NRSG257 Child - Adolescent and Family Nursing - Free Samples to Student

Case Study 1
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.
Anne is the oldest of five children and her parents own and run an Indian restaurant in the city.
Case Study 2
Jay is a four-month old boy admitted to the paediatric unit via emergency with vomiting, decreased feeds, no bowel actions and intermittent spasmodic abdominal pains. During the spasmodic pain episodes, Jay draws his legs up and has a high pitched cry.
After a diagnostic ultrasound, intussusception was thought to be the cause of the presenting symptoms and Jay was admitted to the ward. His treatment plan included observation, electrolyte monitoring and IV therapy until a contrast enema could be implemented to correct the intussusception.
The approximate length of stay for Jay will be 2 days, during which time, Jay’s mother is informed that the rotavirus vaccine that Jay had at 4 months has increased the incidence of this condition amongst infants. Jay’s mother is now having serious doubts regarding future vaccines for Jay.
Case Study 3
Sue is a 14-year-old indigenous girl who lives in a remote community in rural Australia. Sue has been treated for repeated episodes of streptococcal pharyngitis and impetigo over the last 2 years. The local health clinic have registered Sue and her siblings for a secondary prophylaxis program where she receives Benzathine Penicillin G IM routinely to aid in reducing risk of developing ARF/ RHD. However, Sue has failed to attend the clinic on multiple occasions to receive her IM antibiotics.

Sue has presented to the remote area health clinic complaining of a 4 day history of acute joint pain in her knees, ankles, elbows and shoulders. 
A health history taken by the remote area nurse on arrival reveals that Sue reports having a sore throat 2-3 weeks ago, migratory joint pain starting with her knees and ankles and which now includes other joints. Her temperature is 38.
When Sue is assessed by the remote clinic medical officer, a diagnosis of Acute Rheumatic Fever is suspected. The doctor at the clinic attending to Sue informs her mother that she needs to be transferred to a hospital for cardiology review and echocardiogram. The closest hospital that provides these services is 800km away

Acute appendicitis can be defined as the inflammation of the appendix which is actually a narrow blind ended tube that remains connected to the postero-medial end of the caecum. It mainly remains associated with abdominal pain and can be described as the condition which can result in abdominal surgery in the children (Shweiki et al., 2016). This assignment is also based on the case study where nursing professionals have to care for Anne who is a 10 year old child who has undergone appendicitis surgery and requires care and support in the hospital.

Appendicitis occurs due to the inflammation of the inner lining of the vermiform appendix that gradually spread to other parts of the body. The main reason for its occurrence is the obstruction of the appendiceal lumen due to a number of purposes.  Lymphoid hyperplasia that takes place secondary to that of the infectious as well as inflammatory disorders might result in obstruction. Besides, faecal statis and faecaliths might also obstruct but they are more common in elderly people (Allievi et al., 2017). Bacterial obstructions, although rare might also occur along with blockage due to foreign materials or due to neoplasm. These forms of obstructions mainly result in the increasing of pressure within the lumen. Such increase in the pressures mainly takes place due to the continuous secretion of the fluids as well as mucus from the mucosa (Hughes & Lu, 2015). Additionally, the intestinal bacteria within the appendix are also seen to undergo multiplication. This again leads to the recruitment of the white blood cells as well as the formation of the pus (Flum, 2015). This causes further increase of the intra-luminal pressure and this leads to the obstruction in the venous outflow. Ischemia is seen to occur in the appendiceal wall and this situation results in the loss of epithelial integrity as well as bacterial invasion. Researchers are of the opinion that thrombosis which occurs in the appendicular artery as well as the veins lead to perforation as well as gangrene of the appendix (Wagner et al., 2018). When this process is seen to continue, it results in the development of a peri-appendicular abscess. This might get localized if it gets walled off by the omentum. Alternatively, there might be also occurrence of a generalized peritonitis (Mak et al., 2016). Fluid mixed with bacteria may get spilled from the perforation to different art of the abdomen causing severe pain. In the case study as well, the patient named Anne was admitted to the ward due to right iliac fossa pain due to occurrence of the appendicitis. It had become perforated with the spread of the infectious fluid internally in the peritoneum and it had become gangrenous as well. Therefore, the surgery required removing the organ in order to help the patient get over the pain.

