Nursing Assignment: Pathophysiology Case Study
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Added on 2020-06-06
Nursing Assignment: Pathophysiology Case Study
Added on 2020-06-06
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NURSING (CASE STUDY)
This particular essay is based on a 10 year old girl named Anne, who has been throughappendectomy and is advised to remain in hospital for 10 more days. Main focus is given onpathophysiology of particular medical problem and role of nurses to deliver appropriate care.Growth and development theories are used to focus on expected development of child atparticular age. As per the case, the essay discusses family centred care approach and focuses onthe roles played by parents and nurses in particular approach and its effect on the family ofpatient. 1. PathophysiologyPrimary pathogenic events in case of acute appendicitis get initiated with luminalobstruction. This results from many causes like, fecaliths, foreign body, lymphoid hyperplasia,parasites and by both primary tumours and metastatic tumours. Among all the above mentionedcauses fecal stasis and fecaliths are considered to be most common cause of obstruction in acuteappendicitis (Panagiotopoulou and et.al., 2013). This obstruction then leads to inflammation,increases intraluminal pressure and finally results in ischemia. In this way, appendix keeps onenlarging and stimulates inflammatory changes in surrounding tissues, in case if appendix is nottreated at proper time it get perforated (Pathophysiology of Acute Appendicitis,2016).Due to small luminal capacity and increasing pressure of intraluminal up to 50-65 mm Hgcauses continuous distension in the length of appendix. This condition causes enlargement incecum because of inflammatory process in cecal localised ileum. The content of cecal is storedand is not directed towards right colon. Identification of presence of fecal loading inside largececum by using plain abdominal radiography is a sign of acute appendicitis (Gorter and et.al.,2015).With increase in luminal pressure, the pressure inside venous exceeds which result indevelopment of mucosal ischemia. As luminal pressure overreaches 85 mm Hg, it causesthrombosis of venules that drain appendix. Continuous flow of arteries along with vascularcongestion make appendix more transparent. By time mucous start becoming ulcerated whichcauses invasion of appendiceal wall by intraluminal bacteria's that includes, Escherichia coli,Bacteroids and Pseudomonas (Memon and et.al., 2013).The inflammation now start extending into the adjacent organs, serosa and parietalperitoneum which result in the stimulation of visceral afferent nerve fibres that enters in spinalcord at T8-T10 and causes periumbilical and epigastric pain (Eko and et.al., 2013). Now at this1
stage the pain which was early referred get replaced by somatic pain and this is the reason ofpain in Anne's right iliac fossa . If this situation keeps on progressing it results in decrease inblood flow in arteries and causes infarction. This is gangrenous appendicitis which results after24-36 hours of acute appendicitis (Perforated Appendicitis,2012). In emergency departmentactions were not taken immediately on Anne and the wall of gangrenous appendix get perforatedwhich result in spilling of appendiceal contents into peritoneal cavity. As the sequence of eventsgoes on slowly the inflammatory response is generated in appendix and omentum, which resultsin localized peritonitis along with appendiceal abscess. This is considered as highly criticalcondition in case of appendix and if any step is not taken then it may lead to development ofdiffused peritonitis in patients. As the pathophysiology worsen anorexia, vomiting and nauseamay also develop (Andersson and et.al., 2014).2. Growth and Development TheoriesPiaget's theory of Cognitive Development is concerned with development of thoughtprocess in person. It also deals with how these thought process a person understand, get effectedand his interaction with world (Desai and Potter, 2013). His theory consists of four steps thatprovide information regarding sequence of intellectual development in children.Sensorimotor stage is the first phase from birth to age of two years in which theknowledge of infants about world is limited to his or her motor activities. Second stage is Pre-operational stage which is period between age of two to six during which child is not able tounderstand logics and unable to manipulate information. Next stage is Concrete operational stageit isa period between age seven to eleven, at this stage child start thinking about logics andconcepts also perform some mental operation. This is the age at which parents of Anne shouldstart medical conversation regarding health and hygiene with her.Final stage is Formal operational stage it is the period from the age of twelve and above,at this stage people become capable of thinking logically with appropriate reasons and developskills for systematic planning of life. At this stage children start making decision on the basis oftheir development level. After attaining this stage parents of Anne should educate her andencourage her decision making power regarding her health and hygiene. Similarly according to Bowlby's Attachment Theory, children's are born up with need ofattachment (Cummings and Worley, 2014). This attachment helps in survival of child by2
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