Critique of a Patient Case Using Evidence

This article provides a critique of a patient case using evidence. It discusses the relevant information about the patient, outlines key nursing problems, and prioritizes them. It also considers the entire patient care period and offers possible alternatives. The case focuses on a 6-year-old boy with appendicitis.

CRITIQUE OF A PATIENT CASE USING EVIDENCE

TABLE OF CONTENT
INTRODUCTION...........................................................................................................................3
MAIN BODY ..................................................................................................................................3
Relevant information about the patient (including physiological, psychological and
sociological factors).........................................................................................................................
Include an outline of key nursing problems and also if the patient is at risk of developing
further problems and why ...............................................................................................................
Assigned a clear, measurable goal to each problem........................................................................
Explain how each problem has been prioritized..............................................................................
Consider the entire patient care period............................................................................................
Identifies areas for improvement and offer possible alternatives for each......................................
CONCLUSION................................................................................................................................9
REFERENCES...............................................................................................................................11

INTRODUCTION
The practice of nursing requires specialized knowledge, skill and independent decision
making and this also includes several interventions to be followed. In the present research study,
discussion has been included regarding a 6 year old boy who is having issues related to
appendicitis and whose medical related information should be properly addressed to the family
members (Well, First, it Out and Training, 2013). Furthermore, in the research study nursing care
needs of the patient has been analysed and that are also related to current medical and nursing
management. At the same time, discussion has also been included regarding patient problem and
how nursing intervention can be used to resolve the appendicitis issues.
Along with this, researcher has also discussed complexities, contraindications and
inconsistencies that focuses on patient care; hence on that basis possible alternatives for health
problem has been identified. Discussion has also been stated about perception of illness
regarding of the patient suffering from appendicitis. Future risks for the patient have also been
identified in the study because the risk related appendicitis could increase because of the age
factor (Li and Jones, 2013). Nurses must also be aware that patient’s needs proper care and their
privacy aspects should be protected as well. This means that nursing assistants should not discuss
their care or other personal information with any other person expect the staff members that has
an interest in the care of that patient.
MAIN BODY
Relevant information about the patient (including physiological, psychological and sociological
factors)
The present case has been discussing about a 6 year old boy who is currently hospitalized
because of abdominal pain and he is also identified as appendicitis after carrying out different
tests. It is also identified that the boy also has the history of bloated abdomen and his family and
social history is related with this (Kangasniemi and et. al., 2013). Thus, in this respect looking
towards the case scenario, health care practitioners need to emphasize on maintaining
confidentiality and secrecy at the time of addressing patient’s problems. Further, it is also
identified that the patient is having right lower abdomen pain, nausea and lethargy and his past
history is also related to these aspects. Therefore, as per the diagnosis, the main problem that is
analysed is appendicitis; hence nursing practice should be carried out accordingly.

Pain in the abdomen is one of the most common symptoms of an acute abdominal
pathologic process and this symptom also brings the patient to his physician. Thus, it can be said
that the symptom deserves the utmost care in evaluation. Therefore, as per the sociological
factor, it has been analysed that the family condition of the patient is not suitable as a lot of
economic problem exist in the family (Ciccu-Moore and et. al. , 2014). This is the major reason
that the boy is unable to get prominent access as per his health problem. From previous many
years, financial condition of his parents is not stable; hence various issues are occurring in the
same area.
Moving on to sociological dimensions, it can be articulated that the family needs to
address their child’s issues in confidential manner because they do not want to bring any other
issue about his medical condition. Due to lack of support from the community, the family is
experiencing financial crisis; hence they are unable to render appropriate medical treatment to
the boy. Further, it is also analysed that the boy is scared of the pain; since he is 6 years old, he
has much issues with the acute pain (Wong, Cummings and Ducharme, 2013). Thus, it is clear
that the boy needs to get proper treatment as this problem could amend various risks and
uncertainties in future.
Include an outline of key nursing problems and also if the patient is at risk of developing further
problems and why
According to the case analysis, it is evident that the boy is having serious abdominal pain;
hence this requires proper medical treatment. Nurses must develop suitable care plan so that right
services could be delivered to the boy. However, at the time of conducing nursing practice,
nurses could experience several issues because the boy is very much scared of pain that appears
in his abdomen (Lewis and et.al., 2015). The age factor could be one of the issues in nursing
procedure; hence nurses would not be able to derive any sort of support from the patient at the
time of delivering health care services. Therefore, these are the most common issues that may
arise at the time of conducting nursing practices.
Considering the present case, nurses must emphasize on care plan so that proper
medication and treatment could be provided to the boy in appropriate way. In this respect,
economic condition of the family could also be considered so that accordingly, medical
intervention could be selected. The most important thing that needs to be considered while giving
treatment to the boy is his perception of illness regarding appendicitis (Shepard, 2013). In the

