Observation on the Effect of Rapid Rehabilitation Nursing with Integrated Medical Care in Perioperative Period of Laparoscopic Appendicitis in Children.

AIM: Acute appendicitis is one of the most common causes of acute abdomen in pediatric surgery. The purpose of this study was to observe the effects of integrated rapid rehabilitation nursing in children with laparoscopic appendectomy (LA) during the perioperative period. METHODS: A total of 200 children with appendicitis who underwent LA in our hospital from January 2022 to January 2023 were retrospectively selected as the study subjects. According to the nursing mode, they were divided into a control group (n = 100) and an observation group (n = 100). The control group was treated with routine nursing intervention, and the observation group was treated with an integrated rapid rehabilitation nursing intervention. Perioperative indices (operation time, first postoperative exhaust time, length of hospital stay) were recorded and compared between the two groups. The visual analog scale (VAS) was used to score the two groups at 6 h, 12 h, 24 h, and 48 h after surgery, and the pain degree of the children was quantitatively evaluated. The levels of serum stress response indices (cortisol (Cor), norepinephrine (NE), and adrenocorticotropic hormone (ACTH)) in the two groups were measured. The incidence of postoperative complications, improvement of postoperative quality of life, and nursing satisfaction were compared between the two groups. RESULTS: The operation time, first postoperative exhaust time, and hospitalization time in the observation group were significantly shorter than those in the control group (p < 0.05), and the VAS scores of the patients in the observation group were lower than those in the control group at each time point of 6 h, 12 h, 24 h, and 48 h after surgery (p < 0.05). One hour after surgery, the serum Cor, NE, and ACTH levels of the two groups of patients were significantly higher than those before surgery, and the levels for the observation group were significantly lower than those of the control group (p < 0.05). After treatment, the quality of life scores of patients in both groups was significantly higher than before treatment, and the quality of life scores of patients in the observation group was significantly higher than that of the control group (p < 0.05). The postoperative complication rate of the observation group was 3.00% (3/100), which was significantly lower than that of the control group (13.00% (13/100)) (χ2 = 6.793, p = 0.009). The nursing satisfaction of the observation group was 95.00% (95/100), which was significantly higher than that of the control group (79.00% (79/100)) (χ2 = 11.317, p = 0.001). CONCLUSIONS: The integrated rapid rehabilitation nursing management mode is an intervention that can effectively alleviate the effects of LA on stress reactions and pain in children with appendicitis. It can effectively reduce the incidence of postoperative complications and improve the patient's nursing satisfaction, allowing children with appendicitis to recover as soon as possible after surgery, and can improve patients' quality of life. It helps to improve the overall clinical efficacy, and the treatment process is simple to operate, relatively safe and reliable, has high use value, and is worthy of further promotion in clinical treatment.

Validity and reliability of a pain location tool for pediatric abdominal surgery.

For children with surgical problems, pain location conveys important clinical information. We developed a Location and Level of Intensity of Postoperative Pain (Lolipops) tool consisting of a body outline with a seven-sector abdominal grid, the International Association for the Study of Pain Revised Faces Pain Scale, and a recording chart. The aim of the study was to assess the validity and reliability of Lolipops. Children aged 5-14 years who had undergone laparoscopic appendectomy took both nurse- and investigator-administered Lolipops, and an investigator administered Varni Thompson Pediatric Pain Questionnaires, within 24 hours of surgery. The average age of the 42 participants was 10.7 years; 64% were boys; 24 (57.1%) had acute appendicitis, 13 (31%) had perforated appendicitis, and 5 (11.9%) were uninflamed. Pain scores were higher at the laparoscopic port incision sites than in upper abdominal sites distant from incisions or expected inflammation, mean (SD) 3.3 (2.3) and 1.1 (1.8), respectively (p < .0001). In children with acute appendicitis, pain scores were higher in the right iliac fossa than in upper abdominal sites, mean (SD) 3.3 (2.5) and 0.4 (0.7), respectively (p = .001). In children with perforated appendicitis, Lolipops demonstrated a more widespread pain pattern. Correlations between nurse and investigator were fair to moderate with an overall intraclass correlation coefficient of 0.597. This study presents a new tool to measure the location of pain in pediatric surgical patients and shows it to be valid and reliable.

Diagnóstico de enfermagem de crianças em pós-operatório de apendicectomia / Children's nursing diagnosis in appendectomy post surgery / Diagnostico de enfermeria de ninos en postoperatorio de apendicectomia

Estudo exploratório-descritivo, cujos objetivos foram determinar o perfil dos diagnósticos de enfermagem, identificar as características definidoras, bem como os fatores relacionados e de risco de crianças no pós-operatório de apendicectomia. Participaram do estudo 17 crianças, internadas na Unidade de um Hospital da Rede Estadual do Ceará, de maio a junho de 2009. O instrumento de coleta de dados constituiu-se de um roteiro elaborado segundo domínios apresentados pela Taxonomia II da North American Nursing Diagnosis Association (NANDA) e das informações dos prontuários do paciente. As informações levantadas determinaram as respostas humanas, as características definidoras e os fatores relacionados e de risco. Foram identificados 13 diagnósticos de enfermagem diferentes, 21 características definidoras e 16 fatores relacionados. Mediante a identificação dos diagnósticos de enfermagem nessa clientela, os enfermeiros podem propor intervenções fundamentadas e específicas, proporcionando a implementação de ações eficazes e imediatas para a resolução dos problemas identificados. Assim, este estudo fornece uma base para a sistematização do cuidado de enfermagem ao paciente em período pós-operatório de apendicectomia.

