Pathophysiology of Appendicitis

In nursing profession, child and nursing care involve care for a sick newborn to an adolescent to make him recover from any road accident (Cockcroft, 2012). These professional work as a part of multidisciplinary teams and their key roles include assessing and planning the requirements involved in childcare unit, dealing with emergencies, supervising junior staff, organizing workload and preparing notes of the events (Shields et al., 2012). In this assignment discussion about Anne (10) whose signs and symptoms have been recognized as appendicitis has been informed. Further, after describing the pathophysiology of presented problem, evaluation of the nurse’s role in delivering the appropriate nursing care in relation to Anne’s case study will be described with growth and developmental theories, family-centered care and the effect of hospitalization on the child will be mentioned in this assignment.

The appendix is a finger-shaped pouch present in the lower right side of the abdomen and inflammation of this pouch is called as appendicitis. As per Singal et al. (2012) there is no specific role of this vestigial organ in the human body, however, the presence of lymphatic tissue imparts in the immune system. As per Bhangu et al. (2015) the emergence of appendicitis in teenage or young adults determines due to the pathophysiological role of different lymphoid aggregates, which is present in a huge amount in the appendix during this period. Therefore, as per this theory of Chandrasegaram et al. (2012), such obstruction commences inflammatory changes in the surrounding tissue which eventually rises the intraluminal pressure and ischemia (Singal et al., 2012). Further, the inflammation in the appendix makes it enlarged and the surrounding tissues such as peritoneum and percicecal fat becomes inflammatory. The primary event of obstruction occurs in the luminal obstruction, which could have resulted due to hyperplasia in lymphoid tissues, parasites and foreign bodies, fecaliths, and presence of metastatic and primary tumors. Within this as per the research of Nasiri et al. (2012), fecaliths and the fecal stasis are one of the major reasons for the obstruction which is followed by fruit seeds, vegetable matters, and intestinal worms (Chandrasegaram et al., 2012). Due to untreated obstruction, perforations and rapid distension of the appendix are witnessed, which is a sign of acute appendicitis. As the luminal pressure within appendix increases venous pressure, mucosal ischemia starts developing, and once the pressure is beyond 85mm Hg, thrombosis occurs, which commences the arterial flow, vascular congestion, and engorgement of the appendix (Bhangu et al., 2015). Further due to extending inflammation to the peritoneum, serosa and nearby organs, visceral afferent nerve fibers which are associated with the spinal cord at T8 to T10, are stimulated due to which the epigastric and the umbilical pain occurs (Nasiri et al., 2012). During this phase, the pain shifts from the naval area to the lower right side of the abdomen. If it is not treated even in this phase, it compromises the arterial blood flow with a permanent infraction, it leads to perforation and gangrene and the time required for this changes ranges from 24 to 36 hours of shifting of the pain. Besides this extreme pain, patients suffer from nausea, vomiting tendency and anorexia, which makes the condition much worse pathophysiologically (Singal et al., 2012).

Growth and Developmental Theories for Children

Growth and developmental theories are important in nursing studies so that while caring for a patient, a nursing professional can prepare a framework of care, are able to provide logic and explanations to the interventions (Moon, 2013; Karmiloff-Smith, 2018). Where growth is associated with a quantitative change in the patient such as age, weight and so on, development is concerned with the qualitative, progressive, and continuous process of change (Hockenberry & Wilson, 2014). There are four aspects, which should be involved in the developmental care for Anne (10) who is admitted to the healthcare facility due to appendicitis. These are biophysical, psychosocial, cognitive and moral aspect if development (Alligood, 2017). Further, the list of theories for each of this aspect contains Gesell’s theory, genetic theory of aging, Nongenetic Cellular Theories physiological theory of aging (biophysical), Erikson’s theory for psychosocial development, Jean Piaget’s cognitive theory of development and moral development (Fawcett & Desanto-Madeya, 2012). Within these, the cognitive development theory of Jean Piaget will be used for the treatment of appendicitis of Anne (10). Inhelder, Sinclair and Bovet (2014) suggests that while caring for patients of such tender age, nursing professional should use the developmental theory for the cognitive strength of the patient.  As per this, the age of Anne fits in the concrete developmental stage of cognitive development and therefore in this time the logical thoughts are developed (Piaget & Inhelder, 2013). This stage is named as a concrete developmental stage because the thinking of children at this stage is similar to concrete; their thinking becomes sophisticated and logical in nature. Besides this, the Denver developmental scale, which was first developed in 1967 to determine the mental development of young children up to the age of 6 years, can also be used for Anne, as it will help to determine her mental development and ability to absorb the medical information provided to her (Wang et al., 2013). Therefore, the nursing professionals in care will provide a lucid and easy representation of Anne’s health condition to her so that her mental state would not be affected and she can decide about her healthcare related needs with the help of healthcare professionals. Hence, as per the research of Piaget (2013), this growth and developmental theory of cognitive development by Jean Piaget will be used in this case of Anne.