practice of nursing, the boy will not be able to support the nurses since he has no idea about the
problem and medication purpose as well. Further, nurses should carry out their duties in
encouraging manner so that boy may not get scared of the medications and treatment.
As per medical terminologies, Appendicitis is a painful medical condition in which the
appendix becomes inflamed and filled with pus (a fluid that is made up of dead cells and that
often results from an infection). If not treated properly, then it may cause the appendix to burst
and this can also spread infection throughout the abdomen (Reinbeck and Fitzsimons, 2013).
Thus, according to the risk factors, it can be said that the patient needs to get suitable medical
treatment as early as possible so that the issues of co-morbidity could be avoided.
Assigned a clear, measurable goal to each problem
Here, the problem identified with the patient is appendicitis and thus heath care home
needs to take proper care of their parents in regard to identify clear, measurable goal to such
problem. Proper analysis of the issue needs to be done in regard to identify the issues and then
accordingly health care facilities should be provided. It is also essential for them to outline the
problem from which patient is suffering (Oster and Braaten, 2017). Care providers need to assess
the requirement of health care patients and thus nursing practice need to identify the past history
of patient and then provide them appropriate treatment to obtain better results. Through
identifying the problem of patient, care nurses needs to give proper care so that desired goals
could be attained as per the issue. Here, patient is suffering from abdominal pain and after
examining it has been identified as appendicitis and the patient have identified a past history of
bloated abdomen (Ethridge and Lamb 2010). Therefore, care plan needs to be prepared
accordingly and thus proper and clear goals needs to be identified so that best results could be
attained in terms of satisfying the patient needs. Here, nursing practice requires to be effectively
carried out and thus identify the areas for improvement so that best possible alternatives could be
assessed (Yuan, Williams and Man, 2014).
Here, the problem faced by patient is abdominal pain and thus care providers need to
critically examine and then come to any conclusion. After conducting various tests, it has been
identified that patient is suffering from appendicitis and therefore he is having pain in lower
abdomen. Also, health care home needs to give proper care and support to their patients in
various form so that they feel satisfied with the services provided by nurses and health care

workers (Christensen and Kockrow, 2013). Further, confidentiality is one of the major problem
and thus it is essential for health care home to maintain it so that name and personal identity of
the patient should not be leaked. However, it is one of the main concern of any patient that their
name should not be disclosed as well as their disease and all this should be kept secret. Thus, it is
a clear and measurable goal that helps health care home to easily accomplish it by providing
right care and duty towards the patients and help them in relieving the pain suffering by them.
Care delivery and nursing practice aims to be effectively measured and identified by identifying
the past history of patient, family history, social history as all these are crucial in terms of giving
relevant care and support to patients (Fathoni, Sangchan and Songwathana, 2013).
Explain how each problem has been prioritized
One of the main need of heath care home is to prioritize every problem being faced by
patients and then delivering due care and support to them in relation to overcome the pain from
which they are suffering. It also identifies that outlining proper care plan needs to be followed by
health care workers so that best care facilities needs to be provided to patients. Here, patient is
complaining about abdominal pain and thus care providers needs to properly examine and
conduct different tests in order to identify the exact problem (Röing and Holmström, 2015).
Thus, such health problem needs to be prioritized by care workers so that they can plan proper
solution to the disease. It has been evaluated that patient is suffering from appendicitis due to
pain in lower abdominal. Now the duty of health care workers start as they need to give proper
instructions to their family to provide all the past history of their family as well as patients which
helps them to give best care opportunity to patient. After identifying the case history it assists
them to render the best care needs and thus proper care and support at the time of surgery.
Appendicitis needs to be cured because then only patient will be relieved from health issue
(Kahn and et. al., 2015).
It is essential for health care workers to prioritize the problems of every patient because it
helps them to obtain satisfaction. Nurses and care providers render the best care facilities to
patients so that prioritizing care problems helps in fulfilling their needs and obtain best care and
support. Here, patient is suffering from lower abdominal pain and thus doctors needs to examine
the patient illness and then cure them accordingly. Care home needs to maintain proper
confidentiality regarding patient's health and personal information and do not share this with

