Which of the following statements by an eighteen-year-old best illustrates their developmental stage?

Choice A reason: Abdominal pain that is most intense at McBurney point is a classic sign of acute appendicitis. McBurney point is located about two-thirds of the way from the navel to the right hip bone. It is the site of the base of the appendix, where the inflammation is most severe. The pain usually starts around the navel and then shifts to the lower right abdomen. The pain may worsen with movement, coughing, or pressure.

Choice B reason: Rebound tenderness is a symptom of peritonitis, which is a complication of acute appendicitis. Peritonitis is an inflammation of the lining of the abdominal cavity, which can occur if the appendix ruptures and spills its contents. Rebound tenderness is a sharp pain that occurs when the abdomen is quickly released after being gently pressed. It indicates irritation of the peritoneum, the membrane that covers the abdominal organs.

Choice C reason: Abdominal pain that is relieved by eating is not a typical feature of acute appendicitis. In fact, appendicitis may cause loss of appetite, nausea, and vomiting. Eating may worsen the pain by stimulating the digestive tract and increasing the pressure on the appendix.

Choice D reason: Bright red or dark red rectal bleeding is not a common manifestation of acute appendicitis. It may indicate other conditions, such as hemorrhoids, anal fissures, diverticulitis, ulcerative colitis, or colon cancer. Rectal bleeding may occur in some cases of appendicitis if the inflammation affects the cecum, the first part of the colon, but it is usually not bright or dark red.

Choice A reason: Unfamiliar equipment should be shown to the child and the family before the surgery, as part of the preoperative education and preparation. This can help reduce the child's fear and anxiety, as well as increase the child's understanding and cooperation during the surgery¹.

Choice B reason: Explain that an endotracheal tube will be needed for the surgery, regardless of how well it goes. The endotracheal tube is inserted through the mouth or nose into the trachea to provide mechanical ventilation during the surgery and the immediate postoperative period. The child and the family should be informed about the purpose, duration, and possible complications of the endotracheal tube, as well as the methods of communication and comfort measures².

Choice C reason: Mention the postoperative discomfort and interventions that the child may experience after the surgery, such as pain, nausea, chest tubes, drains, dressings, and monitors. The child and the family should be reassured that these are normal and expected, and that the nurse will provide adequate pain relief and care. The child and the family should also be taught about the postoperative activities and exercises, such as deep breathing, coughing, turning, and leg movements, to promote recovery and prevent complications³.

Choice D reason: Let the child hear the sounds of an ECG monitor, as well as other equipment that will be used during the surgery, such as a blood pressure cuff, an oxygen mask, and an IV pump. This can help familiarize the child with the sounds and sensations that he or she will encounter during the surgery, and reduce the fear of the unknown. The child should also be encouraged to ask questions and express feelings about the surgery⁴.