CCA206 Care of Children and Adolescents

Introduction

William (Bill) Giovanni aged sixteen years and eleven months. The patient has been diagnosed with acute appendicitis and I have been requested to take over his nursing care in the emergency department until his bed is ready in the theatre. During this time I learn more about the history of Bill from this brother. This paper is a critical appraisal of the first case study involving Bill. The analysis will involve pathophysiology of acute appendicitis, the signs, and symptoms, the growth, and development stages of adolescents considering informed consent based on Gillick competence, child protection roles of nurses, cultural and psychological needs when planning for care, strategies of creating a safe and supportive atmosphere for the patient while at the hospital.

Pathophysiology of Acute appendicitis

Acute appendicitis is due to the blockade of the appendiceal lumen which can be caused by different causes. The blockage then causes a pressure increase in the lumen which is associated with the unceasing secretion of fluids and mucus from the mucosa and its immobility. On the other hand, intestinal bacteria in the appendix increases, resulting in the gathering of white blood cells and the development of pus and later on increased intraluminal pressure (Petroianu & Barroso, 2016). With continued blockage of the appendiceal, intraluminal pressure increases and surpasses that of the appendiceal veins causing venous outflow blockage. As a result, appendiceal wall ischemia starts leading to a decline in epithelial integrity, and the appendiceal wall is attacked by bacteria. Within hours, such a localized condition might exacerbate due to the clotting of blood in the appendicular artery and veins damaging the appendix (Bhangu et al., 2015).  

Signs and symptoms of acute appendicitis

The common symptom of severe appendicitis is abdominal pain which starts as epigastric pain and is not properly localized. However, sometimes the pain migrates to the right lower quadrant of the abdomen. At this level and position, the pain becomes well-localized and sharp. The patients often lie down, stretch their hips, and folds their knees upwards to help avoid movements and mitigate their increasing pain (Snyder, Guthrie, & Cagle, 2018). After an assessment, there is likely to be rebound tenderness and percussion pain at McBurney’s point. In extreme situations, patients can manifest symptoms of sepsis, hypotension, and pain on palpation of the LIF. Most of these features are manifested by Bill who has bilateral lower abdominal pain, especially to the left, rebound tenderness, and dehydration. These clinical signs indicate that the client has acute appendicitis (Petroianu, 2012).

Growth and development milestones of Adolescents

The adolescent stage of development consists of critical physical, cognitive, social, and emotional changes (Flensborg-Madsen & Mortensen, 2015). William (Bill) Giovanni is a typical adolescent aged sixteen years and eleven months. Concerning physical milestones most teenagers become increasingly agile and organized thus enabling them to swiftly undertake various activities of interest (Zohar et al., 2019). The agility of Bill is manifested in his character as described by his brother Owen.  Cognitive milestones among adolescents are when they become increasingly concerned about their individual lives and the world around them (Aris et al., 2019). Bill is afraid of IV medications and thinks they can make him end like his mother who is an IV drug user. He is also less tolerant to pain. Such a character is likely to affect nursing assessment and planning of care. The RN has to be sensitive to the needs of the teenager and be compassionate to show that he/she cares and have him cooperate during diagnosis and treatment.

The adolescent transition is gradual and they manifest a high ability to think, arrive at informed assumptions, and differentiate between facts and fiction. They begin to develop more abstract ideas comparing expectations and reality (Sawyer et al., 2018). Bill knows that his father died in hospital and he is fearful of being treated in hospital because he has developed the assumption that it’s a place of death. Now, this is a hurdle that a RN will have to deal with in order to treat him. Nurses have the responsibility of creating a conducive environment during his hospital stay by developing and improving nurse-patient relationship.

These development milestones significantly influence nursing assessment and planning of care. The nurse dealing with Bill has to examine his situation independently and determine which support is accessible and the coping skills to be enhanced. The patient is reserved and therefore when planning their care, the nurse has to collaborate with the adolescent and family (Owen) to obtain such information. This is necessary for clarifying the problem and ascertaining the most effective intervention.

