Pathophysiology And Nurse Role In Appendicitis Case Study

Pathophysiology

The paper deals with the case study of Anne. She is presented to the emergency department for the right iliac fossa pain. The surgical team decided for appendectomy after observation of signs and symptoms. The clinical handover showed a gangrenous perforated appendix with peritonitis. She is under pain management and antibiotic therapy for infection. She will remain in hospital for 10 days. In response to the case study the, essay discusses the pathophysiology of the presenting complaint in the case study. Further, the role of the nurse in developing appropriate nursing care is evaluated in the essay.  Pathophysiology And Nurse Role In Appendicitis Case Study

Right illiac fossa pain occurs in the surface of the human abdomen inside the right inferior part. The common cause of the presentation to the emergency room is the infection in right iliac fossa. It is manifested as fever and pain. This localises the pain and tenderness and is common in the patents with appendicitis as appendix is located in right iliac fossa. Therefore, Anne may have the right iliac fossa pain due to appendicitis and is the most common diagnosis (Kharbanda, et al., 2016). She was presented to the emergency room for right iliac fossa pain and was also diagnosed as appendicitis based on her signs and symptoms.

Appendicitis is caused by various factors that obstruct the appendiceal lumen. The various factors may be lymphoid hyperplasia, foreign bodies, and inspissated stool. The common cause being lymphoid obstruction. The obstruction increases the pressure in the lumen. It results in the continuous secretion of the mucus and fluids from the mucosa and its stagnation. During appendicitis, the bacterial population in the intestine multiply, accumulating more white blood cells. Inflammatory response ensues with the bacterial growth and edema. Due to accumulation of pus, more intraluminal pressure is formed (Skarda, et al., 2015).

The pressure in the appendiceal lumen increases with the obstruction, rising above the appendiceal veins. It results in the venous outflow obstruction, appendiceal wall ischemia and diminishing of epithelial integrity. This further increases the bacterial invasion in the appendiceal wall, resulting in gangrenous appendix. This localised condition becomes worst with thrombosis of the appendicular artery and veins. It causes perforation and gangrene of the appendix and is the most common complication of appendicitis. The gangrenous appendix will perforate and the appendiceal contents will spill into the peritoneal cavity. It is during this continuing process that peritonitis and periappendicular abscess may occur. Diffused peritonitis may occur if the body does not wall of the process (Obinwa, Casidy, & Flynn, 2014).

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Evaluation Of The Nurse Role

The common emergency procedure for the appendix is the Appendectomy, the surgical removal of appendix. In case of Anne, after appendectomy, the handover on return to ward is the gangrenous perforated appendix with peritonitis. In case of Anne the appendix is perforated so the patient will have longer duration of symptoms. It also increases the need of fluid resuscitation and broad spectrum of intervention as Anne has perforated disease along with peritonitis. Hence, this process has increased her hospital stay. She is administered with antibiotics to fight the infection. Morphine PCA is the effective in relieving pain and IV therapy is used to relive the fluid loss (Salminen, et al., 2015).

In order for the nurse to develop appropriate care for Anne post operation, the nurse must be aware of her growth and development. Anne is 10 years old and the expected developmental milestones at this age, includes quick physical and social growth as per Jean Piaget’s theory. Anne at this age is expected to have rapid development of the cognitive skills. Pathophysiology And Nurse Role In Appendicitis Case Study  It includes a good speed in reading, and performing mathematical calculations such as addition, subtraction, and others. Children of 10 years demonstrate good language development (Piaget, 2015). Therefore, before communicating with Anne, the nurse must assess if the child can converse easily with people of different ages and if the speech pattern is near to an adolescent. It will help the nurse to effectively assess the pain and location by communicating with Anne. Medication can be adjusted based on the, changing level of pain. It will be easy to administer antibiotics and inform Anne to communicate the mode of medication or else it will hamper the care. The nurse may explain medical procedures to Anne using simple drawings and showing video clips. When communicating with Anne, the nurse must use simple terms that can be easily understood (Salminen, et al., 2015).

According to Piaget’s Cognitive Developmental Theory, at the age of 10, a child is expected to have well integrated perceptual motor skills, and may be able to identify the difference between the intention and behaviour. Children at this age, tend to gain logical reasoning skills and strengthen sensory and motor functions.  Therefore, in case of Anne, the nurse may be able to provide accurate information on the progress of her situation. It will relive anxiety in the child due to emotional support. The nurse must be able to explain the symptoms of exacerbation to Anne such as blood pressure, temperature, cardiac frequency, and respiratory frequency. At this age, adequate physical endurance is expected, therefore, a low limb exercises can be explained to the student to prevent postoperative complications (Piaget, 2015).

According to Freud’s psychosexual theory, experiences of conflict, affect the child’s course of development (Freud, 2014). The nurse must assess the mental stamina of the patent to prepare for extended hospital stay and reduce emotional distress. The lack of patience, intelligence and maturity may hamper the care process. Considering the developmental milestones at the age of 10, Anne should be involved in the medical procedure that will affect the child. Further, the nurse must assess where there are deviations from the developmental milestone pertaining to this age and accordingly involve Anne’s parents. The nurse must consider the age and maturity of the child and if she is capable of verbalising her feelings.  Anne should be given full opportunity to express her views and the nurse must maintain the patient’s and the parent’s autonomy for greater good. The nurse must adhere to principle of ethics, which include the right to autonomy, beneficence, non-maleficence and social justice (Scanlon, Cashin, Bryce, Kelly, & Buckely, 2016). The care plan should be designed in a manner that will benefit the patient and family, instead of harm.

