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Paradigm Shifts In Treatment Of Appendicitis

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Paradigm Shifts In Treatment Of Appendicitis

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Paradigm Shifts In Treatment Of Appendicitis

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Discuss About The Paradigm Shifts In Treatment Of Appendicitis.


The above case study is based upon a 10-year child who is suffering from acute appendicitis. The medical condition in which the appendix is obstructed due to excessive deposition of mucus in the appendicular lumen. It’s an inflammation of vermiform appendix which can be chronic or acute. It is considered as one of the most common cause of abdominal pain in children. The essay will cover the pathophysiology of appendicitis, evaluation of the nurse’s significance and their role in providing proper nursing care, growth & development theories, family centered care and the after effects of child hospitalization on family and even on child itself.
The blockage of appendix mainly caused by stool, foreign body, lymphoid hyperplasia or cancer (Hassan, Greenstein, Neuman & Hahn, 2017). The main causes of lymphoid hyperplasia are not clear but infection, immunodeficiencies, inflammatory bowel diseases, food allergies, etc. are some of the causes.  In lymphoid hyperplasia, the number of cells in the lymph node increases. This further leads to swelling or enlargement of appendix causing obstruction. The increase in secretion of mucus further increases the pressure in the lining of the walls of appendix also leads to blockage of blood vessels, thrombosis and even slowing down the flow of lymphatic fluid. After the obstruction the recovery process slows down. Due to the obstruction the appendix becomes ischemic leading to ischemia. This further leads to necrosis of the appendix when lot of bacteria  (Hirsch, 2017) is produced at the site. These bacteria start leaking out of the damaged walls which leads to pus formation both inner and outer side of appendix. Thus, this stage is known as suppuration. Later the appendix ruptures which leads to sepsis or peritonitis. During all these stages, abdominal pain is one of the common symptoms (Petroianu & Barroso, 2016).In critical appendicitis Polymorph nuclear cells are present inside the wall of appendix. Pus, faeces, Mucous etc get into abdominal cavity through the hole further peritonitis condition. The swelling of the membrane lining pelvic cavity, internal organs, abdomen is called peritonitis (De Onis, 2017). The condition left undiagnosed and untreated can further lead to a condition known as septicaemia which happens because of blood infection as a result of little blood pressure and supply to vital organs. The toxin discharged by bacteria prompts the response of immune system during the contamination. Because of the discharge of toxin into the stream of blood, dilation of large vessels and leakage of small vessel occur causing the fluid to enter tissue from the stream of blood (Mak,& Loeff, 2016). The fluid filled appendix compresses the nerve whose sensation causes the right iliac fossa pain in patients. Because of septicaemia, peritonitis; neutrophil, C- reactive protein, white blood cells increase causing the decrease in immune system.
Growth & Development theories
Development is alteration in cognition, feeling and societal change whereas growth is described as a bodily process of increase in weight, trunk and extremities and height. The continuous alteration leading to rise in complexity and skill is called developmental milestone. Girls have spurt of physical growth along with outcome of permanent teeth which makes them taller and weightier than boys (Hughson, Stainton, & Koutoukidis, 2016). Muscle power and physical skills amplifies in this period. The paediatrics classifies 10-year-old as below the school age child. The development and growth of child are influenced by a number of reasons such as health status, culture, environment, nutrition, gender, life style and adult guidance. Erikson’s Psychosocial Development in fourth part namely Inferiority versus Industry, a child tries to practice significant cultural skills, along with work and play with peers. In this phase child recognizes and grows a sense of their possessed aptitude. Aptitudes and abilities practiced by child, leads to sense of psychosocial strength of competency and industry (Turley, Vanek, Johnston, & Archibald, 2018). The child learned working, preparation and sharing by seeing other people in this phase. The children feel poised and industrious in their aptitudes when they are supported by their teachers and parent for their creativities. When they are not supported positively they grow sense of hesitation and insufficiency in their aptitudes due to their feeling of being inferior (Trajkovski, Schmied, Vickers, & Jackson, 2013). In actual