In this case, Anne, a girl of age ten years is presented at a healthcare facility with right iliac fossa pain, and after evaluation, the operative staff recognized signs and symptoms of appendicitis and took her to the theatre for an appendectomy. However, they realized she had a gangrenous perforated appendix with peritonitis. This discussion illustrates pathophysiology of the presenting complaint and evaluates the response of the pediatric nurse to provide the best care which incorporates growth and developmental theories for the specific age group, family-centered care by family and the impacts of hospitalization on the child and family.
Pathophysiology of appendicitis refers to the series of actions that lead to the development of appendicitis. An understanding of the appendicitis pathophysiology is helpful in acknowledging how fast the state should be controlled in case a medical diagnosis is suspected. Appendicitis is the inflammation of the inner lining of the vermiform appendix that distributes to its other parts (Rollins, Varadhan, Neal & Lobo, 2016). Although appendix has been thought to be recent functionless studies shows that unlike its closest neighbor colon it comprises several clusters of a particular type of white blood cells known as B along with T lymphoid cells. The white blood cells clusters also called lymphoid tissues are part of defense systems in the gut which liaises the function of immunologic to defend the body from the penetration by catastrophic organisms.
Appendicitis arises when the appendix becomes acutely inflamed, and it is not known why it happens, but it is thought to occur due to appendix lumen being blocked by lymphoid hyperplasia, fecaliths or ordinary fecal matter because of a viral infection (Mendoza-Sagaon, Hamitaga, Hurni & Voumard, 2016). Despite a therapeutic and diagnostic improvement in medicine, it remains a clinical emergency, and it commonly causes an acute abdominal pain (Hecker et al., 2016). However, the generality of appendicitis in young children recommends a pathophysiology responsibility for lymphoid aggregates that jeopardize in amplitude in the appendix. Once the appendix is obstructed, blood flow rate to body tissues reduces allowing bacteria to multiply. Since the lumen is blocked, the pressure within the appendix increases cutting venous drainage hence resulting in ischemia which if not treated can lead to gangrene and necrosis. However, once this stage is attained the appendix is at risk of perforating for the perforation takes only 72 hours to happen after the appendix has been blocked. After perforation, inflammatory cells and bacteria are relinquished into the surrounding tissues influencing inflammation of the peritonitis causing diffuse abdominal pain.
Nursing considerations involve pain related to inflames appendix and deficiency of fluid volume compared to nil by mouth status. However, if the appendix is already raptured when the child is seen in the emergency ward the possibility of peritonitis increases significantly, and the child requires IV antibiotics for hydration (van den Boom et al., 2018). From the case study, the doctors conducted appendectomy(Flum, 2015) on Anne because of the gangrenous perforated appendix with peritonitis and went back to the ward with a nasogastric tube in situ for free drainage and allowing the intestines to rest preventing the child from vomiting and nausea (Joundi et al., 2018). Furthermore, Anne is on IV antibiotics to shield infections and morphine PCA for the relief of pain.
Growth and developmental theories
Growth and developmental theories are helpful in understanding about the patient in regards to age, their thinking, behavior and providing care. To commence with the Freud theory of psychosexual development defines how personality is developed during childhood via a sequence of stages which represents the fixation of libido in various areas of the body. Sexual energy accumulates and discharged as the body matures biologically (Freud, 2017). According to this theory, it is essential for children to complete each stage successfully otherwise mental abnormality can happen.
According to Piaget theory, children undergo four universal stages of cognitive advancement, and it concerns a child building a mental world model (Barrouillet, 2015). Furthermore, the improvement is biologically based, and it changes as the child matures. The four phases in the Piaget theory are sensorimotor which ranges at the age of 0-2, the preoperational varying at the age of 2-7, concrete operational ranging at the age of 7-11 and the formal operational reaching at the age of 11 and above. The sensorimotor phase concentrates on object performance is identified, and it still exists when it is out of sight. Also, there is an ability acknowledgment to control the object and act intentionally (Barrouillet, 2015). Looking at the preoperational phase, children develop the ability of language use, categorizes units using individual features like the color and selfishly reasoning difficulty by viewing things from another point of view.
