Problem
Patient History
Past Medical History: No significant medical history; has never been hospitalized
Allergies: No known drug allergies
Medications: None
Code Status: Full Code
Social/Family History: He lives with his parents and two sisters. The family has recently moved to the area from out-of-state and has not yet established a primary care provider. They currently have no private health insurance coverage. The patient has been having difficulty making friends at school and is experiencing depression.
Situation:
The patient is an eight-year-old male brought to the ED by his parents with signs and symptoms of appendicitis. He has been ill for the last two days, and his pain became worse and localized in his lower right quadrant today. He also has a "fever" according to his mother. Admission orders have been written.
Background:
He presents to the ED with complaints of severe localized pain in the right lower quadrant of the abdomen, nausea, vomiting and fever. Two days ago, he began complaining of loss of appetite and cramping-type pain. His mother states he just wasn't acting like himself. By that evening, he was complaining of generalized abdominal pain. Yesterday, he complained of nausea and increased abdominal pain that was more localized on the right side. He had an emesis that was mostly clear mucus last evening. The mother states, "He has not eaten for two days, but I finally convinced him to eat some crackers and soda this morning."
Preparation Questions
A. Describe the clinical manifestations of appendicitis with its underlying pathophysiology and associated lab findings. Include information about the typical timeframe for progression of symptoms.
B. What assessment findings would indicate the appendix has or is about to rupture? Discuss how this would affect the nursing plan of care for the pediatric patient.
C. What affect does race, age and insurance status have on the risk of rupture in cases of appendicitis?
D. What developmental factors need to be considered when assessing a child's self-rating of pain?
E. Why isn't the test for rebound tenderness consistently recommended with the pediatric patient?
F. What would be the priority nursing diagnoses in the care of the family coping with emergency surgery for appendicitis in a child?
G. Discuss the postoperative nursing management of the child with appendicitis. Include both the traditional open appendectomy as well as the laparoscopic approach.
H. What are the early signs and symptoms that will be present in the pediatric patient who is developing sepsis?
I. What are the priority nursing interventions in the patient experiencing early sepsis?
J. What strategies can the nurse use to assist the family of a child who is hospitalized?
K. Develop a discharge plan for the pediatric patient being discharged on home antibiotic therapy.
L. Discuss the importance of including other members of the healthcare team in discharge planning.