• Internal Code :
  • Subject Code : NRSG257
  • University :
  • Subject Name : Nursing

Anne, Jay and Sue Case Study


Anne, a 10-year-old girl child has been encountered with the problem of iliac fossa pain as presented in the case study. On the arrival in emergency department she was further diagnosed that she was suffering with appendicitis. Appendicitis is the major chronic condition that the patient has been seen impacted with severely. Her transfer has been done to the ward after the process of appendectomy where the surgeons delegated that she was suffering from the gangrenous perforated appendicitis with peritonitis. She found that she needed to be admitted in the hospital for 10 days and on medication. In order to manage her deteriorating condition, she was prescribed with antibiotics and analgesics. Prolonged hospitalization has been regarded as the biggest risk factor for impacting the growth and development of any individual. In the course of the case study, the effects of the hospitalization on the growth and development of the child have been discussed in compliance to several growth and developmental theories among children. Nurse-patient relationship plays a crucial role in lowering down the stress levels among patients. Family-centered approach has been practiced by the nurses in order to manage the stress levels among the patient and the family members. In the case study, effectiveness of therapeutic relationships has also been displayed in managing the effects of hospitalization among the child, siblings and other immediate family members.

Appendix Pathophysiology

Appendix can be referred to as the vestigial body organ whose function is still not very well known (Smith amp Wright, 2018). However, there are certain studies that show that it has some neuroendocrine and immunological characteristics. Appendicitis is the inflammation in the vermiform region. The disease is very much common in the adolescent and preadolescent generation. Abdominal pain can be referred to as the primary symptom of the appendicitis (Bhangu et al., 2015). The pathophysiology of the appendicitis can be differentiated in five varied stages that occurs in a time span of 24 to 36 hours (Petroianu amp Barroso, 2016). The primary stage of the disease includes the appendix inflammation, blockage of the lumen of the appendix due to faecolith faecal matter or lymphoid hyperplasia. In the next stage the visceral afferent thoracic nerves gets stimulated and significantly causes pain in the peri-umbical region and has lasted for about 4-6 hours (Drake et al., 2014). During the later third stage, after the obstruction, blood that is flowing into the tissues of appendix limits and has led to bacteria multiplication.

Due to obstruction of lumen, the pressure within the appendix rises and eradicates the drainage of venous that leads to the various complications of ischaemia. With the prolonged problem of ischemia, development of gangrene and necrosis in appendix has taken place (Hodges et al., 2018). This makes bacteria extensively potent to invade the luminal wall and leads to the transmural inflammation which can be referred to as the fourth stage of the disease. However, in the last and final fifth stage the transmural inflammation becomes extended and very much severe beyond the problem of appendix and reach out to the parietal peritoneum and to the adjacent parts (Drake et al., 2014). It is during the progression of the disease when the abdomens lower right quadrant starts pains a lot that further extends to the risk of anorexia, vomiting, nausea, fever, etc. and takes 48 hours to complete the disease. Appendicitis tends to result in perforation if not treated by appendectomy (Drake et al., 2014). The bacteria develop out from the appendix into the periphery region where the event further leads to the bacterial peritonitis and eventually death.

Growth and developmental theories

According to the given case-study, Anne was suffering from the severe gangrenous perforated appendicitis. Anne gets hospitalised for 10 days due to perforation that has led to severe infection in her body. It has been found that being in hospital for a long time due to appendicitis tends to impact the psychological wellness of many people (Shawk et al., 2018). As Anne, is just 10 years old, prolonged hospitalization can have a great impact on the aspects of her development and growth. Many theorists use many theories to explain the concept of development and growth. It has been found that the growth and development of a child have a major and significant influence of physical, psychological and environmental factors on to great limits. Erik Eriksons theory systematically explains that the process of evolution among the individuals is greatly influenced by the various psychological, biological and sociological events that occurs during childhood (Cherry, 2017 Fraser et al., 2017).

Chronic illness or severe hospitalization during childhood impacts the thinking process of people. Children who has suffered burden of illness, surgery or hospitalization feels socially isolated and believes in being away from the society due to the lack of social partnership. According to the case study, the patient is 10 years of age and is in a phase of developing cognitive abilities. One of the other theories discussed by Jean Piaget discusses about the cognitive development of a child. It discusses about the development of a child falling in the age range of 7 to 11 years in the operational stage. Piagets theory very well explains that this age allows the process of critical thinking among the developing children (Carey, Zaitchik amp Bascandziev, 2015). It is the stage where the children become vigilant and understands the facts surrounding the situations and events in a more systematic and inductive manner. The children falling in this age category also start responding to the situation by being vigilant and thinking logically about the situation. Perforation of appendix leading to further infection, chronic pain and prolonged hospital stay can be a life turning event in the life of patientin the process of her growth and development both physically and psychologically (Bhangu et al., 2015). All of these factors can collectively play a huge role in impeding the self-confidence and moral of the patient and can be regarded as one of the biggest adverse events in the patients life.

