Child, Adolescent and Family Nursing

Running head: CHILD, ADOLESCENT and FAMILY NURSING
Child, Adolescent and Family Nursing
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1CHILD, ADOLESCENT and FAMILY NURSING
Introduction:
Discussed below is the case study of a 10 year old patient who was presented to the
Emergency Department with right iliac fossa pain, which led to the suspicion of appendicitis.
Further evaluation by the surgical team revealed that the patient had a gangrenous perforated
appendix with peritonitis. The aim of the essay is to develop understanding of the
pathophysiology of the condition and outline the role of the nurse in the care of patient.
Description of the pathophysiology of the presenting complaint
Appendicitis:
This is a condition that is caused due to the inflammation of the appendix. The
appendix is a vestigial organ, and lies at the end of the colon on the lower right side of the
abdomen. The appendicitis is caused to a blockage of the inner lining of the appendix leading
to an infection (Matsushita et al., 2018). The infection is caused due to the proliferation of
bacteria which results in the inflammation and swelling of the appendix. The obstruction of
the appendicidal lumen can be caused due to an increased pressure due to secretion of excess
mucous and fluids by the mucosa of the lumen (Petroianu & Barroso, 2016). The bacteria of
the intestine that are in the appendix starts to proliferate which triggers the recruitment of
white blood cells leading to an inflammatory response and formation of pus (Allievi et al.,
2017).
Peritonitis:
Peritoneum is a serous membrane that lines the abdominal cavity and the abdominal
organs. Inflammation of this membrane is known as peritonitis (Oliver, 2017). The
inflammation can be caused due to several reasons such as a wound in the abdomen, ruptured
appendix, and perforations in the colon, pancreatitis, diverticulitis, pelvic inflammatory

2CHILD, ADOLESCENT and FAMILY NURSING
disease, Crohn’s Disease or infections of the gall bladder, bloodstream or intestine. The
inflammation is caused when bacteria gets in contact with the peritoneum through a rupture
in the GI tract (Ross et al., 2018).
Gangrenous Perforated Appendix:
A gangrenous and perforated Appendix is the sign of an acute stage of Appendicitis in
which the walls of the appendix starts to die and decay leading to perforations and acute
peritonitis (Alvarado, 2018). This is caused due to an extreme form of inflammation leading
to gangrenous appendix due to blockage of the lumen of the appendix, obstructing blood
flow. The perforations are then caused due to the formation of gangrenous tissues deprived of
oxygen and nutrients from blood (Lotti, 2017). Thrombosis in the appendicular artery due to
the increased pressure also leads to perforation and gangrene of the appendix (Gorter et al.,
2017).
Evaluation of the role of nurse:
Related Growth and Developmental Theories:
The patient is 10 years old girl, who had to remain admitted to the hospital for a long
time in order to manage her condition and prevent complications before undergoing surgery.
She is completely dependent on her parents and thus it is vital for the nurses to understand the
implications of the hospital stay on her overall wellbeing. This can be understood in the
context of some of the developmental theories that explains the stages of development and
behavioral changes occurring in the child in the course of development and maturation. Some
of the developmental theories applicable in this context include:
Attachment Theory by Bowlby: