Case Study on Appendicitis

This case study discusses the effects of appendicitis on pediatric patients, developmental theories, family-centered care, and the impact of hospitalization.

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

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CASE STUDY ON APPENDICITIS
Appendicitis can be described as the inflammation of the appendix that is actually a
finger shaped pouch that remains projected in the colon on the right side of the abdomen. It
results in huge pain on the right side of the abdomen and in severe condition; the appendix might
burst spilling out infectious fluid internally in the abdomen that results in peritonitis, another
severe condition (Drake et al., 2014). This assignment would be mainly based on caring for a
pediatric patient who needed to undergo appendectomy due to severity of the appendicitis that
followed peritonitis. Developmental theories, family centered care and effect of hospitalization
on child would be discussed in the assignment.
Appendicitis occurs when the appendix of the individuals become severely inflamed.
Researchers have not been able to understand the exact reasons about the occurrence of
appendicitis but they have put forward different hypothesis explaining the occurrences of the
appendicitis (White et al., 2016). One of the most accepted reasons is that the lumen of the
appendix is blocked by fecoliths as well as normal fecal matter or might be due to lymphoid
hyperplasia that might occur because of the viral infection. Studies have shown that when the
lumen of the appendix becomes obstructed, it results in the reduction of the flow of the blood to
the tissues and therefore the bacteria is seen to get multiplied. The lumen of the appendix being
obstructed, the pressure within the organ is seen to be increased and this results in the reduction
of the venous drainage (Alvarado, 2018). This might result in the occurrence of ischemia. When
such conditions of the ischemia are seen to be untreated, it can lead to situations of necrosis as
well as gangrene. Many of these researchers call this stage the most vulnerable stage because this
stage remains at the higher risk where perforation might occur. It can take around 72 hours for
the perforation to occur when the obstruction occurs in the appendix. It is seen that when the
appendix is seen to perforate, bacteria and the inflammatory cells are released in the surrounding

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structures. This condition results in the development of inflammation of the peritoneum region.
This makes the child develop the peritonitis symptoms and this is seen to result in the diffusion
of the abdominal pain. The patient named Anne also had to undergo the surgery of
appendectomy where the appendix had been completely removed. Perforation had already
occurred in the appendix and infectious fluid had released put causing peritonitis. This made her
suffer from pain in the right iliac fossa that required treatment.
One of the most important developmental theories that the nursing professional could use
is the Piaget’s cognitive developmental theory. This theory mainly describes development of a
child’s thought procedures. This theory mainly gives the nurses an idea about the four stage
model about the different ways the mind processes new information which are encountered. The
stage where the child named Anne belongs is called the concrete operations stage (Lefafa et al.,
2014). This stage is mainly seen to extend from the age 7 to that of age 11. During this time, the
child is seen to accumulate physical experiences and child learns to accommodate. The child
learns to develop logical structures of reasoning in associating their physical experiences with it
(De Ribaupierre, 2015). They tend to gain a better understanding of their mental operations and
tend to think logically about the different types of concrete events. However, they do not
understand any abstract as well as hypothetical concepts. Therefore, Anne might develop the
curiosity as to why such things happened with her and might want to know them from the nurse.
In such situation, it becomes important for the nurse to explain the entire causal factors and the
procedures of occurrence of the disease by which she can easily understand and does not feel
confused. It also becomes important for the professionals to discuss the entire situations in ways
by which she is not scared or depressed about the situation and therefore they have to be very

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careful about it. Otherwise, it might affect their health outcome resulting in mental and emotional
turmoil.
Another theory that the nursing professional can also take into consideration while caring
for the patient is the Bowlby’s attachment theory. This theory is of the opinion that every child is
born with the innate need to develop attachments. This form of attachments help in the survival
of the children as it helps in ensuring that the child will receive the care as well as the get enough
protection from the caregiver. The quality of the attachments are the determining factor as this
will show the behavioral as well as motivational patterns where both the child and the caregiver
will engage in behaviors that will help in development of proximity (Holmes, 2014). Children
have the tendency to remain close as well as connected to their caregivers. In turn, the caregivers
have the responsibility for ensuring safe haven as well as secure base for exploration.
Researchers are of the opinion that children who receive constant support and care develop a
secure attachment style while those who do not may develop avoidant, disorganized and
ambivalent (Bacciagaluppi et al., 2016). Nursing professionals, who would be caring for Anne,
needs to be careful that they develop a trusting relationship with the child where the child can
release all her stress and tensions to the nurses. In order to develop a friendly bond, the nurse
needs to have a mental connect with the child and therefore work accordingly with the patient
and development of a therapeutic relationship with the patient. Better, the attachment of the
nurse with Anne, her fear and anxiety will reduce and this will have less health outcome on the
child.
Family centered care is one of the best approaches that the nursing professionals can
undertake when caring for pediatric patient. It mainly incorporates understanding as well as
respecting the unique needs of the family as well as their preferences in the care of the child.

