Pathophysiology of Appendicitis
This essay is about Anne who is a 10 year old girl and has been suffering from right iliac fossa pain. She was taken to a local hospital and was diagnosed with appendicitis. The doctors decided to perform appendectomy. They also found a gangrenous perforated appendix with peritonitis. Since she was suffering from severe infection and there were a lot of complications, she was advised hospitalization for 10 days of IV antibiotics and pain management. This essay demonstrates the pathophysiology of appendicitis, growth and developmental theories such as JMD theories which includes psychoanalytical theory by Freud, Piaget theory and Maslow’s hierarchy of needs theory. It also demonstrates family centered care and the effects of hospitalization on the patient and family members. This essay demonstrates how evidence based information can be implemented into contemporary Australian nursing practice.
Appendicitis occurs due to the obstruction of the lumen of the appendix and it also occurs due to several bacteria such as yersinia species, adenovirus, cytomegalovirus, actinomycosis, foreign substances, tumors and tuberculosis. Obstruction involves the filling of lumen distal with mucous which increases to intra luminal and intramural pressure and also causes distension (Cobb, 2017).This results in rapid multiplication of bacteria residing inside the appendix. Bacteria that are most commonly found in the appendix are Bacteroides fragilis and Escherichia coli. Pathophysiology involves several symptoms such as reflex anorexia, nausea and vomiting, and visceral pain that occur due to the dilatation of the appendix. The small venules and capillaries get affected by thrombosis when the pressure of the lumen becomes more than the venous pressure thus causing and congestion and swelling of the appendix. Inflammation occurs in the serous membrane of appendix which leads to increase in pain. Due to the thrombosis of small arterioles bacteria start leaking out thus leading to the formation of pus inside the appendix (Drake et al., 2014). The pus also forms a layer outside the appendix region. Due to the infection of bacteria and ischemia inflammation occur which results in the death of cells and gangrene. The condition further worsens and results in perforation of the appendix due to gangrenous appendix. It also results in peritonitis which involves swelling of the innermost layer of the abdomen and organs present in it. Perforation of the appendix is most commonly found in children as compared to adult individuals (Shweiki et al.,2016 ).
There are several growth and development theories such as JMD theories which includes psychoanalytical theory by Freud. He was the first to identify the development of an individual through several stages such as oral stage, anal stage, phallic stage, latency and Genital stage. This theory played an important role in helping nurses in understanding the behavior and condition of mental health in different patients (Hahn, Coricelli & Matteo, 2016).It also helps in understanding different behaviors of patients related to ego and id. Anne belongs to the Latency stage since its range is from 6-12 years so the major development task for her is to focus on relationships. Freud theory helps individuals to accept who they are and improve their health and well being.
Growth and Developmental Theories
Piaget theory focuses on the fact that interaction with the environment plays a significant role in the development of human beings. The nurses gain knowledge and understand the main features of developmental psychology and it helps them to assess the stage of development a child has attained (Mischel, 2013).This helps them accomplishing several tasks of development. Piaget’s theory has made a significant contribution in understanding the intellectual level and cognitive development in children.
Maslow’s hierarchy of needs theory is a theory of psychology that aims to motivate individuals and is based on a five stage model that includes biological and physiological needs such as air, food, drink, shelter, warmth, and sleep. Safety needs include protection and security, law, stability, order, and freedom from fear (Maslow, 2013).Love and belongingness needs include, friendship, intimacy, trust and acceptance, receiving and giving love and affection, social interaction among family, friends, and work. Esteem needs include achievement, independence, status, dominance, which plays a very important role in realizing potential of self, self-fulfillment, seeking personal advice for growth and development. This theory helps nurses and health care professional to motivate patients suffering from different types of disorders and diseases (Maslow, 2013).
A proper communication to patients plays an important role in improving the hospital journey and reduces the anxiety, stress and depressive symptoms. Lack of proper communication leads to issues such as a delay in treatment and sometimes may cause adverse health effects among them (Curtis et al., 2013).This decreases their bonding with healthcare professionals such as clinicians and nurses and creates misunderstanding and confusion about the treatment and the precautionary measures that should be taken. It may lead to mental issues such as anxiety and may have a negative impact on the psychological condition of the patients.
Family centered care plays a significant role in improving the well being of the members of the patient. It involves providing care sucgh as emotional care, motivation and guidance which helps them to prevent depressive symptoms and other health disorders related to it. Healthcare staff should have a responsible attitude towards their patients as well as their family members. The doctors and the nursing staff should act as a guide and provide support in all their problems and issues (Festini, 2014).They should advise them about the precautionary measures to be followed .This will improve the psychosocial health of the family members of the patient and help her in getting cured in less amount of time. Cognitive development is the field of studying psychology that focuses on the development of child on the basis of his or her ability to learn, process the information and the development of brain (Lehne & Rosenthal, 2014).