The paediatric nurses must provide the family centred care model. For this case, the role of the nurse is to educate the patient’s family member about the care plan, side effects of education and care after discharge. Anne and her parents will be informed that she cannot immediately resume sports or other play activities and must not engage in lifting heavy objects. The diet plan appropriate for Anne’s condition and alert on the changes in bowel movement may be notified. Anne should be instructed on taking adequate fluids and maintain hydrated state of body. The nurse must inform the family regarding the care for the incision area. It includes keeping it clean, and regular dressing. The nurse must notify the family about the emergency help in case of Anne’s troubled breathing, loss of consciousness and abdominal pain and explain the signs of infection. It will help the family to contact the physician in case of immediate help (Peter, et al., 2015).

When dealing with the family and involving them in the medical conversation, the nurse must be cautious on not using medical jargons, and explain in lucid language. The nurse must take the informed consent of the guardians during the treatment (urinary analysis, blood tests and medication) and care process. It is essential to value the needs, preferences and beliefs of the family members to maintain the patient centred care (Hockenberry & Wilson, 2014). Hospital is the place for patient from diverse cultural and linguistic background. Thus, the role of the nurse is to identify the communication barrier and arrange for medical interpreter. Further, the nurse must take into consideration, the cultural and religious preferences. For instance, the Hindu Brahmins prefer to take bath three times a day. It may affect the dressing and wound infection. The possible spiritual care should be given, to the family. Therefore, nurse must educate the patients on complications of the infection at the surgical site. Further, the client’s family should be encouraged to actively participate in problem solving related to illness (Chau, et al., 2016).

The nurses must cater to the emotional and psychological needs of the patient and the family. During the illness, booth the patient and the loved ones undergo stress and anxiety. Lack of health literacy, awareness on the illness, socioeconomic status and understanding of medial jargons create stress and anxiety. The cause of the emotional upset in child may be due to separation from familiar figures. Every child has varying degree of coping with hospitalisation due to differ degree of intelligence and temperament. It will influence both the short and long-term effects of hospitalisation (Gorter, et al., 2016). The nurses must encourage positive attitude in Anne and her family to promote active coping role. It will decrease the complications after discharge. The involvement of the family in Anne’s care is based on Bowlby’s Attachment Theory. Children have innate need for attachment and proximity can be ensured by maintaining safe and secured environment. Similarly, the family will also feel supported by ensuring proximity (Goldberg, Muir, & Kerr, 2013).

Conclusion

In conclusion, appendicitis is the complicated illness and is associated with severe physical and mental implications. The assignment clearly discussed the pathophysiology of perforated appendix and peritonitis. Based on several developmental theories the nursing role in regards to care for Anne has been presented. Illness have significant impact on the patient and the family, thus family centred care is implemented and the factors that may hamper care is briefly illustrated. Conclusively, the assignment has been helpful in gaining deep insight on the role of nurse in paediatric setting.

References

Chau, D. B., Ciullo, S. S., Watson-Smith, D., Chun, T. H., Kurkchubasche, A. G., & Luks, F. I. (2016). Patient-centered outcomes research in appendicitis in children: bridging the knowledge gap. Journal of pediatric surgery, 117-121.

Freud, S. (2014). On the sexual theories of children. . Read Books Ltd.

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Gorter, R. R., van den Boom, A. L., Heij, H. A., Kneepkens, C. F., Hulsker, C. C., Tenhagen, M., & Van Der Lee, J. H. (2016). A scoring system to predict the severity of appendicitis in children. Journal of Surgical Research, 452-459.4.

Hockenberry, M. J., & Wilson, D. (2014). Wong’s Nursing Care of Infants and Children-E-Book. . Elsevier Health Sciences.

Kharbanda, A. B., Madhok, M., Krause, E., Vazquez-Benitez, G., Kharbanda, E. O., Mize, W., & Schmeling, D. (2016). Implementation of electronic clinical decision support for pediatric appendicitis. . Pediatrics.

Obinwa, O., Casidy, M., & Flynn, J. (2014). e microbiology of bacterial peritonitis due to appendicitis in children. Irish Journal of Medical Science , 585-591.

Peter, D., Robinson, P., Jordan, M., Lawrence, S., Casey, K., & Salas-Lopez, D. (2015). Reducing readmissions using teach-back: enhancing patient and family education. Journal of Nursing Administration, 35-42.

Piaget, J. (2015). Structuralism (Psychology Revivals). Psychology Press.

Salminen, P., Paajanen, H., Rautio, T., Nordström, P., Aarnio, M., Rantanen, T., & Sand, J. (2015). Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. Jama, 2340-2348.

Scanlon, A., Cashin, A., Bryce, J., Kelly, J. G., & Buckely, T. (2016). The complexities of defining nurse practitioner scope of practice in the Australian context.  Collegian, 129-142.

Skarda, D. E., Schall, K., Rollins, M., Andrews, S., Olson, J., Greene, T., & Scaife, E. (2015). A dynamic postoperative protocol provides efficient care for pediatric patients with non-ruptured appendicitis. Journal of pediatric surgery, 149-152.  Pathophysiology And Nurse Role In Appendicitis Case Study