NRSG257 Case Study: Perforated Appendix, Nursing & Child Growth

This case study assesses the care of a 10-year-old patient, Anne, admitted with a gangrenous perforated appendix and peritonitis. It reviews the pathophysiology of the condition, detailing the progression from appendiceal obstruction to perforation and subsequent peritonitis. The report emphasizes the importance of understanding child growth and development theories, such as Kohlberg's theory of moral development, Piaget’s theory, and Freud's psychosexual development theory, in providing appropriate nursing care. It highlights the nurse's role in supporting the child's emotional and social development while hospitalized, as well as the significance of family-centered care in reducing parental stress and promoting the child's recovery. The case study concludes by underscoring the need for diligent and high-quality nursing care in pediatric cases, involving both the healthcare team and the family to ensure the best possible outcome for the child.

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Introduction
This report involves a case study assessment review for patient Anne, a 10-year-old
child admitted to the emergency department with right iliac fossa pain. At the emergency,
further assessments are done and that she might be having acute appendicitis and she is
booked for appendectomy theatre at the ward. However, hand over team at the ward reveal
that the patient is having a dangerous perforated appendix with peritonitis. She is fixed with a
nasogastric tube, free drainage pipe and drug administration based on the nature of her
condition. The patient is admitted to staying in the hospital for the next 10 days. This review
assesses the path physiology of her condition, growth and development family and
hospitalized chair and daily.
Path physiology of gangrenous perforated appendix with peritonitis
Appendicitis prevalence accounts to 8% of the total emergencies related to acute pain.
An approximate figure of 80,000 conditions associated with appendicectomy is carried
yearly. There is an occurrence of 1 to 2 cases in 10,000. The incidence is 25:10,000 children
ages 10-19 years old. Gangrenous perforated appendix with peritonitis often depicts a
classical history of pain starting at 24-36 hours of pain which starts in the umbilical area
moving towards right lower among less than have of children with this. Often such child
presents low-grade fever, (Bhangu, Soreidi, Di Assarsson & Drake, 2015).
Due to obstruction of the appendices, there is an increase in intraluminal pressure
increase with accumulation of undrained mucus which contains bacterial proliferation. The
pressure persists on the lymphatic and venous drainage which causes impairment. If
untreated, the congestion limits the flow of arterial inflow which hinders movement of
substrate exchange.
The presented luminal obstruction may not be observed with histological examination
however the tissue may present with inflammation due to the noxious agents. Children having
Yersinia, Salmonella and shigella depict cystic fibrosis, distension which is a painful and
abnormal production of mucus.
The chronic state of the disease shows luminal infection which invades the
intraluminal wall, this leads to gangrene and perforation occurrences. If the state persists
adjacent organs such as ileum, omentum and occum start to wall off hence causing localized
formation. Further rupture of the primary appendix abscess leads to fistulas between the
bladder and appendix, small intestine, cecum or sigmoid, (Wu, & Maa, 2015).
As the condition progress, pain can present perforation with peritoneal irritation,
when the presentation seems to be delayed, an abscess may be present. Young children have
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difficulty in understanding and articulating the symptomatology as compared to the elderly
adults thus the reason why there is a presentation with perforations.
Perforations rates as reported are high among children with 82% of reported cases
having peroration among under 5 years while 100% occurrences among 1-year-olds. Delays
in diagnosis presentations have been shown to cause an elevated. Patients with limited access
physicians are more likely to present severe state of the disease.
Appendix perforation results in diffusion of peritonitis and further localization of the
abscess. Common type among children is diffuse peritonitis due to low-level momentum.
Normally it originates from intestinal bacteria at the appendix multiplying, which leads to
oedematous wall precipitating bacterial infection; this results in compromised blood flow,
which leads to thrombosis and vein aggravation on the inflammatory process which leads to
gangrene and perforation, (Anderson, Moore & Jordan, 2018).
Growth and development perspective
Nurses play a critical role in management of patients. They have an important role in
managing of disease and facilitating recovery. Acute appendicitis is a common cause of pain
in the abdomen among children. The probability of getting appendicitis among male gender
compared to female is estimated to be around 8.6% and 6.7%. However common problem
among children is acute appendicitis. Acute appendicitis incidences are uncommon among
infants and increases gradually after birth and get its peak during the teen years and then later
decline at geriatric age. Acute appendicitis has been declining over the recent years,
especially during the past decade, (Britto et al, 2017). Variation of disease vulnerability has
been observed to be determined by race, sex, race, socio economic and general population. In
western countries appendectomy rates are reducing significantly.
Theory of Moral Development- Kohlberg’s theory
Theory of moral development reflects a critical aspect in ensuring bioethics is en-
calculated in the biomedical practice. The theory largely borrows from the Piaget’s theory of
child growth and development. The theory entails three levels; pre-conditional morality,
conventional morality and post conventional morality. The stages are in a consequence form
and offers qualitatively work. The stages form a pyramid cal approach, with higher stages
being more cognitive. Kohlberg’s theory is key for the nursing professional in implementing
appropriate nursing intervention. At pre conventional level the nurses ought to be sensitive to
what is wrong or right in their action. At the conventional level morality calls for the
consumers of health services nurses provide to judge the moral actions of their work. With
this, as a nurse , there is need to provide appropriate care which is safe and offers faster and
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quick recovery. In level, post conventional morality, the health care professionals need to
stand up by standing up to the principle morality of our action, (Gibbs, 2013).