The role of the family in such care process of a child is similar to the nursing professionals as a vulnerable child can only be controlled by the empathy and care of her parents and siblings. This is an important aspect in child and pediatric nursing as using the family centered care in the treatment of patient, as nurses are only able to understand the level of medication conversation or informed care they can provide to the patient depending upon their human behavior and knowledge (Bowlby, 2012). However, implementing family center care provides their treatment an array so that holistic care can be approached (Bakker et al., 2013). In this pediatric care process of Anne, the role of her parents and her four siblings are very important, as through them the nursing professionals will be able to collect the consent and compliance to the ethical and nursing interventions (Coyne, 2015). Hence, in care process of Anne, the nursing professionals need to understand the emotional, social and developmental support they and the patient require from the family and involve them in the care process actively in decision-making, planning and provision of Anne’s care process (Hockenberry & Wilson, 2014). The first thing the nursing professionals should perform is to assess Ann’s understanding about her hospitalization so that the level of participation of the patient and family in the care process can be determined (Cockcroft, 2012). The entire family and the patient will be provided with a presentational representation of Anne’s health issue and will be provided with the consequences of not providing her with appropriate care. All the children will be assessed for their mental and cognitive strength after going through the presentation so that their vulnerability does not affect the care process of the patient (Shields et al., 2012). Finally, Anne’s father and mother will be asked to take an active part in the care process by following the healthcare professional’s instruction carefully throughout the care process so that their daughter could be treated according to the care framework. Therefore, using the family-centered care, assessment of the awareness of the associated family, appropriate care will be provided to Anne, and her family will take an active part in the care process throughout (Bakker et al., 2013).

The Role of Family-Centered Care in Nursing

Rokach (2016) mentions that the effect of hospitalization varies for each child, depending on their ability to cope with the stress and tension of healthcare facilities. This effect varies widely from physical, psychological and emotional effect, as children are prone to the adverse effect of such a stressful environment of healthcare facilities. This also has several consequences for the family involved in the care process of the children admitted. Shields et al. (2012) mention that the experience of children of hospitalization is generally full of anxiety and traumatic, as they are unable to understand and cope up with the schedule, consumers and professionals and their attitude. While scared, and under stress, children require their parents and family so that they can feel strong and capable to cope up with the situation. Hence, in case of Anne, her family was involved in the care process so that her parents can control her with the force of strength and ability to cope up with the stress and pain of healthcare interventions. Further, in case of Anne, her siblings will be allowed to meet her thrice daily so that with familiar faces and voices, Anne could not feel isolated or alone within healthcare facility (Bowlby, 2012). Further to understand her psychological stability while care interventions in the child care unit of healthcare facility, a psychologist will be asked to assess her mental state and provide her with some activities and interventions using which, without any physical movement she can keep herself busy and free from any negative thoughts (Ball et al., 2013). Moreover, in the process of needles and injections, the pediatric nurses should use different techniques so that diverting the patient in some other activities they can provide her with painful nursing interventions. These interventions will help the healthcare professionals to understand the mental state of the patient without any forceful activity and they will be able to divert the patient from her negative and destructive thinking without implementing any harsh or painful intervention. Finally, the nursing professionals should assess the patient’s stress and anxiety level once daily so that emergence of stress and depression could be assessed in its early stage and important interventions could be applied (Rokach, 2016).

