Hypothetical Assessment and Plan for HDFS 4810: Hospitalized Child and Family.

1. RUNNING HEAD: HYPOTHETICAL Martin 1
ASSESSMENT AND PLAN
Hypothetical Assessment and Plan: Post-op Appendectomy for School-Aged Child
Emma Grace Martin
Department of Family and Consumer Sciences, University of Georgia
HDFS 4810: Hospitalized Child and Family
Professor Lauren Holley, MS, CCLS, CPST
October 4, 2021

2. HYPOTHETICAL ASSESSMENT Martin 2
School-aged children are at an age where they are expanding their social world, roles and
lifetime values through developing relationships with humans other than their primary caregiver.
A somewhat-lengthy hospital stay, intense surgery, and separation from peers and family can
impact their development greatly. Through developmental theories and medical analysis, a
hypothetical assessment plan is developed for an eight-year-old, Caucasian male, who is the
middle child in his family. In his family, he has a mother, father, and two siblings. One of his
siblings is a brother of the age of four years old and the other sibling is a sister of the age fifteen
years old. The patient was experiencing symptoms of appendicitis such as vomiting and pain in
the lower right side of his abdomen. Since an appendectomy is a thin pouch attached to the large
intestine, the result of appendicitis is a medical emergency, and the appendix was removed right
away. If this was not treated within 48 to 72 hours following symptoms, the appendix can rupture
which leads to a life-threatening emergency and immediate hospitalization. (John Hopkins
Medicine, Appendicitis, 2021) The patient’s appendix was only swollen and not ruptured, so the
treatment plan for this acute case involves a laparoscopic appendectomy, where a surgeon uses
surgical tools and cameras to view into one’s abdomen and remove the appendix. Since a
laparoscopic appendectomy is done through the result of small abdominal incisions instead of
one large two to four-inch incision, the recovery process is faster, and the patient can heal with
less pain and a small amount of scarring. (Mayo Clinic, Appendicitis, 2021) The prognosis of the
medical treatment of this patient is generally short, within a weeks of recovery time. Because this
was an emergency surgery, the patient was admitted to the hospital and the one-hour surgery was
performed. The patient is to be released from the hospital 48 hours after the surgery, and then the
home-care remedies will be performed. There is a focus on the importance of the patient
understanding the implications of this surgery so he can cognitively process these events and

3. HYPOTHETICAL ASSESSMENT Martin 3
consequences. (Rollins, et. al, 2005) His treatment plan will also include industry activities while
he is in the hospital in hopes that the medical setting will be slightly more normalized for him,
and he will not have an ample amount of stress for missing school and being separated from his
peers.
The developmental tasks that this patient is experiencing are those of a school-aged child,
which makes him a little less vulnerable to the anxieties of hospitalization due to the number of
developmental achievements he has achieved at this age. (Rollins et al., 2005) Supported by
Erikson, this school-aged child falls into the developmentally challenging category of industry
versus inferiority. In this stage, children are learning to work and cooperate with others through
socializing and activities. They can form relationships with other adults and peers, as well as
complete tasks to make and put things together. (Rollins et al., 2005) Also supported by Piaget,
in this stage, school-aged children become concrete operational thinkers, where they can better
process information and think logically. This is a big milestone for the patient because he can
now understand relationships between events and experiences. (Rollins et al., 2005) Due to the
fact that this time period is critical for social, emotional, physical, and cognitive development,
there are hospitalization issues that may affect his development. The unfamiliar hospital setting
of his post-op, separation from peers, changes of routine this patient faces the possibility of
negative emotions, anxiety, and fear of missing school for the next few weeks in his recovery
process. Since his surgical procedure was the result of an emergency room visit (from the nature
of appendicitis being an emergency procedure), it is important that his family and healthcare
providers focus on active coping, support, and locus of control of this patient’s situation. There
are many stressful events that children can experience during hospitalization at this patient’s age.
Some being the patient’s surgery was intrusive, therefore he will experience the physical

