NUR3503: Nursing Children and Young People – Assessment Answer

Introduction

Siena, a 9-year-old partially immunised girl is presented in the emergency department. She is having a one-week history of abdominal pain and fever, an ultrasound was performed that is confirming the perforated appendix. She was undertaken for the surgery and after that shifted to the general ward. The assessment will discuss the pathophysiology of presenting condition, discussion of assessment that is undertaken to prioritise and manage the condition of Siena. Post-operative care is crucial for the patient undergoing surgery that manages the vitals. It will be taken care of with the application of family-centred models and giving information that helps in the recovery of Siena.

Pathophysiology

Conditions of ruptured appendix take place when the obstruction from the appendiceal orifice stems that is leading to inflammation, localised ischemia, perforation and the development of an abscess. The obstruction will cause lymphoid hyperplasia, infection and tumours that are leading to an impact on the appendix. Obstruction will lead to the cause of appendicitis that is resulting in the increase of intra-luminal pressure and intramural pressure due to which outcomes will be seen in terms of small vessel occlusion and stasis in the lymphatic system (Jumah & Wester, 2022). It is noted that once the obstruction is there then the appendix is getting filled with mucus and becomes distended. It will be making the compromise with the wall of the appendix that changes the physiology and leads to ischemic and narcotic conditions. The overgrowth of the bacteria in the appendix region impacts the appendix and leads to obstruction. When the appendix is unable to restore the content that makes a small tear that leaks out the content in the rest of the abdomen and causes complications in the abdominal regions. A condition resulting in pain in the lower quadrant of the abdomen that is stimulated in the T8 through T10 nerves (Pederiva et al., 2021). It will make the appendix to be more inflamed which leads to vague pain in the centralised area. The signs and symptoms that result in admission in the emergency setting are fever and abdominal pain occurring due to worsening of the pathophysiology of the condition.

Assessment

The paediatric assessment triangle is the tool present that is providing the accurate method for the rapid assessment of a child within an emergency setting. It will take the evaluation of the condition that is visual and auditory evaluation of the child's: appearance, work of breathing, and circulation to skin (Wu et al., 2023). The PAT is performed in the identification of triage significant negative likelihood ratio. The primary assessment framework is the first examination and evaluation of a patient by a medically trained person who focuses on the evaluation of the patient and tries to stabilise the condition in an emergency setting. Three basic components will be there: airway, breathing and circulation that are presenting the immediate threats to life and will identify the signs and symptoms that are causative by a particular condition. It is critical for patient safety that is allowing the designing of holistic care of patients and creating the opportunity to identify primary signs and symptoms (Yang et al., 2019). Taking the primary assessment, it is found that the heart rate was 130 beats per minute, respiration rate is 28 breaths per minute and temperature is 38.6 which is defining the primary concern area of the patient. The paediatric Acute Response and Recognition Observation Tool is another tool that is used as the age-specific tracker and trigger chart that include the concern of family and escalation to the care pathways that is fully integrated into the tool (Riedesel et al., 2019). It will be taking the calculation of respiratory distress score, oxygen saturation, heart rate calculated with each minute and pain scale score.

Taking the reference of the assessment, a PARROT tool is applied that allows the gathering of information. Temperature 38.6-degree, HR= 130 beats per minute, Oxygen saturation 90% on room air, RR= 28 breaths per minute with mild distress, and BP = 100/70mmHg are the reported ranges of the vitals. Potential nursing problems will include the complications associated with the Nasogastric tube and indwelling catheter. The potential issue is the aspiration that is making the patient feel discomfort as it passes through the nostril into the stomach (Lounis et al., 2020). It will induce gagging and vomiting in the patient. In addition, potential issues will be seen in terms of infection at the site of insertion. Risk of infection at the surgical incision site and risk for deep vein thrombosis related to immobility. The insertion that has been performed includes the two intravenous cannula, nasogastric tube and indwelling catheter and three steri-striped strips at the incisional sites. All these insertion sites will be reflecting the issue of infection. An infection will lead to inflammation at the site of surgery. It is important to take care of the surgical site as the patient is under the influence of analgesics that make her unable to feel any kind of pain (Doğan & Gürleyen, 2022). Therefore, it is important to take care of surgical sites that lead to a reduction in infection and inflammation.

