Case Study on Appendicitis and Family Centered Care

This case study discusses appendicitis, its causes, and the importance of family centered care in treating pediatric patients. It also explores developmental theories like Erikson's and Piaget's. The nursing professionals need to effectively communicate and share complete as well as unbiased information with the parents and the families in ways that are useful to them. The parents are the primary caregiver of the children and therefore involving them in the care of the children not only strengthen them and empower the parents but also help the children to gain strength and enjoy a sense of security and bonding within the foreign hospital environment.

Running head: CASE STUDY ON ANNE
CASE STUDY ON ANNE
Name of the student:
Name of the university:
Author note:

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CASE STUDY ON ANNE
Appendicitis is inflammation of the appendix. This organ can be described as the
three and half inch long tube like tissue that is seen to be an extending part from the large
intestine. Appendicitis can be described as the medical emergency that requires almost
prompt surgery for the removal of the swollen appendix. When it is left untreated, the
inflamed appendix has the chance of bursting or getting perforated (Dangleban & Madbak,
2017). This results in the spilling of the infectious materials present inside the appendix into
the abdominal cavity. This results in the occurrence of the peritonitis situation. Researchers
describe this situation as the serious inflammation of the peritoneum which is the abdominal
cavity lining (Drake et al., 2014). This can become fatal if not treated immediately. The
assignment would show how nursing professionals would be caring for a child affected by the
disorder and will help the family to cope up with the situation.
The main cause of acute appendicitis is the obstruction of the lumen of the appendix.
Fecalith (which is actually a hard mass of faecal matter) as well as normal stool and that of
lymphoid hyperplasia are some of the main causes that result in obstruction of the lumen of
the appendix. The lumen, which is distal to the obstruction site, starts getting filled up with
mucus. Thereby it starts acting as a closed loop obstruction (Alvarado, 2018). This
obstruction starts developing distension as well as increase in the intraluminal and intramural
pressure and as the situation becomes progressive, the bacterium that resides here in the
appendix starts multiplying rapidly. The most common bacteria that start multiplication in the
appendix are the Bacteroides fragilis as well as Escherichia coli. It is then found that
distension of the lumen of the appendix results in reflex anorexia as well as vomiting and
nausea and visiting.
The pressure continues to increase and when the pressure of the lumen exceeds the
venous pressure, the small venules as well as capillaries become thrombosed. However
arterioles remain open and this this results in engorgement and congestion of the appendix.

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the inflammatory procedure soon starts involving the serosa of the appendix. Therefore, in
the parietal peritoneum in this region, there results in classical right lower quadrant pain.
Once the small arterioles are seen to get thrombosed, division at the antimesenteric border
also start becoming ischemic (Kothadia, Katz & Ginzburg, 2015). Farther infection and
perforation occurs in the appendix. Therefore the bacteria is seen to leak out through the
dying walls and results in formation of pus within the organ and also surrounding the
appendix. Perforation is usually seen just beyond the obstructions rather than at the tip vision
of the appendix.
In the case study as well, right iliac fossa pain was found to be present in the patient
because the appendix have already become perforated and resulted a gangrenous condition
due to the spilling of infectious fluid in the abdominal cavity. It required immediate surgery
so that appendix can be removed and the spreading of infection can be controlled (Rentea &
Peter, 2017).
Erikson’s eight-stage theory of psycho-social development mainly describes that
growth as well as the change that every individuals go throughout life. This theory mainly
focuses on the impact of different types of social interaction as well as the conflicts that
might arise at the different stages of the development. Researchers are of the opinion that
better the individuals balance this conflicts, they will be able to handle each of the stages
successfully and this will in turn help them to be live a successful life in harmony (Light,
2017). A lifelong psychological virtue can only be developed when the individuals can
successfully overcome the challenges and face the developmental crisis properly. The
theorists propose eight important ages and the important stage that can be applied to the case
study of Anne is the industry versus inferiority stage. This stage is mainly seen to take place
in children during the early years from approximately 5 to 11. In this stage, children are seen
to develop a sense of pride in their accomplishments as well as their abilities. Studies have

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shown that children who are constantly encouraged and commended by their parents would
develop a feeling of competence and would start believing their skills and feeling
empowered. Those individuals who are seen to receive little or no encouragement at all from
the parents, peers as well as the teachers would start developing fear, would suffer from lack
of confidence, and will start doubting their abilities of being successful (Osherson, 2017).
It is extremely important for every individual to correctly develop a balance at this
stage of the psychosocial development so that they can effectively develop competence and
starts believing on their abilities. Anne is in this stage and hence the nursing professionals
have to be very careful while interacting with her. The patient might be going through a
strenuous stage as she has to live being separated from her parents and siblings and she might
not be able to cope with the situation of separation (Berk, 2017). If not handled properly, this
inability to cope with the strenuous situation would never develop and she might go into
expressive state. Therefore, the nurses should constantly encourage her and communicate
with her to develop strength and resilience building. This would help her feel empowered and
help her to learn to handle such situation in the future effectively.
Another theory that can be also developed is the Piaget’s theory that remains mainly
concerned with the development of the thought procedure of the children as they grow up.
This theory mainly explains how the through procedures can influence the ways by which
individuals understand and thereby interact with the world (Syed & Mclean, 2017). He has
put forward 4 important theories out of which the stage that is applicable for this case is the
concrete operational stage. This stage is mainly applicable for children between the age 7 and
11. During this time, the children are seen to gain better understanding of the mental
operations. Here, the children are seen to start thinking logically about the different types of
concrete events. They cannot understand abstract as well as hypothetical concepts. They tend
to understand that not all people will mainly have similar viewpoints to them and that others

