Question:

Anne, a 10-year-old girl presented to the hospital emergency department with right iliac pain.

Appendicitis was suspected after further examination by the emergency register.

Anne is taken to theatre by the surgical team after they agree that her symptoms are appendicitis.

The surgical team found a perforated, gangrenous appendix. This was reported to Anne upon her return to the ward.

Anne has been discharged from the hospital with a nasogastric tube and is receiving free drainage, IV therapy, morphine PCA, and triple IV antibiotics.

Anne will need to be admitted to hospital for pain management and IV antibiotics.

Anne is the youngest of five children. Her parents own and manage an Indian restaurant.

Case Study 2

Jay is a four month old boy who was admitted to the paediatric Unit via emergency. Jay had vomiting, diarrhea, and intermittent spasmodic abdominal symptoms.

Jay raises his voice and draws his legs up during spasmodic abdominal pain episodes.

Jay was admitted on the ward following a diagnostic ultrasound that revealed intussusception as the cause of his presenting symptoms.

His treatment consisted of observation, electrolyte monitor and IV therapy until a contrast catheter could be used to correct the intussusception.

Jay will need to stay in the hospital for approximately two days. Jay’s mother was informed by Jay about the fact that Jay had received the rotavirus shot at four months, which may have increased the chances of Jay contracting this condition.

Jay’s mom is now having serious doubts over future vaccines.

Case Study 3

Sue, a 14 years-old Indigenous girl lives in a rural Australian community.

Sue has had several episodes of streptococcal impotence and pharyngitis in the past 2 year.

Sue and her siblings have been registered with the local health clinic to receive Benzathine Penicillin G IM regularly as a secondary prophylaxis program. This helps reduce the risk of developing ARF/ RHD.

Sue has not been able to go to the clinic to get her IM antibiotics.

Sue brought a 4-day history of joint pain in her knees.

On her arrival, Sue gave a detailed health history. She said that she had a sore neck two to three weeks ago. She also suffered from migratory joint pain. This started with her ankles but now includes her knees.

Her temperature is 38oC

Acute Rheumatic fever is diagnosed in Sue after she is examined by the remote clinic physician.

Sue’s doctor informs her mother that she will need to be transferred from the clinic to undergo a cardiology review as well as an echocardiogram.

800 km away is the closest hospital offering these services.

Sue lives in the same house as her mother and six younger brothers and sisters.

Discuss the pathophysiology in the case study.

In your chosen case, assess the nurse’s role as a provider of nursing care that is developmentalally appropriate.

Answer to Question: NRSG257 Child, Adolescent And Family Nursing

Introduction

Appendicitis (or severe abdominal pain) is a critical medical emergency.

Surgery is the main treatment for acute appendicitis.

Appendicitis continues to be a major health problem, despite all of the improvements in diagnostics and therapeutic procedures.

This assignment is inspired by Anne, a 10-year old girl who has been diagnosed with and treated for appendicitis.

The first section of the paper will focus on the pathophysiology behind appendicitis.

The nurse’s role in providing developmentally-appropriate nursing care will be discussed in the second section.

This section will address growth and developmental theories, family care, and the effects of hospitalisation on children.

A. Pathophysiology

Obstructive appendicitis begins with the obstruction of an appendicular lumen.

Obstructing the appendicular lumen is most common in children (Schlossberg and colleagues, 2015).

Lymphoidhyperplasia can also be caused by viral illnesses, such as gastroenteritis or mononucleosis.

But there are other causes.

These include foreign body, gastrointestinal parasites or Crohn’s disease. Elgazzar, 2014.

Some tumours include adenocarcinoma or carcinoid tumours.

A luminal obstruction is caused by the accumulation of distal and intraluminal secretions. This leads to impaired venous outflow.

When the venous inflow is affected, so is the arterial inflow.

Tissue ischemia and transmural inflammation are all consequences of an increase in intraluminal pressure. This can lead to tissue ischemia, overgrowths of bacteria, appendiceal injury, and eventually perforation (Elgazzar (2014)).

Perforation occurs in 72 hours.

This could lead to inflammation in the parietal pertoneum and other close structures that can cause abdominal abscesses.

Narsule found that appendiceal leakage is more common among children than it was in adults, and especially in young children.

The study found that perforation could occur within 24 hours after obstruction developed. Additionally, the risk was higher if symptoms lasted longer (Narsule Kahle Kim Anderson Luks, 2011,).

Anne presented with a perforated, gangrenous and infected appendix.

The perforated apex is characterized by an apparent defect in its wall.

Perforated appendixes often have thick, purulent fluid.

The cause of the perforated Appendix is likely to be bowel obstruction or ileus.

However, suppurative appsendicitis can cause gangrenous symptoms.

A gangrenous stomach is characterized by edematous, congested blood vessels and fibrinopurulent mudates.

Clear or turbid peritoneal fluid might also be a sign of gangrenous appendix.

It may be protected by omentum (Schlossberg et al., 2015).

Acute appendicitis can cause periumbilical pain in the beginning stages.

As the inflammation worsens, the appendiceal serosal surfaces begin to accumulate exudates.

As in Anne’s case, severe pain can occur when exudates touch parietal-peritoneum (Ryan Wenger 2007, 2007).

Perforation results in the release of bacteria into the abdominal cavity and inflammatory secetion. As a result, peritonitis develops.

Peritonitis’ severity and location will vary depending on how well the proximate bowel loops and the omentum can control luminal spillage.B.

B.

In order to provide high quality care, pediatric nurses need to be familiar with the child’s psychosocial, cognitive, and physical development.

Psychosexual development by Sigmund Frud, Erikson’s Theory of Psychosocial Development and Piaget’s Theory of Cognitive Development are three of the most important growth theories.

