The Pathophysiology of the Presenting Complaint in the Case Study

The case study presented here involves a girl named Anne of age ten who has been introduced in a hospital with right iliac fossa pain and when she has signs and symptoms of appendicitis. Anne was taken to the theatre so that an appendectomy could be performed and after the operation, they noticed a gangrenous perforated appendix with peritonitis. The discussion involves the pathophysiology of appendicitis and the evaluation of how nurses are responsible in giving the best health care.

Appendicitis results from the appendix becoming edematous and inflamed because of being occluded by a tumor, fecalith, foreign body or lymphoid hyperplasia (Dickson-Lowe, Ibrahim, Munthali & Hasan, 2015). Although there has been an improvement in diagnostic and therapeutic medicine appendicitis has remained a clinical emergency and commonly results in acute pain. This process of inflammation increases the intraluminal pressure generating a generalized, per umbilical or progressively severe pain that becomes localized to the right lower quadrant of the abdomen in a short duration of time (Alvarado, 2018). Immediately, the inflamed appendix is filled with pus and once it is obstructed an overgrowth of bacteria occurs due to a reduced blood flow rate to the body tissues (Kouskos, Komaitis, Kouskou, Despotellis & Sanidas, 2014).

When the lumen is blocked it also becomes ischemic since the appendix pressure increases reducing the venous drainage. In case this ischemia is not treated it leads to necrosis and finally to gangrene. At this stage, the appendix is at the risk of perforation and once it occurs the inflammatory cells and bacteria are relinquished into the surrounding tissues affecting inflammation of the peritonitis leading to diffuse abdominal pain (Almström, Svensson, Patkova, Svenningsson & Wester, 2017). In the case where the appendix is already raptured at the time the child is at the emergency ward, there is a possibility of peritonitis to increase substantially and to prevent hydration there is a need for intravenous antibiotics (Chiniwalar, Mohan & Ardhanari, 2014). The doctors in the case study performed an appendectomy on Anne since the appendix has gangrene perforation with peritonitis. Anne is on intravenous antibiotics for infection prevention along with morphine PCA for pain relief, and she returned to the ward with a nasogastric tube in situ free drainage.

 Growth and developmental theories

 The growth and developmental theories used are the Erikson theory, Freud theory, and the Piaget theory. The Erikson theory advocated a psychoanalytical psychosocial evolution that integrates a total of eight phases of personality advancement (Allen, 2015).  However, a person encounters psychological crises in every personality development phase, and it might have negative and positive effects on it. The age of zero to the age of one is the first phase and the child experiences conflict in basic trust versus mistrust (Allen, 2015). The second stage is the early childhood that ranges from the age of one and three and the conflict encountered at this phase is autonomy versus shame. Furthermore, play age phase starts at the age of three to six years and virtue of purpose and the conflict encountered is initiative versus guilt.

Evaluation of the Nurse’s Role to Deliver Developmentally Appropriate Nursing Care in Relation to Your Chosen Case Study

The school age phase is the fourth stage that commences at six years to twelve years, and their resolution is competence. The conflict tolerated at this stage by the children is the industry versus inferiority (Allen, 2015). Moreover, the next step is the adolescent phase that ranges between twelve and nineteen years that includes a contention of identity versus confusion along with virtue of fidelity. The early adulthood and the adulthood phases follow with the latter ranging from twenty to twenty-five years while that of adulthood starts from twenty-six years up to sixty-four years. The discords experienced at these phases are the intimacy versus isolation and generativist versus stagnation. The last aspect is the old stage that commences at the age of sixty-five until death (Allen, 2015). In this stage, the conflict encountered is integrity versus despair. Therefore, putting into consideration the Erikson’s theory it is clear that the age of Anne lies in the school age phase whose conflict is industry versus inferiority. This means that at this age children needs support from parents, guardians, and teachers so that they can achieve their goals with confident otherwise they would feel inferior, and this might affect Anne unsympathetically.

Freud theory proposes a psychosexual development which refers to how personality is improved at the time of childhood through a series of phases which represent the fixation of libido on several parts of the body (Freud, 2017). As the body matures biologically sexual energy accumulates and then it is discharged. Freud’s theory demonstrates the relevance of children to complete every phase effectively to prevent the occurrence of mental abnormality (Freud, 2017). Piaget is the last theory that indicates that children undergo four universal stages of cognitive development (Lefa et al., 2014). This theory concerns a child creating a mental world model, and the growth is biologically based, and changes as the child continue to grow. The sensorimotor stage is the first phase that starts from birth to two years, and it focuses on the execution of an entity. This phase is identified and still exists even when it is out of sight, and there is a possibility of acknowledgment to handle the substance together with acting intentionally (Lind, 2017).

