Posted: July 22nd, 2021

NRSG257 | Child and Family Nursing


Appendicitis is a crucial medical emergency and a standard reason for extreme stomach ache. The first therapy for acute appendicitis is surgical procedure. Regardless of the advances in diagnostic and therapeutic procedures, appendicitis remains to be a serious well being burden. This project relies on a case examine of Anne, a ten-year-old woman, who has been identified and handled for appendicitis. The primary a part of the paper will talk about the pathophysiology of appendicitis. Within the second part, it can discover the nurse’s position in providing developmentally appropriate nursing care. This part will particularly talk about development and developmental theories; household centred care and impacts of hospitalisation of the kid.

A. Pathophysiology

The pathophysiology of acute appendicitis begins with obstruction of the appendicular lumen. In youngsters, the obstruction of the appendicular lumen is primarily attributable to lymphoid hyperplasia (Schlossberg, 2015). Lymphoid hyperplasia is related to viral sicknesses like gastroenteritis, mononucleosis or higher respiratory an infection. Nevertheless, there are a number of different causes of the obstruction. These causes embody international our bodies, gastrointestinal parasites and Crohn’s illness (Elgazzar, 2014). Some tumours corresponding to adenocarcinoma and carcinoid tumours. Luminal obstruction ends in accumulation of distal secretions in addition to intraluminal stress, which results in the impairment of venous outflow. As soon as the venous outflow is impaired, the arterial influx can also be affected adversely. The rise in intraluminal stress ends in tissue ischemia, transmural irritation, overgrowth of micro organism, appendiceal infarction and finally, perforation (Elgazzar, 2014). The progress from obstruction to perforation at all times happens over 72 hours. Irritation would possibly consequently prolong into the parietal peritoneum and shut buildings resulting in stomach abscesses.  

Narsule and colleagues discovered that appendiceal perforation is extra prevalent in youngsters, particularly younger youngsters, in comparison with adults. The examine unravelled that the possibility of perforation inside 24 hours of improvement of obstruction was 7.7 p.c, and the chance appeared to extend with length of signs (Narsule, Kahle, Kim, Anderson, & Luks, 2011). Within the case examine, Anne introduced with a gangrenous perforated appendix with peritonitis. The perforated appendix is characterised by an apparent defect within the wall of the appendix. A thick and purulent peritoneal fluid can also be noticeable within the perforated appendix. The perforated appendix is likely to be linked to ileus or bowel obstruction. Then again, the development of gangrenous is expounded to suppurative appendicitis. A gangrenous appendix is characterised by edematous, congested vessels and fibrinopurulent exudates. One other attribute is the rise in peritoneal fluid, which is likely to be clear or turbid. It is likely to be walled off by omentum, mesentery or adjoining bowel (Schlossberg, 2015).

Within the first phases of acute appendicitis, the shopper would possibly expertise periumbilical ache due to the T10 innervation of the appendix. Nevertheless, because the irritation elevates, an exudate deposits on the appendiceal serosal floor. A extreme ache, identical to within the case of Anne within the case examine, happens when the fashioned exudates contact the parietal peritoneum (Ryan-Wenger, 2007). Furthermore, perforation results in the discharge of micro organism and inflammatory secetion into the stomach cavity. Consequently, peritonitis develops. The severity and placement of peritonitis are inclined to differ based mostly on the diploma of which the omentum and proximate bowel loops can management the spillage of luminal contents.

B. Progress and developmental theories

Nurses in pediatric ought to perceive the kid’s bodily, cognitive and psychosocial developmental stand to supply high quality care. Three vital development and developmental theories are psychosexual improvement by Sigmund Freud, Erikson’s principle of psychosocial improvement and Piaget’s principle of cognitive improvement.

Psychosexual Improvement principle by Freud 

Oral (Zero-1 years): An toddler experiences pleasure primarily from the mouth, with sucking (Thurston, 2014). The oral behaviour of an toddler additionally helps relieve stress, and it performs an important position within the formation of ego.

 Anal (1-Three years): At this developmental stage, the kid derives pleasure from the anal. Youngsters can management physique secretions.

Phallic (Three-6 years): The kid takes pleasure of their genitals. Youngsters begin touching their sexual organs. At this developmental stage, youngster struggles with sexual ardour in the direction of the other intercourse father or mother.  

