Appendicitis and Peritonitis: Nursing Interventions for Child Patient

This assignment is based on nursing interventions for a child patient who underwent surgery for appendectomy and requires care in the hospital from healthcare professionals to fight infection. It discusses the impact of hospitalization on the child and family members. Developmental theories like Piaget's Cognitive Developmental Theory and Bowlby’s attachment theory are applied to understand the child's thought process and attachment needs. Family-centered care is discussed as a way to reduce emotional trauma and ensure better quality of life for all.

Running head: APPENDICITIS AND PERITONITIS
APPENDICITIS AND PERITONITIS
Name of the student:
Name of the university:
Author note:

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APPENDICITIS AND PERITONITIS
Appendicitis is mainly defined as the condition that includes inflammation of the inner
lining of mainly the vermiform appendix that in turn spreads to the other parts of the body.
Researchers are of the opinion that although diagnostic and even therapeutic advancement in
medication had taken place, this clinical condition had still prevailed to be a clinical emergency
and is still been found to be one of the acute causes of the abdominal pain (Svensson et al.,
2015). This assignment would be mainly be based on the nursing interventions of caring for a
child patient who had undergone surgery for appendectomy and requires care in the hospital
from the healthcare professionals to fight infection.
Appendicitis is mainly seen to occur after the obstruction of the appendiceal lumen. The
important causal factors are the occurrence of the lymphoid hyperplasia that might occur as a
secondary outcome if inflammatory bowel disorder as well as infections with the latter being
more common in the children. Fecaliths and fecal stasis are the causes in the elder patients,
parasites in the eastern countries and more rarely neoplasm and foreign bodies. Appendicitis
would take place when the appendiceal lumen is obstructed due to above-mentioned causes
(Hartwich et al., 2016). Such obstruction caused by the substances results in increasing the
pressure with the appendiceal lumen. This associates with the increase in the continuous
secretion of the mucus as well as the fluids and mucus from the mucosa and the stagnation of this
material. Within the same time, the intestinal bacteria within the appendix are seen to multiply
and this leads to the recruitment of the large number of white blood cells. This is seen to
associate with that of the formation of pus and subsequent higher intra-luminal pressure
(Svensson et al., 2017).
When obstruction in the appendiceal region is seen to persist over a long period, intra-luminal
pressure is seen to rise above that of the appenidiceal veins. This in course of time results in

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obstruction in the venous flow. Therefore, this results in the beginning of the appendiceal wall
ischemia, which in thereby results in the loss of the epithelial integrity. This is seen to allow
bacterial invasion mainly in the appendiceal wall (Shah et al., 2016).
Within a very few hours of the occurrence of this situation, the local condition might seem to get
worsen. This would be mainly because of the thrombosis of the appendicular artery and the
veins. This would lead to perforation as well as gangrene of the appendix region. When this
procedure is seen to continue, a peri-appendicular abscess or the peritonitis might also occur.
Therefore, in the child patient, these occurrences have taken place and therefore the child was
suffering from immense pain and was admitted to the emergency ward.
One of the most important developmental theories that can be applied to the child named
Anne is the Piaget's Cognitive Developmental Theory. This theory mainly helps in understanding
the development of the though process of the children and shows the different ways by which
thought procedures help in influencing the ways individuals interact and understand the
surrounding world. Anne would be belonging to the specific stage called the Concrete
Operational stage as this stage mainly includes individuals belonging to age group between 7 and
11 and Anne belongs to the age of 10. During this stage, children are seen to develop better
understanding of the different mental health problems they are seen to start thinking logically as
well as concrete events (Osherson, 2017). However, they might face difficulty in the
understanding abstract as well as hypothetical concepts. In case of Anne, it is seen that she is 10
years old where she might learn to think logically; therefore, she might raise questions to the
nursing professionals about her disorder. Therefore, it becomes every important for the nursing
professionals to make her understand her disorder but in a tone and manner that do not create
fear and anxiety in the patient. The nursing professionals should make her understand the

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disorder in a way by which she can relate to and not in any ways that might leave confusion in
her.
Another developmental theory that can be applied is the Bowlby’s attachment theory.
The researchers named John Bowlby had proposed that early relationship with that of the
caregivers might play an important as well as the major role in the development of the child and
thereby they should be continuing to influence social relationships throughout life (Sieglar,
2016). Children are born with innate requirement to develop attachments and such attachments
help in the aiding of the survival and ensure that the child receives care as well as protection.
Therefore, the professionals should ensure that both the child and the caregivers should be
engaging in the behaviors that would be designed for ensuring proximity. Children should be
needing to stay close as well as connected to the different caregivers who in turn should be
providing safe haven and hence a secure base for exploration. Therefore, the nursing
professionals who would be caring for the child would require to develop empathetic and
compassionate relationship with the patient. She needs to be friendly with her and less
judgmental and have to understand the psychology of the child who had undergone surgery. The
child might feel fearful, anxious and threatened and therefore, the professionals have to be her
constant companion and talk to her in ways by which the child can rely, trust and confide in the
professional. This would help in developing attachment and positive outcome on the child
(Coyne et al., 2016).
A child of the age 10 might have several developmental milestones but the ones, which
are worth mentioning in regards to the case scenario, are the emotional changes and the cognitive
changes. Physical changes like preliminary changes before the onset of puberty might affect
children in this age but such references are not required in the case study. The children are seen