The preoperational stage commences from two years to seven years, and the child can organize items and also use language (Lind, 2017). The next step is the concrete operational phase that commences at seven years to the age of eleven. In this stage, a child can think logically and understand conservation of figures, categorize items by various attributes and organize them in the correct order. Finally, the formal operational stage ranges from eleven years and above, and the child is concerned with the hypothetical and future along with generating tests and hypotheses (Lind, 2017). In addition to that, the child can think logically on abstract propositions

Growth and Developmental Theories

Family-centered care

Family-centered care incorporates diversity and cultural competence in the circumstances of socioeconomic, demographic and ethnic traits (Smith, Swallow & Coyne, 2015).  To establish this family-centered care, there is a need for planning, presentation, and evaluation of health services with the cooperation of the family (Coyne, Hallström & Söderbäck, 2016). However, this centered family care incorporates the collaboration with family members to plan and give attention to the child, share information with the family, providing respect and dignity to the child and the family together with allowing the family to be involved in the care.

The objective of family-centered care is to extend the pediatrician responsibilities to necessitate screening, assessment, referral of clients of emotional social and physical issues which can impact the health and social well-being of a child unsympathetically (Smith, Swallow & Coyne, 2015). From the case study, Anne’s parents should be informed by the specialists of the complications that will arise after the surgery like an infection. The family is responsible for taking care of Anne after being provided with recommendations which might include abstaining in lifting heavy objects, the use of mild laxative, drinking a lot of water to prevent constipation and dietary issues. Being the oldest of five children and her parents were busy operating a restaurant, Anne’s siblings can be affected immensely by the surgery. Consequently, it is not possible for Anne to play with her siblings and her siblings might be worried about her.

The effects of hospitalization of the child, on the child and family.

On the side of a child, the child undergoes a lot of stress and encounters several anxieties and fears more so when they are separated from their parents (Tener, Ofir, Lev-Wiesel, Franco & On, 2016). Also, when the body is not functioning well, it brings worries to the child and may not want to share their feelings with the hospital staff. In that case, nurses should be familiar with the elements of family-centered care for the advancement of communication process, understanding all the problems that the family has experienced and promoted the sharing of information concerning the health of the child to assist the child (Eleftheriadou, Noble & Bor, 2018).

On the other side, families may have a feeling of loneliness, anger, worry, apprehension and for them to minimize the effects the parents should have confidence on the staff, visit the child frequently, have a discussion with the team on the likes and the dislikes of the child along with communicating with the child whenever they are leaving the hospital (Karlsson, Englund, Enskär & Rydström, 2014). To prevent Anne and her family from suffering too much from the hospitalization process, the nurse should communicate to the family about what the doctor said concerning the health of Anne together with educating them the procedures that should be followed to make sure that they are motivated with the care.

Family-Centered Care

Conclusion

It is learned that nurses have the responsibility in understanding all actions that to the presenting complaint of appendicitis so that they can take the appropriate precautions and measures to handle the situation and take care of the child. Nurses must be knowledgeable of the growth and development theories so that they can categorize their clients with their respective developmental stages. Family-centered care is vital in every healthcare institution so that the family and the nurses can corporate to improve the health of the patient.

References

Allen, B. P. (2015). The Seasons of Our Lives: Erik Erikson. In Personality Theories (pp. 175-198). Psychology Press.

Almström, M., Svensson, J. F., Patkova, B., Svenningsson, A., & Wester, T. (2017). In-hospital Surgical Delay Does Not Increase the Risk for Perforated Appendicitis in Children. Annals of surgery, 265(3), 616-621.

Alvarado, A. (2018). Clinical Approach in the Diagnosis of Acute Appendicitis.

Chiniwalar, S., Mohan, N., & Ardhanari, R. (2014). Complications of Acute Appendicitis and their Management. The Appendix-ECAB-E-Book, 62.

Coyne, I., Hallström, I., & Söderbäck, M. (2016). Reframing the focus from a family-centered to a child-centered care approach for children’s healthcare. Journal of Child Health Care, 20(4), 494-502.

Dickson-Lowe, R. A., Ibrahim, S., Munthali, L., & Hasan, F. (2015). Case Report: Intussusception of the vermiform appendix. BMJ case reports, 2015.

Eleftheriadou, Z., Noble, L., & Bor, R. (2018). Communicating with children and young people. Clinical Communication Skills for Medicine, 111.

Freud, S. (2017). Three Essays on the Theory of Sexuality: The 1905 Edition. Verso Books.

Karlsson, K., Englund, A. C. D., Enskär, K., & Rydström, I. (2014). Parents’ perspectives on supporting children during needle-related medical procedures. International journal of qualitative studies on health and well-being, 9(1), 23759.

Kouskos, E., Komaitis, S., Kouskou, M., Despotellis, M., & Sanidas, G. (2014). Complicated acute appendicitis within a right inguinal hernia sac (Amyand’s hernia): report of a case. Hippokratia, 18(1), 74.

Lefa, B., Livingston, C., November, I., Condy, J., Chetty, R., Shaik, N., … & Aronstam, S. (2014). The Piaget theory of cognitive development: an educational implication. Educ Psychol, 0-8.

Lind, G. (2017). The Theory of Moral-Cognitive Development A Socio-Psychological Assessment. In Moral Judgments and Social Education (pp. 25-48). Routledge.

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.

Tener, D., Ofir, S., Lev-Wiesel, R., Franco, N. L., & On, A. (2016). Seriously clowning: Medical clowning interaction with children undergoing invasive examinations in hospitals. Social work in health care, 55(4), 296-313.