At the concrete operational stage the child can characterize objects by many features and place them in order, can think logically and acknowledge conservation of figures, weight, and mass (Barrouillet, 2015). Finally, the child at the formal operational stage thinks logically on abstract propositions, he or she is concerned with the hypothetical and the future and generates tests and hypotheses (Furth, 2017). Therefore, Ann being ten years old should concentrate on critical thinking, learning, and a suitable task can be set to evaluate her development.
The Erikson theory proposed a psychoanalytical of psychosocial development which incorporates eight stages of personality development (Cherry, 2017). At each stage of personality development an individual experiences psychological crises which could contain positive or negative impacts on personality development. The first stage is at the age of zero to one with a virtue of hope, and a conflict of mistrust versus necessary trust and the culmination at old age is the appreciation of relatedness and interdependence (Cherry, 2017). Early childhood of one to three years have a resolution of will with a conflict of shame versus autonomy and their culmination at an old age is accepting the life cycle from integration to disintegration. The third stage of play age ranges between three to six years with a resolution of purpose, and their conflict is guilt versus initiative. Their culmination in old age is humor, resilience, and empathy.
The fourth stage of the Erikson theory is the school-age which ranges from six to twelve years. In this stage, their virtue is competence with a conflict of inferiority versus industry and phase of old age is accepting one’s life course and unsuccessful wishes. The adolescent stage starts from twelve to nineteen years accompanied by confusion versus identity (Steele, 2017). In this stage, fidelity is a virtue, and the culmination of the old age is logical and aesthetic perception, sense of life complexity and merging of sensors. The sixth stage is the early adulthood starting at the age of twenty to twenty-five years with a conflict of isolation versus intimacy. The phase at aging is the awareness of relationship complications, a value of loving freely and affectionateness with love as a resolution (Cherry, 2017). Adulthood stage starts at twenty-six to sixty-four years with a conflict of stagnation versus generativist and their culmination in old age is caring, empathy and showing concern for others with the virtue of care.
Finally, old age starts from sixty-five years to death, and they have a conflict of despair versus integrity, and their stage in old age is the sense of strong integrity to endure physical disintegration, and their resolution is wisdom (Cherry, 2017). According to this theory, the stage where Anne’s age lies feels confident to attain their objectives, and in case unsupported by parents and teachers, they might feel inferior and can adversely affect Anne.
Family-centered care refers to a model of service used while delivering nursing care to children and the relevance of the family to the children is emphasized (Coyne, 2015). However, it incorporates the planning, presentation, and assessment of the health services with the family cooperation. The core concepts that are involved are the sharing of data with family, family participating in the care, collaborating with the family to plan and provide child’s attention along with the respect and dignity for the family and child (Smith, Swallow & Coyne, 2015). Family-centered care comprises of cultural competence and diversity in the context of demographic, socioeconomic and ethnic characteristics.
The relevance of family-centered care is that it fulfills the developmental and physiological needs of children and it supports their well-being and health. Furthermore, it aims at extending the roles of the pediatrician to involve evaluation, screening, referral of patients of social, emotional and physical problems which can adversely affect social well-being and health of the child (Smith, 2018). From the case study, Anne’s parents should have the consent from the professionals about the complications after surgery such as abscess or infection.
The responsibility of a family regarding taking care of Anne at home suggested by the doctor might contain the use of mild laxative, dietary, avoiding lifting of heavy objects or climbing stairs and drinking too much water to prevent constipation (Kaakinen, Coehlo, Steele & Robinson, 2018). Since Anne is the oldest of five children and her parents are very busy operating a restaurant her siblings can be significantly influenced after she undergoes surgery. She cannot be in a position to play with them again, and they may become worried about Anne since they are not aware of what might have occurred to her. Therefore, family-centered care is needful for Anne and her siblings until she regains her healthy life.
Hospitalization of a child can have several effects on the child and family. A child may be worried about the body not functioning well; separation from the family; he or she might want to be with their parents always or may not want to share what they feel with the facility professionals. Also, families may feel worried, apprehensive, angry or lonely and in order to minimize these impacts of hospitalization on a child parents should always visit the child, demonstrate confidence on the staff attending to the child, discuss with the nurses about the likes and dislikes of their child and let the child know the time they are leaving or coming back (Kaakinen, Coehlo, Steele & Robinson, 2018).
