Pathophysiology And Nurse’s Role In Appendicitis Case Study Of A Pediatric Example Paper
Choose one (1) of the case studies below. Your Assessment will be written in academic essay format. Using evidence specific to your chosen case study, address the following two (2) points:
1. Describe the pathophysiology of the presenting complaint in the case study.
2. Evaluate the nurse’s role in delivering developmentally appropriate nursing care in relation to your chosen case study. Address:
- growth and developmental theories,
- family centred care and,
- the effects of hospitalisation of the child, on the child and family
Anne is a 10 year old girl who has presented to the emergency department in the local hospital with right iliac fossa pain. On further assessment by the emergency registrar, appendicitis is suspected. The surgical team agree that the signs and symptoms are associated with appendicitis and take Anne to theatre for an appendectomy.
The handover on return to the ward is that the surgical team found a gangrenous perforated appendix with peritonitis. Anne has returned to the ward with a nasogastric tube in situ on free drainage, morphine PCA, IV therapy and triple IV antibiotics.
Due to the severity of the infection and the potential complications, Anne will need to remain in hospital for 10 days of IV antibiotics and pain management.
Anne is the oldest of five children and her parents own and run an Indian restaurant in the city.
Jay is a four-month old boy admitted to the paediatric unit via emergency with vomiting, decreased feeds, no bowel actions and intermittent spasmodic abdominal pains. During the spasmodic pain episodes, Jay draws his legs up and has a high pitched cry.
After a diagnostic ultrasound, intussusception was thought to be the cause of the presenting symptoms and Jay was admitted to the ward. His treatment plan included observation, electrolyte monitoring and IV therapy until a contrast enema could be implemented to correct the intussusception. Pathophysiology And Nurse’s Role In Appendicitis Case Study Of A Pediatric Example Paper
The approximate length of stay for Jay will be 2 days, during which time, Jay’s mother is informed that the rotavirus vaccine that Jay had at 4 months has increased the incidence of this condition amongst infants. Jay’s mother is now having serious doubts regarding future vaccines for Jay.
Sue is a 15-year-old indigenous girl who lives in a remote town in rural Australia. Sue was diagnosed with cystic fibrosis in infancy. Since then, Sue has been prescribed a regimen of pancreatic enzymes, periodic antibiotics, inhalers and exercises.
Sue has presented to the local hospital complaining of shortness of breath and tells the triage nurse that she has cystic fibrosis.
A health history taken by the triage nurse on arrival reveals that Sue has had a two-year history of smoking cigarettes and is not always compliant with her medication or cystic fibrosis management plan.
Sue lives with her mother and 6 younger brothers and sisters.
Description Of Appendicitis Pathophysiology
Children and adolescents need special care in the course of achieving their milestones. The 10-year-old girl is ailing from appendicitis causing discomfort which culminates in a difficult of maneuvering activities. The right iliac fossa is the primary area where the pain is perceived before conduction of the surgery. It is the anatomical region where the appendix is located. The pathology transpires due to an infection or metastasis of an ailment from the surroundings structures. The appendix does not have clear functions in the body. As pointed out by Fraser (2014), the hemodynamic parameters of the body can function normally without it. In a healthy body functioning process, it empties its contents to the cecum. At times it can be blocked making it less efficient in passing the digestive materials (Cantrell, 2012). The ultimate result is inflammation which triggers the discomfort that is felt in the iliac region. Acute abdomen is experienced by most individuals because the nervous system is sensitized. The inflammation inhibits blood supply to the structure culminating in irritation. If not addressed promptly it can lead to adverse ramifications such as necrosis of adjacent tissues.
Surgery is recommended in most setups because it is the core procedure of getting rid of the ailment. As pointed out by Bowden & Greenberg (2013), an intraluminal pressure builds up when the pathology advances to severe stages. The blockage of the appendix has been attributed to various elements. The presence of gallstones blocks the pathway that is followed in relaying food materials to the cecum. Alteration of the normal physiology is realized predisposing the organ to infections. The supply and drainage of blood are dependent on the presence of patent vessels (Berman, 2014). Gallstones occlude the capillaries making it hard for the nourishment of the various cells in the structure. Inflammation of the lymphoid tissues makes abnormal proliferation of tissues to occur. According to Barnes & Rowe (2013), bacterial growth makes the prognosis to be adverse.
