Appendicitis in Children: Developmentally Appropriate Nursing Care

This essay discusses the pathophysiology of appendicitis in a ten-year-old girl named Anne, who presented with right iliac fossa pain and was diagnosed with a gangrenous perforated appendix with peritonitis. It evaluates the pediatric nurse's role in providing developmentally appropriate care, incorporating growth and developmental theories like Freud's psychosexual theory, Piaget's cognitive development theory, and Erikson's psychosocial development theory. The essay also emphasizes the importance of family-centered care, including sharing information with the family, involving them in the care process, and addressing the potential impacts of hospitalization on both the child and her family, particularly her siblings. Nursing considerations involve pain management and fluid balance, with the goal of minimizing the negative effects of hospitalization through family support and tailored nursing interventions. The essay concludes by highlighting the need for nurses to understand pathophysiology, adhere to professional codes of conduct, and utilize family-centered care to support the well-being of pediatric patients and their families.

Running head: NURSING ASSIGNMENT 1
Nursing Assignment
Student’s Name
Institutional Affiliation

NURSING ASSIGNMENT 2
Introduction:
In this case, Anne, a girl of age ten years is presented at a healthcare facility with right
iliac fossa pain, and after evaluation, the operative staff recognized signs and symptoms of
appendicitis and took her to the theatre for an appendectomy. However, they realized she had a
gangrenous perforated appendix with peritonitis. This discussion illustrates pathophysiology of
the presenting complaint and evaluates the response of the pediatric nurse to provide the best
care which incorporates growth and developmental theories for the specific age group, family-
centered care by family and the impacts of hospitalization on the child and family.
Describe the pathophysiology of the presenting complaint in the case study.
. Pathophysiology of appendicitis refers to the series of actions that lead to the
development of appendicitis. An understanding of the appendicitis pathophysiology is helpful in
acknowledging how fast the state should be controlled in case a medical diagnosis is suspected.
Appendicitis is the inflammation of the inner lining of the vermiform appendix that distributes to
its other parts (Rollins, Varadhan, Neal & Lobo, 2016). Although appendix has been thought to
be recent functionless studies shows that unlike its closest neighbor colon it comprises several
clusters of a particular type of white blood cells known as B along with T lymphoid cells. The
white blood cells clusters also called lymphoid tissues are part of defense systems in the gut
which liaises the function of immunologic to defend the body from the penetration by
catastrophic organisms.
Appendicitis arises when the appendix becomes acutely inflamed, and it is not known
why it happens, but it is thought to occur due to appendix lumen being blocked by lymphoid

NURSING ASSIGNMENT 3
hyperplasia, fecaliths or ordinary fecal matter because of a viral infection (Mendoza-Sagaon,
Hamitaga, Hurni & Voumard, 2016). Despite a therapeutic and diagnostic improvement in
medicine, it remains a clinical emergency, and it commonly causes an acute abdominal pain
(Hecker et al., 2016). However, the generality of appendicitis in young children recommends a
pathophysiology responsibility for lymphoid aggregates that jeopardize in amplitude in the
appendix. Once the appendix is obstructed, blood flow rate to body tissues reduces allowing
bacteria to multiply. Since the lumen is blocked, the pressure within the appendix increases
cutting venous drainage hence resulting in ischemia which if not treated can lead to gangrene and
necrosis. However, once this stage is attained the appendix is at risk of perforating for the
perforation takes only 72 hours to happen after the appendix has been blocked. After perforation,
inflammatory cells and bacteria are relinquished into the surrounding tissues influencing
inflammation of the peritonitis causing diffuse abdominal pain.
Nursing considerations involve pain related to inflames appendix and deficiency of fluid
volume compared to nil by mouth status. However, if the appendix is already raptured when the
child is seen in the emergency ward the possibility of peritonitis increases significantly, and the
child requires IV antibiotics for hydration (van den Boom et al., 2018). From the case study, the
doctors conducted appendectomy(Flum, 2015) on Anne because of the gangrenous perforated
appendix with peritonitis and went back to the ward with a nasogastric tube in situ for free
drainage and allowing the intestines to rest preventing the child from vomiting and nausea
(Joundi et al., 2018). Furthermore, Anne is on IV antibiotics to shield infections and morphine
PCA for the relief of pain.
Evaluate the nurse's role to deliver developmentally appropriate nursing care about
your chosen study.

