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Discuss About The Antibiotic Treatment Of Acute Appendicitis In Children.

Causes of Appendicitis

Appendicitis is mainly defined as the condition that includes inflammation of the inner lining of mainly the vermiform appendix that in turn spreads to the other parts of the body. Researchers are of the opinion that although diagnostic and even therapeutic advancement in medication had taken place, this clinical condition had still prevailed to be a clinical emergency and  is still been found to be one of the acute causes of the abdominal pain (Svensson et al., 2015). This assignment would be mainly be based on the nursing interventions of caring for a child patient who had undergone surgery for appendectomy and requires care in the hospital from the healthcare professionals to fight infection.

Appendicitis is mainly seen to occur after the obstruction of the appendiceal lumen. The important causal factors are the occurrence of the lymphoid hyperplasia that might occur as a secondary outcome if inflammatory bowel disorder as well as infections with the latter being more common in the children. Fecaliths and fecal stasis are the causes in the elder patients, parasites in the eastern countries and more rarely neoplasm and foreign bodies. Appendicitis would take place when the appendiceal lumen is obstructed due to above-mentioned causes (Hartwich et al., 2016). Such obstruction caused by the substances results in increasing the pressure with the appendiceal lumen. This associates with the increase in the continuous secretion of the mucus as well as the fluids and mucus from the mucosa and the stagnation of this material. Within the same time, the intestinal bacteria within the appendix are seen to multiply and this leads to the recruitment of the large number of white blood cells. This is seen to associate with that of the formation of pus and subsequent higher intra-luminal pressure (Svensson et al., 2017).


When obstruction in the appendiceal region is seen to persist over a long period, intra-luminal pressure is seen to rise above that of the appenidiceal veins. This in course of time results in obstruction in the venous flow. Therefore, this results in the beginning of the appendiceal wall ischemia, which in thereby results in the loss of the epithelial integrity. This is seen to allow bacterial invasion mainly in the appendiceal wall (Shah et al., 2016).

Within a very few hours of the occurrence of this situation, the local condition might seem to get worsen. This would be mainly because of the thrombosis of the appendicular artery and the veins. This would lead to perforation as well as gangrene of the appendix region. When this procedure is seen to continue, a peri-appendicular abscess or the peritonitis might also occur. Therefore, in the child patient, these occurrences have taken place and therefore the child was suffering from immense pain and was admitted to the emergency ward.

Stages of Cognitive Development

One of the most important developmental theories that can be applied to the child named Anne is the Piaget's Cognitive Developmental Theory. This theory mainly helps in understanding the development of the though process of the children and shows the different ways by which thought procedures help in influencing the ways individuals interact and understand the surrounding world. Anne would be belonging to the specific stage called the Concrete Operational stage as this stage mainly includes individuals belonging to age group between 7 and 11 and Anne belongs to the age of 10. During this stage, children are seen to develop better understanding of the different mental health problems they are seen to start thinking logically as well as concrete events (Osherson, 2017). However, they might face difficulty in the understanding abstract as well as hypothetical concepts. In case of Anne, it is seen that she is 10 years old where she might learn to think logically; therefore, she might raise questions to the nursing professionals about her disorder. Therefore, it becomes every important for the nursing professionals to make her understand her disorder but in a tone and manner that do not create fear and anxiety in the patient. The nursing professionals should make her understand the disorder in a way by which she can relate to and not in any ways that might leave confusion in her.

Another developmental theory that can be applied is the Bowlby’s attachment theory. The researchers named John Bowlby had proposed that early relationship with that of the caregivers might play an important as well as the major role in the development of the child and thereby they should be continuing to influence social relationships throughout life (Sieglar, 2016). Children are born with innate requirement to develop attachments and such attachments help in the aiding of the survival and ensure that the child receives care as well as protection. Therefore, the professionals should ensure that both the child and the caregivers should be engaging in the behaviors that would be designed for ensuring proximity. Children should be needing to stay close as well as connected to the different caregivers who in turn should be providing safe haven and hence a secure base for exploration. Therefore, the nursing professionals who would be caring for the child would require to develop empathetic and compassionate relationship with the patient. She needs to be friendly with her and less judgmental and have to understand the psychology of the child who had undergone surgery. The child might feel fearful, anxious and threatened and therefore, the professionals have to be her constant companion and talk to her in ways by which the child can rely, trust and confide in the professional. This would help in developing attachment and positive outcome on the child (Coyne et al., 2016).

