Question

Case Studies

Ginny, 4 years old, has been transported to the local children’s hospital with a fever and abdominal pain. Her physician suspects that it is appendicitis. After reviewing the appropriate diagnostic tests and consulting a pediatric surgeon, the diagnosis of appendicitis is confirmed. Ginny is scheduled for an appendectomy as soon as possible. Ginny’s parents are at her bedside and are having trouble processing the recent turn of events as they occurred very suddenly and progressed quickly. Ginny has two older siblings, who are currently staying with a neighbor.

1. What do you think would be some of Ginny’s reactions to hospitalization?

2. What are the factors affecting Ginny’s reaction to her hospitalization? (think about stages of development)

3. What are some of the reactions Ginny’s family may experience regarding Ginny’s hospitalization?

The nurse has reviewed the surgeon’s orders and is beginning to prepare Ginny for her appendectomy (see above). Ginny is notably upset and her parents are equally anxious about the surgery. The nurse prepares Ginny for the operation and then focuses her attention on addressing the needs of Ginny and her parents.

4. What is the nurse’s role in caring for Ginny during her hospitalization?

5. What are some of the things the nurse can do to prepare Ginny for surgery?

6. What are some of the steps the nurse will do to prepare Ginny and her family for discharge?

Answer 1

1. Ginny’s reactions to hospitalization

Common stressors and fears for preschoolers in the hospital

• Misconceptions arise from inability to distinguish reality and fantasy. For example, a child might fear that hospitalization/illness is a punishment for wrong-doing.
• Fear of long separation from loved ones
• Fear of loss of control
• Fear of bodily injury or harm

2. The factors affecting Ginny’s reaction to her hospitalization

3. The reactions of Ginny’s family regarding her hospitalization

4. The nurse’s role in caring Ginny during her hospitalization

5. The things the nurse can do to prepare Ginny for surgery

1. Maintain NPO status.
2. Administer fluids intravenously to prevent dehydration.
3. Monitor for changes in level of pain.
4. Monitor for signs of ruptured appendix and peritonitis
5. Position right-side lying or low to semi fowler position to promote comfort.
6. Monitor bowel sounds.
7. Apply ice packs to abdomen every hour for 20-30 minutes as prescribed.
8. Administer antibiotics as prescribed
9. Avoid the application of heat in the abdomen.
10. Avoid laxatives or enema.

6.   

Discharge and Home Healthcare Guidelines

• MEDICATIONS. Be sure the patient's parents understands any pain medication prescribed, including doses, route, action, and side effects. Make certain the patient understands that he or she should avoid operating a motor vehicle or heavy machinery while taking such medication.
• INCISION. Sutures are generally removed in the physician’s office in 5 to 7 days. Explain to parents the need to keep the surgical wound clean and dry.
• Teach to observe the wound and report to the physician any increased swelling, redness, drainage, odor, or separation of the wound edges. Also instruct the patient to notify the doctor if a fever develops.
• Needs to know these may be symptoms of wound infection. Explain to avoid heavy lifting and should question the physician about when lifting can be resumed.
• COMPLICATIONS. Instruct about possible complication of appendicitis is peritonitis.
• Discuss symptoms that indicate peritonitis, including sharp abdominal pains, fever, nausea and vomiting, and increased pulse and respiration.
• To seek medical attention immediately should these symptoms occur.
• NUTRITION. Instruct the diet can be advanced to her normal food pattern as long as no gastrointestinal distress is experienced.