anyone otherwise it would result in breaches of confidentiality act. Health care workers need to
give proper care (Hensel and Flint, 2015).
Health care workers need to carry out effective principle that is providing high quality
safe patient care in nursing practice and thus provide the best care facilities to patients. It is
essential for health care home workers to assess the past history of patient so that they can render
the care accordingly. Also, they need to prioritize their care as per the problem faced by workers
because it is essential for them to give treatment to patients who are in pain and thus solve their
problems as soon as possible (Wong, Cummings and Ducharme, 2013).
Consider the entire patient care period
Herein, this care period has been described for a 6 years old child who was initially
suffering from a severe abdominal pain and later found to be afflicted from appendicitis. It was
thus deliberated to be a medical emergency where appendicitis in children is often referred to be
a dreadful state where it causes immense pain and an aggravated infection in the appendix
(Ciccu-Moore and et.al., 2014). It is mainly due to an unsure outlook towards it actual
functioning in the body, removal of this part is considered to be the most safe measure for the
prevention of appendicitis. In context to which, appendectomy is the surgery named to be the
most common emergency surgery for the children enduring from appendicitis. It is a surgical
removal of the organ called appendix from patient's body and is usually performed at the time of
emergency. Where most of the time, a prime reason behind such removal is basically due to
another vital concern of the patient's and their respective surgeons to not come up with such
issues again and again.
Also, this body organ is also not referred to play any such crucial role in the body and
hence its removal is entirely a justified clause. It however requires the patient and their family
members to take some precautionary measures with some proper care where that period is
generally termed as postoperative care. It is also due to its fundamental time of recovery that
takes at least 4 to 6 weeks of time followed by the below mentioned care period that is followed
by a successful completion of the surgery (Fathoni, Sangchan and Songwathana, 2013). After
which the patients are being taken to the post anaesthesia care unit also termed as PACU and are
being kept their until their anaesthesia starts wearing off. At this time, the care staff is continually
required to check the temperature of patient's body by together checking their heart rate and

breathing at regular interval of time. It is after a complete wear off of instilled anaesthesia with
some pivotal signs of stabilization the patient is then required to be transferred to the hospital
rooms.
It is firstly in context to a non ruptured appendix with no prior harm before the surgery
that further leads to a quick recovery of the patient. Wherein, the very next day the patient is then
required to offer clear liquid food after whose successful toleration, they can also consume solid
foods (Kahn and et.al., 2015). It is once after the patient have started to eat and drink the normal
food, this leads to the removal of intravenous so that the patient can hereby perform some sort of
physical activities like getting out of the bed to perform other routine activities, etc. Some
patients are however in need of medicine to get rid of the pain caused from large incision took
place while performing the surgery. It is however with a prime responsibility of the nursing staff
to take care of the patient with continual checks so as to detect the healing of incisions after
which the patients with such uncomplicated appendectomy can leave within a care period of 1-2
days.
Now, in context to the present case script of 6 years old boy suffered from appendix and
went through an appendectomy of a ruptured appendix as per his past history is required to go
through some other sort of care period measures. It is where getting recovered from the surgery
done for a punctured appendix is slightly longer than the above detected situation where it
hereby needs a principal treatment for the infection (Lewis and et.al., 2015). This needs a
minimal stay of 4 days in the hospital and could range more longer in case the complications
tends to develop. However, the drain is required to stay in place by the timer the pus completely
stops exhausting with a continual check of the nursing staff to change the packed gauze bandage.
Apart from which, intravenous antibiotics are also required to be continued throughout
the care period during hospitalization. Wherein, one after the discharge of patient, there exists
some prescribed oral antibiotics that should be continued to intake as per the given direction of
the surgeon or physician (Oster and Braaten, 2017). However, the drainage and along with the
gauze bandage pack are needed to be kept in place with prompt instructions to properly care that
particular area where in case of a sudden increase in the drainage, the physician is hereby
required to be informed. Also, in case of any change in the colour or consistency of the drainage,
it should be removed by the doctor themselves after completely resolving the infection.