Nursing management strategies involve assessment and relieving pain through medication. Antibiotics are given as the medication that improves the infection and manages the chances of infection at the surgical site and in the abdomen. Siena is not seen as supportive of taking medication as she is having a phobia of medication served in syringes (Gray & Mizrahi, 2020). Nurses have to provide the intervention that leads to compliance with medication and manage post-operative care. The non-pharmacological intervention will consist of cold compression therapy that is provided with the placement of an ice pack placed over a painful area that is reducing the swelling. It will manage the interaction of the skin. Second, is the prevention of fluid volume deficit that is common in patients undergoing surgery (Feng et al., 2021). Patients with surgery on the appendix need the fluid bolus before and post-operation to counteract dehydration. Oral fluid intake should be encouraged in patients and urine output needs to be recorded. The current handover depicts the recorded heart rate of 130 beats per minute and mild distress. Therefore, it is important to take care of the fluid in the body that is managing the vitals of the patient (Dooki et al., 2022). Monitoring adequate bowel movements required for pain control leads to constipation. It is also needed to encourage the adequate intake of water and the use of stool softeners that facilitate the movement of the bowel. Lastly, pain management and prevention of infection as maintaining a clean environment and providing wound care to the postoperative patient will restore vitality for the patient. To meet the requirement of patients, it is important to provide a family-centred care model that meets the need of patients and enhance the participation of the family members (Hassan et al., 2022). It is a way of providing services that is assuring the health and well-being of children and their families that makes respectful families and professional partnerships. It honours the strength, culture, tradition and expertise that families and professionals get into relationships. Recognizing and respecting one's knowledge and expertise help the nurses to partner with the family of the patient (Fluke et al., 2020). For example, Siena has a phobia of not taking medication intravenously which can be dealt with with the help of her parents. It will help in making the relationship and delivering the medication to the patient. The second way that can be applied is the shared power and decision-making that leads to the nurse's and family members' relationship by which alternatives can be decided for the patient (Shah et al., 2020). The way will lead to physical, emotional, social and spiritual health that help the fast recovery.

Health promotion

Promoting health in the case of Siena and his family requires education and awareness about the consumption of food and exercise. In addition, helping the patient's family to understand the importance of medication and taking it on time. Also, it is seen that patients are taken to ED when the appendix ruptures which can be managed with timely intervention (Ingram et al., 2020). Therefore, making arrangements for community services can help in the allocation of the sources and utilisation of a range of services. It is a community of professionals that aims to provide quality services.

Conclusion

Paediatric care is defined as medical care for children with any kind of serious disease. In this case, Siena is a 9-year-old partially immunised girl admitted to the ED with the complaint of a perforated appendix. It requires the nursing assessment and intervention like management of infection and bolus movement and dietary practices that facilitate the recovery. At last, taking the help of the community members to participate in the care of patients.

References

Dooki, M. E., Nezhadan, M., Mehrabani, S., Osia, S., Hadipoor, A., Hajiahmadi, M., & Mohammadi, M. (2022). Diagnostic accuracy of laboratory markers for diagnosis of acute appendicitis in children. Wiener Medizinische Wochenschrift, 172(13-14), 303-307.https://doi.org/10.1007/s10354-021-00898-8

Doğan, M., & Gürleyen, B. (2022). The role of immature granulocyte in the early prediction of acute perforated and nonperforated appendicitis in children. Turkish Journal of Trauma and Emergency Surgery, 28(3), 375. https://jag.journalagent.com/travma/pdfs/UTD-41347-CLINICAL_ARTICLE-DOGAN.pdf

Feng, S., Lai, X. H., Lou, Y., & Liu, W. (2021). Diagnostic value of procalcitonin and C-reactive protein level for predicting appendiceal perforation in children. HK J Paediatr (new series), 26(1), 3-7.https://www.hkjpaed.org/details.asp?id=1315&show=1234

Fluke, L. M., McEvoy, C. S., Peruski, A. H., Shibley, C. A., Adams, B. T., Stinnette, S. E., & Ricca, R. L. (2020). Evaluation of disparity in care for perforated appendicitis in a universal healthcare system. Pediatric Surgery International, 36, 219-225.https://doi.org/10.1007/s00383-019-04585-z

