Pre-Operative Care For Acute Appendicitis: A Critical Appraisal

The given case study highlights that Bill, a 16 years 11 months old adolescent had been diagnosed with Acute Appendicitis. He is suffering from mild bilateral abdominal pain associated with tenderness, hot flushes, nausea and diaphoresis. Given the fact that Bill required to be operated, the nurse has been appointed to ensure pharmacological management of Bill’s pain, provide him with Intravenous Antibiotics and help him remains fasting so that he can be prepared for operation theatre. Bill is showing immense sign of discomfort and pain. The nurse has been informed by Bill’s brother that Bill has low pain tolerance, become high anxious in hospital setting and is highly reluctant to IV medications since her mother is an IV drug user. It is the role of the nurse to help him calm and prepare him for the theatre. In this critical appraisal paper, the given scenario has been analyzed on the basis of the diagnosis, age of the patient and nursing standards.

In order to provide effective pre-operative care to the patient, it is crucial for the healthcare service provider to have effective idea of the pathophysiology of the diagnosed illness. Direct luminal obstruction, as a result of a lymphoid and faecolith hyperplasia, affected faeces, or, in rare cases, an appendiceal or caecal tumour, is the most common cause of acute appedicities. Appendicitis is assumed to be caused by blockage of the abdominal lumen, which is usually caused by lymphoid hyperplasia but it can also be caused by a fecalith, foreign object, or even parasites, according to Cheluvappa (2019). Dilatation, bacterial overgrowth, hypoxia as well as inflammation are all symptoms of blockage. Gangrene, Necrosis and rupture can result if left untreated (Perez & Allen, 2018). When the appendix is occluded, symbiotic bacteria can grow, causing acute inflammation. Pathophysiology Of Acute Appendicitis Example Paper  Enhanced pressure inside the appendix as a result of diminished venous drainage as well as localized inflammatory can lead to ischaemia. Ischemia in the appendiceal wall often lead to necrosis that can result in appendix to break open if left untreated. According to Obuz, Arslan and Kucuk (2019), when the interior of the appendix becomes clogged, the patient get acute appendicitis. Diseases in the digestive system, like viruses, bacteria as well as parasites, can cause appendicitis. It might also occur if faeces blocks or traps the tube that connects the large intestine as well as appendix of the patient.

Bill has been complaining of mild pain along with rebound tenderness, nausea, hot flushes and diaphoresis in the lower right side of his abdomen. The pain due to acute appendicitis is caused as result of inflammation. As per Sag et al. (2021), when the appendix gets infected, the bacteria multiply in a rapid manner resulting in swollen as well as inflamed appendix. The pain site is lower right side abdomen since that is where the appendix is located. Nausea and hot flushes takes place as a result of distension of the lumen of the appendix (Matsushita et al., 2018). The symptom of diaphoresis is caused as a result of pain and other stated uneasiness as a result of acute appendicitis.

According to Ayazi et al. (2021), while caring for infant, toddler and adolescence patient, it is highly crucial for the nurses to consider their growth and development milestones while providing them with effective care. When it comes to a pre-operative nurse, it is crucial for him or her to consider the same, since it will help him or her to understand the specific need off the patient which in turn help him or her to determine how to communicate effectively with the patient so that a trusted bond can be developed (Castillejos et al., 2021). A trusted bond will enhance the adherence of the patient along with enhancing his or her cooperation in developing nursing plan.

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Considerations For Caring For Adolescent Patients

Given the fact that the age of Bill is 16 years 11 months, he is an adolescence. As per Pitts et al. (2020), one of the crucial growth and development milestones he have reached is the ability to understand logical facts and make logical thinking (Zugai, Stein?Parbury & Roche, 2019). Hence, it is crucial for the nurse to  educate Bill about his condition and clearly communicate the benefits  of the medications and operation. Given the fact that an adolescent patient is more prone to be afraid of asking questions, the nurse should demonstrate a friendly gesture and allow enough time for the patient to collect his thoughts and reflect on his feelings. For instance, given the fact that Bill is afraid of IV medication, instead of pressurizing him, the nurse needs to educate him how IV medication work and why it is different from drug addiction through IV injections (Speedie, & Middleton, 2021). Also, Bill is found to be panicking in hospital setting which possess the potential to affect his health and demotivate him to opt for the operation (Zugai et al., 2019). Here also, the nurse must consider his growth and development milestone to help him understand that there is nothing to be afraid of and explain to him how the operation and adherence to the nursing plan can relieve him from the pain he is currently going through.

The Gillick competence can be defined as a functional ability to make decision and give consent to a medical procedure. A Gillick competent child possess the capability to provide consent to the medical procedure as an autonomous adult.  As per the Case study, Bill, currently is highly scared of IV injections, hospital setting and the medical theatre. The nurse should decide whether he is Gillick competent or not after communicating with him and educating him about the necessity of the IV medications and the operation. In case, the patient is determined to not to follow the instruction that is required for his recovery, the nurse should communicate with his NOK and declare him as Gillick incompetent.  However, if he demonstrate signs of logical thinking and understand the need of the operation, he should be considered Gillick Competent and abled to provide the necessary informed consent..