Family-Centered Care
Cognitive behavioral therapy can be provided to Anne that would help in instilling positivity and getting well soon (Ehde, Dillworth & Turner, 2014).The nurses should have patience during communication with her family members. They should treat them with respect and also understand their requirements. Palliative care should be given to her in a proper manner which is special type of care to that provides relief from both physical and mental pain and stress (Poulsen et al., 2014).The nursing staff should process the information gathered by them by analyzing the data by proper understanding of important signs and symptoms in the patient They should discriminate correct from incorrect information to avoid any errors in the treatment procedure.
Anne should be advised to follow several preventive measures to improve her health condition such as taking rest, proper sleep, a well-balanced diet and regular exercise. She should be provided counseling with a psychiatrist to share her issues and problems that will instill positivity in her. Nurses should treat her with respect and patience and provide quality care to her (Mischel, 2013). There are several nursing care goals for providing priority nursing care in relation to the nursing issues that have been identified. Anne should be empowered and provided care by understanding her needs and demands. She should be advised to follow a few precautions to manage emotional issues like taking regular exercise and a well balanced diet.
There would be negative effects of hospitalization of the child, on the child and her family. The main reason behind it is that she is very young to bear the pain of the surgical procedure and she has been advised to stay in the hospital for 10 days which is quite longer for a child of 10 years. She might also not feel comfortable with nasogastric tube and other therapies such as morphine patient controlled analgesia, intravenous therapy and triple intravenous antibiotics. The family members of the patient also suffer from several issues due to hospitalization such as financial crisis, responsibilities related to house old, negative effects on the education of other children, and boredom (Ågotneset al.,2016). The hospitalization of Anne might lead to a huge loss in their restaurant business as well leading to depression and other mental issues in the family members. The family members of the patient should be taken care of by the hospital staff and helped whenever in need regarding to the treatment of patient and other issues related to accommodation and transport. The nurses should give respect and handle her with patience. They should also think from her point of view by providing proper solution to their doubts (Lehne & Rosenthal, 2014).
Effects of Hospitalization on Patients and Families
Doctors and nurses should have a responsible attitude towards Anne as well as her family members (Gordon et al., 2012).Anne should be advised to have a nutritional diet along with plenty of fluids which would help in the regeneration of tissue and healing. She should be advised protective measures to avoid various kinds of infection, injuries after the patient has under gone surgery. They should wash hands in a regular manner as it is significant in preventing infection. The nursing staff should use clean and aseptic techniques in order to prevent contamination.
It can be summarized that Anne should be provided proper care and counseling so that she gets well soon and leads a healthy life. The clinicians and the nurses should help her in every way possible, according to her requirements so that she is satisfied with their service. She should be counseled and guided properly to take appropriate rest and several precautions to improve the condition of her health. She should be advised to follow self- management which would involve taking care of her according to the precautions given. It will help in providing psychosocial care and improve the condition of her health in less duration of time.
References
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Cobb, T. (2017). Appendicitis following blunt abdominal trauma. The American Journal of Emergency Medicine.
Curtis, J. R., Back, A. L., Ford, D. W., Downey, L., Shannon, S. E., Doorenbos, A. Z., … & Arnold, R. W. (2013). Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial. Jama, 310(21), 2271-2281.
Drake, F. T., Mottey, N. E., Farrokhi, E. T., Florence, M. G., Johnson, M. G., Mock, C., … & Flum, D. R. (2014). Time to appendectomy and risk of perforation in acute appendicitis. JAMA surgery, 149(8), 837-844.
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Maslow, A. H. (2013). A theory of human motivation. Simon and Schuster.
Maslow, A. H. (2013). Toward a psychology of being. Simon and Schuster.
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Poulsen, S., Lunn, S., Daniel, S. I., Folke, S., Mathiesen, B. B., Katznelson, H., & Fairburn, C. G. (2014). A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa. American Journal of Psychiatry, 171(1), 109-116.
Shweiki, E., Price, T. P., Patel, P. H., Koenig, G. J., Beekley, A. C., Rittenhouse, D. W., … & Cohen, M. J. (2016). Synchronous Acute Appendicitis and Acute Cholecystitis: A Discussion of a Century’s Worth of Epidemiologic, Basic Science, and Clinical Research, Explicating the Pathophysiology of a Likely Underrecognized Historical Condition. The American Surgeon, 82(11), 1140.
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