4. HYPOTHETICAL ASSESSMENT Martin 4
symptoms of nausea and pain. (Rollins et al., 2005) Along with the fact that this patient will
experience separation from his family and therapeutic interventions of physical exams and
waking up after his surgery. (Rollins et al., 2005)
The family stressors surrounding this patient’s hospital visit and surgical procedure are
more positive because he has a family member, his father, at the hospital with him and another
family member, his mother, at home to continue care for his two siblings. These stressors come
from the decision of the parents having to manage this illness separately, the unexpected
admission into the hospital, and the changes in routines of daily family life. (Rollins et al., 2005)
The stress of his siblings is underestimated, and they are forced to deal with the family concerns
due to the absence of a parent in the family system. (Rollins, et al., 2005) The younger sibling is
developing in the developmental stage Erikson categorizes as autonomy versus shame and doubt.
Attachment is important in this stage, but his little brother is experiencing the internal feelings of
wanting to make autonomous decisions for himself. His psychosocial safety is important, and
this abrupt hospital visit of his brother may trigger feelings of separation from his father and
frightening fantasies of what his older brother is enduring in the hospital setting without him.
(Rollins, et al., 2005) When observing the behavior of the patient’s little brother, there are
language barriers that prevent him from being able to fully understand what is occurring to his
older brother in the hospital. The explanation of treatment can be best explained to him through
objects and visual demonstrations, in order to help him correctly understand the acute surgery
that has taken place. The patient’s older sister is in the stage of adolescence, more specifically as
Piaget states, the stage of formal operations. In this stage, adolescents can think abstractly and
imagine the conditions of the problem. Specifically, to her little brother’s case, she can develop
hypotheses about what is logically occurring to him at the hospital during his surgery and after.

5. HYPOTHETICAL ASSESSMENT Martin 5
(Rollins, et al., 2005) Family support is very important during this time especially since the
family is being separated for a short period of time. The patient is dealing with the psychosocial
challenge of not being with his family and vise-versa for his family at home as well as his father
in the hospital with him. As a result of the disruption of the family routine, the family as a whole
must cater to the needs of the child and to the needs of the siblings. The parents as well must
focus on their own personal coping as well which includes being a strong advocate for their child
in ensuring he is receiving the best medical help while attending to their own mental health. The
presence of social support, therapeutic play, and parental involvement will make for the strong
recovery for the patient and family.
The possible future implications for this patient include a one to three-week recovery
time, since his appendix had not yet burst, and he received laparoscopic surgery. The medical
implications of the patient’s post-op include the possibility of a nasogastric tube in the child’s
nose where the patients stomach contents will be removed and an intravenous line where he will
directly receive medicine and fluids to fight off infection. (Appendectomy: Complete
Appendicitis, 2021) Since this was an emergency procedure, proper preparations were not able to
be given, so it is important that injections and intravenous insertions be explained to him in a
developmentally appropriate manner. The next few weeks of the patient’s future will include
resting, little exercise, a normal diet and excessive fluids, medication for pain, and careful
attention to his incisions. (Appendectomy: What to expect at home, 2021) The family must plan
for the transition of their child and sibling returning home and become active participants in the
present and future. Overall, an in-depth analysis of the patient’s background and diagnoses,
treatment plan, and implications for the family make for a strong hypothetical assessment plan
that will ensure the safety of the patient and the strong enmeshment of the family system.

6. HYPOTHETICAL ASSESSMENT Martin 6
References
Appendectomy: Complex appendicitis. Nationwide Children's Hospital. (n.d.). Retrieved October
5, 2021, from https://www.nationwidechildrens.org/family-resources-education/health-
wellness-and-safety-resources/helping-hands/appendectomy-complex-appendicitis.
Appendectomy: What to expect at home. Appendectomy: What to Expect at Home | Kaiser
Permanente. (n.d.). Retrieved October 5, 2021, from
https://healthy.kaiserpermanente.org/health-wellness/health-
encyclopedia/he.appendectomy-what-to-expect-at-home.ug3573.
John Hopkins Medicine. (n.d.). Appendectomy. Johns Hopkins Medicine. Retrieved October 5,
2021, from https://www.hopkinsmedicine.org/health/treatment-tests-and-
therapies/appendectomy.
Kristine, A. (2021). Child and Adolescent Development: A Social Justice Approach. Bassim
Hamadeh.
Mayo Foundation for Medical Education and Research. (2021, August 7). Appendicitis. Mayo
Clinic. Retrieved October 5, 2021, from https://www.mayoclinic.org/diseases-
conditions/appendicitis/diagnosis-treatment/drc-20369549.
Rollins, J. H., Bolig, R., & Mahan, C. C. (2005). Meeting children's psychosocial needs across
the health-care continuum. PRO-ED, Inc.