Jean Piaget had proposed one of the most influential theories concerning cognitive development which is known as the Piaget's cognitive development theory. This theory mainly explains the development of different types of thought procedures and mental States from the time of birth to that of adulthood. It mainly helps in looking at how different types of thought procedures are able to influence the way individuals understand and thereby interact with the world (Sieglar, 2016). There are four different stages of this theory out of which the state which is applicable in the case study is called the Concrete operational stage. The stage mainly occurs between the period of 7 years age and 11 years age. Researchers have found that their thinking becomes more logical as well as organized but it still remains concrete and rigid (Homes et al., 2016). Children are seen to use inductive logic and different types of reasoning skills from specific information to a General principle (Barrouillet, 2015). At this stage the egocentrism of the child is seen to disappear and the children start to understand that the viewpoint of others might not match with the viewpoint of them. In the case study it is seen that Anne is a child of 10 years. The child might have many concerns regarding the causes of her suffering and pain that had made her admitted to the hospital (Lefa et al., 2014). As she would not be having any egocentrism in the stage, the nursing professional can easily make her understand about the different factors that had made her admitted. Since the child is not judgmental in this stage, it would be helpful for the nurse to explain to her and help her reduce anxiety and fear (Petroniou & Barasso, 2016). However, the nurse should be very careful while discussing the disorder because any kind of confusion or concern among the nursing professional might again raise a feeling of fear in the patient. Therefore, nursing professionals have to be very careful while explaining the disorder to the patient and helping her to develop her viewpoint.

Another theory that can be applied is called the Erikson's Stages of Psychosocial Development. Proposed by Erik Erikson, the stage 4 called the Industry vs. Inferiority stage can be applied to Anne as this stage as this stage refers to the children who are between the age 5 and age 11. Through social interactions, children are seen to begin to develop a sense of pride in their different abilities as well as accomplishments (Berk, 2017). The theorist is of the opinion that those children who are continuously encouraged and commended by caregivers, parents as well as teachers would develop a feeling of competence and they would start believing in their skills. These individuals who do not receive any form of encouragement from parents, caregivers, teachers or peers will have doubts on their capabilities. In this case study, it is seen that Anne is a little child of only ten years old who had to go through severe emotional and mental turmoil as well as physical suffering to go through a surgery in the tender age (Crain, 2015). Different types of feelings like fear, anxiety, insecurity hopelessness, loneliness might affect her. The nursing professionals caring for her should constantly encourage her to be confident and overcome such feelings effectively. They should be her constant companion and help her overcome such feelings thereby emerging out with strong independent emotions and overcome fear and anxiety in strenuous situations. This would make Anne more confident in her future and would help her to be brave and courageous when such strenuous situations occur in her life in future.

Family centered care can be defined as the approach which involves an effective partnership between the Healthcare providers, the families and the patient in the planning as well as delivery and evaluation of care Studies suggest that care involving families in providing care to children has positive outcomes on the physical and mental health of child as well as better emotional outcomes on the parents (Davidson et al., 2017). In such form of care, parents are continuously encouraged and supported by the Healthcare professionals for staying with their child when they are receiving health care services. In case of Anne, her parents should be also receiving the information and support they need, so that they do not become anxious and fearful about the condition of a child and can be a strong support to Anne. They should be asked questions about what they want and what they need for betterment of situation. This would help in the identification of the goals for their child. The parents should be actively participating in the child care and becoming full member of the care teams (Curtis et al., 2016). When the parents are made the members of the multidisciplinary Healthcare teams and they are shared all important information, they feel empowered. They can successfully overcome any form of confusion that results in anxiety fear and hopelessness in them.

