Principles Of Pediatric Nursing: Pathophysiology Of Appendicitis And Nursing Essay.

Pathophysiology of Appendicitis and Peritonitis

Discuss about the Principles of Pediatric Nursing.

Appendicitis is one of the most common disorder, which needs emergency surgery before the development of any complications. Instead of the fact that in most patients the symptoms of acute appendicitis is easily diagnosed, but in some cases, some variable signs are seen, where the clinical diagnosis is difficult in initial stage, which promote ignorance of the condition and thereby leading to a severe condition of the disorder (Schietroma et al., 2012). In the current case study, the focus is an 8-year old boy mark, who has gone through a severe case of appendicitis, where the infection perforated the peritoneal cavity, causing peritonitis. In this essay the pathophysiology of appendicitis will be discussed. In addition to this the nursing care based on developmental theories, family-centered care and effect of hospitalization will be highlighted based on this case.

The case study is focused upon the 8 years old boy, Mark, who was experiencing right iliac fossa pain and admitted to the emergency department of a local hospital. Upon assessing his symptoms, physicians suspected the onset of appendicitis. After confirming the situation, the emergency department doctors took him to the theater for an appendectomy. The surgical team identified a gangrenous perforated appendix with peritonitis. It is a severe infection in appendix. Peritonitis is characterized as the inflammation of serosal membrane lining the abdominal cavity. The peritoneum is a sterile environment, but the pathogenic microorganisms or their toxic products can cause intra-abdominal sepsis, which causes the inflammation of peritoneum (Bröker et al., 2012). The pathophysiology of peritonitis is related to the intra-abdominal sepsis from a  perforated viscus, which is caused from direct spillage of lumina contents in the peritoneum. The bacterial inoculation in the sterial area is related to the inflammation and infection of appendix.

The perforated appendix is caused by the obstruction of the appendiceal lumen due to insisted stool, lymphoid hyperplasia or the infection caused by microorganism. However, considering the correlation within the appendicitis and distribution of lymphoid tissue, the obstruction of the lumen can be highlighted as a common cause (Chen et al., 2012). The bacterial overgrowth in the lumen is influenced by the obstruction of lumen, which further leads to the distention of lumen with increased intraluminal pressure. It then leads to venous obstruction. All of these processes lead to bacterial overgrowth, acute inflammation and edema (Markar et al., 2012). As a result of these, the appendix becomes ischemic and edematous, which further promotes the necrosis of appendiceal wall along with the invasion of bacteria through the ischemic wall, causing a gangrenous appendicitis.          

Nursing Care for Pediatric Patients with Appendicitis

In the case of Mark, this condition was not recognized and neglected. As a result, the gangrenous appendix perforated into the sterile peritoneal cavity with spillage of appendiceal residue, causing peritoneal infection. In Mark’s case, this sequence of events occurred slowly and the appendix contained by the “inflammatory response and omentum”, which further led to localized peritonitis and appendiceal abcess (Schietroma et al., 2012). Finally, the progress in this condition causes sepsis and diffuse peritonitis. In this condition, the bacterial overgrowth is generally promoted by a range of facultative aerobic bacteria, which are involved in other colonic disorders (Chen et al., 2012). As the bacterial pathogens, which have grown in the appendic’s wall are perforated through the peritoneal cavity, the same bacterial culture could be isolated from both the gangrenous appendicitis and infected peritoneal cavity.

According to the case study, Mark was initially suspected with appendicitis and was suggested for an appendectomy. The result of the post surgery states that the boy was suffering from gangrenous perforated appendix with peritonitis. He was under few medications after the operation and other treatments associated with his complications (Ball et al., 2012). Due the severe infection he was retained in the hospital for 10 days under the nursing care. Nursing is a noble job. The status of a nurse in pursuing her professional practices states the value a community places on the nursing job. The values, ethics and beliefs related to the profession are an integral part o0f the professional education practice.

According to Perry et al. (2014), perforation of appendix is a major complication that can lead to peritonitis. Therefore, proper nursing intervention is important in order to reduce the severity of Mark’s condition. The main priorities of the nurse in such a condition are prevention of complications, promote comfort, and give the details of the information related to the surgical procedure, treatment requirements and the complications associated with this condition (Butcher et al., 2013). In this case the nursing management will involve relieving goal, anxiety reduction, controlling and prevention of the fluid volume deficit, elimination of the infection caused by the disruption in the GI tract and attaining most favorable nutrition.

The various theories of development provide a structural framework in order to think about the growth, development and learning. As discussed by Barnes & Rowe (2013), the developmental theories give a base to understand the set of guiding concepts and principles which explains the human development. The understandings of theories are very important since the nursing practice is directly responsible for assuring physical, cognitive and moral development in the patients. Every child passes through certain predictable stages of development as they move towards adulthood.

