Acute Appendicitis in Pediatrics and Adolescents

This article discusses the pathophysiology and nursing management of acute appendicitis in pediatric and adolescent patients. It also covers growth and development theories, family-centered care, and the role of nurses in managing sickle cell disease in pediatric and adolescent patients.

Running head: SCD IN PEDIATRICS AND ADOLESCENTS
Acute Appendicitis in Pediatrics and Adolescents
Name
Institution

SCD IN PEDIATRICS AND ADOLESCENTS 2
Acute Appendicitis in Pediatric and Adolescents
Introduction
Managing pediatric clients can be really exciting and challenging at the same time. This
is because pediatric clients require a special approach of communication and rapport building to
achieve their compliance and trust. Furthermore, the pediatric patients are usually accompanied
by their families or caregivers; therefore, the nurse must not only meet the needs of the patient,
but also of the family. The nursing process is a significant tool and bedrock of clinical nursing
and nursing practice. The latter is crucial for effective planning and provision of patient-centered
nursing care (Alfaro, 2016). Accurate diagnosis relies on comprehensive and accurate
assessment of the patient. This paper will decipher the pathophysiology and nursing management
of a 10-year old client managed with acute appendicitis.
Pathophysiology
Appendicitis is a condition that involves the inflammation of the appendix. In 40% of the
cases, appendicitis is asymptomatic and may go unnoticed (Sommers & Fannin, 2015).
Appendicitis could either occur as acute or chronic. The clinical features of appendicitis are
decreased appetite, nausea, vomiting and abdominal pain. The disease is one of the most
common causes of abdominal pain (Lewis et al. 2014). Appendicitis commonly occurs between
the age of 5 and 40 years. Some of the risk factors for appendicitis include living in rural areas,
male gender, and high-income households.
Some of the conditions that present with similar symptoms include gastroenteritis, lobar
pneumonia, pancreatitis, ulcerative colitis, abdominal trauma, intussusceptions and Merkel’s
diverticulitis in children (Lewis et al. 2014). In women, similar features are seen in ectopic
pregnancy, pelvic inflammatory disease, endometriosis and ovarian torsion. The diagnosis of

SCD IN PEDIATRICS AND ADOLESCENTS 3
appendicitis usually relies on the clinical features. Laboratory and imaging tests can be applied in
instances where a diagnosis is not clear. Ultrasound and computed tomography are usually the
imaging tests of choice for appendicitis (Brown et al. 2017). Complete blood count could be
done to determine if there is an elevation in the levels of WBCs and urine test to rule out UTIs or
ectopic pregnancy.
The first intervention for a patient presenting with clinical features of appendicitis would
manage the pain that is usually excruciating. Morphine is usually administered to the patients
scheduled for an appendectomy at 0.1 mg/kg morphine sulfate to a ceiling dosage of 10 mg/kg
run over 5 minutes (Brown et al. 2017). Acute appendicitis is basically treated by surgical
interventions to reduce the risks associated with the complications that could occur if it bursts.
The surgical procedures are laparotomy or laparoscopy (Sommers & Fannin, 2015). Antibiotics
are generally effective in non-complicated cases where the appendix has not ruptured.
Role of Nurses
Nurses play a critical role in the management of pediatric and adolescent patients
including monitoring and evaluating them, participating in the development of and treatment
action plan and educating the patients and referring them when necessary. Nurses should identify
the clients that are unable to manage their condition effectively and teach them within the
confines of an effective asthma action plan. An effective treatment action plan is a written
document that is developed through collaboration of the patient and the caregivers to help them
manage their condition more effectively. An action plan describes the patients’ daily treatment,
the medications that the client is using and the time when the medications are due.
Growth and Development Theories

SCD IN PEDIATRICS AND ADOLESCENTS 4
Erik Erikson’s Psychosocial Theory
Erik Erikson developed the theory in the early 1960s, which illustrates eight stages
through which people are faced with new problems. He, however, states that the outcomes in
every stage are dependent on how these people tackled these problems (Marcia, 2012). These
stages were, however, named as per these potential outcomes. The eights stages are divided into
two whereby five of them happen up to the age of 18 years of an individual with the other three
happening in the adult stages. In every stage, the experiences encountered by an individual are
likely to have either a positive or negative impact on the development of personality (Cherry,
2017). Thus, Erikson states that these catastrophes are of a psychosocial nature since they
include the psychosocial needs of the person differing from the society’s needs.
However, as per the theory, a success in completing every stage leads to a healthy
individuality and the achievement of basic significant traits which can be used by the ego to
resolve successive catastrophes. Besides, failing to complete every stage successfully may lead
to a reduced capacity to complete auxiliary stages and thus leading to a more unhealthy
individuality as well as a sense of identity (Cherry, 2017). In the initial stage, children usually
are doubtful about the environment in which they exist and thus to decide these feelings of
doubt, they look into their main caregiver for stability and constancy of care. Marcia (2012)
asserts that at this stage, the child will end up developing a sense of hope due to the
establishment of the sense of trust between him and the caregiver.
Continuity has, however, been exemplified in my life in many aspects. My career in
sports has been one of the aspects that have exemplified continuity since I was a child. I never
seemed to look like a talented athlete in my earlier ages despite having a passion for games. I