This is a descriptive-exploratory study whose goal was to determine the profile of nursing diagnosis and to identify the defining characteristics, related factors and risk factors in children during appendectomy post-surgery. Seventeen children admitted to a Public Hospital in Ceará were observed from May to June 2009. The instrument of data collection was the patient’s medical reports and a guide elaborated according to the Taxonomy II from the North American Nursing Diagnosis Association (NANDA). The information obtained determined the human answers, the defining characteristicsas well as the related and risk factors. 13 different nursing diagnosis, 21 defining characteristics and 16 related factors were identified. Through the nursing diagnosis identification in the patients, the nurses can recommend specific interventions and can provide the implementation of effective and immediate actions to solve the identified problems.This study offers thus a basis to nursing care systematization to patients in appendectomy post-surgery.

Estudio exploratorio descriptivo realizado con el objetivo de determinar el perfil de los diagnósticos de enfermería e identificar las características de definición , los factores relacionados y de riesgo en niños en postoperatorio de apendicectomía. Participaron del estudio 17 niños internados en la unidad de un hospital estatal del Estado de Ceará/Brasil, de mayo a junio de 2009. Se utilizó como herramienta de recogida de datos un cuestionario estructurado en conformidad con las directrices de Taxonomía II, de la North American Nursing Diagnosis Association (NANDA) y la ficha médica del paciente. Las informaciones recogidas determinaron las respuestas humanas, las características de definición y los factores relacionados y de riesgo. Se identificó un total de 13 diagnósticos de enfermería, 21 características de definición y 16 factores relacionados. Mediante la identificación de los diagnósticos de enfermería de los pacientes, los enfermeros pueden proponer intervenciones fundamentadas y específicas que promuevan la puesta en práctica de acciones eficaces e imediatas para resolver los problemas identificados. El presente estudio ofrece, entonces, basepara sistematizar la atención de enfermería al paciente en el postoperatorio de apendicectomía.

Home next day: early discharge of children following appendicectomy.

Fifty-six children in two groups were discharged within 24 hours of an uncomplicated appendicectomy. While the children in the first group (N = 21) were visited by a nurse at home within 24 hours of discharge, the second group (N = 35) just received telephone calls. The cohort was evaluated by telephone interviews two weeks after discharge. All children fulfilling the discharge standards were discharged safely within 24 hours of surgery. Any physical complaints post-discharge were considered minor. The nurses were able to provide reassurance to the families, give advice and deal with minor problems. As a result the families felt safe and reassured, and in only one case did the fragility of parental confidence become obvious. This study has demonstrated the safety of discharging these children within 24 hours of surgery and the value to nursing contacts in enabling the families to care for their children at home.

Treatment and management of acute appendicitis.

Acute appendicitis is one of the most common surgical conditions, and affects about seven per cent of the population. Perforation of the appendix and associated peritonitis is the most common complication. This guided reflection article discusses the signs, pre and postoperative treatment and nursing management of patients presenting with acute appendicitis.

Early discharge following uncomplicated appendicectomy in children.

This cohort evaluation investigated the discharge of 15 children within 12 to 24 hours following an uncomplicated appendicectomy who were subsequently supported by an outreach nurse. By monitoring the child's progress, providing the support the family was expected to require and offering professional back-up for any unforeseen problems the outreach nurse ensured the child's safety and improved quality of care after early discharge from the hospital. The pivotal importance of the outreach nursing input was demonstrated when the expected visit did not materialise for one child.

Perioperative assessment of fetal heart rate and uterine activity.

Improvements in surgical techniques and anesthesia allow women the option to schedule needed surgery during pregnancy. However, perioperative monitoring of the fetus and uterine activity remains a matter of controversy. Monitoring may allow rapid improvement of the fetal status or uterine activity when early compromise or contractions are detected. The reassurance and decreased medicolegal risks provided by perioperative monitoring may offset the cost of a perinatal nurse and use of monitoring equipment even though the drug and anesthetic effect on the fetal heart limit the benefits of monitoring. Simply providing adequate maternal respiratory support during surgery may improve the fetal pattern but will not eliminate external surgical effects. The need for additional research is described, and the role of the perinatal nurse is detailed in a suggested protocol.

Nursing patients through 'Pathways of Care'.

Pathways of Care can lead to standardised practice. Improved recordkeeping can save nursing time and improve continuity of care.

The role of the nurse: extended or expanded?

The subject of role extension has been much debated, particularly in recent years as a result of changing healthcare policies, growing demands by nurses and the public, and arguments about the very nature of nursing itself. The recent media furore over the theatre sister who performed an appendectomy is but one example. This article will take account of recent trends and look at the different concepts of role extension and role expansion. How nursing can best adapt these roles to meet patients' needs will also be considered.

Managing appendicitis in the elderly patient.

The incidence of acute appendicitis in the elderly will continue to increase as the elderly population enlarges. Because appendicitis is much more serious in elderly patients compared to younger patients, the care we render to elderly individuals must be optimal, and recent improvements in care have dropped mortality rates significantly.

Laparoscopic appendectomy incidental to gynecologic procedures.

1. The advantages of laparoscopic appendectomy over the traditional "open" method include decreased chance of wound infection, early ambulation and resumption of normal daily activities, decreased postoperative pain, improved diagnostic accuracy, better visualization of intra-abdominal anatomy, improved cosmetic results, and avoidance of "open" appendectomy if pathology is found during routine gynecologic laparoscopic surgery. 2. Single-puncture laparoscopy has several advantages over the multiple-puncture approach, including simplicity, expediency, lower cost, avoidance of potential complications associated with multiple punctures, improved cosmetic results, and flexibility to be converted into multiple-puncture laparoscopy or laparotomy when indicated. 3. Laparoscopy is expected to eventually replace laparotomy as the primary approach for most cases of diseases of the appendix. It is not suitable in cases of dense adhesions with distorted anatomy, malignancy, or severe pelvic peritonitis.