Nursing Case Study: Pathophysiology, Developmental Care, Family-Centered Care, and Impact of Hospitalization

Running head: NURSING CASE STUDY
Nursing case study
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1NURSING CASE STUDY
Nurses spend the most of time with the patients not only implementing care interventions
but also in the intervention planning procedures. Hence, it is very important for the nursing
individuals to take into consideration the personal lived experience and needs of the patient while
planning the care. Especially for the paediatric patients, it is absolutely essential for the care plan
to be aligned with the theoretical underpinnings of human growth and development, in order to
provide an optimally patient centred and holistic care (Vaziri et al., 2013). This assignment will
attempt to analyse a case study of Anne, a 10-year-old patient with acute appendicitis, exploring
the pathophysiology and plan a care that while assessing growth and developmental theories,
family centred care and the impact of hospitalization on the child.
The case study represents the scenario of a patient named Anne, a 10-year-old who had
been presented in the emergency facility with right iliac fossa pain, which as diagnosed to be a
case of acute appendicitis. The emergency healthcare team had decided to bring the patient for an
appendectomy surgery which is the most common intervention implemented for acute
appendicitis. However, further complications were discovered in the patients in the form of the
gangrenous perforated appendix with peritonitis, which is a deadly adverse exacerbation that can
easily lead to fatal consequences if adequate care is not taken immediately. Exploring the
pathophysiology of the condition, it can be stated that the peritonitis is an inflammation of the
serosal membrane present lining the abdominal cavity and the organs that are contained within
(Petroianu & Barroso, 2016). In reaction to certain environmental stimuli by a pathogen, the
perineum gives an inflammatory response facilitating the infection (Petroianu & Barroso, 2016).
It has to be mentioned in this context that the function of the appendix can be extended to the
immune system due to the presence of lymphatic tissue (Yilmaz et al., 2013). The patient, in this
case, had appendicitis which was complicated further by the presence of gangrenous appendicitis

2NURSING CASE STUDY
with peritonitis; the most common pathophysiology is due to the luminal obstruction. There can
be many contributing factors behind the inflammation, however as in this case peritonitis is also
associated; the most common contributing factor is the secondary infection by generally
Escherichia coli (Yilmaz et al., 2013). The infection generally leads t obstruction and which in
turn leads to the inflammation (Minutolo et al., 2014). The inflamed appendix in the next step
perforates and due to the obstructed luminal cavity, there is an enhanced intraluminal pressure
which in turn increases the venous pressure as well. This enhanced pressure leads to thrombosis
of the appendix venules and impairment of the lymphatic and venuous drainage leading to
ischemia with heightened mucous production that compromise the integrity of the appendix wall
and hence, the wall is invaded by the intraluminal bacteria such as E. coli. Soon after, the
inflammation extends towards the serosa, parietal peritoneum, and adjacent organs (Petroianu &
Barroso, 2016). Here the bacterial invasion and the mucosal hyperplasia lead directly to acute
peritonitis (Yilmaz et al., 2013). The roles and responsibilities of a caring nurse do not end in
these interventions only, there is need of the nursing professional to consider the psycho-social
and developmental aspects of the patient under care as well (Biondi et al., 2016).
According to the Erikson’s theories psychosocial of growth and development,
development is a dynamic process, although growth and development are interdependent
processes, taking place in the first 20 years of life (McLeod, 2013). There are 8 stages of the
development according to this theory and each stage is associated with psychosocial changes in
the child according to age. Hence, each child according to their developmental stage has a
distinct psyche and the care planning will need to address the impact. It has to be mentioned that
in this case, the patient is in the concrete operational stage and there are a variety of different
developmental needs at this age which the care plan will also have to take into account (Brown