Appendicitis refers to an inflammation of the appendix as a result of blockage and infection. Despite the technological advances in the medical field, appendicitis remains a medical emergency which can lead to very serious complications if interventions are not instituted within the first 24 hours. An inflamed appendix may perforate and become gangrenous within the first 72 hours of the presentation of symptoms. This condition rarely affects children under one year and it is more prevalent in males.
The most common treatment regimen for appendicitis is appendectomy which will involve insertion of drainage tubes and naso-gastric tube to prevent abscess formation and antibiotic therapy. For its treatment one requires hospitalization regardless of the age (Salminen, 2015). Hospitalization and the course of treatment affect people differently especially in pediatrics it may have a lasting effect on them (Alvarado, 2018).
Appendicitis is a condition that presents with the inflammation of the inner lining of the appendix, known as the vermiform appendix which spreads to other layers of the appendix. In most cases the inflammation results from infection (McCance, 2018). The appendix is located at the right lower quadrant of stomach and it arises from the cecum during embryology. Histologically the appendix is made up of cells similar to the colonic mucosa (simple columnar epithelial cells), the sub-mucosa of the appendix is made up of lymphoid follicles which increase with because they are few during birth (Knox, 2015). The number of follicles peaks at 200 follicles at 20 years of age after which the quantity goes down tremendously and the number of follicles continues to reduce through the adult life (Flum, 2015).
The main function of the appendix is that it acts as a reservoir for normal flora of the gut which aid in the healing after intestinal infections. The appendix does not play any significant role in maintaining the normal homeostatic balance of the body physiologically, therefore; its removal is highly tolerated. The anatomical position of the appendix slightly varies, therefore the presentation of the symptoms and tenderness largely depends on the exact anatomical position and the site of inflammation on the appendix (Girard-Madoux, 2018).
The lymphoid follicles found in the appendix play a role in the body’s immune system. An infection or an abscess in other regions of the body can lead to an inflammatory reaction in the appendix causing blockage and eventual appendicitis (Girard-Madoux, 2018). Alternatively, blockage can result from fecal matter, any foreign matter in the appendix or a tumor. The blockage will result in the inflammation of the appendix (Feldman, 2015). Once blocked the bacteria in the appendix begin to multiply and distension of the appendix results, this leads to increased intraluminal pressure which prevents venous drainage, thus making the appendix ischemic and congested (Glass, 2016).
The accumulation of bacteria causes an antigen antibody reaction which results to ischemia at the cellular level. Ischemia may progress to gangrene formation due to impaired blood flow and poor oxygenation of the appendix. As the symptoms worsens perforation of the inflamed appendix may occur, leading to leakage and spread of the inflammatory exudate into the peritoneum causing peritonitis which presents with worsened symptoms and affects other body systems (Bayhan, 2015). There will be tachycardia and tachypnea in response to excruciating pain in the peritoneum. Gangrene formation and perforation mostly occurs 72 hours after the symptoms of appendicitis begin to show (Kothadia, 2015).
The most classic symptom of appendix is sharp pain in the lower right quadrant of the abdomen. Other symptoms accompanying pain are nausea, vomiting, loss of appetite, pyrexia and loss of flatulence. The pain is mostly localized to the site of inflammation at the right lower quadrant during the onset of the symptoms, though the pain may radiate to the peri-umbilicus area or the iliac fossa depending on the severity of the inflammation and the innervation of the appendix by nerve T10. The pain may progress to generalized abdominal pain if there is perforation and the exudates and products of the inflammatory process have leaked to the peritoneum causing peritonitis (Bayhan, 2015).
Pain is the classical symptom, because pain is the first symptom of any inflammatory process in the body. During an inflammatory process there is inflammation which results into tenderness and fever (Marzuillo, 2015). The tenderness and fever causes pain because of the extensive nervous supply of the adnominal mucosa. Pain also causes vomiting and nausea because of its localization in gastrointestinal system. Appendicitis is managed by appendectomy followed by antibiotic therapy and hospitalization for preoperative and post-operative care (Cheng, Abdominal drainage to prevent intra?peritoneal abscess after open appendectomy for complicated appendicitis., 2015).
