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

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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.