NRSG257: Nursing Case Study on Pediatric Acute Appendicitis Care

This nursing case study examines the case of Anne, a 10-year-old patient diagnosed with acute appendicitis and subsequent complications of gangrenous perforated appendix with peritonitis. It explores the pathophysiology of peritonitis, highlighting the inflammatory response of the perineum to pathogens and the role of the appendix in the immune system. The case study also delves into the psychosocial and developmental aspects of care, referencing Erikson's theories of psychosocial development and Piaget's stages of cognitive development to emphasize the need for developmentally appropriate care. Family-centered care is discussed as a crucial element, stressing the importance of respecting the child and parents' wishes, sharing unbiased information, and empowering the family in the care process. Furthermore, the impact of hospitalization on the child's psychological well-being and the family's dynamics is considered, with recommendations for therapeutic communication, parental support, and community resources. The assignment concludes by underscoring the significance of holistic nursing care that addresses developmental needs, familial involvement, and the potential trauma of hospitalization alongside medical interventions.

Running head: NURSING CASE STUDY
Nursing case study
Name of the student:
Name of the university:
Author note:

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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

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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

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& Desforges, 2013). According to the Piaget stages of development theory, a child at the age of
10 goes through logical and reasoning cognitive development and the children at this age are
very aware of the external environments (Demetriou, Shayer & Efklides, 2016). Needless to say,
given the age of Anne, she will be very sensitive to the care environment and the experience.
And along with that, the surgery followed by the acute infection will also have a significant
impact on her physical growth and development. Hence, the developmentally appropriate care
will need to address both the factors.
At this age, the children like to take initiatives and be involved in the problem-solving
procedure which provides them with confidence and helps them overcome inadequacy (Potts &
Mandleco, 2012). Hence, the nursing professional will need to engage in a therapeutic
relationship with her and involve her in the care procedure. Information and patient education
will also ensure maximal inclusion, hence the nurse must inform and education Anne at each step
of care planning and implementation. At this age, the intrusion of privacy can also result in
negative outcomes; hence least intrusive measures will need to be implemented in case of
auxiliary temperature, oral medications maintaining the utmost respect for her privacy and
choices (Brown & Desforges, 2013).
Family centred care is a very common concept of care program which aids the nurses to
provide the most efficient and holistic patent centred care to the patients (Potts & Mandleco,
2012). This practice is the most practiced in the context of child health, most preferably for the
paediatric patients going through chronic or acute health conditions (Abraham & Moretz, 2012).
This care principle is based on a set of family-oriented values, attitudes and approaches,
integrating the biomedical condition of the child in light of the primacy of family in the child’s
life (Potts & Mandleco, 2012). In order to provide quality family-oriented care to Anne, the

4NURSING CASE STUDY
nurse will need to listen to and respect the child and her parents’ wishes and preferences while
honouring their ethnicity. Along with that, the nurse will have to share honest and unbiased
information with the parents and family along with that patient, and collaborate with her family
to provide them the ultimate decisive power (Kuo et al., 2016). Lastly, it has to be understood
that family is an integral source of comfort and safety in the perception of a child and in order to
provide optimal family centred care, the nurse will have to recognize the individual strengths and
weaknesses, to empower Anne and her parents to regain control of her recovery and health (Potts
& Mandleco, 2012).
Hospitalization can have a significant impact on the psychological health and well being
of a child that is going through an acute and chronic illness (Lerwick, 2013). It has to be
understood that for Anne, she had gone through a surgical procedure and an exacerbation which
can be considered a severe life-threatening condition. Hence the chances of extreme fear and
uncertainty being ingrained in her psyche are very high, along with that the impact of loneliness
and pain can have a great impact on both emotional well-being and response (Lerwick, 2013). In
case of Anne, the nurse will have to engage her in the therapeutic relationship and communicate
with her encouraging her to express her fears and doubts. A child in acute care can be easily
irritated and restless due to the fear, pain and separation from family, and can interfere with
medication administration and IV therapies. In such case, the nurse will have to carefully calm
the patient and educate her about her health and the need for therapeutic assistance (Lerwick,
2013).
The impact of hospitalization can be great on the family as well; the separation from
Anne and not being able to care for her can irritate, agitate or depress her parents, filling them
with anxiety and guilt. In such condition, the nurse will need to provide supportive assistance

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and counseling to her parents and informing them about her progress diligently. The nurse will
have to involve her parents with as many aspects of care planning and implementation as
possible to aid a holistic family centred care. The separation of Anne while being in the hospital
might as well have an impact on her siblings and the restaurant business of the parents might also
suffer due to Anne’s hospitalization as well creating a financial and psychosocial impact on the
family. The community care nurse will need to advise the family for contacting the counseling
and community social care support that they can avail.
Nursing care can be considered a fundamental and irreplaceable part of the care
experience of the sick and ailing. It has to be understood that for the paediatric patients the
impact of an acute illness and the hospitalization can have a significant impact on the growth and
developmental aspect of the child. Hence the care planning will have to consider developmental
aspects, familial importance and the impact of hospitalization, along with the medical care plan,
which has bee demonstrated in the assignment in details.

