Assignment on Case Study of Anne
Added on 2020-02-18
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Running head: APPENDICITIS 1Appendicitis: Case StudyStudent’s NameUniversity Affiliation
APPENDICITIS 2ContentsIntroduction......................................................................................................................................2A.Pathophysiology.......................................................................................................................2B.Growth and developmental theories.........................................................................................4Psychosexual Development theory by Freud...............................................................................4Psychosocial development by Erikson.........................................................................................5Cognitive development by Piaget................................................................................................6C.Family centred care..................................................................................................................6D.The effects of hospitalisation of the child................................................................................8Conclusion.......................................................................................................................................8References........................................................................................................................................9
APPENDICITIS 3Appendicitis: Case StudyIntroductionAppendicitis is an important clinical emergency and a common cause of severe abdominal pain. The primary treatment for acute appendicitis is surgery. Despite the advances in diagnostic and therapeutic procedures, appendicitis is still a major health burden. This assignment is based on a case study of Anne, a ten-year-old girl, who has been diagnosed and treated for appendicitis. The first part of the paper will discuss the pathophysiology of appendicitis. In the second section, it will explore the nurse’s role in offering developmentally suitable nursing care. This section will specifically discuss growth and developmental theories; family centred care and impacts of hospitalisation of the child. A.PathophysiologyThe pathophysiology of acute appendicitis starts with obstruction of the appendicular lumen. In children, the obstruction of the appendicular lumen is primarily caused by lymphoid hyperplasia [ CITATION Sch15 \l 1033 ]. Lymphoid hyperplasia is associated with viral illnesses likegastroenteritis, mononucleosis or upper respiratory infection. However, there are several other causes of the obstruction. These causes include foreign bodies, gastrointestinal parasites and Crohn’s disease [ CITATION Elg14 \l 1033 ]. Some tumours such as adenocarcinoma and carcinoid tumours. Luminal obstruction results in accumulation of distal secretions as well as intraluminal pressure, which leads to the impairment of venous outflow. Once the venous outflow is impaired,the arterial inflow is also affected adversely. The increase in intraluminal pressure results in tissue ischemia, transmural inflammation, overgrowth of bacteria, appendiceal infarction and eventually, perforation [ CITATION Elg14 \l 1033 ]. The progress from obstruction to perforation
APPENDICITIS 4always occurs over 72 hours. Inflammation might consequently extend into the parietal peritoneum and close structures leading to abdominal abscesses. Narsule and colleagues found that appendiceal perforation is more prevalent in children, especially young children, compared to adults. The study unravelled that the chance of perforation within 24 hours of development of obstruction was 7.7 percent, and the risk seemed to increase with duration of symptoms [ CITATION Nar11 \l 1033 ]. In the case study, Anne presented with a gangrenous perforated appendix with peritonitis. The perforated appendix is characterised by an obvious defect in the wall of the appendix. A thick and purulent peritoneal fluid is also noticeable in the perforated appendix. The perforated appendix might be linked to ileus or bowel obstruction. On the other hand, the progression of gangrenous is related to suppurative appendicitis. A gangrenous appendix is characterised by edematous, congested vessels and fibrinopurulent exudates. Another characteristic is the increase in peritoneal fluid, which might be clear or turbid. It might be walled off by omentum, mesentery or adjacent bowel[ CITATION Sch15 \l 1033 ]. In the first stages of acute appendicitis, the client might experience periumbilical pain because of the T10 innervation of the appendix. However, as the inflammation elevates, an exudate deposits on the appendiceal serosal surface. A severe pain, just like in the case of Anne in the case study, occurs when the formed exudates touch the parietal peritoneum [ CITATION Rya07 \l 1033 ]. Moreover, perforation leads to the discharge of bacteria and inflammatory secetion into the abdominal cavity. As a result, peritonitis develops. The severity and location of peritonitis tend to differ based on the degree of which the omentum and proximate bowel loops can control the spillage of luminal contents.
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