Developmental Theories in Pediatric Nursing

There are various theories based on the development of human beings. Piaget termed the stage of the school going children as concrete operational stage. Depending on the age it can be concluded that Mark, belongs to this stage. According to Piaget, the school age children are capable of identifying concrete solutions to any complications or problems and thus, they can discover the impact of such complications on relationships (Haley & Stott, 2013). In regards to the case of Mark, he was able to identify his problems and the sympathetic approach towards him after the surgery. Due to his severe infection and surgery he experienced chronic pain. As a nurse one should therefore be aware of the age before initiation with the nursing intervention. As a pediatric nurse, she should understand the thought process of Mark and the emotional disturbance caused due to his condition. In response to this stimulation activities which are meaningful and appropriate should be designed. Presence of the parents for an eight years old child is more important that experiencing of strangers should be prioritized. The duty of a pediatric nurse is not only to monitor Mark’s clinical outcomes, medication, preventions of spreading of infection due to nosocomial infection, providing proper diet, but also to make certain explain them the details of their treatment, provide them with story books, offering of manipulative toys and show sympathy and care in order to promote his cognitive health ("Child, adolescent and family nursing (Book, 2012) [WorldCat.org]", 2016).

Another theory, related to human growth and development is Kohlberg’s theory of moral development.  According to this theory, a school age child enters into the conventional development stage (Hockenberry & Wilson, 2014). One of the most striking characteristics of children of this age is that these children have trouble related to self-care measures when they are away from the guidance of either their parents or nurse. Therefore, as a nurse it is very important to take proper decision based on the need of the child. Evidences reflect the fact that a moral and positive moral can speed up the curing process. Therefore it becomes necessary for the pediatric nurse to take proper and situational decision related Mark’s treatment process. In addition to this she should also keep in mind to integrate the child in the decision making process to boost up his moral.

There are two determinants that can aid in identifying the pattern of an individual’s development. The two determinants are nature and nurture. According to Johnson (2013), nurses can relate the concept of self-efficacy in teaching children and his families. Plan a teaching project for these children to foster healthy life style. In terms of the sick children their needs may cause the parents to withdraw them from the social world in order to focus on child care. The member of the multidisciplinary team especially nurses can help promoting family resilience. Family centered approach aids in offering mental, emotional and practical support to the parents adapting to the child’s illness. In case of Mark, such an approach can provide help to support his family members (Banazadeh et al., 2015). As a key member of the multidisciplinary team caring for Mark with appendectomy operation and peritonitis and his family, the nurse can develop a therapeutic, long-standing relationship in the next 10 days of the child’s stay in the hospital. The family-centered approach will involve parents in caring through information and providing education to combat with the stress and anxiety associated with their child’s condition. Therefore, the pediatric nurses should possess extensive communication, teaching and management skills.

Kohlberg’s Theory of Moral Development

The healthcare professionals involved in the caring for the child and family should adapt a holistic approach of treatment during the stay in the hospital, in order to assure proper care provided to the child. According to Bowlby, hospitalization can cause mental scars on children significantly due to the separation of the child from his or her parents. Studies and evidences confirmed the advantages of admitting the parents in the children ward (Alavi et al., 2015). The outcome of the studies reflects positive results on the distress level. Moreover, hospitalization is associated with psychological and emotional distress due to the routine procedure for the child as well as the parents. In this case study, Mark is not adapted to the routine treatment procedure and the clinical environment. Therefore, it is important for a pediatric nurse to understand the emotional stress of the child and his parents and educate them to cope up with the clinical settings. Moreover, in order to preserve and help Mark to adapt with his physical and environmental change, it is necessary for the nurse to show friendly gestures, sympathy and empathy during the treatment procedure (Banazadeh et al., 2015).

Appendicitis is one of the common disorders if diagnosed in the initial stage, can be treated but if the condition is not treated in the initial stages can lead to complications such as Mark, who suffered from appendicitis and during his operation gangrenous perforated appendix with peritonitis was observed. In such a condition a child’s physical, mental and cognitive development are hampered. Therefore, a pediatric nurse should be aware of the effect of hospitalization on the child and his family. Depending upon several developmental theories, care should be given to the child for improving his health condition.

Reference List:

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Barnes, M., & Rowe, J. (2013). Child, youth and family health: Strengthening communities. Elsevier Health Sciences.

Bröker, M. E., van Lieshout, E. M., van der Elst, M., Stassen, L. P., & Schepers, T. (2012). Discriminating between simple and perforated appendicitis. Journal of Surgical Research, 176(1), 79-83.

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Child, adolescent and family nursing (Book, 2012) [WorldCat.org]. (2016). Worldcat.org. Retrieved 11 September 2016, from https://www.worldcat.org/title/child-adolescent-and-family-nursing/oclc/776539269

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Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2014).Maternal child nursing care. Elsevier Health Sciences.

Schietroma, M., Piccione, F., Carlei, F., Clementi, M., Bianchi, Z., Vita, F. D., & Amicucci, G. (2012). Peritonitis from perforated appendicitis: stress response after laparoscopic or open treatment. The American Surgeon, 78(5), 582-590.