Our client Anne is 10-year-old. As the child develops there are many theories explaining the different stages of growth and development. The theories that most likely apply to the development of Anne is the Gesell’s theory of biophysical development which links development to the genetic make-up of their parents (Newman, 2017). This theory tries to explain the role of genes and their interaction with the environment during the development of a child. Appendicitis has a positive genetic link therefore Anne may have developed it due to her genetic make-up especially if any of her parents had appendicitis in the past (Crain, 2015).
Another theory at play here is the Erikson developmental theory where by Anne is at the stage of industrious versus inferiority. At this stage Anne interacts with her fellow peers in schools and other social gathering trying to be an industrious person in the community, she is also maturing up and is able to understand what is happening in her body; however this does not give the right to make medical decisions regarding her health that is why, the medical team should involve her parents. (Crain, 2015). This brings out a unique scenario whereby the parents must be involved in every step of the treatment process, because of Anne’s inability to make informed decision. How Anne is handled may either traumatize her or make similar experiences in future bearable. Cognitive theories like Jean Piaget’s theory also play a major role in the cognitive development of Anne and how she will relate this experience with similar experiences in future, because at this stage she can understand what is happening to her and she can remember this experience in future (Arnett, 2015).
The most concern for children within the age bracket of 6-12 years is health hazards such as infections, accidents and cancers. Appendicitis may result from an inflammatory reaction elsewhere in the body because of the lymphoid tissue found in the appendix and its role in immunologic functions. Children at this stage are developing their cognitive functions and they are able to think in concrete and use inductive reasoning though deductive reasoning is not in play, she can make mature adult like conversation (Crain, 2015). Infections in other body parts can lead to the development of appendicitis, given her age Anne may have contracted an infection from her daily interactions with the environment and this can lead to the presenting condition.
Family centered care is the cornerstone for successful management and treatment of most pediatric cases. The family play an integral role in the growth and development of a child (Allen, 2015). The family should be associated in the care of children under the age of 18 years because of their inability to make informed choices, their inability to consent to medical procedures and the immaturity. Adults will understand the importance of certain medical procedures while a minor may not fully understand the consequences. In all states anyone under the age of 18 years in regarded as a minor with an inability to make serious life decision especially medical decisions (Davidson, 2017).
Children at this stage trust their guardians and parents more than any other person. Involving the parent during medical procedures and allowing them to stay with their children improves the outcome of the treatment. Visits from loved ones reduces anxiety and emotional break downs from children because they feel valued (Davidson, 2017).
As nurses we should understand that family is a constant in any child’s life, therefore we should be able to share whole and unbiased information to the next of kin, and encourage and facilitate familial interaction from siblings to aunties and uncles of the affected child. We should counsel the family and encourage them to visit the child in hospital as often as possible depending on the hospital rules, because familial support the emotional needs of the child. In addition, the family plays a role in the growth and development of the child as stated by different theories of growth and development according to the different stages of growth and development.
The experience of hospitalization is different for everyone. This variation in experiences is brought about by is brought about by the support system the child has (Liu, 2017). However, despite a strong support system the child may experience periods of loneliness and anxiety especially when the parents are not around (Mroczkowski, 2017). Hospitalization has toil on both the parent and the child. The parent has to adjust their schedule to accommodate the new developments and the child has to adopt to periods where by the parents are not with them. The hospital policies also play a role on the experience of hospitalization which can either be positive or negative. Some hospitals have policies that allow the parents at specific times while others allow parents to be with their children fulltime. Hospitals with family friendly policies will result into a more positive experience and quick recovery compared to hospitals without such policies (Davidson, 2017).