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might have different thinking patterns that do not match with them (Degges & White, 2017).
Therefore, as the children are seen to have crossed the stage of egocentrism, the nurses would
get the scope of making Anne understand the reasons why she had developed the disorder as
Anne might have this inquiry in her head. However, they need to be very careful to ensure
that they describe the disorder in ways by which they do not make her scared as this would
have negative impact. They should discuss every aspects of Anne’s concern logically as she
would have developed the capability of understanding logics.
Family centered care can be defined as the partnership that takes place
between families and health care professionals. It can be defined as a collaborative
relationship that ultimately helps families in setting effective goals for their children and their
treatment and recovery. One of the most important principles of family centered care is that
the Healthcare professionals need to effectively communicate and share complete as well as
unbiased information with the parents and the families in ways that are useful to them (Smith,
Swallow & Coyne, 2015). Researchers are of the opinion that parents are always found to be
in a confused and stressful state during the hospitalizations of their children because they do
not get proper information about what is happening to their child. They also do not know
what the doctors are doing with their child. They also remain tensed about the fate of the
interventions that the professionals are applying on the child. Therefore more clear and
transparent the information, the lessee will be anxiety and fear of the parents (Brosco et al.,
2018). This will have better effect on the child and on his health outcomes.
Another important principle of family-centered care that needs to be encouraged by
the healthcare professionals is the strength building among the family members. The latter are
encouraged for building on the strengths by effective participation in the different
experiences that help in enhancing their control and Independence. Researchers are of the
opinion that to achieve this, the family members and the patients are to be given proper

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information, variety of resources are to be shared and others that make it easier for the
parents to participate in their care of the children (King & Chiarello, 2014). Another
important principle is that the Healthcare professionals should co-operate with families, the
community caregivers as well as other Healthcare provider in order to ensure that the care
given to the children not only aligns with the requirements and their care priorities of the
children but also ensures the coping power of the children and the family members. the
Healthcare professionals taking care of Anne should ensure that they involve her parents and
the family members in the decision making, communicate with them the necessary
information regarding the Health and Care plan with parents, maintain and dignity and
autonomy, and respect their cultural preferences and health literacy. The parents are the
primary caregiver of the children and therefore involving them in the care of the children not
only strengthen them and empower the parents but also help the children to gain strength and
enjoy a sense of security and bonding within the foreign hospital environment.
Hospitalization often results in the creation of stress not only on the child who is
admitted but also on the parents of the child. Some of the major stresses for hospitalization
are the separation, loss of control as well as fear, anxiety, nervousness and many others.
Anxiety is often seen to occur of pediatric patients of this age mainly because of the sudden
onset of the disorder and being admitted to the foreign environment where they had not been
present before. The limited experience of the child is indeed one of the main reasons that
make them anxious. Fear occurring due to the cause of separation from their parents as well
as the family members is another contributor for higher suffering of the patients (Labrose et
al., 2017). The children of this age start to live and think independently but they still need the
support and acre of their parents whenever they face difficulty in life. They also need care in
different of their activities and even in times of fear and stress, not getting the parents in such
strenuous, moments of ill health might make Anne more nervous and scared.

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On the other hand, parents are also seen to suffer from a sense of guilt and
disappointment thinking that their carelessness might have resulted their ward to go through
the phase of suffering and this makes them depressed (Homaira et al., 2016). Moreover, these
feelings also results in development of anger where they cannot forgive themselves, they feel
anxious thinking how their children would be able to cope with the painful days and all these
result in the development of helplessness in them (Weaver & Weaver, 2014). Moreover, they
cannot understand the disorders completely, are properly informed by the professionals and
many others that give them a hard time. Therefore, family centered care would help the
healthcare professionals to help both Anne and her parents and siblings to fight with the
different forms of challengers that occur and help them lead better quality lives.
From the above discussion, it is clearly understood that appendicitis is medical
emergency that requires surgery when identified in the pediatric patient. However, for
handling such patients, nurses need to develop ideas about developmental theories like
Erikson’s theory as well as Piaget’s theory successfully so that they can give proper holistic
care to patients. They also need to ensure providing family centered care as effects of
hospitalization have both negative outcomes on parents and the child as well. These would
help in ensuring better quality lives for all.

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References:
Alvarado, A. (2018). Clinical Approach in the Diagnosis of Acute Appendicitis.
Berk, L. (2017). Development through the lifespan. Pearson Education India.
Brosco, J. P., Pulgaron, E., Vanderbilt, D. L., Macias, M., Mathew, M. S., & Blum, N. J.
(2018). The Interprofessional/Family-Centered-Care Observation Rubric (I-FOR):
Results of a Multicenter Study of a New Measure of Educational Outcomes. Maternal
and child health journal, 1-9.
Dangleben, D. A., & Madbak, F. G. (2017). Acute Care General Surgery. Springer.
Degges-White, S. (2017). Erikson’s Theory Of Psychosocial Development. College Student
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Kothadia, J. P., Katz, S., & Ginzburg, L. (2015). Chronic appendicitis: uncommon cause of
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Labrosse, R., Vincent, M., Nguyen, U. P., Chartrand, C., Di Liddo, L., & Pastore, Y. (2017).
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