Nursing Assignment: Appendicitis Case Study

This nursing essay presents a case study of Anne, a 10-year-old girl diagnosed with gangrenous perforated appendicitis and peritonitis. The essay details the pathophysiology of appendicitis, focusing on the role of bacterial infection and the resulting inflammation and complications. It then explores relevant growth and development theories, including Freud's psychoanalytic theory, Piaget's theory of cognitive development, and Maslow's hierarchy of needs, to understand Anne's condition and the impact on her psychological well-being. The essay emphasizes the importance of family-centered care, addressing the emotional and practical challenges faced by Anne and her family during hospitalization. It also discusses the implementation of evidence-based practices in Australian nursing, highlighting the need for effective communication, cognitive behavioral therapy, and palliative care. Finally, the essay addresses the negative effects of hospitalization on both the child and her family, emphasizing the importance of responsible and empathetic care from healthcare professionals.

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Nursing Assignment
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This essay is about Anne who is a 10 year old girl and has been suffering from right
iliac fossa pain. She was taken to a local hospital and was diagnosed with appendicitis. The
doctors decided to perform appendectomy. They also found a gangrenous perforated
appendix with peritonitis. Since she was suffering from severe infection and there were a lot
of complications, she was advised hospitalization for 10 days of IV antibiotics and pain
management. This essay demonstrates the pathophysiology of appendicitis, growth and
developmental theories such as JMD theories which includes psychoanalytical theory by
Freud, Piaget theory and Maslow’s hierarchy of needs theory. It also demonstrates
family centered care and the effects of hospitalization on the patient and family
members. This essay demonstrates how evidence based information can be implemented
into contemporary Australian nursing practice.
Appendicitis occurs due to the obstruction of the lumen of the appendix and it also
occurs due to several bacteria such as yersinia species, adenovirus, cytomegalovirus,
actinomycosis, foreign substances, tumors and tuberculosis. Obstruction involves the filling
of lumen distal with mucous which increases to intra luminal and intramural pressure and
also causes distension (Cobb, 2017).This results in rapid multiplication of bacteria residing
inside the appendix. Bacteria that are most commonly found in the appendix are Bacteroides
fragilis and Escherichia coli. Pathophysiology involves several symptoms such as reflex
anorexia, nausea and vomiting, and visceral pain that occur due to the dilatation of the
appendix. The small venules and capillaries get affected by thrombosis when the pressure of
the lumen becomes more than the venous pressure thus causing and congestion and swelling
of the appendix. Inflammation occurs in the serous membrane of appendix which leads to
increase in pain. Due to the thrombosis of small arterioles bacteria start leaking out thus
leading to the formation of pus inside the appendix (Drake et al., 2014). The pus also forms a
layer outside the appendix region. Due to the infection of bacteria and ischemia inflammation

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occur which results in the death of cells and gangrene. The condition further worsens and
results in perforation of the appendix due to gangrenous appendix. It also results in peritonitis
which involves swelling of the innermost layer of the abdomen and organs present in it.
Perforation of the appendix is most commonly found in children as compared to adult
individuals (Shweiki et al.,2016 ).
There are several growth and development theories such as JMD theories which
includes psychoanalytical theory by Freud. He was the first to identify the development of an
individual through several stages such as oral stage, anal stage, phallic stage, latency and
Genital stage. This theory played an important role in helping nurses in understanding the
behavior and condition of mental health in different patients (Hahn, Coricelli & Matteo,
2016).It also helps in understanding different behaviors of patients related to ego and id.
Anne belongs to the Latency stage since its range is from 6-12 years so the major
development task for her is to focus on relationships. Freud theory helps individuals to accept
who they are and improve their health and well being.
Piaget theory focuses on the fact that interaction with the environment plays a
significant role in the development of human beings. The nurses gain knowledge and
understand the main features of developmental psychology and it helps them to assess the
stage of development a child has attained (Mischel, 2013).This helps them accomplishing
several tasks of development. Piaget’s theory has made a significant contribution in
understanding the intellectual level and cognitive development in children.
Maslow’s hierarchy of needs theory is a theory of psychology that aims to motivate
individuals and is based on a five stage model that includes biological and physiological
needs such as air, food, drink, shelter, warmth, and sleep. Safety needs include protection and
security, law, stability, order, and freedom from fear (Maslow, 2013).Love and belongingness