Latency (6-12 years): At this stage, sexual wishes are inclined to subside. Youngsters begin to concentrate on different actions related to cognitive and social development.

Genital (12 years to maturity): Sexual wishes re-emerge at this stage and adolescents follow applicable sexual behaviour (Thurston, 2014).

Acceptable nursing care

The nurse ought to clarify to Anne what remedies and procedures she is going to bear. Based mostly on Freud’s principle, Anne will place significance on her privateness. The nurse ought to thus present robes, covers and inside wears to reinforce the privateness of Anne. One other technique of enhancing privateness is to shut the pediatric ward door and knock earlier than coming into.

Psychosocial improvement by Erikson 

Belief vs distrust (Zero-1 years): Belief is promoted by the supply of meals, clear clothes, consolation and contact (Kail & Cavanaugh, 2015). In case, the caregivers fail to supply fundamental wants, infants study to distrust others.

Autonomy vs disgrace and doubt (1-Three years): The independence of the toddler is exhibited by the flexibility to manage physique excretions and motor exercise. Youngsters who're condemned for failure to manage motor exercise are inclined to develop disgrace and doubt of their capabilities.

Initiative vs guilt (Three-6 years): At this stage, youngsters met extra people exterior of the household. As such, youngsters are uncovered to new actions and begin to discover the world. Nevertheless, steady criticism ends in a sense of guilt.

Business vs inferiority (6-12 years): At this developmental stage, youngsters develop new curiosity and concentrate on cognitive and mental improvement. The kids are happy with their accomplishments at school, sports activities, and residential. A way of inferiority develops if youngsters are unable to perform what is predicted.

Identification vs position confusion (12-18 years): As adolescents enter maturity, they establish with sure values and roles (Kail & Cavanaugh, 2015). The adolescents who're unable to establish a significant definition of self-tend to face confusion in a single or a number of roles of their life.Acceptable nursing care

Based mostly on Erikson’s principle, Anne has already gained a way of self-worth on account of involvement in numerous actions. The nurse ought to encourage Anne to convey particular pastimes to the hospital. Additionally, the nurse ought to encourage the kid to proceed education.

Cognitive improvement by Piaget

Sensorimotor (Zero-2 years): At this developmental stage, infants study by enter obtained by way of the senses and by their motor exercise (Shaffer & Kipp, 2010).

Preoperational (2-7 years): Though logic just isn't totally developed at this stage, youngsters assume by utilizing phrases as symbols. Youngsters exhibit egocentrism and depend on transductive reasoning.

Concrete operational (7-11 years): At this stage, there's a transition from transductive reasoning to the extra exact data of trigger and affect.

Formal operational (11 years to maturity): At this age, the mature mental thought has already been achieved (Shen & Hendren, 2014). Adolescents are unable to assume clearly and make rational selections.

Acceptable nursing care

In accordance with Piaget’s principle, youngsters between 6-12 years are able to mature thought. Therefore, the nurse ought to clarify to Anne the clear particulars in regards to the therapy. The nurse also needs to present Anne the gear that's being utilized in therapy.

C. Household centred care

The sickness of a kid, just like the case of Anne, can have a traumatic affect on each the household and the kid. Consequently, pediatric nurses adopted household centred care to reinforce the nicely being of kids and their household (Harrison, 2010). Within the case of Anne, the idea ought to be a collaboration of the nurses and household to design, ship and consider care. The pediatric nurses ought to work with Anne’s household to design one of the best plan care potential for Anne. This strategy is attributable to the truth that dad and mom know their youngsters higher than the nurse. Anne’s household together with her siblings is the first supply of help. Household centred care can be an applicable selection of providing help on this traumatic interval in Anne’s life. An in depth collaboration between the household and nurses will even cut back the kid’s and father or mother’s anxiousness (Saleeba, 2008).

The father or mother’s position in pediatric care is likely to be unclear in some cultures. Nevertheless, most dad and mom acknowledge that respect, help and collaboration are basic features in household centred care idea (Gill, et al., 2014). A number of difficulties come up in household centred care because of the poor communication, and inadequate data regarding how the strategy capabilities. Completely different perceptions of the household may also trigger misalignment within the interactions between relations and the nurses.  