NURSING ASSIGNMENT 4
i) Growth and developmental theories
Growth and developmental theories are helpful in understanding about the patient in regards
to age, their thinking, behavior and providing care. To commence with the Freud theory of
psychosexual development defines how personality is developed during childhood via a
sequence of stages which represents the fixation of libido in various areas of the body. Sexual
energy accumulates and discharged as the body matures biologically (Freud, 2017). According to
this theory, it is essential for children to complete each stage successfully otherwise mental
abnormality can happen.
According to Piaget theory, children undergo four universal stages of cognitive advancement,
and it concerns a child building a mental world model (Barrouillet, 2015). Furthermore, the
improvement is biologically based, and it changes as the child matures. The four phases in the
Piaget theory are sensorimotor which ranges at the age of 0-2, the preoperational varying at the
age of 2-7, concrete operational ranging at the age of 7-11 and the formal operational reaching at
the age of 11 and above. The sensorimotor phase concentrates on object performance is
identified, and it still exists when it is out of sight. Also, there is an ability acknowledgment to
control the object and act intentionally (Barrouillet, 2015). Looking at the preoperational phase,
children develop the ability of language use, categorizes units using individual features like the
color and selfishly reasoning difficulty by viewing things from another point of view.
At the concrete operational stage the child can characterize objects by many features and
place them in order, can think logically and acknowledge conservation of figures, weight, and
mass (Barrouillet, 2015). Finally, the child at the formal operational stage thinks logically on
abstract propositions, he or she is concerned with the hypothetical and the future and generates

NURSING ASSIGNMENT 5
tests and hypotheses (Furth, 2017). Therefore, Ann being ten years old should concentrate on
critical thinking, learning, and a suitable task can be set to evaluate her development.
The Erikson theory proposed a psychoanalytical of psychosocial development which
incorporates eight stages of personality development (Cherry, 2017). At each stage of personality
development an individual experiences psychological crises which could contain positive or
negative impacts on personality development. The first stage is at the age of zero to one with a
virtue of hope, and a conflict of mistrust versus necessary trust and the culmination at old age is
the appreciation of relatedness and interdependence (Cherry, 2017). Early childhood of one to
three years have a resolution of will with a conflict of shame versus autonomy and their
culmination at an old age is accepting the life cycle from integration to disintegration. The third
stage of play age ranges between three to six years with a resolution of purpose, and their
conflict is guilt versus initiative. Their culmination in old age is humor, resilience, and empathy.
The fourth stage of the Erikson theory is the school-age which ranges from six to twelve
years. In this stage, their virtue is competence with a conflict of inferiority versus industry and
phase of old age is accepting one’s life course and unsuccessful wishes. The adolescent stage
starts from twelve to nineteen years accompanied by confusion versus identity (Steele, 2017). In
this stage, fidelity is a virtue, and the culmination of the old age is logical and aesthetic
perception, sense of life complexity and merging of sensors. The sixth stage is the early
adulthood starting at the age of twenty to twenty-five years with a conflict of isolation versus
intimacy. The phase at aging is the awareness of relationship complications, a value of loving
freely and affectionateness with love as a resolution (Cherry, 2017). Adulthood stage starts at
twenty-six to sixty-four years with a conflict of stagnation versus generativist and their
culmination in old age is caring, empathy and showing concern for others with the virtue of care.

NURSING ASSIGNMENT 6
Finally, old age starts from sixty-five years to death, and they have a conflict of despair
versus integrity, and their stage in old age is the sense of strong integrity to endure physical
disintegration, and their resolution is wisdom (Cherry, 2017). According to this theory, the stage
where Anne’s age lies feels confident to attain their objectives, and in case unsupported by
parents and teachers, they might feel inferior and can adversely affect Anne.
Family-centered care
Family-centered care refers to a model of service used while delivering nursing care to
children and the relevance of the family to the children is emphasized (Coyne, 2015).
However, it incorporates the planning, presentation, and assessment of the health services
with the family cooperation. The core concepts that are involved are the sharing of data with
family, family participating in the care, collaborating with the family to plan and provide
child's attention along with the respect and dignity for the family and child (Smith, Swallow
& Coyne, 2015). Family-centered care comprises of cultural competence and diversity in the
context of demographic, socioeconomic and ethnic characteristics.
The relevance of family-centered care is that it fulfills the developmental and
physiological needs of children and it supports their well-being and health. Furthermore, it
aims at extending the roles of the pediatrician to involve evaluation, screening, referral of
patients of social, emotional and physical problems which can adversely affect social well-
being and health of the child (Smith, 2018). From the case study, Anne’s parents should have
the consent from the professionals about the complications after surgery such as abscess or
infection.