Conclusion

Child and pediatric care nursing professionals face difficult and dilemmatic situations, as care process of children are always difficult and full of barriers. In this assignment, the case of Anne (10) was discussed who is suffering from acute appendicitis and is admitted to the healthcare facility for 10 days. Therefore, after providing the pathophysiology of her appendicitis condition, the growth and developmental theory of Jean Piaget for cognitive development were discussed and used. Further, the role of family-centered care in case of Anne was discussed so that her experience of hospitalization could be assessed and improved

The Effects of Hospitalization on Children

References

Alligood, M. R. (2017). Nursing Theorists and Their Work-E-Book. Elsevier Health Sciences.

Bakker, A., Maertens, K. J., Van Son, M. J., & Van Loey, N. E. (2013). Psychological consequences of pediatric burns from a child and family perspective: a review of the empirical literature. Clinical psychology review, 33(3), 361-371.

Ball, J. W., DrPH, R. N., Bindler, R. C., & Cowen, K. J. (2013). Child health nursing. Prentice Hall.

Bebbington, A., Glasson, E., Bourke, J., de Klerk, N., & Leonard, H. (2013). Hospitalisation rates for children with intellectual disability or autism born in Western Australia 1983–1999: a population-based cohort study. BMJ open, 3(2), e002356.

Bhangu, A., Søreide, K., Di Saverio, S., Assarsson, J. H., & Drake, F. T. (2015). Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet, 386(10000), 1278-1287.

Bowlby, J. (2012). The making and breaking of affectional bonds. Routledge.

Chandrasegaram, M. D., Rothwell, L. A., An, E. I., & Miller, R. J. (2012). Pathologies of the appendix: a 10?year review of 4670 appendicectomy specimens. ANZ journal of surgery, 82(11), 844-847.

Chinn, P. L., & Kramer, M. K. (2013). Integrated Theory & Knowledge Development in Nursing-E-Book. Elsevier Health Sciences.

Cockcroft, S. (2012). How can family centred care be improved to meet the needs of parents with a premature baby in neonatal intensive care?. Journal of Neonatal Nursing, 18(3), 105-110.

Coyne, I. (2015). Families and health?care professionals’ perspectives and expectations of family?centred care: hidden expectations and unclear roles. Health expectations, 18(5), 796-808.

Fawcett, J., & Desanto-Madeya, S. (2012). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories. FA Davis.

Hockenberry, M. J., & Wilson, D. (2014). Wong’s nursing care of infants and children-E-book. Elsevier Health Sciences.

Inhelder, B., Sinclair, H., & Bovet, M. (2014). Learning and the Development of Cognition (Psychology Revivals). Psychology Press.

Karmiloff-Smith, A. (2018). Précis of Beyond modularity: A developmental perspective on cognitive science. In Thinking Developmentally from Constructivism to Neuroconstructivism(pp. 64-94). Routledge.

Moon, J. A. (2013). Reflection in learning and professional development: Theory and practice. Routledge.

Nasiri, S., Mohebbi, F., Sodagari, N., & Hedayat, A. (2012). Diagnostic values of ultrasound and the Modified Alvarado Scoring System in acute appendicitis. International journal of emergency medicine, 5(1), 26.

Piaget, J. (2013). Mental Imaginery in the Child: Selected Works vol 6. Routledge.

Piaget, J., & Inhelder, B. (2013). The growth of logical thinking from childhood to adolescence: An essay on the construction of formal operational structures. Routledge.

Rokach, A. (2016). Psychological, emotional and physical experiences of hospitalized children. Clinical Case Reports and Reviews, 2(4), 399-401.

Shields, L., Zhou, H., Pratt, J., Taylor, M., Hunter, J., & Pascoe, E. (2012). Family?centred care for hospitalised children aged 0?12 years. Cochrane database of systematic reviews, (10).

Singal, R., Mittal, A., Gupta, A., Gupta, S., Sahu, P., & Sekhon, M. S. (2012). An incarcerated appendix: report of three cases and a review of the literature. Hernia, 16(1), 91-97.

Wang, B., Zhan, S., Gong, T., & Lee, L. (2013). Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anaemia. Cochrane Database of Systematic Reviews, (6)