Hospitalization on the child results in both emotional as well as psychological trauma not only on the child but also on the parents and the families. Researchers are of the opinion that the major stressors of the hospitalization are seen to include separation, loss, anxiety, control, pain and bodily injuries. The ways and intensity of the children reacting to these crisis are entirely influenced by the developmental age of the child, their previous experiences with their illness of their coping skill as well as the support system that are available to them (Capurso & Ragni, 2016). Anxiety is seen to stem of from the onset of the rapid onset of the illness as well as the injury especially when the child is not having or having limited experience of the disorder (Sieglar, 2016). Anne had no previous history of such appendix issue and so, it might result in creation of the Anxiety. She might also develop fear. Such fear is mainly seen to rise from the separation from their family as well as the parent and also because of the unfamiliar environment and losing of control of the child. Parents provide constant support, care and love to their child in home and they become concerned about how their child will be able to manage and tackle so many negative situations alone. Such feelings result in helplessness among the parents making them go through emotional turmoil (Curtis et al., 2016). They feel frustrated and hold themselves guilty thinking that they could not take proper care of their child. In such situations, nursing professionals should share detailed information with family members and try to reduce the anxiety and negative thoughts. They should develop good bonds with the child and provide her support in ways by which she can overcome such feeling.

From above discussion, it can be seen that appendicitis results in surgery in children and such hospitalization might have negative outcomes on patients and family members. Therefore, nurses need to use proper developmental theories so that they can understand the psychology of the child at the particular age and give care. They should also follow family centered approach that would involve family as an important part of healthcare team. Hospitalizations also have negative outcomes on health of the patient and family members and therefore this should be also taken care of.

References:

Allievi, N., Harbi, A., Ceresoli, M., Montori, G., Poiasina, E., Coccolini, F., ... & Ansaloni, L. (2017). Acute appendicitis: still a surgical disease? Results from a propensity score-based outcome analysis of conservative versus surgical management from a prospective database. World journal of surgery, 41(11), 2697-2705.

Barrouillet, P. (2015). Theories of cognitive development: From Piaget to today.

Berk, L. (2017). Development through the lifespan. Pearson Education India.

Capurso, M., & Ragni, B. (2016). Psycho-educational preparation of children for anaesthesia: A review of intervention methods. Patient education and counseling, 99(2), 173-185.

Crain, W. (2015). Theories of Development: Concepts and Applications: Concepts and Applications. Psychology Press.

Curtis, K., Foster, K., Mitchell, R., & Van, C. (2016). Models of care delivery for families of critically ill children: an integrative review of international literature. Journal of pediatric nursing, 31(3), 330-341.

Davidson, J. E., Aslakson, R. A., Long, A. C., Puntillo, K. A., Kross, E. K., Hart, J., ... & Netzer, G. (2017). Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Critical care medicine, 45(1), 103-128.

Flum, D. R. (2015). Acute appendicitis—appendectomy or the “antibiotics first” strategy. New England Journal of Medicine, 372(20), 1937-1943.

Holmes, A. V., Atwood, E. C., Whalen, B., Beliveau, J., Jarvis, J. D., Matulis, J. C., & Ralston, S. L. (2016). Rooming-in to treat neonatal abstinence syndrome: improved family-centered care at lower cost. Pediatrics, 137(6), e20152929.

Hughes, T. M., & Luu, M. B. (2015). Acute appendicitis. In Common Surgical Diseases (pp. 169-171). Springer, New York, NY.

Mak, G. Z., & Loeff, D. S. (2016). Paradigm shifts in the treatment of appendicitis. Pediatric annals, 45(7), e235-e240.

Lefa, B., Livingston, C., November, I., Condy, J., Chetty, R., Shaik, N., ... & Aronstam, S. (2014). The piaget theory of cognitive development: an educational implication. Educ Psychol, 0-8.

Petroianu, A., & Barroso, T. V. V. (2016). Pathophysiology of acute appendicitis.

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.

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.

Wagner, M., Tubre, D. J., & Asensio, J. A. (2018). Evolution and Current Trends in the Management of Acute Appendicitis. Surgical Clinics.