Gordon, A. J., Choi, J. H., Ginsburg, H., Kuenzler, K., Fisher, J., & Tomita, S. (2020). Oral antibiotics and abscess formation after appendectomy for perforated appendicitis in children. Journal of Surgical Research, 256, 56-60. https://doi.org/10.1016/j.jss.2020.05.082

Gray, D. T., & Mizrahi, T. (2020). Trends in appendicitis and perforated appendicitis prevalence in children in the United States, 2001-2015. JAMA network open, 3(10), e2023484-e2023484.https://doi.org/10.1001/jamanetworkopen.2020.23484

Hassan, T., Saeed, S., Khan, M. S. G., Hingoro, G. M., & Islam, S. M. (2022). Frequency of wound infection in children undergoing appendectomy for acute versus perforated appendicitis. The Professional Medical Journal, 29(01), 26-30.https://doi.org/10.29309/TPMJ/2022.29.01.6461

https://doi.org/10.1016/j.jss.2019.12.018

Ingram, M. C. E., Calabro, K., Polites, S., McCracken, C., Aspelund, G., Rich, B. S., ... & Raval, M. V. (2020). Systematic review of disparities in care and outcomes in pediatric appendectomy. Journal of Surgical Research, 249, 42-49.

Jumah, S., & Wester, T. (2022). Non-operative management of acute appendicitis in children. Pediatric Surgery International, 39(1), 11.https://doi.org/10.1007/s00383-022-05284-y

Lounis, Y., Hugo, J., Demarche, M., & Seghaye, M. C. (2020). Influence of age on clinical presentation, diagnosis delay and outcome in pre-school children with acute appendicitis. BMC pediatrics, 20, 1-9.https://doi.org/10.1186/s12887-020-02053-5

Pederiva, F., Bussani, R., Shafiei, V., Codrich, D., Guida, E., & Schleef, J. (2021). The histopathology of the appendix in children at interval appendectomy. Children, 8(9), 811.https://doi.org/10.3390/children8090811

Pogorelić, Z., Domjanović, J., Jukić, M., & Poklepović Peričić, T. (2020). Acute appendicitis in children younger than five years of age: diagnostic challenge for pediatric surgeons. Surgical infections, 21(3), 239-245.https://doi.org/10.1089/sur.2019.175

Riedesel, E. L., Weber, B. C., Shore, M. W., Cartmill, R. S., Ostlie, D. J., Leys, C. M., ... & Kohler, J. E. (2019). Diagnostic performance of standardized ultrasound protocol for detecting perforation in pediatric appendicitis. Pediatric Radiology, 49, 1726-1734.https://doi.org/10.1007/s00247-019-04475-5

Shah, A. A., Nizam, W., Sandler, A., Kane, T., Manicone, P., Williams, M., ... & Petrosyan, M. (2020). Assessing surgical care delivery at facilities caring for higher volumes of minority children utilizing the pediatric quality indicator for perforated appendicitis: a propensity-matched analysis. Pediatric Surgery International, 36, 407-414.https://doi.org/10.1007/s00383-019-04604-z

Veeralakshmanan, P., Ackah, J., Panahi, P., Ibrahim, R., & Coleman, M. (2020). Early versus interval appendicectomy for localised perforated appendicitis in children: A best evidence review. Annals of Medicine and Surgery, 59, 161-164.https://doi.org/10.1016/j.amsu.2020.09.028

Wu, Z., Zhao, L., Feng, S., & Luo, J. (2023). Hyperfibrinogenemia and hyponatremia as predictors of perforated appendicitis in children: A retrospective cohort study. International Journal of Colorectal Disease, 38(1), 72.https://doi.org/10.1007/s00384-023-04362-4

Yang, J., Liu, C., He, Y., & Cai, Z. (2019). Laboratory markers in the prediction of acute perforated appendicitis in children. Emergency medicine international, 2019.https://doi.org/10.1155/2019/4608053

You Might Also Like

Paediatrics Assignment Help

Understanding the Roles of Paediatric Nurses

NUR3503 Importance of Active Play Assignment Sample

Looking For Complete Assignment Sample Get It On WhatsApp