Child and Family Nursing: Case Study of Appendicitis in a 10-Year-Old

This essay presents a case study of a 10-year-old patient named Anne, admitted to the emergency department with right iliac fossa pain, diagnosed with appendicitis, and undergoing an appendectomy. The essay explores the pathophysiology of appendicitis, including the causes of obstruction, the inflammatory process, and complications such as a gangrenous perforated appendix and peritonitis. It then evaluates the crucial role of the nurse in developing appropriate nursing care for Anne post-operation, considering her developmental stage based on Piaget's and Freud's theories. The nurse's responsibilities include effective communication, pain management, medication administration, patient and family education, and adherence to ethical principles. Family-centered care is emphasized, with detailed explanations of post-operative care, dietary guidelines, and signs of infection. The essay highlights the importance of addressing the emotional and psychological needs of both the patient and family, acknowledging the impact of illness on their well-being. Overall, the assignment provides a comprehensive overview of the nursing care required for a child with appendicitis, emphasizing the importance of a holistic approach.

Running Head: Child and Family nursing
Child and Family nursing
Name of the Student
Name of the University
Author Note

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Introduction
The paper deals with the case study of Anne. She is presented to the emergency
department for the right iliac fossa pain. The surgical team decided for appendectomy after
observation of signs and symptoms. The clinical handover showed a gangrenous perforated
appendix with peritonitis. She is under pain management and antibiotic therapy for infection. She
will remain in hospital for 10 days. In response to the case study the, essay discusses the
pathophysiology of the presenting complaint in the case study. Further, the role of the nurse in
developing appropriate nursing care is evaluated in the essay.
Pathophysiology
Right illiac fossa pain occurs in the surface of the human abdomen inside the right
inferior part. The common cause of the presentation to the emergency room is the infection in
right iliac fossa. It is manifested as fever and pain. This localises the pain and tenderness and is
common in the patents with appendicitis as appendix is located in right iliac fossa. Therefore,
Anne may have the right iliac fossa pain due to appendicitis and is the most common diagnosis
(Kharbanda, et al., 2016). She was presented to the emergency room for right iliac fossa pain and
was also diagnosed as appendicitis based on her signs and symptoms.
Appendicitis is caused by various factors that obstruct the appendiceal lumen. The
various factors may be lymphoid hyperplasia, foreign bodies, and inspissated stool. The common
cause being lymphoid obstruction. The obstruction increases the pressure in the lumen. It results
in the continuous secretion of the mucus and fluids from the mucosa and its stagnation. During
appendicitis, the bacterial population in the intestine multiply, accumulating more white blood

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cells. Inflammatory response ensues with the bacterial growth and edema. Due to accumulation
of pus, more intraluminal pressure is formed (Skarda, et al., 2015).
The pressure in the appendiceal lumen increases with the obstruction, rising above the
appendiceal veins. It results in the venous outflow obstruction, appendiceal wall ischemia and
diminishing of epithelial integrity. This further increases the bacterial invasion in the appendiceal
wall, resulting in gangrenous appendix. This localised condition becomes worst with thrombosis
of the appendicular artery and veins. It causes perforation and gangrene of the appendix and is
the most common complication of appendicitis. The gangrenous appendix will perforate and the
appendiceal contents will spill into the peritoneal cavity. It is during this continuing process that
peritonitis and periappendicular abscess may occur. Diffused peritonitis may occur if the body
does not wall of the process (Obinwa, Casidy, & Flynn, 2014).
The common emergency procedure for the appendix is the Appendectomy, the surgical
removal of appendix. In case of Anne, after appendectomy, the handover on return to ward is the
gangrenous perforated appendix with peritonitis. In case of Anne the appendix is perforated so
the patient will have longer duration of symptoms. It also increases the need of fluid resuscitation
and broad spectrum of intervention as Anne has perforated disease along with peritonitis. Hence,
this process has increased her hospital stay. She is administered with antibiotics to fight the
infection. Morphine PCA is the effective in relieving pain and IV therapy is used to relive the
fluid loss (Salminen, et al., 2015).
Evaluation of the nurse role
In order for the nurse to develop appropriate care for Anne post operation, the nurse must
be aware of her growth and development. Anne is 10 years old and the expected developmental