As famous within the case examine, Anne’s dad and mom run an Indian restaurant, which insinuates they're Indians. The Indian tradition may be very particular relating to reincarnation ache. Some Indian households would possibly favor that acute care emphasizes on signs administration in addition to management of the kid’s ache. In some case, Indians would possibly favor to keep away from caring for the acutely ailing youngster and as a substitute concentrate on religious wants of the kid (Wiener, McConnell, Latella, & Ludi, 2013). This organisation would possibly disrupt household centred care infective and delay the restoration course of.

D. The results of hospitalisation of the kid

Youngsters are affected otherwise by hospitalisation based mostly on their talents to deal with stress. Stress is the first impact of kid hospitalisation as a result of the kids are separated from their households and supportive surroundings. Most youngsters are inclined to expertise emotional disturbance due to the hospitalisation expertise (Kortesluoma, Punamäki, & Nikkonen, 2008). Emotional upset can also be widespread in youngsters who're separated from their dad and mom for an extended interval. Private elements just like the youngster’s temperament and intelligence end result of their model of dealing with long-term and short-term hospitalisation. When Anne stays within the hospital for ten days, she would possibly grow to be emotionally upset or develop stress as a result of the surroundings is unfavourable. Similar to the hospitalised youngster, the entire household particularly the dad and mom, are inclined to develop stress and anxiousness (Tehrani, Haghighi, & Bazmamoun, 2012). The extent of affect on the household will, nevertheless, rely on the flexibility to develop resilience.  


Appendicitis is related to a wide selection of danger elements. Lymphoid hyperplasia is, nevertheless, the main issue for the prevalence of acute appendicitis in youngsters. As mentioned on this project, lymphoid is linked to a number of fundamental viral infections corresponding to gastroenteritis and mononucleosis. Anne has undergone surgical procedure to deal with appendicitis and thus requires shut care, which might be provided by nurses in collaboration with the household. Full disclosure of the therapy procedures and privateness are a few of the approaches that the nurses ought to use when caring for Anne. Lastly, there's a likelihood that Anne will expertise emotional upset, and the household will endure stress and anxiousness.


Elgazzar, A. (2014). Synopsis of Pathophysiology in Nuclear Medication. Springer.

Gill, F., Pascoe, E., Monterosso, L., Younger, J., Burr, C., Tanner, A., et al. (2014). Father or mother and employees perceptions of family-centered care in two Australian youngsters’s hospitals. European Journal for Particular person Centered Healthcare. European Journal for Particular person Centered Healthcare , 1 (2), 317-325.

Harrison, T. M. (2010). Household Centered Pediatric Nursing Care: State of the Science. J Pediatr Nurs , 25 (5), 335-343.

Kail, R., & Cavanaugh, J. (2015). Human improvement: A life-span view. Cengage Studying.

Kortesluoma, R., Punamäki, R., & Nikkonen, M. (2008). Hospitalized youngsters drawing their ache: the contents and cognitive and emotional traits of ache drawings. Journal of Youngster Well being Care , 12 (four), 284-300.

Narsule, C., Kahle, E., Kim, D., Anderson, A., & Luks, F. (2011). Impact of delay in presentation on charge of perforation in youngsters with appendicitis. AM J Emerg Med , 29 (eight), 890-893.

Ryan-Wenger, A. (2007). Core Curriculum for Main Care Pediatric Nurse Practitioners. Mosby Elsevier.

Saleeba, A. (2008). The significance of family-centered care in pediatric nursing. Faculty of Nursing Scholary Works , 18, 1-7.

Schlossberg, D. (2015). Medical infectious illness. Cambridge College Press.

Shaffer, D., & Kipp, Okay. (2010). Developmental psychology: Childhood & adolescence. Cengage Studying.

Shen, H., & Hendren, R. (2014). Youngster and adolescent psychiatry for the specialty board evaluation. Routledge.

Tehrani, T., Haghighi, M., & Bazmamoun, H. (2012). Results of stress on moms of hospitalized youngsters in a hospital in Iran. Iranian journal of kid neurology , 64 (Three), 39.

Thurston, C. (2014). Important Nursing Look after Youngsters and Younger Folks: Idea, Coverage and Follow. Routledge.

Wiener, L., McConnell, D., Latella, L., & Ludi, E. (2013). Cultural and spiritual issues in pediatric palliative care. Palliative & supportive care , 11 (1), 47-67.

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