NURSING ASSIGNMENT 7
The responsibility of a family regarding taking care of Anne at home suggested by the
doctor might contain the use of mild laxative, dietary, avoiding lifting of heavy objects or
climbing stairs and drinking too much water to prevent constipation (Kaakinen, Coehlo,
Steele & Robinson, 2018). Since Anne is the oldest of five children and her parents are very
busy operating a restaurant her siblings can be significantly influenced after she undergoes
surgery. She cannot be in a position to play with them again, and they may become worried
about Anne since they are not aware of what might have occurred to her. Therefore, family-
centered care is needful for Anne and her siblings until she regains her healthy life.
ii) The effects of hospitalization of the child, on the child and family.
Hospitalization of a child can have several effects on the child and family. A child may be
worried about the body not functioning well; separation from the family; he or she might
want to be with their parents always or may not want to share what they feel with the facility
professionals. Also, families may feel worried, apprehensive, angry or lonely and in order to
minimize these impacts of hospitalization on a child parents should always visit the child,
demonstrate confidence on the staff attending to the child, discuss with the nurses about the
likes and dislikes of their child and let the child know the time they are leaving or coming
back (Kaakinen, Coehlo, Steele & Robinson, 2018).
A nurse should acquaint herself with family-centered care elements to promote family and
childlike sharing of information regarding the health of the patient, communicating and
cooperating with the child and family along with acknowledging problems that the family
goes through and coping procedures that might be useful to assist the family. From the case
study, Anne and her family can suffer via the impacts of hospitalization, and therefore a

NURSING ASSIGNMENT 8
nurse should relay what the doctor said about the health of Anne with her family, cooperate
and teach them what she is required and how Anne can be motivated by family-centered care.
Support from the family is vital since Anne can trust her family than anybody else to feel
comfortable and nurses should discuss the likes and dislikes of Anne so that she can be
assisted in the hospital (Kaakinen, Coehlo, Steele & Robinson, 2018).
Conclusion:
From the discussion, it is essential for nurses to understand the pathophysiology and
professional code of conduct to handle the situation and the correct measures of taking care
of patients. Growth and developmental theories are required so that nurses can understand
their patients and their developmental stages. To support the well-being of a patient the
centered family care is essential so that parents can cooperate with nurses and the child,
nurses to educate parents to understand more about the patient's likes and dislikes to
minimize the impacts of hospitalization on a child and family.
References

NURSING ASSIGNMENT 9
Barrouillet, P. (2015). Theories of cognitive development: From Piaget to today.
Cherry, K. (2017). Erik Erikson's Stages of Psychosocial Development. Psychology.
Psychosocial Theories. Päivitetty, 14, 2017.
Coyne, I. (2015). Families and health‐care professionals' perspectives and expectations of
family-centered care: hidden expectations and unclear roles. Health Expectations, 18(5),
796-808.
Flum, D. R. (2015). Acute appendicitis—appendectomy or the “antibiotics first” strategy. New
England Journal of Medicine, 372(20), 1937-1943.
Freud, S. (2017). Three Essays on the Theory of Sexuality: The 1905 Edition. Verso Books.
Furth, H. G. (2017). Young children's understanding of society. Issues in childhood social
development (pp. 228-256). Routledge.
Hecker, A., Hecker, B., Hecker, M., Riedel, J. G., Weigand, M. A., & Padberg, W. (2016). Acute
abdominal compartment syndrome: current diagnostic and therapeutic
options. Langenbeck's archives of surgery, 401(1), 15-24.
Joundi, R. A., Saposnik, G., Martino, R., Fang, J., Porter, J., & Kapral, M. K. (2018). Outcomes
among patients with direct enteral vs. nasogastric tube placement after acute stroke.
Neurology, 10-1212.
Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M. (2018). Family health care nursing:
Theory, practice, and research. FA Davis.

NURSING ASSIGNMENT
10
Mendoza-Sagaon, M., Hamitaga, F., Hurni, Y., & Voumard, N. (2016). Appendix extraction
after laparoscopic appendectomy in children: A smooth, safe, and inexpensive technique.
Journal of pediatric surgery, 51(2), 341-343.
Rollins, K. E., Varadhan, K. K., Neal, K. R., & Lobo, D. N. (2016). Antibiotics versus
appendicectomy for the treatment of uncomplicated acute appendicitis: an updated meta-
analysis of randomized controlled trials. World journal of surgery, 40(10), 2305-2318.
Smith, J., Swallow, V., & Coyne, I. (2015). Involving parents in managing their child's long-term
condition—A concept synthesis of family-centered care and partnership-in-care. Journal
of pediatric nursing, 30(1), 143-159.
Smith, W. (2018). Concept Analysis of Family-Centered Care of Hospitalized Pediatric
Patients. Journal of Pediatric Nursing, 42, 57-64.
Steele, W. (2017). A Theological Dialogue with and Evaluation of Erik H. Erikson’s Theory of
Identity Development in Light of Pauline Baptismal Theology in Romans and Some
Implications for Pastoral Care.
Van den Boom, A. L., de Wijkerslooth, E. M., van Rosmalen, J., Beaverdam, F. H., Boerma, E.
J. G., Boermeester, M. A., ... & Dekker, J. W. T. (2018). Two versus five days of
antibiotics after appendectomy for complicated acute appendicitis (APPIC): study
protocol for a randomized controlled trial. Trials, 19(1), 263.