Paediatric Appendicitis Case Study: Family-Centered Care Approach

This case study focuses on the care of Anne, a 10-year-old child who underwent surgery for acute appendicitis. It discusses the pathophysiology of appendicitis, highlighting the causes and progression of the condition, including perforation and gangrene. The application of Jean Piaget's cognitive development theory, specifically the concrete operational stage, is explored to understand Anne's perspective and reduce anxiety through clear explanations. Erik Erikson's psychosocial development theory, particularly the Industry vs. Inferiority stage, is also applied to emphasize the importance of encouragement and emotional support from nursing professionals to foster confidence and resilience in Anne. The case study further emphasizes the significance of family-centered care, involving parents in the care process to alleviate their anxiety and provide comprehensive support to both the child and their family during hospitalization, which can cause emotional and psychological trauma. The importance of nurses using proper developmental theories and family-centered approaches to understand the psychology of the child at the particular age and give care is highlighted.

Running head: PAEDIATRIC CASE STUDY
PAEDIATRIC CASE STUDY
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Acute appendicitis can be defined as the inflammation of the appendix which is
actually a narrow blind ended tube that remains connected to the postero-medial end of the
caecum. It mainly remains associated with abdominal pain and can be described as the
condition which can result in abdominal surgery in the children (Shweiki et al., 2016). This
assignment is also based on the case study where nursing professionals have to care for Anne
who is a 10 year old child who has undergone appendicitis surgery and requires care and
support in the hospital.
Appendicitis occurs due to the inflammation of the inner lining of the vermiform
appendix that gradually spread to other parts of the body. The main reason for its occurrence
is the obstruction of the appendiceal lumen due to a number of purposes. Lymphoid
hyperplasia that takes place secondary to that of the infectious as well as inflammatory
disorders might result in obstruction. Besides, faecal statis and faecaliths might also obstruct
but they are more common in elderly people (Allievi et al., 2017). Bacterial obstructions,
although rare might also occur along with blockage due to foreign materials or due to
neoplasm. These forms of obstructions mainly result in the increasing of pressure within the
lumen. Such increase in the pressures mainly takes place due to the continuous secretion of
the fluids as well as mucus from the mucosa (Hughes & Lu, 2015). Additionally, the
intestinal bacteria within the appendix are also seen to undergo multiplication. This again
leads to the recruitment of the white blood cells as well as the formation of the pus (Flum,
2015). This causes further increase of the intra-luminal pressure and this leads to the
obstruction in the venous outflow. Ischemia is seen to occur in the appendiceal wall and this
situation results in the loss of epithelial integrity as well as bacterial invasion. Researchers are
of the opinion that thrombosis which occurs in the appendicular artery as well as the veins
lead to perforation as well as gangrene of the appendix (Wagner et al., 2018). When this
process is seen to continue, it results in the development of a peri-appendicular abscess. This

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might get localized if it gets walled off by the omentum. Alternatively, there might be also
occurrence of a generalized peritonitis (Mak et al., 2016). Fluid mixed with bacteria may get
spilled from the perforation to different art of the abdomen causing severe pain. In the case
study as well, the patient named Anne was admitted to the ward due to right iliac fossa pain
due to occurrence of the appendicitis. It had become perforated with the spread of the
infectious fluid internally in the peritoneum and it had become gangrenous as well.
Therefore, the surgery required removing the organ in order to help the patient get over the
pain.
Jean Piaget had proposed one of the most influential theories concerning cognitive
development which is known as the Piaget's cognitive development theory. This theory
mainly explains the development of different types of thought procedures and mental States
from the time of birth to that of adulthood. It mainly helps in looking at how different types
of thought procedures are able to influence the way individuals understand and thereby
interact with the world (Sieglar, 2016). There are four different stages of this theory out of
which the state which is applicable in the case study is called the Concrete operational stage.
The stage mainly occurs between the period of 7 years age and 11 years age. Researchers
have found that their thinking becomes more logical as well as organized but it still remains
concrete and rigid (Homes et al., 2016). Children are seen to use inductive logic and different
types of reasoning skills from specific information to a General principle (Barrouillet, 2015).
At this stage the egocentrism of the child is seen to disappear and the children start to
understand that the viewpoint of others might not match with the viewpoint of them. In the
case study it is seen that Anne is a child of 10 years. The child might have many concerns
regarding the causes of her suffering and pain that had made her admitted to the hospital
(Lefa et al., 2014). As she would not be having any egocentrism in the stage, the nursing
professional can easily make her understand about the different factors that had made her