The age of Anne is a crucial age that can have a vital effect on the life of the child. To manage the physical and psychological adversities of the child, nurses needs to be more effective and attentive in managing and enhancing the physical and mental health condition of the patient (Haley amp Stott, 2013). Educating the child about her condition and complications of the disease can help the patient understand and self-manage the disease in a better manner (Hamime et al., 2015 Haley amp Stott, 2013). Medications such as morphine, triple IV antibiotics, intravenous fluid therapies, etc. can be used to manage the pain condition of the patient with the care provision of Anne by giving counselling and relaxation therapies (Zou et al., 2016).

Family-centered care

According to the case study, Anne is the eldest child and live with her parents and other four siblings. It has been noticed that chronic illness tends to have an impact just not on the patient but also on the family of the patient. In nursing, family centered care approach is the more efficient approach in order to meet the optimal health status of the patient but also in achieving early recovery and patient satisfaction (Park et al., 2018 Berman, Snyder amp Frandsen, 2016). Family centered care is a concept in which the families participate in the care process along with the patients. Motivation has a biggest role to play in the family centered care in order to provide patients and their families with emotional support and educates the families to be with the child during the process of hospitalization to feel safe, secure and valued (Coyne, Holmstrm amp Sderbck, 2018).

Educating patient and parents regarding the health status, medical complications and medication can be purposed as a part of family centered care plan (DeHoff et al., 2016 Fraser et al., 2017). As the patient is a minor, parents can facilitate the care process between the childand the healthcare provider in an effective manner. Nurses with effective communication skills plays an important role in building effective therapeutic relationship. An effective communication has an overall good impact on the family and enhances the involvement of the family and patient in the entire care process (Riley, 2015). Family centered care plan can also help in managing the stress levels among the patients as well as the family members due to the burden of hospitalization and extensive care delivery process (Park et al., 2018).The family centered approach also helps nurses to get more familiar with the values, feelings and belief of the child in order to enhance the care delivery by integrating a person-centered approach.

Effects of hospitalization on child and immediate family

Annes hospitalization directly affects all the members of her family including her siblings extensively. The deteriorating health conditions tend to cause age related behaviours like aggression, low self-esteem and social isolation in children (Hawkley amp Capitanio, 2015). Therapeutic relationships can be shared between among the patient and nurses in order to eradicate the problem of isolation and imbibe a sense of confidence in the patient (Berman, Snyder amp Frandsen, 2016). It has also been found that other siblings in the family have an impact of hospitalisation of one sibling. Complications may take place among the other siblings as they feel neglected by the parents and also feels burden of managing household chores on their own.

It also adds up to the mental stress where some siblings are extensively close to one another. It can be observed that distressing situations arouses anxiety, dilemma, fear of loss among the people related to the welfare of the child (Pinkney, 2018). It has also been given in the case study that Annes parents run an Indian restaurant. The burden of care on the parents also impacts their professional life and makes it difficult to manage, that can create possibilities of tensions and conflicts among the family. Nurses can play a pivotal role in managing the effective relationship with all the members involved in order to mitigate the disturbances in the personal and professional horizons (Kingma, 2018). Nurses can also accompany Anne during hospitalization incorporating a family centered care approach in order to manage her physical and psychological health along with the wellness of the family.


Thus, the pathophysiology of appendicitis has been discussed effectively in accordance to the given study. It is found that with the due time the complications of appendicitis becomes more severe and turns into gangrenous perforated appendicitis. In order to remove harmful substances from the body, Anne needs to be taken proper care of in the hospital with properly administering prescribed antibiotics. The effect of the hospitalization on the cognitive growth and development of the child has also been mentioned in the discussion of case-study. Hospitalization tends to have a large impact on the child, siblings and other members of the family. Nurses plays an extensive role in managing the physical as well as psychological condition of the child and also in promoting family-centered care. Effective therapeutic relationship with the nurses are also very valuable in order to lower the stress levels of the patients.


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