As per the Australian Nursing and Midwifery Federation, one of the most crucial responsibilities of a nurse is to protect a child from Abuse and neglect while caring for him or her. In this Scenario, the newly appointed graduate nurse must ensure that bill is not abused verbally, physically or emotionally while he is being communicated with during the process of providing care. According to Fardell et al. (2018), given the fact that a child is more vulnerable  to inappropriate medical administration and medical errors, it is the role of a nurse to ensure that the child has been provided with the appropriate medication and an effective nursing plan his made for him that an ensure rapid recovery of the patient. In case of Bill, the role of the nurse includes rechecking the medications before administration.

Gillick Competence And Informed Consent

According to Baird et al. (2019), it is highly crucial for the nurses to consider the psychological needs of the patients while developing thee care plan since it not only makes the patient feel a part of hiss care and valued, but it also enhances the adherence of the patient to the medical procedure. In case of Bill I highly scared of IV medications while he needs to be given 5 IV medications, his psychosocial needs involves effective education and mental support from the end of the nurse as well as his family member. Along with educating Bill about the importance of IV medication, the nurse can arrange a virtual or real meet up with Bill’s peers to motivate and provide mental support to him.

In addition to this, during the post-operative care plan, Bill should be communicated for taking his suggestions and cooperation for aspects like meal planning. This will make him feel valued and understood.

According to the NMBA standard in order to provide a safe and emotionally supportive environment, nurses must demonstrate cultural competence along with treating the client with respect, empathy and dignity (nursingmidwiferyboard.gov.au., 2022). In case of Adolescence care,  children and adolescences often undergo neglect and ignorance which affect their psychology. In Case of Bill, the nurse should treat him with effective empathy, provide him with the required information along with panning the care pan in cooperation with him. Additionally, the treatment procedure should be hygienic and appropriate in nature to ensure his safety.

As per NMBA standard 5, The Nurses are responsible for ensuring that the medication prided to the patient is in the correct amount and supplied to the right patients at the appropriate time as well as through the appropriate channel (nursingmidwiferyboard.gov.au., 2022).   For this effective management of the EHR along with effective monitoring the treatment is needed. In case of bill, The RN should ensure that all the 5 IV medications are provided to him at appropriate time and in appropriate quality.

Conclusion

From the above discussion, it can be concluded that through effective psychological as well as professional support from the end of the nurses, bill will be able to undergo the operation in an appropriate way. In order to provide effective pre-operative care to the patient, it is crucial for the healthcare service provider to have effective idea of the pathophysiology of the diagnosed illness. One of the most important growth and development milestones he has achieved is his capacity to comprehend logical facts and reason logically. As a result, the nurse must inform Bill on his health and thoroughly describe the benefits of the meds and surgery. Bill is also observed to be anxious in a hospital setting, which has the potential to harm his health and demotivate him from undergoing the surgery. The nurse must also examine his developmental milestones in order to assist him comprehend that there is nothing to be scared of and to explain how the surgery and adherence to the nursing plan can alleviate him of the discomfort he is presently experiencing.

References

Ayazi, K., Nikraftar, P., Hatamabadi, H., Shojaeian, F., & Family, S. (2021). Three patients with acute appendicitis diagnosis following blunt abdominal trauma. Journal of Emergency Practice and Trauma.

Baird, H., Patterson, P., Medlow, S., & Allison, K. R. (2019). Understanding and improving survivorship care for adolescents and young adults with cancer. Journal of adolescent and young adult oncology, 8(5), 581-586.

Castillejos, A. V., Herrera, C. B., Durán, M. A. S., Aranda, J. M., Hibert, M. Á. M., García, R. C., & Dominguez, J. E. (2021). Appendicitis in Children: Fundamentals and Particularities. In Doubts, Problems and Certainties about Acute Appendicitis. IntechOpen.

Cheluvappa, R. (2019). Identification of new potential therapies for colitis amelioration using an appendicitis-appendectomy model. Inflammatory Bowel Diseases, 25(3), 436-444.

Fardell, J. E., Patterson, P., Wakefield, C. E., Signorelli, C., Cohn, R. J., Anazodo, A., … & Sansom-Daly, U. M. (2018). A narrative review of models of care for adolescents and young adults with cancer: barriers and recommendations. Journal of adolescent and young adult oncology, 7(2), 148-152.

Matsushita, M., Fukata, N., Omiya, M., Nishio, A., Seki, T., & Okazaki, K. (2018). Pathophysiology of the appendix in ulcerative colitis. The American Journal of Gastroenterology, 113(4), 622.

nursingmidwiferyboard.gov.au. (2022). Nursing and Midwifery Board of Australia – Registered nurse standards for practice. Retrieved 30 April 2022, from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Obuz, E., Arslan, R. S., & Kucuk, S. (2019). An unusual cause of phlegmonous appendicitis, actinomycosis: a case report. Gastroenterology & Hepatology, 10(2), 104-6.

Perez, K. S., & Allen, S. R. (2018). Complicated appendicitis and considerations for interval appendectomy. Journal of the American Academy of PAs, 31(9), 35-41.

Pinkerton, R., Donovan, L., & Herbert, A. (2018). Palliative care in adolescents and young adults with cancer—why do adolescents need special attention?. The Cancer Journal, 24(6), 336-341.

Pitts, B., Aalsma, M. C., Brooks, M., Galagali, P., McKinney Jr, R., McManus, P., … & Richardson, L. (2020). Improving integration of behavioral health into primary care for adolescents and young adults. Pathophysiology Of Acute Appendicitis Example Paper