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Nursing Care for Anne: Pathophysiology of Appendicitis

Assessment Task 1 – Case Study


Description:Please refer to the NRSG257 “Assessment” and “Additional

Unit Resources” on the National LEO page for more

comprehensive information on this assessment task.


Purpose:This assessment task will allow students to demonstrate

their critical thinking and reasoning, as well as their

research skills. Students will also demonstrate how

evidence based information can be implemented into

contemporary Australian Nursing practice.


Assessment criteria:The rubric for this assessment is outlined in full below. The

essay is aimed at critically evaluating the research explored

related to a chosen case study presented. This essay

requires use and evaluation of evidence-based sources

when caring for children, adolescents and their families in

relation to current Australian nursing practice.


INSTRUCTIONS:

Your Assessment will be written in academic essay format with an introduction, body and conclusion according to APA Guidelines.

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. (300-500 words)
  2. Evaluation of the nurse’s role to deliver developmentally appropriate nursing care in relation to your chosen case study. Address
  • family centred care and,
  • growth and developmental theories,
  • the effects of hospitalisation of the child, on the child and family. (1100-1300 words)

Case Study 1

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.

Answer

Nursing Care for Anne

In this essay, we will talk about the pathophysiology of appendicitis and the role of nurses to deliver the better care in relation to the chosen situations. We will also discuss the effects of hospitalization on the patients and the family. Additionally, we will try to explore the role of nurses in discovering the development process of the adolescent girls like Anne and role of family care centered in this scenario. The patient Anne is a 10 years old girl of Indian origin. She is presented to the emergency department in local hospitals with severe right lilac pain. Therefore, the medical team suspected appendicitis and advised for an appendectomy. The family background of Anne is indicating that she is the oldest child and having four siblings. Her father has own Indian restaurant in the city. Her medical handover suggested that she has developed a perforated gangrenous appendix. Therefore, Anne has returned to the ward with nasogastric and prescribed to administrate intravenous antibiotic therapy along with morphine PCA. Furthermore, she is advised for 10 days of hospitalization.           

In a pathophysiological aspect, the appendix is a small inactive, extended part of the human digestive system which is located in the right side of the lower abdomen in the human body. It can be stated that it is a tubular extended part of the colon (de Souza, da Costa & de Souza, 2015). Therefore, in human body appendix is an inactive organ. However, according to many studies, it can act as a storehouse of bacteria. Under the microscopic examination, it is revealed that it has own blood circulation system through the appendiceal an artery (N. & B., 2017). Thus, the internal mucosal lining of the appendix is similar to the colon. Therefore, severe inflammation of the appendix is known as appendicitis which required immediate medical intervention. It has been isolated that the disease is common between the ages of 20-30.  However, it can affect both young adolescence and old age people. 

Thus appendicitis can cause due to any obstruction in the appendiceal lumen. The obstruction can precipitate due to tumors, entry of foreign particles, stools into the appendix which can result in severe infections in the appendix and increase the chances of intraluminal pressure and ischemia (Shogilev, Duus, Odom & Shapiro, 2014). Therefore, the obstruction can prevent the mucosal blood flow as a result of ischemia develops. The appendicitis can be classified as acute appendicitis and chronic appendicitis. In both cases, increase number of eosinophils and decrease number of interstitial cells can raise intestinal motility and dysmotility (Smith, Parker, Kotzé & Laurin, 2017). In the case of acute appendicitis, it has been observed that entry of foreign particles can obstruct the lumen and facilitate the bacterial growth and development within the lumen. If the condition becomes untreated then distended appendix with severe pain can result within a few hours. Additionally, bacterial inflammation can lead to necrosis or gangrene (Kooij, Sahami, Meijer, Buskens & te Velde, 2016). Thus, the condition can cause a rupture of the appendix and release the pus or infectious fluid into the abdomen. Therefore, it can cause whole-body infections. Studies suggested that the rupture of the appendix can lead to the peritoneum in which abdominal cavity become contaminated and develop blood infections (Drake et al., 2014). Thus, peritoneum can be considered a fatal condition. 

Therefore, the incident of appendicitis can cause severe abdominal pain and the severity of the pain completely depending on the situation and stage of disease progression. In this condition, the patient can experience fever, cramp, vomiting and nausea (Christodoulidis et al., 2012). Thus, the surgical removal of the infected appendix is known as appendectomy which is essential to prevent the perforation of the appendix.  Therefore, the perforation can increase the death rate due to appendicitis (Nshuti, Kruger & Luvhengo, 2014). Hence, a quick identification of the condition and proper intervention process can help in patient survival. 