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References:
Abraham, M., & Moretz, J. G. (2012). Implementing patient-and family-centered care: part I-
understanding the challenges. Pediatric Nursing, 38(1), 44. Retrieved from
https://search.proquest.com/openview/41d5925fbda8ed6898bcb315a3d9a4db/1?pq-
origsite=gscholar&cbl=47659
Biondi, A., Di Stefano, C., Ferrara, F., Bellia, A., Vacante, M., & Piazza, L. (2016).
Laparoscopic versus open appendectomy: a retrospective cohort study assessing
outcomes and cost-effectiveness. World Journal of Emergency Surgery, 11(1), 44. doi:
10.1186/s13017-016-0102-5
Brown, G., & Desforges, C. (2013). Piaget's theory. Routledge. Retrieved from
file:///C:/Users/absas/Downloads/9781135661205_googlepreview.pdf
Demetriou, A., Shayer, M., & Efklides, A. (Eds.). (2016). Neo-Piagetian theories of cognitive
development: Implications and applications for education. Routledge. Retrieved from
https://books.google.co.in/books?
hl=en&lr=&id=IZSkDAAAQBAJ&oi=fnd&pg=PP1&dq=Demetriou,+A.,+Shayer,+M.,+
%26+Efklides,+A.+(Eds.).+(2016).+Neo-Piagetian+theories+of+cognitive+development:
+Implications+and+applications+for+education.
+Routledge&ots=832Ey7Yv6w&sig=UZI7KeFHC499wR5QHKy0VtarwrI#v=onepage&
q&f=false
Doklestić, S. K., Bajec, D. D., Djukić, R. V., Bumbaširević, V., Detanac, A. D., Detanac, S.
D., ... & Karamarković, R. A. (2014). Secondary peritonitis-evaluation of 204 cases and

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literature review. Journal of medicine and life, 7(2), 132. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4197493
Kuo, D. Z., Houtrow, A. J., Arango, P., Kuhlthau, K. A., Simmons, J. M., & Neff, J. M. (2012).
Family-centered care: current applications and future directions in pediatric health
care. Maternal and child health journal, 16(2), 297-305. Doi: 10.1007%2Fs10995-011-
0751-7
Lerwick, J. L. (2013, August). Psychosocial implications of pediatric surgical hospitalization.
In Seminars in pediatric surgery (Vol. 22, No. 3, pp. 129-133). Elsevier. Retrieved from
http://www.sempedsurg.org/article/S1055-8586(13)00034-6/abstract
McLeod, S. (2013). Erik Erikson. Retrieved August, 9, 2013. Retrieved from
http://docshare04.docshare.tips/files/17487/174877910.pdf
Minutolo, V., Licciardello, A., Di Stefano, B., Arena, M., Arena, G., & Antonacci, V. (2014).
Outcomes and cost analysis of laparoscopic versus open appendectomy for treatment of
acute appendicitis: 4-years experience in a district hospital. BMC surgery, 14(1), 14. doi:
10.1186/1471-2482-14-14
Petroianu, A., & Barroso, T. V. V. (2016). Pathophysiology of Acute Appendicitis. JSM, 4(3),
1062. Retrieved from
https://pdfs.semanticscholar.org/4925/57b99b0a1e3e9620a99c3efa647ac90d5499.pdf
Potts, N. L., & Mandleco, B. L. (2012). Pediatric nursing: Caring for children and their
families. Cengage Learning. Retrieved from https://books.google.co.in/books?
hl=en&lr=&id=ZN4EhF1m1QkC&oi=fnd&pg=PR3&dq=Potts,+N.+L.,+

8NURSING CASE STUDY
%26+Mandleco,+B.+L.+(2012).+Pediatric+nursing:
+Caring+for+children+and+their+families.
+Cengage+Learning&ots=drhdcZFBWj&sig=YJ4Ztd2eFm4RS7EIBEqN0_EJEFQ#v=on
epage&q&f=false
Vaziri, M., Pazouki, A., Tamannaie, Z., Maghsoudloo, F., Pishgahroudsari, M., & Chaichian, S.
(2013). Comparison of pre-operative bilirubin level in simple appendicitis and perforated
appendicitis. Medical journal of the Islamic Republic of Iran, 27(3), 109. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3917482/
Yilmaz, M., Akbulut, S., Kutluturk, K., Sahin, N., Arabaci, E., Ara, C., & Yilmaz, S. (2013).
Unusual histopathological findings in appendectomy specimens from patients with
suspected acute appendicitis. World Journal of Gastroenterology: WJG, 19(25), 4015.
doi: 10.3748/wjg.v19.i25.4015