Identifies areas for improvement and offer possible alternatives for each
It is with reference to identify some key areas of improvement in the above ascertained
measures of appendectomy and its postoperative care. Where this surgery is itself associated with
a major risk of wound infection and abscess formation onto the area of removed appendix due to
a surgical site of incision along with some other relative number of complications (Röing and
Holmström, 2015). It is thereby suggested to adopt some other possible alternatives for each of
these complex areas where the patient is firstly required to be treated with crystal clear surgical
tools. Beside this, the doctors should also possess a vigilant outlook towards maintaining other
hygienic requisitions to accomplish a successful operation. Additionally, once the patient gets
back to home then they must be instructed to constantly check the incision site where it must be
dried but the wound should not be closed completely.
Likewise, in case the incision starts draining blood with the edges pulling apart then also
the physician must be immediately notified. Wherein, symptom of fever with an increased sense
of pain in the incision site should together be reported to the doctor. All these instructions if
required then should be given in a written notification to the patient where here in the case of 6
years old child, his parents should rigorously follow these directions (Well, First, it Out, and
Training, 2013). Also, the normal activities should be resumed in accordance to the given
direction of the surgeon with a cautious approach where it is assumed to be healed within a
minimal time period of 4 to 6 weeks. During which, heavy lifting of goods and other energetic
activities must be completely avoided with timely intake of any prescribed antibiotics for pain
medication.
CONCLUSION
Above study concludes patient care is crucial for health care home and thus they need to
identify the problem faced by care users so that appropriate care needs to be given to them. It
also identifies that confidentiality needs to be maintained by care home so that it does not leak
the patients personal information as well as past medical history otherwise it would result in
breaching of confidentiality. Also, here the problem outlined is appendicitis and patient is at risk
so that appropriate care delivery needs to be planned and improve the health conditions of care
user. For which, appropriate care measures have been discoursed in this report by identifying any

further scope of improvement in them. Herein, it is with a leading focus on the surgical method
of removing the appendix termed as appendectomy by together outlining its postoperative care
measures. This has been done with a precise identification of each of the measurable goals as a
way of explicating each of the prioritized problems associated with the treatment of appendix.

REFERENCES
Christensen, B. L. and Kockrow, E.O., 2013. Foundations and adult health nursing. Elsevier
Health Sciences.
Ciccu-Moore, R., and et.al., 2014. Care and comfort rounds: improving standards: Kathleen
Stoddart and colleagues relate one nursing team’s positive experience of implementing
regular patient checks. Nursing Management. 20(9). pp.18-23.
Ethridge, P. and Lamb, G. S., 2010. Professional Nursing Case Management Improves Quality,
Access and Costs: A system with nurses as the primary healthcare providers produces
dramatic reductions in LOS and in cost, while truly" humanizing" healthcare. Nursing
management. 20(3). pp.30-37.
Fathoni, M., Sangchan, H. and Songwathana, P., 2013. Relationships between Triage
Knowledge, Training, Working Experiences and Triage Skills among Emergency Nurses
in East Java, Indonesia. Nurse Media Journal of Nursing. 3(1). pp.511-525.
Hensel, J. M. and Flint, A. J., 2015. Addressing the access problem for patients with serious
mental illness who require tertiary medical care. Journal of health care for the poor and
underserved .26(1). pp.35-48.
Kahn, S. A., and et.al., 2015. Measuring satisfaction: factors that drive hospital consumer
assessment of healthcare providers and systems survey responses in a trauma and acute
care surgery population. The American Surgeon. 81(5). pp.537-543.
Kangasniemi, M., and et.al., 2013. Ethical issues in patient safety: Implications for nursing
management. Nursing ethics. 20(8). pp.904-916.
Lewis, S.L., and et.al., 2015.Study guide for medical-surgical nursing: Assessment and
management of clinical problems. Elsevier Health Sciences.
Li, Y. I. N. and Jones, C. B., 2013. A literature review of nursing turnover costs. Journal of
nursing management. 21(3). pp.405-418.

Oster, C. and Braaten, J., 2017. Striving for the impossible: Should nursing managers in highly
reliable organisations accept that two patients in every 100 will fall, or should they urge
staff to aim for zero harm?. Nursing Management. 23(10). pp.17-17.
Reinbeck, D. M. and Fitzsimons, V., 2013. Improving the patient experience through bedside
shift report. Nursing management. 44(2). pp.16-17.
Röing, M. and Holmström, I.K., 2015. Malpractice claims in Swedish telenursing: lessons
learned from interviews with telenurses and managers. Nursing research. 64(1). pp.35-43.
Shepard, L. H., 2013. Stop going in circles! Break the barriers to hourly rounding. Nursing
management. 44(2). pp.13-15.
Well, E., First, F., it Out, W. and Training, C.B., 2013. Unions say snack bar vouchers to reward
staff ‘unprofessional’. Nursing Management. 19(4).
Wong, C. A., Cummings, G. G. and Ducharme, L., 2013. The relationship between nursing
leadership and patient outcomes: a systematic review update. Journal of nursing
management. 21(5). pp.709-724.
Yuan, H. B., Williams, B. A. and Man, C. Y., 2014. Nursing students’ clinical judgment in high-
fidelity simulation based learning: A quasi-experimental study. Journal of Nursing
Education and Practice. 4(5). pp.7.