Adolescents need to be trained how to recuperate from pathologies. Surgery curbs culmination of adverse prognosis. Advanced forms of the disease can lead to busting of the appendix. Bacteria and other contents are channeled to the peritoneal cavity. As stated by Bowden & Greenberg (2013), complications emerge making it hard for recuperation to take root. Administration of pain relieving agents is not advised during the initial stages of the disease unless a candid assertion is made. After surgery of the pediatric, analgesics can be given to increase comfort. There ought to be a clear course of therapy which is aimed at reducing episode of deterioration. A multi-professional approach is preferred in increasing the quality of care of the patient. Nurses are essential in sensitizing other health care professionals on the disease process (Ball, Bindler, Cowen & Shaw, 2015). Nutritionists are core in determining the actual feeds that are supposed to be ingested to reduce vulnerability to adverse effects of appendicitis.
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A nurse ought to mobilize the rest of the healthcare team in the provision of care. The nasogastric tube must be kept patent for an effective drainage. Laboratory investigations must be done in the course of hospitalization. They give an overview of the course that the condition is taking. Interventions are solely based on the findings. Deviating from the normal physiological dynamics requires a prompt nursing and medical orchestration of management. According to Muscari (2016), a routine physical assessment allows the patient to verbalize any uncertainties which are crucial in allaying anxiety. The young girl is of a tender age who is yet to attain all milestones. A close association with the nurse will make her have a sense of belonging thus reducing episodes of developing complications such as depression.
Treatment And Analgesic Use In Appendicitis
According to the psychoanalytic theory, the mindset of a young person is orchestrated by the conditions that are provided in the environment. The nurse has a role of ensuring that affirmative practices are done. For instance, the child should be allowed to play freely without being limited as long as the surgical site is not adulterated. According to Ball et al. (2015), being confined indoors is detrimental as it sabotages the psychology of the child. Any positive traits that are exemplified by the girl ought to be motivated. Giving of incentives makes a child to replicate the behavior which later on forms the basis of her personality. Refuting of ill-behavior makes the child follow the correct course of conduct. It is advisable for the child to be put in an environment which has fellow children. Adults may not provide a serene environment for sharing of core attributes that are needed during growth and development. Gaming gadgets and toys can be availed so that she child can use them whenever she is bored. Being left without any activity attracts thoughts which can lead to undesirable prognosis (Brooker et al. 2016). For instance, detachment can transpire making the primary clinical condition to be hard to manage because of the development of complications. She should not be restricted so much while maneuvering the therapeutic environment unless the action is proven to poses more harm than benefit to her. The morphine that is prescribed should be given to alleviate pain.
The child is undergoing growth which needs supplementation of enough food. Provision of a balanced diet avails vital nutrients that are needed for growth and development. Cognition, strength and physical growth are established when cells and tissues are provided with the necessary elements. The hospital must be well endowed with various food materials. The surgical area needs replenishment to heal within the shortest time possible. The nurse should ensure that a regular nutritional review is done to prevent deterioration of the various systems. The surgery necessitates the provision of nutrients that curb the proliferation of secondary pathologies. Ambulation is important during the hospitalization period. It prevents the development of ailments such as bed sores which can be countered when necessary mitigation strategies are employed.
Psychology theorists assert that the cognition of a person is shaped in the process of being modeled. According to Gordon et al. (2012), comprehension of ideas and demystification of claims is dependent on the people that a child associates with. The ten-year-old girls should be given moral support in the course of recuperating from her condition. She is bound to depict uncertainties because she has not been exposed to various environments. Pathophysiology And Nurse’s Role In Appendicitis Case Study Of A Pediatric Example Paper Appendectomy and appendicitis may not be known to her considering that only a small percentage of the population suffers from it. She should be enlightened on the dynamics associated with the disease besides providing reassurance. Parents or guardians ought to be within her vicinity to avoid episodes of feeling neglected. The nurse should train the parents on how to relate to the girl to prevent adverse ramifications.
