Outcomes of very high C-reactive protein levels in paediatric practice.

Siba Prosad Paul, Alifa De Aguiar, Joanna Barnden, Anna Cannon and Megan Eaton discuss the implications of high levels of the inflammatory marker, drawing on local audit.

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.

Implementation of an advanced nursing directive for suspected appendicitis to empower pediatric emergency nurses.

In response to a clinical safety review, we have implemented an AND to empower our pediatric emergency nurses to identify and initiate care directives for children with suspected appendicitis. Future quality assessment and research studies will focus on the accuracy of the AND in predicting which children will have imaging studies or an appendectomy as well as the impact of the AND on key pediatric ED flow measures.

School Nurses on the Front Lines of Medicine: An Adolescent Female Student with Severe Abdominal Pain.

Abdominal pain is a common chief complaint encountered by school nurses. This article explains the etiology of abdominal pain in children and adolescents, describes the office assessment, and delineates life-threatening conditions associated with severe abdominal pain that may prompt the school nurse to transfer the student to a local emergency department.

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.

Common pediatric surgical problems.

Common pediatric surgical problems, including hernias, pyloric stenosis, intussusception, and appendicitis continue to present a challenge to the health care provider. Clinical presentation may be typical, may vary with age or signs and symptoms, or may be vague and inconclusive. Management of these problems may range from nonoperative to traditional surgical intervention. Nursing implications include counseling, patient and family education, pre- and postoperative care, and the prevention of complications.

The role of the advanced practice nurse in pediatric general surgery.

The advanced practice nurse (APN) functions in pediatric surgery in a variety of ways. In the inpatient setting, the APN can provide care to infants and children with many complex congenital and other surgical anomalies. In the outpatient office, the role includes diagnosis, management, education, and care coordination for children with both routine and complex diagnoses. This article discusses the differences in some of these roles and a few of the common diagnoses seen by the APN in a pediatric surgical practice on a routine day.

Recognizing the various presentations of appendicitis.

Appendicitis is one of the most common causes of acute abdominal pain in the industrialized world. Appendicitis must be considered in the differential diagnosis of any patient presenting with abdominal pain. Workup may include blood tests, abdominal radiographs, abdominal ultrasound, and focused appendix computed tomography. Unfortunately, none of these provides definitive results. Although several signs and symptoms are associated with appendicitis, their inconsistent presentation, especially among the young and the elderly, can lead to an erroneous diagnosis. The classic sequence of symptoms includes the onset of vague epigastric or periumbilical pain; associated nausea, anorexia, or unsustained vomiting; and pain migrating to the right lower quadrant. In uncomplicated cases, the treatment of appendicitis is appendectomy. However, less definitive presentations merit further diagnostic testing and close follow-up.

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.

Nursing activities and outcomes of care in the assessment, management, and documentation of children's pain.

This study describes how assessment and documentation of children's acute postoperative pain is managed by nurses in university hospitals in Finland. A survey was conducted of 303 nurses working in children's wards of university-affiliated hospitals, and at the same time a retrospective chart review of 50 consecutive cases of operation of acute appendicitis was carried out. Charts were analyzed by content analysis, and the results of the survey are reported with percentage distribution and nonparametric statistical calculations. The results indicate that nurses assess pain mainly by observing the child's behavior and changes in physiology. Pain measurement instruments are rarely used, and nurses do not recognize them. The documentation of pain care is unsystematic and does not support the continuity of care. There is a clear need for development of assessment and documentation practices in the studied hospitals. Future research should look at the postoperative care of pain at home as well as care in non-university-affiliated hospitals.