Attachment Theory


A child of the age 10 might have several developmental milestones but the ones, which are worth mentioning in regards to the case scenario, are the emotional changes and the cognitive changes. Physical changes like preliminary changes before the onset of puberty might affect children in this age but such references are not required in the case study. The children are seen to develop stronger and complex relationships with friends and this becomes an important aspect in their life. Therefore, Anne can miss friends of her school and nurses should take steps in ways by which she gets over the sadness and missing of friends. They can engage her in different activities on the hospital bed only (Shields, 2015). She might get concerned about the body image as puberty approaches and therefore nurses need to clarify every aspect regarding the surgery to the patient to overcome her confusions of the body image. Children at this age might start becoming independent of the family but they are seen to maintain close bonds with their parents and with siblings and cousins. They tend to have frequent squabbles with siblings, fight with younger siblings and others.  Therefore, professionals can arrange for phone calls when she remembers them or misses them and constantly give her hope of her getting well and discharging from the hospitals (Rankin, 2015).


Researchers are of the opinion that healthcare professionals caring for the child should also consider the impact of thee admission of the child on the family members. Family centered acre is mainly developed for caring for children in the hospital ensuring that the care is planned by the healthcare members surrounding the family and not only the child. This would help in the reduction of the emotional trauma and would help in the recovery procedures as well. One of the most important aspect of the FCC is information sharing (Roueu et al., 2017). The healthcare professionals should communicate and thereby share the complete as well as unbiased information of the different ways that are affirming as well as useful. Studies have revealed that when patients and families are seen to receive information timely, completely and accurately, it would help them to overcome anxiety, fear, tensions and stress. It would also help them to participate in care and decision making effectively. Therefore, professionals should discuss information in details with the parents so that they can overcome stress and fear. It also involves ensuring collaboration participation of the team members with the families and parents in order to provide care to the children that align with the children’s needs and likings (Curtis & Northcott, 2017). This would help Anne to feel homely in the alien environment of the hospitals and would help both Anne and her parents to live a better quality life that is free from stress and fear.

Developmental Milestones of Children


Studies reveal that experiences of children in being hospitalized is mainly anxiety provoking and even traumatic. Children are mostly seen to be prone towards falling ill and their hospitalization is a stressful event that has potential untoward consequences for the children and even their families. Many of the children are seen to consider hospitals as the foreign land to whose outcomes, schedules and languages they are completely unaware of. It is seen that as they have cognitive as well as emotional limitations and even dependence on the others, children are particularly seen to be vulnerable towards stress that is involved in adapting to their condition of illness as well as hospitalization (Burge et al., 2014). When children get scared, tired or are in pain, they become dependent on the safe as well as the stable environment of their home and even the love and support of their family members. This gives them the ability to scope and feel strong and capable. As children grow up, they depend on their parents and family support and well-being for daily functioning and when they become ill, they tend to need the support of the family. This is mainly because their limited coping skills and emotional resources are not designed appropriately for handling the tremendous amount of physical and emotional stress on them during hospitalization. Therefore, they are seen to feel lonely and scared. Therefore, it is important for healthcare professionals to provide a safe and empathetic environment of their home and help them to reside in a newly developed familiar and comfortable environment that do not seem alien to them. Often lack of information results in anxiety and stress in the parents who tend to get confused, stressed as well as agitated when they cannot understand what would be done with the child and what would be the fate of the child (Shields, 2016). Moreover, the sufferings of the child create an emotional turmoil in the parents making them feel helpless, as they cannot contribute to the pain relieving session of the child. All these result in development of sadness and emotional instability that affect the quality of the lives of all. In such situation, family centered care is helpful in tackling the situations effectively and ensuring better quality lives does all (Mortenson et al., 2015).