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admitted. Since the child is not judgmental in this stage, it would be helpful for the nurse to
explain to her and help her reduce anxiety and fear (Petroniou & Barasso, 2016). However,
the nurse should be very careful while discussing the disorder because any kind of confusion
or concern among the nursing professional might again raise a feeling of fear in the patient.
Therefore, nursing professionals have to be very careful while explaining the disorder to the
patient and helping her to develop her viewpoint.
Another theory that can be applied is called the Erikson's Stages of Psychosocial
Development. Proposed by Erik Erikson, the stage 4 called the Industry vs. Inferiority stage
can be applied to Anne as this stage as this stage refers to the children who are between the
age 5 and age 11. Through social interactions, children are seen to begin to develop a sense of
pride in their different abilities as well as accomplishments (Berk, 2017). The theorist is of
the opinion that those children who are continuously encouraged and commended by
caregivers, parents as well as teachers would develop a feeling of competence and they would
start believing in their skills. These individuals who do not receive any form of
encouragement from parents, caregivers, teachers or peers will have doubts on their
capabilities. In this case study, it is seen that Anne is a little child of only ten years old who
had to go through severe emotional and mental turmoil as well as physical suffering to go
through a surgery in the tender age (Crain, 2015). Different types of feelings like fear,
anxiety, insecurity hopelessness, loneliness might affect her. The nursing professionals caring
for her should constantly encourage her to be confident and overcome such feelings
effectively. They should be her constant companion and help her overcome such feelings
thereby emerging out with strong independent emotions and overcome fear and anxiety in
strenuous situations. This would make Anne more confident in her future and would help her
to be brave and courageous when such strenuous situations occur in her life in future.

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Family centered care can be defined as the approach which involves an effective
partnership between the Healthcare providers, the families and the patient in the planning as
well as delivery and evaluation of care Studies suggest that care involving families in
providing care to children has positive outcomes on the physical and mental health of child as
well as better emotional outcomes on the parents (Davidson et al., 2017). In such form of
care, parents are continuously encouraged and supported by the Healthcare professionals for
staying with their child when they are receiving health care services. In case of Anne, her
parents should be also receiving the information and support they need, so that they do not
become anxious and fearful about the condition of a child and can be a strong support to
Anne. They should be asked questions about what they want and what they need for
betterment of situation. This would help in the identification of the goals for their child. The
parents should be actively participating in the child care and becoming full member of the
care teams (Curtis et al., 2016). When the parents are made the members of the
multidisciplinary Healthcare teams and they are shared all important information, they feel
empowered. They can successfully overcome any form of confusion that results in anxiety
fear and hopelessness in them.
Hospitalization on the child results in both emotional as well as psychological trauma
not only on the child but also on the parents and the families. Researchers are of the opinion
that the major stressors of the hospitalization are seen to include separation, loss, anxiety,
control, pain and bodily injuries. The ways and intensity of the children reacting to these
crisis are entirely influenced by the developmental age of the child, their previous
experiences with their illness of their coping skill as well as the support system that are
available to them (Capurso & Ragni, 2016). Anxiety is seen to stem of from the onset of the
rapid onset of the illness as well as the injury especially when the child is not having or
having limited experience of the disorder (Sieglar, 2016). Anne had no previous history of

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such appendix issue and so, it might result in creation of the Anxiety. She might also develop
fear. Such fear is mainly seen to rise from the separation from their family as well as the
parent and also because of the unfamiliar environment and losing of control of the child.
Parents provide constant support, care and love to their child in home and they become
concerned about how their child will be able to manage and tackle so many negative
situations alone. Such feelings result in helplessness among the parents making them go
through emotional turmoil (Curtis et al., 2016). They feel frustrated and hold themselves
guilty thinking that they could not take proper care of their child. In such situations, nursing
professionals should share detailed information with family members and try to reduce the
anxiety and negative thoughts. They should develop good bonds with the child and provide
her support in ways by which she can overcome such feeling.
From above discussion, it can be seen that appendicitis results in surgery in children
and such hospitalization might have negative outcomes on patients and family members.
Therefore, nurses need to use proper developmental theories so that they can understand the
psychology of the child at the particular age and give care. They should also follow family
centered approach that would involve family as an important part of healthcare team.
Hospitalizations also have negative outcomes on health of the patient and family members
and therefore this should be also taken care of.

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