NRSG 257 Assignment: Treatment Regimen For Appendicitis – Case Study
NRSG 257 Assignment: Treatment Regimen For Appendicitis – Case Study
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Case Study
Anne is a 10 year old girl who has presented to the emergency department in the local hospital with right iliac fossa pain. On further assessment by the emergency registrar, appendicitis is suspected. The surgical team agree that the signs and symptoms are associated with appendicitis and take Anne to theatre for an appendectomy.
The handover on return to the ward is that the surgical team found a gangrenous perforated appendix with peritonitis. Anne has returned to the ward with a nasogastric tube in situ on free drainage, morphine PCA, IV therapy and triple IV antibiotics.
Due to the severity of the infection and the potential complications, Anne will need to remain in hospital for 10 days of IV antibiotics and pain management.
Anne is the oldest of five children and her parents own and run an Indian restaurant in the city.
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Required
1. Describe the pathophysiology of the presenting complaint in the case study.
2. Evaluation of the nurse’s role to deliver developmentally appropriate nursing care in relation to your chosen case study.
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NRSG 257 Assignment: Treatment Regimen For Appendicitis – Case Study Sample Draft Solution:
Introduction
Appendicitis refers to an inflammation of the appendix as a result of blockage and infection. Despite the technological advances in the medical field, appendicitis remains a medical emergency which can lead to very serious complications if interventions are not instituted within the first 24 hours. An inflamed appendix may perforate and become gangrenous within the first 72 hours of the presentation of symptoms. This condition rarely affects children under one year and it is more prevalent in males.
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The most common treatment regimen for appendicitis is appendectomy which will involve insertion of drainage tubes and naso-gastric tube to prevent abscess formation and antibiotic therapy. For its treatment one requires hospitalization regardless of the age (Salminen, 2015). Hospitalization and the course of treatment affect people differently especially in pediatrics it may have a lasting effect on them (Alvarado, 2018).
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Pathophysiology
Appendicitis is a condition that presents with the inflammation of the inner lining of the appendix, known as the vermiform appendix which spreads to other layers of the appendix. In most cases the inflammation results from infection (McCance, 2018). The appendix is located at the right lower quadrant of stomach and it arises from the cecum during embryology. Histologically the appendix is made up of cells similar to the colonic mucosa (simple columnar epithelial cells), the sub-mucosa of the appendix is made up of lymphoid follicles which increase with because they are few during birth (Knox, 2015). The number of follicles peaks at 200 follicles at 20 years of age after which the quantity goes down tremendously and the number of follicles continues to reduce through the adult life (Flum, 2015).
The main function of the appendix is that it acts as a reservoir for normal flora of the gut which aid in the healing after intestinal infections. The appendix does not play any significant role in maintaining the normal homeostatic balance of the body physiologically, therefore; its removal is highly tolerated. The anatomical position of the appendix slightly varies, therefore the presentation of the symptoms and tenderness largely depends on the exact anatomical position and the site of inflammation on the appendix (Girard-Madoux, 2018).
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The lymphoid follicles found in the appendix play a role in the body’s immune system. An infection or an abscess in other regions of the body can lead to an inflammatory reaction in the appendix causing blockage and eventual appendicitis (Girard-Madoux, 2018). Alternatively, blockage can result from fecal matter, any foreign matter in the appendix or a tumor. The blockage will result in the inflammation of the appendix (Feldman, 2015). Once blocked the bacteria in the appendix begin to multiply and distension of the appendix results, this leads to increased intraluminal pressure which prevents venous drainage, thus making the appendix ischemic and congested (Glass, 2016).
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The accumulation of bacteria causes an antigen antibody reaction which results to ischemia at the cellular level. Ischemia may progress to gangrene formation due to impaired blood flow and poor oxygenation of the appendix. As the symptoms worsens perforation of the inflamed appendix may occur, leading to leakage and spread of the inflammatory exudate into the peritoneum causing peritonitis which presents with worsened symptoms and affects other body systems (Bayhan, 2015). There will be tachycardia and tachypnea in response to excruciating pain in the peritoneum. Gangrene formation and perforation mostly occurs 72 hours after the symptoms of appendicitis begin to show (Kothadia, 2015).
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The most classic symptom of appendix is sharp pain in the lower right quadrant of the abdomen. Other symptoms accompanying pain are nausea, vomiting, loss of appetite, pyrexia and loss of flatulence. The pain is mostly localized to the site of inflammation at the right lower quadrant during the onset of the symptoms, though the pain may radiate to the peri-umbilicus area or the iliac fossa depending on the severity of the inflammation and the innervation of the appendix by nerve T10. The pain may progress to generalized abdominal pain if there is perforation and the exudates and products of the inflammatory process have leaked to the peritoneum causing peritonitis (Bayhan, 2015).
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Pain is the classical symptom, because pain is the first symptom of any inflammatory process in the body. During an inflammatory process there is inflammation which results into tenderness and fever (Marzuillo, 2015). The tenderness and fever causes pain because of the extensive nervous supply of the adnominal mucosa. Pain also causes vomiting and nausea because of its localization in gastrointestinal system. Appendicitis is managed by appendectomy followed by antibiotic therapy and hospitalization for preoperative and post-operative care (Cheng, Abdominal drainage to prevent intra?peritoneal abscess after open appendectomy for complicated appendicitis., 2015).
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Growth And Developmental Theories
Our client Anne is 10-year-old. As the child develops there are many theories explaining the different stages of growth and development. The theories that most likely apply to the development of Anne is the Gesell’s theory of biophysical development which links development to the genetic make-up of their parents (Newman, 2017). This theory tries to explain the role of genes and their interaction with the environment during the development of a child. Appendicitis has a positive genetic link therefore Anne may have developed it due to her genetic make-up especially if any of her parents had appendicitis in the past (Crain, 2015).
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Another theory at play here is the Erikson developmental theory where by Anne is at the stage of industrious versus inferiority. At this stage Anne interacts with her fellow peers in schools and other social gathering trying to be an industrious person in the community, she is also maturing up and is able to understand what is happening in her body; however this does not give the right to make medical decisions regarding her health that is why, the medical team should involve her parents. (Crain, 2015). This brings out a unique scenario whereby the parents must be involved in every step of the treatment process, because of Anne’s inability to make informed decision. How Anne is handled may either traumatize her or make similar experiences in future bearable. Cognitive theories like Jean Piaget’s theory also play a major role in the cognitive development of Anne and how she will relate this experience with similar experiences in future, because at this stage she can understand what is happening to her and she can remember this experience in future (Arnett, 2015).
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