The Pathophysiology of Appendicitis
Discuss the Case Study of Anne.
In this essay, case of Anne is discussed. She is diagnosed with appendicitis. Pathophysiology of Anne is discussed. Role of growth and development theories, developmentally appropriate care, family centered care and hospitalization of Anne are discussed.
In this essay case if Anne is discussed. Anne is diagnosed with appendicits. Appendicits is mainly inflammation of the inner lining of vermiform appendix. This inflammation can also spread to other parts. Obstruction of the appendix mainly occurs due to episodes of constipation and low fiber diet. As a result, there is fecalith occlusion in the appendix. Obstruction of the appendix leads to the trapping of the bacteria within appendiceal lumen. These bacteria begin to multiply and as a result appendix distended. Hence, Anne was prescribed with antibiotics (Brogden and Streets, 2013). This leads to the raised intraluminal pressure which obstructs venous drainage. Due to obstruction of the appendix, there is occurrence of ischemia. Ischemia increases chances of bacterial infection due to loss of epithelial integrity. This leads to the open wound and impaired tissue integrity. Infection and ischemia together induces inflammation of appendix. Peritonitis is mentioned in Anne which is an inflammatory condition. Due to inflammation and thrombosis of the appendicular artery and veins there is necrosis and gangrene of appendix (Feldman et al., 2010).
Perforation occurs in the gangrenous appendix. This perforation of the appendix is more common in younger children as compared to the adults. These perforations increase in the children with increase in the duration of symptoms. In Anne case this gangarene and perforated appendix condition mentioned. In the initial phase of the appendicitis, there may be only periumbilical pain because of T10 innervation of the appendix. Anne also mentioned about right iliac fossa pain. She was prescribed with morphine for relieving pain. Release of prostaglandin and bradykinin lead to the development of pain. Wound in the appendix stimulate nociceptors and send pain signals to the central nervous system. With the progression of the inflammation, there is formation of exudates on the appendiceal serosal surface. As result, exudate comes in contact with the parietal peritoneum and pain becomes more intensified and localized in the surrounding area (Story, 2011).
Perforation of the appendix results in the release of mucus fluid due to inflammation and bacteria in the abdominal cavity. This leads to the intensified inflammation of the peritoneal surface and as a result there is development of peritonitis. This peritonitis can be of diffused or localized based on the spillage of the luminal contents in the omentum and the adjacent bowel. If these contents form abscess, pain and tenderness may be localized at the abscess site. If these contents are fluid, pain and tenderness become generalized throughout peritoneum (Loeffler, 2014).
Nurse should incorporate growth and developmental theories in nursing intervention for Anne. These theories include psychoanalytic theories, learning theories, cognitive development theories and system theories. Erikson’s Psychoanalytical theories specifically deal with the awareness of the unconscious activities to the children (White et al., 2005). Appendicitis is associated with the inflammation and pain of the appendix. Nurse should evaluate this knowledge in Anne through psychoanalytical theories. Nurse should evaluate knowledge about social aspects about the disease in Anne. Hence, Anne can discuss about disease with society members and her peers. Scientific understanding and behavioral change can be accomplished through use of Albert Bandura's learning theories (Berk, 2009). Nurse should assess the reasons behind obstruction of appendicitis in Anne. Learning theories can teach Anne to repeat desirable incidences and avoid undesirable incidences. Nurse should ask her about constipation problem and her food habits. Nurse should advise her not to eat food which is responsible for constipation. Nurse should make her realize that an appendix is very common and serious problem in the children. Nurse should make her realize that her diseased condition can affect her family members negatively (Adler-Tapia, 2012). Generally, children are not aware of most of things. Hence, nurse should evaluate Anne’s knowledge and make her diseased condition understand.
Developmentally Appropriate Care for Anne
Piaget’s Cognitive developmental theory is very important in children because children are unable to distinguish between bad and good things as compared to the adults (Berk, 2009). Nurse should evaluate cognitive developmental theory in Anne to change her attitude towards right things. This would be helpful in curing Anne’s diseased condition. Anne can change her behavior towards right things by eating food which would not affect her appendix (Hahn et al., 2016). According to cognitive developmental theory, children are more eager to learn. Hence, nurse should utilize it and teach Anne about disease. Cognitive development theory don’t have place for emotions, hence nurse should not get controlled by emotions of Anne. Bronfenbrenner’s Systems theories of development are mainly based on the interaction and association of different people including family members for changing behavior of children (Berk, 2009). Hence, nurse should evaluate family members of Anne for provision of good food. Evaluation and execution of these developmental theories in Anne by nurse can definitely improve her disease condition (Leifer & Fleck, 2013).