Human has several phases of growth and development. Children are also a part of the human society. Therefore, child development theory is basically concerned about the behavior of the children in critical situations (Badakar et al., 2017).. In our case study, Anne is a young adolescent as per her age is concerned.  In this stage of life, a child can achieve intellectual and physical development along with independence. Erikson theory stated that school going children are belonging to their eight stage of development (Malone, Liu, Vaillant, Rentz & Waldinger, 2016). In this stage of development, the inferiority complex has been observed among the children. However, they can achieve cultural skills and self-competence if they are directed properly by the educators. Additionally, cognitive development is also results which increase their self-esteem and self-capabilities. In this stage of life, they can develop the sense of pride and achievement which can increase their awareness towards the society and environment. The external environment would provide confidence for their future capabilities and achievement. Therefore, failure can be rectified by evaluating the whole situation and accumulating the knowledge for a future attempt. In this age, the children understand the necessity of cooperation and interested in learning a new aspect of the crisis. They can understand the importance of rules and regulations of the specific environment and the try to obey the norms. As per Freud’s theory, Anne is in her latency stage (Badakar et al., 2017). According to Fraud, in this age, the child develops the sense of privacy as physical and mental growth occurs. In addition, they can realize the sexual differences in this age.

Thus, in the case of Anne, during the continuation of her diagnosis and treatment, the nurses should maintain privacy and dignity to feel her safe. Additionally, a proper nursing care can support the growth and development of the hospitalized child. During this age, the children are able to develop different skills and have their future plan. According to the cognitive development theory of Piaget, the children in this age can recognize the effects and reasons of crisis situations (Badakar et al., 2017). Thus, the nurses can share the treatment procedure with Anne as she can understand the exact scenario. In addition, they can improve her studies with help of nurses. The nurses can create bonding by sharing the different aspect of the social life of Anne. This would help them to recognize her passion and encourage her to continue her practice. This would remove her inferiority complex gradually. In this respect, it can be stated that it is essential to support their children mentally and physically which helps in their development process.    

Thus, family nursing care can be considered as fundamental nursing care which can improve the patient’s outcome (Festini, 2014). Family-centered care plays a vital role in the treatment of Anne. In addition, they can play an important role in older people. It has been observed that hospitalization can increase the stress and anxiety among the children and her/his family. Therefore, it is essential to support their psychological condition through the family-centered care. Hence, the prime responsibility of family-centered care is to plan for better health care services along with maintaining collaboration with family and service providers (Rawson & Moretz, 2016). Therefore, the nurses can help the family to continue their own job and duties without any interruption in the treatment process and helps to take correct decisions for emergency situations.     

Thus, Anne is suffering from severe abdominal pain and hospitalized. After the surgical attempt, she put on antibiotics and nasogastric tube. Therefore, nurses can distract her by engaging her in mild physical activity or using some gazettes. This can diver her mind and pain sensation can be suppressed. An interactive and peaceful communication can help her to understand her treatment procedures. Therefore, family-centered care can help her family to understand the treatment procedures with privacy.      

In this context, it can be assumed that Anne has an extended family with four siblings. Her parents were busy to run their own business. Therefore, negligence is a common phenomenon for the child (Bedells & Bevan, 2016). In this crisis, the nurses should realize the situation and provide her complete mental support which can help in her recovery.  

It has been recognized that the incident of hospitalization can create trauma among the families and the patients. The children are mentally unprepared for the certain unexpected situations.  This can create stress and inferiority complex in the children. Furthermore, financial instability can affect the situation adversely. In the case of Anne, severe pain followed by surgery and nasogastric tube feeding along with antibiotic therapy can increase her anxiety level. She can feel alone in this scenario. During the hospitalization, privacy and independence of Anne can get interrupted through the treatment procedures. This can further create loneliness and embarrassment for her (Franck, Ferguson, Fryda & Rubin, 2015). Therefore, nurses should be sympathetic to handling Anne. In addition, her parents should feel tense due to the hospitalization. In such a scenario, the nurses should behave positively despite their work pressure and challenges. Moreover, they should motivate the parents by incorporating them in the treatment procedure. Thus, the environmental modification can be appreciated as it can relax the child from anxiety and stress.

At last, it can be concluded that appendicitis is a common health problem which requires emergency support and treatment to avoid unpleasant situations. Therefore, the nursing care can improve the whole condition by supporting the patients and their families. The nurses should understand the growth and development process of the patients and act accordingly.  Therefore, family care centered is essential for decision making and communicating during an emergency situation. Thus the recovery process of the patients is completely depending on the behavior of the nurse along with the support from the family care centered.

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