A nurse should acquaint herself with family-centered care elements to promote family and childlike sharing of information regarding the health of the patient, communicating and cooperating with the child and family along with acknowledging problems that the family goes through and coping procedures that might be useful to assist the family. From the case study, Anne and her family can suffer via the impacts of hospitalization, and therefore a nurse should relay what the doctor said about the health of Anne with her family, cooperate and teach them what she is required and how Anne can be motivated by family-centered care. Support from the family is vital since Anne can trust her family than anybody else to feel comfortable and nurses should discuss the likes and dislikes of Anne so that she can be assisted in the hospital (Kaakinen, Coehlo, Steele & Robinson, 2018).
Conclusion
From the discussion, it is essential for nurses to understand the pathophysiology and professional code of conduct to handle the situation and the correct measures of taking care of patients. Growth and developmental theories are required so that nurses can understand their patients and their developmental stages. To support the well-being of a patient the centered family care is essential so that parents can cooperate with nurses and the child, nurses to educate parents to understand more about the patient’s likes and dislikes to minimize the impacts of hospitalization on a child and family.
References
Barrouillet, P. (2015). Theories of cognitive development: From Piaget to today.
Cherry, K. (2017). Erik Erikson’s Stages of Psychosocial Development. Psychology. Psychosocial Theories. Päivitetty, 14, 2017.
Coyne, I. (2015). Families and health?care professionals’ perspectives and expectations of family-centered care: hidden expectations and unclear roles. Health Expectations, 18(5), 796-808.
Flum, D. R. (2015). Acute appendicitis—appendectomy or the “antibiotics first” strategy. New England Journal of Medicine, 372(20), 1937-1943.
Freud, S. (2017). Three Essays on the Theory of Sexuality: The 1905 Edition. Verso Books.
Furth, H. G. (2017). Young children’s understanding of society. Issues in childhood social development (pp. 228-256). Routledge.
Hecker, A., Hecker, B., Hecker, M., Riedel, J. G., Weigand, M. A., & Padberg, W. (2016). Acute abdominal compartment syndrome: current diagnostic and therapeutic options. Langenbeck’s archives of surgery, 401(1), 15-24.
Joundi, R. A., Saposnik, G., Martino, R., Fang, J., Porter, J., & Kapral, M. K. (2018). Outcomes among patients with direct enteral vs. nasogastric tube placement after acute stroke. Neurology, 10-1212.
Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M. (2018). Family health care nursing: Theory, practice, and research. FA Davis.
Mendoza-Sagaon, M., Hamitaga, F., Hurni, Y., & Voumard, N. (2016). Appendix extraction after laparoscopic appendectomy in children: A smooth, safe, and inexpensive technique. Journal of pediatric surgery, 51(2), 341-343.
Rollins, K. E., Varadhan, K. K., Neal, K. R., & Lobo, D. N. (2016). Antibiotics versus appendicectomy for the treatment of uncomplicated acute appendicitis: an updated meta-analysis of randomized controlled trials. World journal of surgery, 40(10), 2305-2318.
Smith, J., Swallow, V., & Coyne, I. (2015). Involving parents in managing their child’s long-term condition—A concept synthesis of family-centered care and partnership-in-care. Journal of pediatric nursing, 30(1), 143-159.
Smith, W. (2018). Concept Analysis of Family-Centered Care of Hospitalized Pediatric Patients. Journal of Pediatric Nursing, 42, 57-64.
Steele, W. (2017). A Theological Dialogue with and Evaluation of Erik H. Erikson’s Theory of Identity Development in Light of Pauline Baptismal Theology in Romans and Some Implications for Pastoral Care.
Van den Boom, A. L., de Wijkerslooth, E. M., van Rosmalen, J., Beaverdam, F. H., Boerma, E. J. G., Boermeester, M. A., … & Dekker, J. W. T. (2018). Two versus five days of antibiotics after appendectomy for complicated acute appendicitis (APPIC): study protocol for a randomized controlled trial. Trials, 19(1), 263.
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