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milestones at this age, includes quick physical and social growth as per Jean Piaget’s theory.
Anne at this age is expected to have rapid development of the cognitive skills. It includes a good
speed in reading, and performing mathematical calculations such as addition, subtraction, and
others. Children of 10 years demonstrate good language development (Piaget, 2015). Therefore,
before communicating with Anne, the nurse must assess if the child can converse easily with
people of different ages and if the speech pattern is near to an adolescent. It will help the nurse to
effectively assess the pain and location by communicating with Anne. Medication can be
adjusted based on the, changing level of pain. It will be easy to administer antibiotics and inform
Anne to communicate the mode of medication or else it will hamper the care. The nurse may
explain medical procedures to Anne using simple drawings and showing video clips. When
communicating with Anne, the nurse must use simple terms that can be easily understood
(Salminen, et al., 2015).
According to Piaget's Cognitive Developmental Theory, at the age of 10, a child is
expected to have well integrated perceptual motor skills, and may be able to identify the
difference between the intention and behaviour. Children at this age, tend to gain logical
reasoning skills and strengthen sensory and motor functions. Therefore, in case of Anne, the
nurse may be able to provide accurate information on the progress of her situation. It will relive
anxiety in the child due to emotional support. The nurse must be able to explain the symptoms of
exacerbation to Anne such as blood pressure, temperature, cardiac frequency, and respiratory
frequency. At this age, adequate physical endurance is expected, therefore, a low limb exercises
can be explained to the student to prevent postoperative complications (Piaget, 2015).
According to Freud’s psychosexual theory, experiences of conflict, affect the child’s
course of development (Freud, 2014). The nurse must assess the mental stamina of the patent to

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prepare for extended hospital stay and reduce emotional distress. The lack of patience,
intelligence and maturity may hamper the care process. Considering the developmental
milestones at the age of 10, Anne should be involved in the medical procedure that will affect the
child. Further, the nurse must assess where there are deviations from the developmental
milestone pertaining to this age and accordingly involve Anne’s parents. The nurse must
consider the age and maturity of the child and if she is capable of verbalising her feelings. Anne
should be given full opportunity to express her views and the nurse must maintain the patient’s
and the parent’s autonomy for greater good. The nurse must adhere to principle of ethics, which
include the right to autonomy, beneficence, non-maleficence and social justice (Scanlon, Cashin,
Bryce, Kelly, & Buckely, 2016). The care plan should be designed in a manner that will benefit
the patient and family, instead of harm.
The paediatric nurses must provide the family centred care model. For this case, the role
of the nurse is to educate the patient’s family member about the care plan, side effects of
education and care after discharge. Anne and her parents will be informed that she cannot
immediately resume sports or other play activities and must not engage in lifting heavy objects.
The diet plan appropriate for Anne’s condition and alert on the changes in bowel movement may
be notified. Anne should be instructed on taking adequate fluids and maintain hydrated state of
body. The nurse must inform the family regarding the care for the incision area. It includes
keeping it clean, and regular dressing. The nurse must notify the family about the emergency
help in case of Anne’s troubled breathing, loss of consciousness and abdominal pain and explain
the signs of infection. It will help the family to contact the physician in case of immediate help
(Peter, et al., 2015).

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When dealing with the family and involving them in the medical conversation, the nurse
must be cautious on not using medical jargons, and explain in lucid language. The nurse must
take the informed consent of the guardians during the treatment (urinary analysis, blood tests and
medication) and care process. It is essential to value the needs, preferences and beliefs of the
family members to maintain the patient centred care (Hockenberry & Wilson, 2014). Hospital is
the place for patient from diverse cultural and linguistic background. Thus, the role of the nurse
is to identify the communication barrier and arrange for medical interpreter. Further, the nurse
must take into consideration, the cultural and religious preferences. For instance, the Hindu
Brahmins prefer to take bath three times a day. It may affect the dressing and wound infection.
The possible spiritual care should be given, to the family. Therefore, nurse must educate the
patients on complications of the infection at the surgical site. Further, the client’s family should
be encouraged to actively participate in problem solving related to illness (Chau, et al., 2016).
The nurses must cater to the emotional and psychological needs of the patient and the
family. During the illness, booth the patient and the loved ones undergo stress and anxiety. Lack
of health literacy, awareness on the illness, socioeconomic status and understanding of medial
jargons create stress and anxiety. The cause of the emotional upset in child may be due to
separation from familiar figures. Every child has varying degree of coping with hospitalisation
due to differ degree of intelligence and temperament. It will influence both the short and long-
term effects of hospitalisation (Gorter, et al., 2016). The nurses must encourage positive attitude
in Anne and her family to promote active coping role. It will decrease the complications after
discharge. The involvement of the family in Anne’s care is based on Bowlby's Attachment
Theory. Children have innate need for attachment and proximity can be ensured by maintaining

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safe and secured environment. Similarly, the family will also feel supported by ensuring
proximity (Goldberg, Muir, & Kerr, 2013).
Conclusion
In conclusion, appendicitis is the complicated illness and is associated with severe
physical and mental implications. The assignment clearly discussed the pathophysiology of
perforated appendix and peritonitis. Based on several developmental theories the nursing role in
regards to care for Anne has been presented. Illness have significant impact on the patient and
the family, thus family centred care is implemented and the factors that may hamper care is
briefly illustrated. Conclusively, the assignment has been helpful in gaining deep insight on the
role of nurse in paediatric setting.

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