SCD IN PEDIATRICS AND ADOLESCENTS 5
loved playing soccer with my neighbor’s child which later made my dad buy me a soccer ball.
Despite his efforts, I rarely possessed the skills needed to be a footballer. I used to handle the ball
just like any other toys. However, my parents never discouraged me but instead gave me hope
and showed me how to kick the ball whenever I failed. Over the ages, as I grew up, the skill and
passion in me increased promptly leading to the joining of a soccer academy when I turned eight
years. Since then, I have exemplarily shone and became one of the talented athletes in our
district. Thus, continuity has made me prosper in my career allows me to achieve the successes
in me up to date.
Therefore, I have a belief that my personal experience supports the hypothesis that people
pass through regular developmental stages in their life. For one to become successful, one needs
to pass through problematic stages which need the individual to come up with solutions to
resolve those challenges. Thereafter, as s/he grows older, the challenges continue to emerge
which are associated with the previous stages. However, these challenges make them stronger as
they develop or grow older. Therefore, they ought to learn step by step as well as draw lessons
from their previous challenges since these stages are correlated.
Family Centered Care
For pediatric and adolescent clients, the nursing care cannot exclude the caregiver. Most
parents and families whose children undergo a sickle cell crisis are anxious and restless. It is thus
significant for the nurse to reassure them constantly and keep them updated with the
management and progress of the child (Linton, 2015). The advanced practice nurses are trained
to conduct comprehensive pediatric assessment including the strategies of communicating
effectively to children and adolescents. The teenager should be educated on lifestyle
modification strategies including the need to maintain a healthy weight, engage less in vigorous

SCD IN PEDIATRICS AND ADOLESCENTS 6
exercises, avoid tobacco use and alcohol intake. The child’s respiratory system was also
supported by oxygen therapy nasal cannula 2L/min until the SPO2 and respiratory indicators
improved.
Conclusion
Nurses contribute significantly in the management of SCD pediatric and adolescent
patients including monitoring and evaluating them, participating in the development of an SCD
action plan and educating the patients and referring them when necessary. Managing pediatric
and adolescent clients can be really exciting and challenging at the same time. This is because
pediatric clients require a special approach of communication and rapport building to achieve
their compliance and trust. The management of the pediatric and adolescent population must
incorporate the family for it to be effective. An efficient family-centered approach also assesses
how the disease state of one child would affect the health of the siblings.

SCD IN PEDIATRICS AND ADOLESCENTS 7
References
Alfaro-Lefevre, Rosalinda. (2016). Critical Thinking, Clinical Reasoning and Clinical
Judgment: A Practical Approach, Pageburst E-book on Kno. W B Saunders Co.
Al-Salem, A. (2016). Medical and Surgical Complications of Sickle Cell Anemia. Cham:
Springer International Publishing.
Brown, D., Edwards, H., Seaton, L., Buckley, T., & Lewis, S. M. (2017). Lewis's medical-
surgical nursing: Assessment and management of clinical problems.
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (Eds.).
(2017). Pediatric primary care (6th ed.). St. Louis, Missouri: Elsevier.
Hickey, K. T., Taylor, J. Y., Barr, T. L., Hauser, N. R., Jia, H., Riga, T. C., & Katapodi, M.
(2018). Nursing genetics and genomics: The International Society of Nurses in Genetics
(ISONG) survey. (Nurse education today.)
Cherry, K. (2017). Erik Erikson's Stages of Psychosocial Development. Psychology.
Psychosocial Theories. Päivitetty, 14, 2017.
Costa, F. F., & Conran, N. (2016). Sickle cell anemia: From basic science to clinical practice.
Cham: Springer
Dweck, C. S. (2013). Self-theories: Their role in motivation, personality, and development.
Psychology press.
Marcia, J. E., Waterman, A. S., Matteson, D. R., Archer, S. L., & Orlofsky, J. L. (2012). Ego
identity: A handbook for psychosocial research. Springer Science & Business Media.
Newman, B. M., & Newman, P. R. (2017). Development through life: A psychosocial approach.
Cengage Learning.

SCD IN PEDIATRICS AND ADOLESCENTS 8
Lewis, S. M., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Harding, M., (2014). Medical-
surgical nursing: Assessment and management of clinical problems.
Sommers, M. S., & Fannin, E. F. (2015). Diseases and disorders: A nursing therapeutics
manual. Philadelphia: F.A. Davis Company
Linton, A. D. (2015). Introduction to medical-surgical nursing.
Elsevier Health Sciences
Meier, E. R., Abraham, A., & Fasano, R. M. (2018). Sickle cell disease and hematopoietic stem
cell transplantation. Cham: Springer