Question

5. Why isn't the test for rebound tenderness consistently recommended with the pediatric patient? 6. What would be the priority nursing diagnoses in the care of the family coping with emergency surgery for appendicitis in a child? 7. Discuss the postoperative nursing management of the child with appendicitis. Include both the traditional open appendectomy as well as the laparoscopic approach. 8. What are the early signs and symptoms that will be present in the pediatric patient who is developing sepsis?

5-8

Answer 1

5.Rebound tenderness test is also called as Bloomberg sign.Here the abdomen is compressed or applied pressure on the site where the pain is and relieved.In case of appendicitis it will pain upon releasing the pressure.A child cannot be given this type of pain and this will trigger fear and anxiety leading to poor cooperation. So it is not done consistently. To assess the dictor may ask the child to come off the table and jump once, if any pain it is suggestive of appendicitis

6.The first thing is the fear, inability to cope upon hearing a surgery on a child where surgical blades are used to do an incision.

Nursing Diagnosis

Anxiety related to surgery (appendectomy )as evidence by poor coping mechanism

Or

Ineffective coping mechanism related to surgery as evidenced by deficient knowledge secondary to appendicitis

6.The post operative care for open and Lap.appendectomy are as following

• Assess the level of pain ,its intensity, duration ,frequency, type to plan care (pain is present in left shoulder for w4hours in lap.appendectomy )
• Monitor vital signs ,to get baseline information
• Assess the consciousness of the child
• Assess the peristaltic movement to start on diet
• Administer analgesics ,antibiotics as per order
• Monitor the surgical site for bleeding,discharge,odour especially in open appendectomy to rule out infection
• Maintain NBM till further order ,regain of peristalsia
• Meticulous handwashing to prevent infection

7.The signs and symptoms of sepsis in children are

• Skin:cold and clammy ,pale ,hand and feet are cold to touch
• CNS:dizziness, confusion
• CVS:Tachycardia
• Respiratory :dyspnea,tachypnea
• GIT:nsusea, vomiting ,diarrhoea
• General :extreme raise in body temperature or fall in it