Informed consent and Gillick Competence

Gillick's competence is assessed by examining the decision-making ability of the child in understanding and evaluating risks. A child below sixteen years can consent to medical assessment and treatment if he or she has satisfactory maturity and intelligence to comprehend the nature and effects of that treatment (Griffith, 2016). Based on these characteristics of Gillick competence, the patient (Bill) in the first clinical scenario can make informed consent. Bill is sixteen years and eleven months old based on the information provided by his brother, Bill can associate medical procedures such as IV with her mother who is a drug addict and therefore tend to dislike such treatments. Additionally, his condition is an emergency case, and considering the absence of his mother and father, the doctor is left with the decision of saving his life without the need for seeking consent from any other.  

Child protection responsibilities

Bill was brought into the hospital by his brother and following the clinical diagnosis, he is an emergency case. Additionally, he is grimacing in discomfort and his only mother is a drug addict and might not be involved in the treatment. Bill does not have a father. Considering the situation of the adolescent, he requires child protection. Additionally, the fact that the child is in the hospital setting, the nurses have child protection responsibilities to protect him from harm, pain, and neglect. According to the Victoria legislation on child protection, mandatory reporting to the DHHS Child Protection is required by registered nurses once they have identified and confirmed child abuse (CFCA Resource Sheet, March 2018). Besides offering the urgent medical attention, the RN should advise Bill and try to discourage him from the living in fear due to the past experiences, such as the death of his father and drug addiction of his mother.

The case of Bill would require a multidisciplinary team to address all his issues. The team can be diverse depending on the needs of the patient. They can include doctors, nurse, and counsellor. The doctor will be responsible for diagnosis and treatment recommendations, nurses will offer the required nursing care. A professional counsellor would offer psychological counseling to Bill so that he does not have to live in fear due to the past experiences of the death of his father and current status of his mother who is a drug addict. The counselor will have to ensure that the patient gets facts about the past experiences so that he doesn’t have to live with them (Geldard, Geldard, & Foo, 2019).  

A safe and emotionally supportive environment for the adolescent

Nurses can create an emotionally safe and supportive atmosphere for the teenager at the hospital by showing empathy and developing relationships. Demonstrating empathy will indicate to Bill that the people around him are concerned about his condition and thus he should be hopeful. Relationships are critical for safety and opening up, especially for adolescents. Through an effective nurse-patient relationship, Bill will feel at home and trust his care to the nurses. Additionally, such an environment will enable him to cooperate while being treated (Kidger et al., 2012).

Exercising respectful communication is another vital strategy that nurses can use to create a supportive environment. This would include non-judgmental interaction. This is one way of recognizing and instilling dignity in the youth. Considering his situation, nurses should not condemn or judge him but instead provide an environment in which he will feel safe regardless of his past experiences. Nurses should avoid words that are likely to cause harm, traumatize, or stigmatize and any lack of collaboration should not be confronted. Finally, nurses can create a safe environment for Bill by encouraging him despite his current clinical diagnosis, loss of his father, and the condition of his mother (Kourkouta & Papathanasiou, 2014).

Role of Registered Nurses in the safe administration and management of medications

Nurses play a critical role in drug administration and safety. Nurses should obtain a reliable drug history from the patient or family members. This should include local applications, over-the-counter, or traditional herbs. In the case of Bill, nurses should obtain his medical history. Nurses will also be involved in the prescription of drugs for patients. This includes ensuring that the prescription of clearly written with date, standard drug name, dose, route, and frequency (Berdot et al., 2013).

Nurses are also responsible for inquiring about any allergies to help avoid contraindications with specific drugs. For instance, Bill allergic to lactose and fructose. This implies that he should not be given Lactaid. The nurse is also responsible for correct interpretation of the prescription, recording that the drug has been administered, and observing the reaction of the patient. If the nurse is not sure about the prescription, then she should seek advice or consult the doctor (Medeiros et al., 2016).

Conclusion

Bill has acute appendicitis which requires urgent attention before his condition worsens. He can be observed lying on the bed with his knees bent and crying in discomfort. Adolescents have varied health needs and their treatment approach should be different from normal adults. The patient is sixteen years but he can give informed consent considering the Gillick competence needs. Nurses and the multidisciplinary team have the child protection responsibilities of Bill such as protection from harm, pain, neglect. They should as well consider his psychosocial and cultural needs in enabling them to create an environmentally safe place for him which would require effective therapeutic communication, nurse-patient relationship, empathy, respectful communication, and non-judgmental interaction. The role of nurses in the safe administration and drugs for the adolescent include obtaining a reliable drug history of the patient, drug prescription, and administration

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