Diseased condition in the Anne’s age could have long term effect on her growth and development. Nurse should make aware Anne and her family members about this fact. Nurse should advise Anne and her family members to give more attention to food. Because, food can adversely affect appendix. Nurse should tell her that she should not get depressed due to her diseased condition. She should mingle with society members and her peers. She should not keep her detached from society. Nurse should tell her that society members can help her to improve her diseased condition. Disease condition in this age can adversely affect Anne both physically and mentally (Lowry-Lehnen, 2015). This age appropriate intervention would definitely be helpful in improving diseased condition of Anne.
Family centered care is a vital component of the nursing intervention because children are not developed sufficiently to manage their disease condition. Anne’s family is her main force. Nurse should take this into consideration and involve her family members in providing nursing intervention to her. Nurse should enquire from her family members about her health issues, eating habits and psychological behavior. Based on this information, nurse can plan for her nursing intervention. Family members of Anne would be helpful in giving her emotional stability. It would also be helpful in improving morale of Anne. It would be helpful for Anne to tolerate social consequences. Nurse should give confidence to family members that proper medication can be definitely improve her condition (Law, 2012).
Nurse should involve family members of Anne in planning and delivering nursing care to Anne. Nurse should educate Anne’s family members for managing pain due to appendix. Nurse should advise family members of Anne to maintain proper hygienic conditions because infection due to food can exaggerate disease condition in Anne. Nurse should advise her family members to administer plenty of fluids. It can be helpful in removing obstruction in the appendix (Chalmers, 2017). Understanding of the disease condition can relive stress on family members of the patient and improve confidence in recovery.
Growth and Development Theories: Psychoanalytic, Learning, Cognitive Development, and Systems Theories
Nurse should understand Anne and her mother’s feelings and should give respect to them. Nurse should use respectful words with them. Nurse should comprehend strengths and weaknesses of Anne and her mother. Nurse should plan nursing interventions based on these strengths and weaknesses. Nurse should keep in mind socioeconomic and cultural background of Anne and her family while providing nursing intervention. Nurse should make aware of Anne’s accurate health condition to her family members. Nurse should also make them aware of anticipated effect on appendix after the completion of the nursing intervention (Barnsteiner et al., 2014). Children didn’t feel stress, if nursing intervention provided in the presence of their family members. By keeping this in mind, nurse should provide nursing intervention to Anne in presence of her family members. It is well proved that proper communication with family members is important for providing effective nursing intervention to children. Hence, nurse should ascertain proper communication with family members because it is difficult for Anne to understand health related issues. Communication with family members would be helpful in improving knowledge of family members about the treatment to be provided to Anne. By virtue of this, nurse can incorporate them in decision making and care of Anne at home. Hospitalization can be effectively reduced with implementation of family centered care. Family centered care give satisfaction to Anne and her family members (Shaul, 2014; Watson and Rodwell, 2014). Family centered care would strengthen relation between nurse and Anne’s family members. By virtue of this nurse can win confidence of her family members. Family centered care would be helpful in treating Anne and relieving stress on her family members.
Hospitalization is the significant part of children care. However, long duration hospitalizations of children can negatively affects children both physically and mentally. Anne may feel separated and rejected from the family members and peers due to hospitalization. Anne may feel anxious due to fear of pain during hospitalization. Nurse should give her assurance that hospitalization is for her wellbeing. Also, nurse should assure her that they will discharge her immediately after her improvement (Thurston, 2014). It reflects, nurse should give psychological counseling to Anne and promote her for hospitalization.
Nurse should brief her about medical procedure so that she would be relieved from the stress. Nurse should ask her family members to counsel her for hospital admission. Nurse should give flexibility to her family members to stay with her in hospital and nurse should give permission to her peers to meet her. By virtue of this she would not feel isolated from her family members. This would help to stay happily in the hospital. Literature also mentioned that, children with high morale respond treatment succefully than children with low morale. Nurse should give her assurance that, society is going to help her in improving her condition. Nurse should provide counseling to family members of Anne about financial issues due to hospitalization. Nurse should maintain confidentiality of Anne’s hospitalization. Nurse should provide suitable environment foe Anne in the hospital based on her medical history, behavioural history, cultural background and socioeconomic status (Tehrani et al., 2012; Brykczynska and Simons, 2011). This type of dignity provision to Anne and her family would encourage them for hospitalization. Nurse should consider these factors for hospitalization of Anne.
Appendictis is the inflammatory and infectious condition which specifically affects appendix. Constipation and improper food are the triggering factors for appendicitis. Disease condition worsens due to infection and ischemia. In this case Anne is diagnosed with appendicitis. Nurse should implement growth and development theories for holistic care of Anne. Nurse should consider age of Anne while providing nursing intervention to her. This age consideration is important because in this age there are chances of certain physiological and psychological changes in the children. Multiple factors are involved in the care of Anne. Hence, nurse should implement family centered care to Anne. Nurse should consider multiple factors during hospitalization of Anne. Consideration of all these factors would definitely be helpful in implementing holistic care to Anne.
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