Appendicitis: Pathophysiology, Nursing Care, Growth & Development Theories, Family Centered Care and Effects of Hospitalization on Child and Family

This paper discusses the pathophysiology of appendicitis, evaluation of the nurse’s significance and their role in providing proper nursing care, growth & development theories, family centered care and the after effects of child hospitalization on family and even on child itself.

Appendicitis
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Introduction:
The above case study is based upon a 10-year child who is suffering from acute appendicitis.
The medical condition in which the appendix is obstructed due to excessive deposition of
mucus in the appendicular lumen. It’s an inflammation of vermiform appendix which can be
chronic or acute. It is considered as one of the most common cause of abdominal pain in
children. The essay will cover the pathophysiology of appendicitis, evaluation of the nurse’s
significance and their role in providing proper nursing care, growth & development theories,
family centered care and the after effects of child hospitalization on family and even on child
itself.
Pathophysiology:
The blockage of appendix mainly caused by stool, foreign body, lymphoid hyperplasia or
cancer (Hassan, Greenstein, Neuman & Hahn, 2017). The main causes of lymphoid
hyperplasia are not clear but infection, immunodeficiencies, inflammatory bowel diseases,
food allergies, etc. are some of the causes. In lymphoid hyperplasia, the number of cells in
the lymph node increases. This further leads to swelling or enlargement of appendix causing
obstruction. The increase in secretion of mucus further increases the pressure in the lining of
the walls of appendix also leads to blockage of blood vessels, thrombosis and even slowing
down the flow of lymphatic fluid. After the obstruction the recovery process slows down.
Due to the obstruction the appendix becomes ischemic leading to ischemia. This further leads
to necrosis of the appendix when lot of bacteria (Hirsch, 2017) is produced at the site. These
bacteria start leaking out of the damaged walls which leads to pus formation both inner and
outer side of appendix. Thus, this stage is known as suppuration. Later the appendix ruptures
which leads to sepsis or peritonitis. During all these stages, abdominal pain is one of the
common symptoms (Petroianu & Barroso, 2016).In critical appendicitis Polymorph nuclear
cells are present inside the wall of appendix. Pus, faeces, Mucous etc get into abdominal
cavity through the hole further peritonitis condition. The swelling of the membrane lining
pelvic cavity, internal organs, abdomen is called peritonitis (De Onis, 2017). The condition
left undiagnosed and untreated can further lead to a condition known as septicaemia which
happens because of blood infection as a result of little blood pressure and supply to vital
organs. The toxin discharged by bacteria prompts the response of immune system during the
contamination. Because of the discharge of toxin into the stream of blood, dilation of large
vessels and leakage of small vessel occur causing the fluid to enter tissue from the stream of

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blood (Mak,& Loeff, 2016). The fluid filled appendix compresses the nerve whose sensation
causes the right iliac fossa pain in patients. Because of septicaemia, peritonitis; neutrophil, C-
reactive protein, white blood cells increase causing the decrease in immune system.
Growth & Development theories
Development is alteration in cognition, feeling and societal change whereas growth is
described as a bodily process of increase in weight, trunk and extremities and height. The
continuous alteration leading to rise in complexity and skill is called developmental
milestone. Girls have spurt of physical growth along with outcome of permanent teeth which
makes them taller and weightier than boys (Hughson, Stainton, & Koutoukidis, 2016). Muscle
power and physical skills amplifies in this period. The paediatrics classifies 10-year-old as
below the school age child. The development and growth of child are influenced by a number
of reasons such as health status, culture, environment, nutrition, gender, life style and adult
guidance. Erikson’s Psychosocial Development in fourth part namely Inferiority versus
Industry, a child tries to practice significant cultural skills, along with work and play with
peers. In this phase child recognizes and grows a sense of their possessed aptitude. Aptitudes
and abilities practiced by child, leads to sense of psychosocial strength of competency and
industry (Turley, Vanek, Johnston, & Archibald, 2018). The child learned working, preparation
and sharing by seeing other people in this phase. The children feel poised and industrious in
their aptitudes when they are supported by their teachers and parent for their creativities.
When they are not supported positively they grow sense of hesitation and insufficiency in
their aptitudes due to their feeling of being inferior (Trajkovski, Schmied, Vickers, &
Jackson, 2013). In actual operational phase from Piaget’s phase of cognitive development
supervision is needed though thinking in children becomes more rational and orderly. The
child aged 10 year begins to understand the notion of real talk. In the latent phase, while the
superego continues to mature, id’s energies are repressed rendering the Freud’s Phases of
Psychosexual development (Gaba, 2014). Children grow societal skills, values, form
connection with peers out of family and grown-ups. Because of the growth of the superego
and ego, serene nature in children grow. Sexual energy exists in this latency phase and is
directed towards academic pursuits and social interactions. On behalf of the development of
communication abilities, self-belief and other societal abilities this phase is very vital.
Standard level operational procedures are planned to raise the efficiency in patient care.
Controlled analgesic is generally administered in children after appendectomy to reduce pain.