Piaget’s theory and nurse’s role
The Piaget’s theory illustrates on three aspects, which entail schemas or the building
blocks of knowledge. As a nurse, training for the nursing career and managing patients such
as in our case study is essential after learning and acquainting ourselves with various
concepts of practice so as to offer best quality. At the adaption stage, nurses have adapted on
the challenges which their role fall. Being accommodative and assimilating with patient
situation is of critical importance. Nursing career, being a long journey of learning on health
care quality, passing through the cognitive development of learning is of critical. With skills
and knowledge imparted is critical for offering care of good quality top the patient, (Dasen,
1994).
Psychoanalytic theory
Freud psychosexual development theory depicts that childhood has its own set of
behavior and unconscious behaviour which affects how we act. Freud proposed development
theories which reflect different developmental stages of a child. Freud focussed on different
stages of growth among children which play a significant role in their development. This
stage has been used widely to classify children growth patterns and various characters
depicting these age groups. The Sigmund Freud stages of development reflect how children
behave and portray signs of illness behaviour which might be significant, (Freud, 2018).
Thus it is paramount as a nurse to understand all the relevant factors associated with
care process and the impact child development can play in the recovery process.
Understanding how children communicate is crucial as a nurse so as to dispense appropriate
care.
Developmental appropriate care
Nurse’s role in delivering appropriate care according to the child is critical. As
children grow up to 10 years of age, they start to think of themselves as being almost to
teenagehood. At 10 years it is a period of transition offer challenges as children start
embracing adolescence. The physical development of these children starts to experience
major growth spurs. Girls tend to grow faster than boys in this category compared to boys.
This growth disparity creates ease among the children.
The key milestones often occasioned with this category of children include an
improved demonstration of agility, speed, coordination, and balance. They begin to show
puberty signs, increased sweating and hair growth on the genitalia and muscle development.
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Emotional development starts to develop; children start to develop an improved sense of who
they are. Children at this age start to have more control of emotions and see themselves as
being more skilled, (Woodhead, 2015).
Social development aspect of the child starts to develop for girls hey can be passive of
their close friends and often develop jealousy behavior. 10-year boys often have the ability
for a sense of emotions of others. They are able to read body language. Key milestones at this
age include enjoying secrets things with friends such as creating secret codes and passwords
and identify themselves with persons of similar gender.
Further, there is an improved cognitive development of the children. they start to
think as being adults. They start to gather information and organize well thought out opinions
and thoughts. This period for many children is packed with a lot of learning and rapid growth
development. Learning accelerates at this stage.
Hence, for a nurse it is critical to stay close with the child so as to offer any needs
support. Bad temper needs to be monitored and aggressive behavior needs to be watched, as
it can reflect other significant psychological treatment. Ensuring that there is close
monitoring of the child ensures conditions such s acute appendicitis could have been
monitored way before entering the acute stage. The nurse would be keen to monitor the child
based on the stage he is in the child is able to offer clear communication of any pain he/she
faces, (Diane et al, 2018).
Family-centered care for the patient
As a nurse there is need to support the family in coping with the situation and trained
them to offer the needed recovery for their child. With numerous benefits family-centered
care for the child is critical. This reduces the stress levels of parents when the child is offered
high-quality care at the ward, (Melnyk et al, 2000). However, challenges do exist when trying
to implement such strategies which are positive. Health care providers often report a lack of
adequate education and skills in administering this care. Child hospitalization is often a
challenging task for the family and health care professionals, (Melnyk, 2004). Significant
adjustments are able to align levels of stress. However there are significant challenges which
disadvantage families in providing this care, in that families often feel they are expected to
give more input in a situation more than their capabilities, this causes additional stress and
anxiety for both the child and the parents.
Implementing family-centred care model for the family for this patient is critical.
Limited research has been conducted to outline clear guidelines on family-centered care for
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the children. However critical focus needs to be child-centred and the family focuses
attention on the child so as to monitor closely the status of the disease.
Hospitalised child and family care
Health care transformation to patient-centred care has been taking place. The nurses
and patient have an active role in ensuring that this model success. Patient’s s and their
relatives often give care giving care and matters involving the healthcare team, both care
process. In paediatric care, family-centred care is a critical factor which offers treatment and
care.
Parents engage actively in taking care of the children at the hospital, thus making
them play a pivotal role in the health progress of the child. The ability of the parents to
engage in the participation of the medical process of the child symbolizes family power,
(Aein, Alhan., Mohammadi & Kazemnejad, 2011). Engaging the family in this process
improves the care quality to be offered to the paediatrics in the hospital.
Conclusion
Nurses role in handling paediatric care, calls for diligent needs to be undertaken so as
o ensure high quality being offered during the treatment process. The patient is undergoing
treatment after being diagnosed with gangrene perforated appendicitis. As a nurse,
understanding the growth stage development of the child, aids in providing appropriate care
process for the child. Further understanding the role the family plays is crucial in bringing out
positive family centred care. At the hospital, healthcare team in support of the parents has a
significant for the child quality of care.
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