Psychosexual Development Theory by Freud

Oral (0-1years): An infant feels pleasure mainly from his mouth. He or she also suckers (Thurston 2014.

A baby’s oral behavior can also help relieve tension and play a crucial role in the formation or ego.

Anal (1-3 years old): In this developmental stage, children derive pleasure from anal.

Children can regulate body secretions.

Phallic (6-12 years): When a child enjoys their genitals.

Children are able to touch their sexual organs.

Child struggles to feel sexual passion towards the other parent at this developmental stage.

Latency (6-12years): Sexual desire tends not to subside at this stage.

Children will begin to look at other activities that are related to cognitive and/or social growth.

The Genital (from 12 years old to adulthood). Sexual desires resurface at this stage, and adolescents follow appropriate sexual behaviours (Thurston 2014.

Affordable Nursing Care

Anne should be told by the nurse which procedures and treatments will be performed.

Freud’s theory suggests that Anne will put great importance on her privacy.

Anne will be more private if the nurse provides gowns, covers, or inner wears.

Another way to increase privacy is by closing the door of the pediatric unit and knocking before entering.Psychosocial Development By Erikson

Trust vs. distrust (0-1 years) – Trust is promoted when food, clothing, comfort, and touch are provided (Kail& Cavanaugh (2015)).

Infants will distrust caregivers if they fail to meet their basic needs.

Autonomy and shame (1-3 years): This is the independence of a toddler. It’s demonstrated by their ability control motor activity and body excretions.

Children who are convicted of failing to control motor activities tend to be ashamed of their capabilities.

Initiation vs. guilt (3- 6 years): This stage is when children meet more people than just their family.

Children can discover new things and explore the world as a result.

However, children feel guilty if they are constantly criticised.

6-12 years old: Children in this stage of development are interested in new topics and are focused on their cognitive and intellectual development.

The children are satisfied with their school, home, and sports achievements.

If children don’t achieve what is expected of them, it can lead to a sense of inferiority.

Identity vs. confusion (12-18 Years): As teenagers enter adulthood, they identify themselves with certain values and roles (Kail & Cavanaugh, 2015).

The confusion that adolescents face when they are unable or unwilling to define their self is called identity vs role confusion (12-18 years).

Erikson’s theory says that Anne already feels more self-worth because she is involved in different activities.

Anne should be encouraged to bring to the hospital special pastimes.

The nurse should also encourage Anne’s continued schooling.

Cognitive Development by Piaget

Sensorimotor (0-2 years old): This developmental stage is where infants are taught by motor activity and input (Shaffer & Kipp (2010)).

Preoperational (2-7 year olds): Though logic is not fully developed, children use words and symbols to think.

Children have egocentrism and rely heavily on transductive reasoning.

Concrete operational (7-11years): At this stage, the transition from transductive reasoning is made to more precise knowledge of cause & effect.

Formal operational (11 to adulthood) – At this point, the mature intellect has been attained (Shen & Hendren, 2014).

Adolescents lack the ability to think clearly and make rational choices.Appropriate nursing care

Piaget believes that children between 6-12 are capable mature thought.

Anne should be provided with clear explanations by the nurse concerning the treatment.

Anne should also see the equipment being used.

C. Family Centred Care

Anne’s tragic case shows how illness can cause trauma to both the child and the family.

In order to better the well-being for children and their families, pediatric nurses adopted family-centred nursing (Harrison 2010).

Anne’s case demonstrates that the concept of family-centered care should be developed and implemented by the nurses together with the families to provide and evaluate care.

Anne’s family and the pediatric nurses should collaborate in order to provide the best care for Anne.

This approach is due to the fact parents know their children more than the nurse.

Anne’s family includes her siblings are the main source for support.

Anne could benefit from family-centered support in this difficult time of her life.

Close collaboration between nurses and family members will help reduce anxiety in the child and parent (Saleeba, 2008).

In certain cultures, it might not be clear what the parent’s role is in pediatric care.

But most parents agree that family centred care concepts require respect, support, collaboration and collaboration (Gill et.al., 2014).

Family-centered care is fraught with problems due to poor communication and insufficient understanding of how it works.

The nurses and family may have different views, which could lead to misalignment.

Anne’s parents operate an Indian restaurant. As you can see in the case, this implies they are Indians.

Reincarnation pain is extremely important in Indian culture.

Some Indian families might prefer that acute treatment emphasizes the management of symptoms and the control of the child’s pain.

Indians might opt to ignore caring for their sick child and focus instead on their spiritual needs. Wiener, McConnell Latella and Ludi (2013).

This organisation may disrupt family-centered infective care and delay recovery.

D. The Effects On The Hospitalization Of The Child

Hospitalisation has a variety of effects on children, depending on their stress tolerance.

The primary effect of childhospitalisation is stress. Children are taken away from their families and support environment.

The hospitalization experience can lead to emotional disturbance for most children (Kortesluoma Punamaki, Nikkonen, 2008.

If children are separated from their parents over a long time, emotional upset is common.

Personal factors, such as the child’s intelligence and temperament, can affect how they handle long-term and short term hospitalisation.

Anne could become emotional upset or experience stress if she remains in the hospital more than ten consecutive days.

Stress and anxiety are common in the family, particularly the parents.

However, the level of impact on the entire family will depend on how resilient the family is.

Conclusion

Appendicitis can be caused by a variety of factors.

Acute appendicitis can be caused by lymphoid overplasia, which is the most common factor in children.

Lymphoid is associated with several viral infections like mononucleosis or gastroenteritis.

Anne was a patient in an appendicitis operation and needs close attention from nurses.

Anne should have her treatment information made public and kept private. These are two approaches nurses should follow when caring for Anne.

Anne could experience emotional distress and her family may feel stress and anxiety.

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