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to develop stronger and complex relationships with friends and this becomes an important aspect
in their life. Therefore, Anne can miss friends of her school and nurses should take steps in ways
by which she gets over the sadness and missing of friends. They can engage her in different
activities on the hospital bed only (Shields, 2015). She might get concerned about the body
image as puberty approaches and therefore nurses need to clarify every aspect regarding the
surgery to the patient to overcome her confusions of the body image. Children at this age might
start becoming independent of the family but they are seen to maintain close bonds with their
parents and with siblings and cousins. They tend to have frequent squabbles with siblings, fight
with younger siblings and others. Therefore, professionals can arrange for phone calls when she
remembers them or misses them and constantly give her hope of her getting well and discharging
from the hospitals (Rankin, 2015).
Researchers are of the opinion that healthcare professionals caring for the child should
also consider the impact of thee admission of the child on the family members. Family centered
acre is mainly developed for caring for children in the hospital ensuring that the care is planned
by the healthcare members surrounding the family and not only the child. This would help in the
reduction of the emotional trauma and would help in the recovery procedures as well. One of the
most important aspect of the FCC is information sharing (Roueu et al., 2017). The healthcare
professionals should communicate and thereby share the complete as well as unbiased
information of the different ways that are affirming as well as useful. Studies have revealed that
when patients and families are seen to receive information timely, completely and accurately, it
would help them to overcome anxiety, fear, tensions and stress. It would also help them to
participate in care and decision making effectively. Therefore, professionals should discuss
information in details with the parents so that they can overcome stress and fear. It also involves

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ensuring collaboration participation of the team members with the families and parents in order
to provide care to the children that align with the children’s needs and likings (Curtis &
Northcott, 2017). This would help Anne to feel homely in the alien environment of the hospitals
and would help both Anne and her parents to live a better quality life that is free from stress and
fear.
Studies reveal that experiences of children in being hospitalized is mainly anxiety
provoking and even traumatic. Children are mostly seen to be prone towards falling ill and their
hospitalization is a stressful event that has potential untoward consequences for the children and
even their families. Many of the children are seen to consider hospitals as the foreign land to
whose outcomes, schedules and languages they are completely unaware of. It is seen that as they
have cognitive as well as emotional limitations and even dependence on the others, children are
particularly seen to be vulnerable towards stress that is involved in adapting to their condition of
illness as well as hospitalization (Burge et al., 2014). When children get scared, tired or are in
pain, they become dependent on the safe as well as the stable environment of their home and
even the love and support of their family members. This gives them the ability to scope and feel
strong and capable. As children grow up, they depend on their parents and family support and
well-being for daily functioning and when they become ill, they tend to need the support of the
family. This is mainly because their limited coping skills and emotional resources are not
designed appropriately for handling the tremendous amount of physical and emotional stress on
them during hospitalization. Therefore, they are seen to feel lonely and scared. Therefore, it is
important for healthcare professionals to provide a safe and empathetic environment of their
home and help them to reside in a newly developed familiar and comfortable environment that
do not seem alien to them. Often lack of information results in anxiety and stress in the parents

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who tend to get confused, stressed as well as agitated when they cannot understand what would
be done with the child and what would be the fate of the child (Shields, 2016). Moreover, the
sufferings of the child create an emotional turmoil in the parents making them feel helpless, as
they cannot contribute to the pain relieving session of the child. All these result in development
of sadness and emotional instability that affect the quality of the lives of all. In such situation,
family centered care is helpful in tackling the situations effectively and ensuring better quality
lives does all (Mortenson et al., 2015).
From the above discussion, it becomes clear that hospitalization of the children affects
not only on the health of the children but also the parents and the family members. In the case
study, the child patient had undergone appendicitis surgery following which she has to stay for
ten 10 days in the hospital. Here the nursing professionals need to apply their concept of
developmental theories and thereby ensure nursing interventions that align with her age and
requirements. Family centered care need to be given only after considering the impact of
hospitalization on the patient as well as the child. This would ensure better quality life for all.

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References:
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(2014). Bereaved family member perceptions of patient-focused family-centred care
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child-centred care approach for children’s healthcare. Journal of Child Health
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