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Navigating Perforated Appendicitis: A Comprehensive Nursing Care Approach


Task: How can a comprehensive nursing care plan effectively address the pathophysiology of perforated appendicitis, ensure patient stability, and promote recovery, both during the hospital stay and post-discharge?



Appendicitis is one of the most commonly occurring health conditions that is identified during the teenage years of an individual as well as when in the 20s. It has also been found that appendicitis perforation is one of the severities of the condition which occurs in 2% of the cases. Perforated appendicitis develops after 36 hours of highlighting severe symptoms in a suffering individual (Motazedian et al., 2022). The case study focuses on a 9-year-old girl named Siena who was admitted with fever and abdominal pain which further confirmed perforated appendicitis. The essay will focus on the pathophysiology of perforated appendicitis and provide a nursing care plan as well as a management strategy for the patient.


The pathophysiology of appendicitis is known to account for the hindrance or rupture of the appendiceal orifice. The ideology behind the rupture of the appendicitis often where is within different sets of age groups which leads to diversity in the complications sustained by the individual. The increase in the normal cell count within the lymph node which is also called lymphoid hyperplasia often leads to inflammation, perforation, development of abscess, localized ischemia, as well as frank perforation which further needs to result in peritonitis (Perez & Allen, 2018). The obstruction of appendicitis is thus accounted to be associated with lymphoid hyperplasia malignant or benign tumours, parasitic infections as well as fecaliths. After obstruction of appendicitis, a major increase in the intramural pressure as well as intraluminal pressure is often developed which further results in the occultation of the lymphatic or small vessel stasis (Jones, Lopez & Deppen, 2022). As the rupture or hindrance of the appendix progress, it gets accumulated with an increased amount of Mucus leading to swelling of the appendix. Further, vascular, and lymphatic complications progress which leads to necrotic and ischemic conditions of the wall of the appendix. As parasitic infection by aerobic organisms is one of the causes of appendicitis, obstruction of the appendix further increases the growth of bacterial infection which thus develops a state of aerobic and nonaerobic mixture of organisms within the body (Skjold-Ødegaard & Søreide, 2022). It has been also found that after necrosis and inflammation within the appendix, the risk of perforation increases which demands increased medical assistance in order to avoid further complications.

Nursing assessments and management:

Pediatric Assessment Tool and/or Primary Assessment Framework/PARROT

In order to assess and evaluate the health condition of Siena and analyze potential care management, one of the escalation systems will be involved as a health assessment tool. The escalation system is known to be a series of clinical assessment pathways that helps in the early identification and implementation of actions to pay two patients with the risk of deterioration in pediatric settings. In the case of Sienna, the Pediatric Acute Response and Recognition Observation Tool or PARROT will be used as a means of early recognition and management tool for the risk of deterioration(Government of Western Australia, 2023). It is age-specific health and identifying trigger which focuses on family concerns as well as care pathways that need to be integrated for better management. It is used in order to develop avail sustained Early Working Score on initial admission and current patient condition with the help of the following factors:

? Respiratory distress score: it has been found that post-surgery of perforated appendicitis, Sienna has been respiratory with mild distress which thus grades her with 1 point of respiratory distress score. The respiratory score indicates the severity of the condition as well as the complications witnessed during respiration by a child.

? Respiratory rate calculated over 1 minuteThe respiratory rate of Siena was 28 per minute which is normal when compared to the referenced range of respiration per minute in children between the age of 6 to 12 years (Chourpiliadis & Bhardwaj, 2019).

? Oxygen saturation % (SpO2): The normal oxygen saturation level in children is accounted between 97 to 99%. In the case of Siena, the oxygen saturation level was 90% on room air which indicated low oxygen bound to hemoglobin and the blood contains low oxygen level (Ucrós et al., 2020).

? Oxygen therapy score: based on The Emergency Department Pediatric Early Warning Score, the oxygen therapyscore for Siena is 9 points as the oxygen saturation level ranges between 88 to 93%.

? Heart rate calculated over 1 minute: the normal rate for a child aged between 4 to 12 years is 55 to 85 beats per minute in the resting phase. In the case of Siena heart rate was 130 beats per minute which highlighted increased heart rate and abnormality (Siaplaouras et al., 2021).

? Blood pressure: the normal range of blood pressure and children and children aged between 6 to 12 years is 93 to 120 for systolic and 50 to 78 for diastolic. On analysis of sienna, the blood pressure was within the normal range of force systolic and diastolic pressure indicating 100/70 mm Hg (García-Hermoso et al., 2020).

? Pain scale score: the pediatric pain assessment of Siena indicated severe pain ranging between 7 to 10 post-surgery which highly demanded pain management therapies and medication. In order to manage pain, she was charged with intravenous antibiotics along with PRN Analgesia.