operational phase from Piaget’s phase of cognitive development supervision is needed though thinking in children becomes more rational and orderly. The child aged 10 year begins to understand the notion of real talk. In the latent phase, while the superego continues to mature, id’s energies are repressed rendering the Freud’s Phases of Psychosexual development (Gaba, 2014). Children grow societal skills, values, form connection with peers out of family and grown-ups. Because of the growth of the superego and ego, serene nature in children grow. Sexual energy exists in this latency phase and is directed towards academic pursuits and social interactions. On behalf of the development of communication abilities, self-belief and other societal abilities this phase is very vital.
Standard level operational procedures are planned to raise the efficiency in patient care. Controlled analgesic is generally administered in children after appendectomy to reduce pain. Constant IV therapy is essential till patient is NBM to reinstate electrolyte and fluid balance. Intravenous antibiotics are required to inhibit further infection. Patients are encouraged to take balanced diet and drink ample liquid diet to avoid constipation and reinstate the body fluid (J, D, HE, & CS, 2015). Patients are advised to shun very hot food and shun spicy foods as it irritates the normal epithelial layer. Because Anne’s parent owns and run Indian restaurant, chances are high of Ann eating too much of spicy and hot foods. The free nasogastric drainage through tube should be recorded to know it’s character post operatively. Because of Immature systems and organs, the care provided by nurses might get influenced. Knowledge concerning the necessities of developing phase and health problem associated with it is essential. Nurses perform important duty of coordinator, emotional supporter, educator, carer and resource person (Cundy, Sierakowski, Manna, Cooper, Burgoyne, Khurana, 2016). A number of factors affects preparation and delivery of care such as development and growth, separation and behaviour from family, response to sickness.
Family centered care:
Under family centered care, the family in collaboration with the clinicians provides care to the hospitalised child. The four constituents or principles under family care is collaboration across all the providers, strength building, proper communication and lastly dignity and respect (Katz, & Webb, 2016). The care provider under respect and dignity should value and respect the religion and culture of the individual. If the culture or religion of any individual prohibits any practises then the family should inform the same to the clinician who must obey that. The holistic care can also be a part of the family centred care where the health care provider allows family to share positive and encouraging words in order to make the patient comfortable and reduce their stress. The family participation in child care to reduce the suffering in connection to child’s acute illness by reducing conflicts, tension management, raising resilience and by better communication is supported by this methodology. With family children feel released from their emotional suffering and thus feel safer and sounder. Family focused care values the tradition, strength, culture that brings everybody together as a dutiful family where families sense themselves as members in decision making at diverse level with professional health care benefactor advocating policies and system that maintains their child’s health requirements. The language that would be appropriate in accord with the developmental phase along with child’s cognition should be used by the paediatrician. Cultural Proficiency is essential to provide care to families belonging to different culture (Matsushita, Fukata, Omiya, Nishio, Seki, Okazaki, 2018). Paediatrics patient who can provide legal necessities along with having necessary decision-making ability can give approval for medical care. Biological parent or surrogate parents are needed to Trajkovski give consent with the agreement of the child for the diagnosis and curing of the child.
There are several effects of admitting the child into the hospital on both the child and family at large (Knox & Mortele, 2015).  As per the studies, it has been found that psychosocial effects are considered one of the major factors for affecting the health and wellbeing of both the parents and the child.  The admission of child at early age lead to stress which affects the overall growth and development process.  