Conclusion
Appendicitis is a condition that can affects pediatrics and has the potential to complicate quickly if urgent medical attention is not provided. The unbearable pain associated with this condition requires the presence of family in the medical care for the child because hospitalization is mandatory. The treatment process is also highly determined by the growth and developmental stage of child. The family is able to provide a detailed history which may aide in the diagnostic and treatment process and also the healing process (Davidson, 2017).
References
Allen, B. P. (2015). Personality theories: Development, growth, and diversity. . Psychology press.
Alvarado, A. (2018). Clinical Approach in the Diagnosis of Acute Appendicitis. cdn.intechopen.com.
Arnett, J. (2015). Human Development: A Cultural Approach Plus New Mypsychlab with Pearson Etext–Access Card Package. Pearson.
Bayhan, G. ?. (2015). Unusual Presentation of Shigellosis: Acute Perforated Appendicitis and Peritonitis. Journal of Pediatric Infection/Cocuk Enfeksiyon Dergisi,, 9(1).
Cheng, Y. Z. (2015). Abdominal drainage to prevent intra?peritoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database of Systematic Reviews,, 2.
Cheng, Y. Z. (2015). Abdominal drainage to prevent intra?peritoneal abscess after open appendectomy for complicated appendicitis. Cochrane Database of Systematic Reviews,.
Cheng, Y. Z. (2015). Abdominal drainage to prevent intra?peritoneal abscess after open appendectomy for complicated appendicitis. (Vol. 2). Cochrane Database of Systematic Reviews,.
Cheng, Y. Z. (2015). Abdominal drainage to prevent intra?peritoneal abscess after open appendectomy for complicated appendicitis. (Vol. 2). Cochrane Database of Systematic Reviews,.
Crain, W. (2015). Theories of Development: Concepts and Applications: Concepts and Applications. Psychology press.
Davidson, J. E. (2017). Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Critical care medicine,, 45(1), 103-128.
Feldman, M. F. (2015). Sleisenger and Fordtran’s Gastrointestinal and Liver Disease E-Book: Pathophysiology, Diagnosis, Management. Elsevier Health Sciences.
Flum, D. R. (2015). Acute appendicitis—appendectomy or the “antibiotics first” strategy. New England Journal of Medicine,, 372(20), 1937-1943.
Girard-Madoux, M. J.-V. (2018). The immunological functions of the appendix: An example of redundancy?. In Seminars in immunology. Academic Press.
Glass, C. C. (2016, August). Overview and diagnosis of acute appendicitis in children. In Seminars in pediatric surgery. WB Saunders., 25(4), 198-203.
Knox, M. &. (2015). Normal Anatomy and Imaging Techniques of the Appendix. Gastrointestinal Imaging, 201.
Kothadia, J. P. (2015). Chronic appendicitis: uncommon cause of chronic abdominal pain. Therapeutic advances in gastroenterology,, 8(3), 160-162.
Liu, X. D. (2017). Effects of hospital palliative care on health, length of stay, and in-hospital mortality across intensive and non-intensive-care units: A systematic review and metaanalysis. Palliative & supportive care,, 15(6), 741-752.
Marzuillo, P. G. (2015). Appendicitis in children less than five years old: a challenge for the general practitioner. World journal of clinical pediatrics,, 4(2), 19.
McCance, K. L. (2018). Pathophysiology-E-Book: The Biologic Basis for Disease in Adults and Children. Elsevier Health Sciences.
Mroczkowski, M. &. (2017). 28.0 Management of Agitation/Aggression in the Pediatric Emergency Department, Inpatient Pediatrics Floor, and Beyond. Journal of the American Academy of Child & Adolescent Psychiatry,, 56(10), S42.
Newman, B. M. (2017). Development through life: A psychosocial approach. Cengage Learning.
Salminen, P. P. (2015). Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. Jama,, 313(23), 2340-234
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