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needs include, friendship, intimacy, trust and acceptance, receiving and giving love and
affection, social interaction among family, friends, and work. Esteem needs include
achievement, independence, status, dominance, which plays a very important role in realizing
potential of self, self-fulfillment, seeking personal advice for growth and development. This
theory helps nurses and health care professional to motivate patients suffering from different
types of disorders and diseases (Maslow, 2013).
A proper communication to patients plays an important role in improving the hospital
journey and reduces the anxiety, stress and depressive symptoms. Lack of proper
communication leads to issues such as a delay in treatment and sometimes may cause adverse
health effects among them (Curtis et al., 2013).This decreases their bonding with healthcare
professionals such as clinicians and nurses and creates misunderstanding and confusion about
the treatment and the precautionary measures that should be taken. It may lead to mental
issues such as anxiety and may have a negative impact on the psychological condition of the
patients.
Family centered care plays a significant role in improving the well being of the
members of the patient. It involves providing care sucgh as emotional care, motivation and
guidance which helps them to prevent depressive symptoms and other health disorders related
to it. Healthcare staff should have a responsible attitude towards their patients as well as their
family members. The doctors and the nursing staff should act as a guide and provide support
in all their problems and issues (Festini, 2014).They should advise them about the
precautionary measures to be followed .This will improve the psychosocial health of the
family members of the patient and help her in getting cured in less amount of time. Cognitive
development is the field of studying psychology that focuses on the development of child on
the basis of his or her ability to learn, process the information and the development of brain
(Lehne & Rosenthal, 2014).

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Cognitive behavioral therapy can be provided to Anne that would help in instilling
positivity and getting well soon (Ehde, Dillworth & Turner, 2014).The nurses should have
patience during communication with her family members. They should treat them with
respect and also understand their requirements. Palliative care should be given to her in a
proper manner which is special type of care to that provides relief from both physical and
mental pain and stress (Poulsen et al., 2014).The nursing staff should process the information
gathered by them by analyzing the data by proper understanding of important signs and
symptoms in the patient They should discriminate correct from incorrect information to avoid
any errors in the treatment procedure.
Anne should be advised to follow several preventive measures to improve her health
condition such as taking rest, proper sleep, a well-balanced diet and regular exercise. She
should be provided counseling with a psychiatrist to share her issues and problems that will
instill positivity in her. Nurses should treat her with respect and patience and provide quality
care to her (Mischel, 2013). There are several nursing care goals for providing priority
nursing care in relation to the nursing issues that have been identified. Anne should be
empowered and provided care by understanding her needs and demands. She should be
advised to follow a few precautions to manage emotional issues like taking regular exercise
and a well balanced diet.
There would be negative effects of hospitalization of the child, on the child and her
family. The main reason behind it is that she is very young to bear the pain of the surgical
procedure and she has been advised to stay in the hospital for 10 days which is quite longer
for a child of 10 years. She might also not feel comfortable with nasogastric tube and other
therapies such as morphine patient controlled analgesia, intravenous therapy and triple
intravenous antibiotics. The family members of the patient also suffer from several issues due

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to hospitalization such as financial crisis, responsibilities related to house old, negative
effects on the education of other children, and boredom (Ågotneset al.,2016). The
hospitalization of Anne might lead to a huge loss in their restaurant business as well leading
to depression and other mental issues in the family members. The family members of the
patient should be taken care of by the hospital staff and helped whenever in need regarding to
the treatment of patient and other issues related to accommodation and transport. The nurses
should give respect and handle her with patience. They should also think from her point of
view by providing proper solution to their doubts (Lehne & Rosenthal, 2014).
Doctors and nurses should have a responsible attitude towards Anne as well as her
family members (Gordon et al., 2012).Anne should be advised to have a nutritional diet along
with plenty of fluids which would help in the regeneration of tissue and healing. She should
be advised protective measures to avoid various kinds of infection, injuries after the patient
has under gone surgery. They should wash hands in a regular manner as it is significant in
preventing infection. The nursing staff should use clean and aseptic techniques in order to
prevent contamination.
It can be summarized that Anne should be provided proper care and counseling so that
she gets well soon and leads a healthy life. The clinicians and the nurses should help her in
every way possible, according to her requirements so that she is satisfied with their service.
She should be counseled and guided properly to take appropriate rest and several precautions
to improve the condition of her health. She should be advised to follow self- management
which would involve taking care of her according to the precautions given. It will help in
providing psychosocial care and improve the condition of her health in less duration of time.

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References
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Research on Hospitalization from Nursing Homes; What is Missing?. Ageing
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Cobb, T. (2017). Appendicitis following blunt abdominal trauma. The American Journal of
Emergency Medicine.
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