? Level of consciousness using AVPU (alert, voice, pain, unresponsive): on analysis of the level of consciousness in Siena using SVPU, it was found that she was alert, was able to speak, and was under severe pain which indicated that she was conscious (Chaudhary, Nagula& Taksande, 2022).

Nursing Management Strategies:

Regular monitoring: one of the significant nursing management for Siena will include regulator monitoring and recording of her vitals and stability in order to assess any risk of deterioration and provide early management.

Maintain fluid volume within the body: It is necessary to ensure that fluid volume deficiency is not initiated in the patient and thus proper oral intake of fluid must be maintained based on intake and output analysis (Eta et al., 2023).

Oxygen therapy: as Siena was found to have mild distress while breathing as well as low oxygen saturation in her blood, it will be necessary to provide oxygen therapy in order to restore the deficiency of oxygen in her blood.

Pain management: in order to manage pain and provide a significant amount of comfort to the patient pain management therapies such as counseling must be provided along with medication Mitchell significantly helped in overcoming anxiety and fear (Manworren et al., 2021).

Manage and record bowl movement Colonial offend medication used to maintain and manage pain leads to difficulty related to bowel movement. Also, post-surgical patients suffer difficulty in regulating their bowel movements due to pain and discomfort. In such conditions, the nurse needs to maintain proper water intake as well as provide stool-softening interventions.

The Child and Family-Centred Care Model:

The child and family-centered care model focus on involving the child and the family in a care management process where they will work together as a result as a team with other care and management facilities to set a goal and sustain better recovery. Siena and her family will work along as a team where they will set a goal for her recovery serve as a strength and support for each other as well as make active decisions based on their priorities and cultural values to sustain better recovery (Franck & O'Brien, 2019).

Discharge And Self-Management Education for Siena:

The discharge education for Siena will initially guide her regarding the proper rest she needs to maintain post-surgery and discharge as well as the minimal set of activities that she needs to involve in order to maintain mobility within the body. It will be necessary for Siena to avoid lifting heavy weights are doing stressful activities in order to avoid pressure on the surgical region. It is necessary for Siena to maintain proper diet intake in order to initiate active recovery which might include fibrous intake and avoiding fat and spicy food (Manworren et al., 2021). The discharge plan will also guide Siena regarding the regular intake of medications as well as their dosage. Actions that needs to be taken in case of emergency will also be guided to Siena such as seeking immediate medical assistance in keying of severe pain or other complication.

Health Promotion:

There is a wide range of health promotion strategies that assist patients with better health promotion and recovery from underlying health conditions. The chief health promotion strategies that need to be implemented in the case of Siena include nurturing a supportive environment as well as enforcing community association and collaboration along with skills and development fostering. It will be necessary that proper involvement with the community care providers and assistance are made in order to provide healthcare support nutritious support as well as device management for Siena after discharge from post-surgery condition (Castillo et al., 2019). Siena must be provided with a healthy and safe environment where proper diet physical activity as well as cleanliness and sanitary are maintained to avoid any risk of deterioration and infection.


The nursing management plan will provide Siena and her family with a significant set of assistance in order to enhance recovery from the complication as well as ensure management post-discharge. It will be necessary to guide and instruct Siena and her family regarding the different management strategies they need to maintain to sustain recovery as well as provide the best care post-discharge system with assistance to community and local care providers.


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Chaudhary, R., Nagula, K., & Taksande, A. (2022). Modified Glasgow Coma Scale and the Alert Verbal Painful Unresponsive Scale for Assessing the Level of Consciousness in Pediatric Critical Care Patients—A Comparative Study. Journal of Pediatric Neurology, 20(03), 171-175.DOI: 10.1055/s-0041-1725981

Chourpiliadis, C., & Bhardwaj, A. (2019). Physiology, respiratory rate. Retrieved from: Physiology, Respiratory Rate - Abstract - Europe PMC

Eta, V. E., Bassah, N., Esembeson, M., & Palle, J. N. (2023). Nursing Management of Patients with Appendicitis. In Appendicitis-Causes and Treatments. IntechOpen.DOI: 10.5772/intechopen.1001067

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Jones, M. W., Lopez, R. A., & Deppen, J. G. (2022). Appendicitis. In StatPearls [Internet]. StatPearls Publishing. Retrieved from:

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Skjold-Ødegaard, B., & Søreide, K. (2022). The diagnostic differentiation challenge in acute appendicitis: how to distinguish between uncomplicated and complicated appendicitis in adults. Diagnostics, 12(7), 1724.

Ucrós, S., Granados, C. M., Castro-Rodríguez, J. A., & Hill, C. M. (2020). Oxygen saturation in childhood at high altitude: a systematic review. High altitude medicine & biology, 21(2), 114-125.


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