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Constant IV therapy is essential till patient is NBM to reinstate electrolyte and fluid balance.
Intravenous antibiotics are required to inhibit further infection. Patients are encouraged to
take balanced diet and drink ample liquid diet to avoid constipation and reinstate the body
fluid (J, D, HE, & CS, 2015). Patients are advised to shun very hot food and shun spicy foods as
it irritates the normal epithelial layer. Because Anne’s parent owns and run Indian restaurant,
chances are high of Ann eating too much of spicy and hot foods. The free nasogastric
drainage through tube should be recorded to know it’s character post operatively. Because of
Immature systems and organs, the care provided by nurses might get influenced. Knowledge
concerning the necessities of developing phase and health problem associated with it is
essential. Nurses perform important duty of coordinator, emotional supporter, educator, carer
and resource person (Cundy, Sierakowski, Manna, Cooper, Burgoyne, Khurana, 2016). A number
of factors affects preparation and delivery of care such as development and growth,
separation and behaviour from family, response to sickness.
Family centered care:
Under family centered care, the family in collaboration with the clinicians provides care to
the hospitalised child. The four constituents or principles under family care is collaboration
across all the providers, strength building, proper communication and lastly dignity and
respect (Katz, & Webb, 2016). The care provider under respect and dignity should value and
respect the religion and culture of the individual. If the culture or religion of any individual
prohibits any practises then the family should inform the same to the clinician who must obey
that. The holistic care can also be a part of the family centred care where the health care
provider allows family to share positive and encouraging words in order to make the patient
comfortable and reduce their stress. The family participation in child care to reduce the
suffering in connection to child’s acute illness by reducing conflicts, tension management,
raising resilience and by better communication is supported by this methodology. With
family children feel released from their emotional suffering and thus feel safer and sounder.
Family focused care values the tradition, strength, culture that brings everybody together as a
dutiful family where families sense themselves as members in decision making at diverse
level with professional health care benefactor advocating policies and system that maintains
their child’s health requirements. The language that would be appropriate in accord with the
developmental phase along with child’s cognition should be used by the paediatrician.
Cultural Proficiency is essential to provide care to families belonging to different culture
(Matsushita, Fukata, Omiya, Nishio, Seki, Okazaki, 2018). Paediatrics patient who can

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provide legal necessities along with having necessary decision-making ability can give
approval for medical care. Biological parent or surrogate parents are needed to Trajkovski
give consent with the agreement of the child for the diagnosis and curing of the child.
There are several effects of admitting the child into the hospital on both the
child and family at large (Knox & Mortele, 2015). As per the studies, it has been found that
psychosocial effects are considered one of the major factors for affecting the health and
wellbeing of both the parents and the child. The admission of child at early age lead to stress
which affects the overall growth and development process. The children of school age may
have the tendency to handle the regression, separation, anxiety and all other factors caused by
their admission to the hospital but the need of security and parental guidance increases. These
children often suffer from loneliness, boredom, depression as they are more inclined towards
their peers and daily activities. They do not find themselves comfortable in hospital or school
environment due to their nature, habit and also because they are more physically and
mentally active (Fredman, Baucom, Boeding, & Miklowitz, 2015). The school going children
often finds it difficult in seeking parental guidance and support due to their developmental
age or goal of gaining self-reliance which is also significant to them. They consider that may
look immature, weak or even childish and less dependent even if they are asking for direct
help. This results in developing feelings which they might express in the form of aggression
and some children even gets irritated with their parents, unfriendly behaviour with peers,
developing unaccepting behaviours in the school (Coyne, 2013). These helped to identify
common problems experienced in these age group of children which included acceptance of
hospital reality, helplessness, fear, doubting the hospital staff ability, expressing the
information in more simpler ways, sense of dissatisfaction and trust on the medical personnel
and unwilling dealing with uncertainty. All of these common were identified by FCC. It has
also been seen that in some cases the admission of the sibling into the hospital develops
anger, guilt, anxiety, stress, fear and loneliness in their siblings.
Hence, from the above paper it can be concluded that appendicitis is mostly common in
children which is caused by parasite, foreign bodies, exposure to immunisation and even
hardening of stool. In absence of proper treatment or if not treated then it develops into
peritonitis. The case study is based on a 10-year child who is suffering from appendicitis. The
essay also explained the significance of nurses and their role in child recovery phase. The
other aspect of nursing care for the children included reducing the pain in child, electrolyte
balance, restoring fluid, prevention from other infections and also contributing by providing

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proper support, care both at physical and mental level. The paper also briefed about the
effects of child hospitalisation on family and child itself. It also explained about the
importance of parental support and care to their children, Lastly, the hospital and parents
should work together in bringing out strategies to minimize the stress of the admitted
children.

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