The children of school age may have the tendency to handle the regression, separation, anxiety and all other factors caused by their admission to the hospital but the need of security and parental guidance increases. These children often suffer from loneliness, boredom, depression as they are more inclined towards their peers and daily activities. They do not find themselves comfortable in hospital or school environment due to their nature, habit and also because they are more physically and mentally active (Fredman, Baucom, Boeding, & Miklowitz, 2015). The school going children often finds it difficult in seeking parental guidance and support due to their developmental age or goal of gaining self-reliance which is also significant to them. They consider that may look immature, weak or even childish and less dependent even if they are asking for direct help. This results in developing feelings which they might express in the form of aggression and some children even gets irritated with their parents, unfriendly behaviour with peers, developing unaccepting behaviours in the school (Coyne, 2013). These helped to identify common problems experienced in these age group of children which included acceptance of hospital reality, helplessness, fear, doubting the hospital staff ability, expressing the information in more simpler ways, sense of dissatisfaction and trust on the medical personnel and unwilling dealing with uncertainty. All of these common were identified by FCC. It has also been seen that in some cases the admission of the sibling into the hospital develops anger, guilt, anxiety, stress, fear and loneliness in their siblings.
Hence, from the above paper it can be concluded that appendicitis is mostly common in children which is caused by parasite, foreign bodies, exposure to immunisation and even hardening of stool. In absence of proper treatment or if not treated then it develops into peritonitis. The case study is based on a 10-year child who is suffering from appendicitis. The essay also explained the significance of nurses and their role in child recovery phase. The other aspect of nursing care for the children included reducing the pain in child, electrolyte balance, restoring fluid, prevention from other infections and also contributing by providing proper support, care both at physical and mental level. The paper also briefed about the effects of child hospitalisation on family and child itself. It also explained about the importance of parental support and care to their children, Lastly, the hospital and parents should work together in bringing out strategies to minimize the stress of the admitted children.
Cundy, T., Sierakowski, K., Manna, A., Cooper, C., Burgoyne, L., & Khurana, S. (2017). Fast?track surgery for uncomplicated appendicitis in children: A matched case–control study. ANZ Journal of Surgery, 87(4), 271-276. doi: 10.1111/ans.13744
J, H., FI, L., D, W.S., AG, K., CS, M., HE, W., & TF, T. (2015). Nonoperative treatment of acute appendicitis in children: A feasibility study. US National Library of Medicine National Institutes of Health.
De Onis, M. (2017). Child Growth and Development. Nutrition and Health in a Developing World, 119-141. doi:10.1007/978-3-319-43739-2_6
Fredman, S. J., Baucom, D. H., Boeding, S. E., & Miklowitz, D. J. (2015). Relatives’ emotional involvement moderates the effects of family therapy for bipolar disorder. Journal of Consulting and Clinical Psychology, 83(1), 81-91. doi:10.1037/a0037713
Gaba, S. S. (2014). Septic shock. Research Journal of Pharmacy and Technology, 7(11), 11-1347. Retrieved from
Hassan, S., Greenstein, J., Neuman, J., & Hahn, B. J. (2017). Viral Appendiceal Lymphoid Hyperplasia. Journal Of Emergency Medicine (0736-4679), 52(4), 571-572. doi:10.1016/j.jemermed.2016.12.007
Hirsch, T. M. (2017). Acute appendicitis. JAAPA, 46-47.
Hughson, J., Stainton, K., & KoutoukTrajkovskiidis, G. (2016). Tabbner’s Nursing Care. Elsevier, 400-430.
Katz, A. L. &Webb, S. A. (2016). Informed Consent in Decision-Making in Pediatric Practice. Pediatrics, 138(2), doi: 10.1542/peds.2016-1484
Knox, M., & Mortele, K. J. (2015). Acute Appendicitis. Gastrointestinal Imaging, 204-208. doi:10.1093/med/9780199759422.003.0034
Mak, G., & Loeff, D. (2016). Paradigm Shifts in the Treatment of Appendicitis. Pediatric Annals, 45(7), E235-40. doi: 10.3928/00904481-20160525-01
Matsushita, M., Fukata, N., Omiya, M., Nishio, A., Seki, T., & Okazaki, K. (2018). Pathophysiology of the Appendix in Ulcerative Colitis. The American Journal of Gastroenterology, 113(4), 622-622. doi:10.1038/ajg.2017.506
Petroianu, A., & Barroso, T. V. (2016). Pathophysiology of Acute. SciMedCentral, 1-4.
Trajkovski, S., Schmied, V., Vickers, M., & Jackson, D. (2013). Using appreciative inquiry to bring neonatal nurses and parents together to enhance family-centred care. Journal of Child Health Care, 19(2), 239-253. doi:10.1177/1367493513508059
Turley, J., Vanek, J., Johnston, S., & Archibald, D. (2018). Nursing role in well-child care. Canadian Family Physician, 169-180.
Coyne, I. (2013). Families and health-care professionals’ perspectives and expectations of family-centred care: hidden expectations and unclear roles. Health Expectations, 18(5), 796-808. doi:10.1111/hex.12104

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