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They should also collaborate with the family in every ways making them an effective partner of
the care team help into provide the child with the individualized care that is required by the child.
Developing a relationship with the families and including them in the decision-making,
information sharing and effective collaboration from them are the main tenets of the family
centered care (Festini, 2014). The nursing professionals, who would be attending the patient
named Anne, would be providing the family centered care would have to maintain certain
important aspects. The nursing professionals need to respect the family members with dignity as
well as respect. The expertise, cultures as well as preferences should be valued while providing
care for Anne. Moreover, the parents might be highly concerned, anxious, and fearful about the
condition of their daughter (Smith, Swallow & Coyne, 2015). Therefore, the nursing
professionals need to communicate and thereby share complete and unbiased information with
the patient and the families in ways that would be supportive and useful. The third aspect of this
form of treatment approach is strength building. The nursing professionals should promote the
individuals as well as the family members to build on the strengths by participation in different
experiences and enhancing the control and the independence (Gallo et al., 2016). In this way,
the nursing professionals caring for Anne would empower the parents of Anne and help in
effective development of their mental condition and anxiety.
Effects of hospitalization on the children seem to vary from one child to another.
Researchers are of the opinion that children are seen to vary in their capacities in coping with the
stress of hospitalization. Hospitalization seems to create a psychological distress on children,
which have negative outcomes on their health. It seems a foreign region to them about which
they have no prior knowledge and experience and this tends to make them anxious and
concerned. Researchers are of the opinion that when children get scared, feel pain or tired, they

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tend to search for safe and stable environment of their homes and parents (Altay et al., 2017).
They tend to seek for the love and support of the family members so that they can cope with the
strenuous situations. They tend to rely on their parents for regular functioning and everyday
well-being. Therefore, during the time of hospitalization, children feel scared and tensed and
during these moments, that expect the support and companionship of the parents but it remains
not possible. They tend to feel lonely and scared as they remain cannot tackle the stress
effectively (Rushworth et al., 2017). They become tensed, anxious fearful and all these have
negative influences of their health. Moreover, the parents and siblings also get affected because
of seeing their close members suffer so much and all go through a depressive phase all resulting
on their emotional health. The parents are seen to feel helpless as they cannot help and support
the child completely.
From the above discussion, it becomes clear that appendicitis might affect the health of
pediatric patients increasing the risk of appendectomy and peritonitis. They need to get
hospitalized and it might have huge impacts on mental health of the patient and the family
members. The nursing professionals caring for the pediatric patient should use proper growth and
development theories for ensuring evidence based care helping in providing child specific care.
Moreover, family centered approach should be taken so that family members are also made
effective members of care team and ensuring that they are delivered all information important for
the patient. The period of hospitalization might have various negative impacts on the child and
family and therefore, this should be considered while caring for the patient.

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References:
Altay, N., Kilicarslan-Toruner, E., & Sari, Ç. (2017). The effect of drawing and writing
technique on the anxiety level of children undergoing cancer treatment. European
Journal of Oncology Nursing, 28, 1-6.
Alvarado, A. (2018). Clinical Approach in the Diagnosis of Acute Appendicitis.
Bacciagaluppi, M. (2016). Attachment Theory as an Alternative Basis of
Psychoanalysis. Attachment: New Directions in Relational Psychoanalysis and
Psychotherapy, 10(3), 211-220.
De Ribaupierre, A. (2015). Piaget's Theory of Cognitive Development.
Drake, F. T., Mottey, N. E., Farrokhi, E. T., Florence, M. G., Johnson, M. G., Mock, C., ... &
Flum, D. R. (2014). Time to appendectomy and risk of perforation in acute
appendicitis. JAMA surgery, 149(8), 837-844.
Festini, F. (2014, December). Family-centered care. In Italian journal of pediatrics (Vol. 40, No.
1, p. A33). BioMed Central.
Gallo, K. P., Hill, L. C., Hoagwood, K. E., & Olin, S. C. S. (2016). A narrative synthesis of the
components of and evidence for patient-and family-centered care. Clinical
pediatrics, 55(4), 333-346.
Holmes, J. (2014). John Bowlby and attachment theory. Routledge.

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Lefa, B., Livingston, C., November, I., Condy, J., Chetty, R., Shaik, N., ... & Aronstam, S.
(2014). The piaget theory of cognitive development: an educational implication. Educ
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Rushworth, R. L., Chrisp, G. L., Dean, B., Falhammar, H., & Torpy, D. J. (2017).
Hospitalisation in children with adrenal insufficiency and hypopituitarism: is there a
differential burden between boys and girls and between age groups?. Hormone research
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Smith, J., Swallow, V., & Coyne, I. (2015). Involving parents in managing their child's long-term
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White, L. D., White, L. K., & Baxter, D. F. (2016). Adult Onset Acute Disseminated
Encephalomyelitis Following Appendicitis: A Case Report. J Neurol Neurosci, 7, S3.