From the above discussion, it becomes clear that hospitalization of the children affects not only on the health of the children but also the parents and the family members. In the case study, the child patient had undergone appendicitis surgery following which she has to stay for ten 10 days in the hospital. Here the nursing professionals need to apply their concept of developmental theories and thereby ensure nursing interventions that align with her age and requirements. Family centered care need to be given only after considering the impact of hospitalization on the patient as well as the child. This would ensure better quality life for all.

Family Centered Care

References:

Burge, F., Lawson, B., Johnston, G., Asada, Y., McIntyre, P. F., Grunfeld, E., & Flowerdew, G. (2014). Bereaved family member perceptions of patient-focused family-centred care during the last 30 days of life using a mortality follow-back survey: does location matter?. BMC palliative care, 13(1), 25.

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.

Coyne, I., Hallström, I., & Söderbäck, M. (2016). Reframing the focus from a family-centred to a child-centred care approach for children’s healthcare. Journal of Child Health Care, 20(4), 494-502.

Curtis, P., & Northcott, A. (2017). The impact of single and shared rooms on family?centred care in children's hospitals. Journal of clinical nursing, 26(11-12), 1584-1596.

Hartwich, J., Luks, F. I., Watson-Smith, D., Kurkchubasche, A. G., Muratore, C. S., Wills, H. E., & Tracy Jr, T. F. (2016). Nonoperative treatment of acute appendicitis in children: a feasibility study. Journal of pediatric surgery, 51(1), 111-116.

Mortensen, J., Simonsen, B. O., Eriksen, S. B., Skovby, P., Dall, R., & Elklit, A. (2015). Family?centred care and traumatic symptoms in parents of children admitted to PICU. Scandinavian journal of caring sciences, 29(3), 495-500.

Osherson, D. N. (2017). Logical Abilities in Children: Volume 1: Organization of Length and Class Concepts: Empirical Consequences of a Piagetian Formalism. Routledge.

Rankin, J. M. (2015). The rhetoric of patient and family centred care: an institutional ethnography into what actually happens. Journal of advanced nursing, 71(3), 526-534.

Roué, J. M., Kuhn, P., Maestro, M. L., Maastrup, R. A., Mitanchez, D., Westrup, B., & Sizun, J. (2017). Eight principles for patient-centred and family-centred care for newborns in the neonatal intensive care unit. Archives of Disease in Childhood-Fetal and Neonatal Edition, fetalneonatal-2016.

Shah, S. R., Sinclair, K. A., Theut, S. B., Johnson, K. M., Holcomb III, G. W., & Peter, S. D. S. (2016). Computed tomography utilization for the diagnosis of acute appendicitis in children decreases with a diagnostic algorithm. Annals of surgery, 264(3), 474-481.

Shields, L. (2015). What is “family-centred care”?. European Journal for Person Centered Healthcare, 3(2), 139-144.

Shields, L. (2016). Family-centred care: the ‘captive mother’revisited. Journal of the Royal Society of Medicine, 109(4), 137-140.

Siegler, R. S. (2016). Continuity and change in the field of cognitive development and in the perspectives of one cognitive developmentalist. Child Development Perspectives, 10(2), 128-133.

Svensson, J. F., Patkova, B., Almström, M., Naji, H., Hall, N. J., Eaton, S., ... & Wester, T. (2015). Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Annals of surgery, 261(1), 67-71.

Svensson, J. F., Patkova, B., Almström, M., Naji, H., Wester, T., Hall, N. J., ... & Pierro, A. (2017). Design of studies for Antibiotic treatment of acute appendicitis in Children: in support of RCTs. Annals of surgery, 266(1), e6-e7.

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