jpedsurg.2015.10.024
Hughes, T. M., & Luu, M. B. (2014). Acute Appendicitis. Common Surgical Diseases, 169-171. doi:10.1007/978-1-4939-1565-1_42
Knox, M., & Mortele, K. J. (2015). Acute Appendicitis. Gastrointestinal Imaging, 204-208. doi:10.1093/med/9780199759422.003.0034
Matsushita, M., Fukata, N., Omiya, M., Nishio, A., Seki, T., & Okazaki, K. (2018). Pathophysiology of the Appendix in Ulcerative Colitis. The American Journal of Gastroenterology, 113(4), 622-622. doi:10.1038/ajg.2017.506
Puthenpura, V., Desai, K., Bauer, A., & Marshall, I. (2016). Delayed methimazole-induced agranulocytosis in a 6-year old patient with Graves’ disease. International Journal of Pediatric Endocrinology, 2016(1). doi:10.1186/s13633-016-0034-6
Svensson, J. F., Patkova, B., Almström, M., Naji, H., Hall, N. J., Eaton, S., … Wester, T. (2015). Nonoperative Treatment With Antibiotics Versus Surgery for Acute Nonperforated Appendicitis in Children. Annals of Surgery, 261(1), 67-71. doi:10.1097/sla.0000000000000835
Trajkovski, S., Schmied, V., Vickers, M., & Jackson, D. (2013). Using appreciative inquiry to bring neonatal nurses and parents together to enhance family-centred care. Journal of Child Health Care, 19(2), 239-253. doi:10.1177/1367493513508059
Øglund, G. P., Hildebrand, M., & Ekelund, U. (2015). Are Birth Weight, Early Growth, and Motor Development Determinants of Physical Activity in Children and Youth? A Systematic Review and Meta-Analysis. Pediatric Exercise Science, 27(4), 441-453. doi:10.1123/pes.2015-0041
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