Family-centered care is necessary for providing a multidimensional management system. Any form of procedure should be done in consultation with the parents or elder siblings. Making them knowledgeable of the rationales that are attached to various modes of therapy reduces anxiety. Besides running a restaurant in the city, they should have an adequate time with the child. It makes them maneuver the therapeutic environment with an affirmative mindset which escalates the nature of relations with the young girl. Social learning theory stipulates that a child needs to be provided with a serene environment in the course of performing various activities (Fraser, 2014). The mentality of the child can be orchestrated depending on the conditions that are provided to her. When family members and the nurse assures her of a positive prognosis, she is made to understand that the disease process is a normal occurrence which gets countered with time. Drug regimens should be typically administered by the nurse. At times the girl might need parents to be available to encourage her to take the various therapy formulations. They should be encouraged to take part in the process because it makes the child to have a positive view of the hospital procedures. Hospital visits by friends should be encouraged as it provided psychotherapy. Fellow children are vital in sharing sentiments that cannot be conveyed when elder are employed. The kind of communication that is realized when conversing with peers makes a child demystify claims that would otherwise not have been addressed.
Responsibilities Of The Nurse During Recuperation
Being hospitalized can culminate in effects that affect the recuperation process. Staying away from home can make the child feel detached from her siblings or friends. She might sustain psychological torture making her thought process to be altered (Hockenberry & Wilson, 2015). The presence of indwelling nasogastric tubes causes discomfort. The nurse should ensure that anxiety is allayed besides encouraging parents to organize regular visits by close allies. The therapy regimens may not resonate with the young child considering that most of the drugs are sour. The girl must be encouraged to take them as it is the only way of recuperating from the pathology. It is important to comprehend the effects of a child’s presentation to health services as it forms the basis of addressing the various problems (Toy, 2015). The most effective therapy can only be imposed after a proper analysis of the pathology. Aspects such as iliac pain can be countered after a candid investigation of the cause. A child needs care which encompasses all aspects of growth and development. Deviating from the required recommendations culminated in the development of gaps which hinder achievement of basic milestones.
In conclusion, appendicitis causes acute abdomen and marked limitation of physical activity which deters manipulation of activities. Appendectomy is the primary therapy regimen of countering it. The young child must be given a definitive care to ensure that all milestones are achieved without incurring problems. A family-centered approach allows for the demystification of claims and affirming of positive attributes. The nurse is core in ensuring that all stakeholders are involved in the execution of care. The strange hospital environment causes anxiety and discomfort. The nurse ought to provide health messages besides counseling the young child on activities that can realize various ramifications.
References
Ball, J., Bindler, R. M. G., & Cowen, K. J. (2013). Child health nursing: Partnering with children and families. Boston [etc.: Pearson.
Ball, J., Bindler, R. M. G., Cowen, K. J., & Shaw, M. R. (2015). Principles of pediatric nursing: Caring for children. Hoboken, NJ: Pearson Education
Barnes, M., & Rowe, J. (Eds.) (2013). Child, youth and family health: strengthening communities (2nd Ed.). Sydney: Churchill Livingstone Elsevier.
Bowden, V.R., & Greenberg, C.S. (2013). Children and their families: the continuum of care (3rd Ed.). Philadelphia: Lippincott Williams & Wilkins.
Berman, A.J., Snyder, S., Levett-Jones, T., Dwyer, T., Hales, M., Harvey, N., Stanley, D. (2014). Kozier & Erb’s fundamentals of nursing (3rd Australian Ed.). Sydney: Pearson.
Brooker, C., Waugh, A., Van, R. R. M., & Jordan, P. J. (2016). Foundations of nursing practice: Fundamentals of holistic care. Edinburgh: Mosby/Elsevier
Cantrell, M. A. (2012). Pediatric nursing. New York: McGraw-Hill.
Fraser, J., Waters, D., Forster, E., & Brown, N. (2014). Pediatric nursing in Australia: Principles for practice. Melbourne: Cambridge University Press.
Gordon, B.K, Miles, S., McLeod, M., El Ali, M., & Gale, P.L. (2012). Child, adolescent and family nursing. Sydney: Pearson.
Haley, C. (Ed.). (2013). Pillitteri’s Child and family health nursing in Australia and New Zealand. Sydney: Lippincott Williams & Wilkins.
Hockenberry, M.J., & Wilson, D. (Eds.) (2015). Wong’s nursing care of infants and children (10th Ed.). St Louis: Elsevier Mosby.
Kyle,T., & Carman,S. (2013). Essentials of pediatric nursing. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
Muscari, M. E. (2016). Pediatric nursing. Philadelphia: Wolters Kluwer
Toy, E. C. (2015). Pediatrics. New York: McGraw-Hill Education. Pathophysiology And Nurse’s Role In Appendicitis Case Study Of A Pediatric Example Paper
