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Care of the Pediatric Patient in Surgery: Neonatal Through Adolescence ” CARE OF THE PEDIATRIC PATIENT IN SURGERY : NEONATAL THROUGH ADOLESCENCE 1961 1961 CARE OF THE PEDIATRIC PATIENT IN SURGERY : NEONATAL THROUGH ADOLESCENCE STUDY GUIDE Disclaimer AORN and its logo are registered trademarks of AORN, Inc. AORN does not endorse any commercial company’s products or services. Although all commercial products in this course are expected to conform to professional medical/nursing standards, inclusion in this course does not constitute a guarantee or endorsement by AORN of the quality or value of such products or of the claims made by the manufacturers. No responsibility is assumed by AORN, Inc, for any injury and/or damage to persons or property as a matter of product liability, negligence or otherwise, or from any use or operation of any standards, recommended practices, methods, products, instructions, or ideas contained in the material herein. Because of rapid advances in the health care sciences in particular, independent verification of diagnoses, medication dosages, and individualized care and treatment should be made. The material contained herein is not intended to be a substitute for the exercise of professional medical or nursing judgment. The content in this publication is provided on an “as is” basis. TO THE FULLEST EXTENT PERMITTED BY LAW, AORN, INC, DISCLAIMS ALL WARRANTIES, EITHER EXPRESSED OR IMPLIED, STATUTORY OR OTHERWISE, INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY, NON-INFRINGEMENT OF THIRD PARTIES’ RIGHTS, AND FITNESS FOR A PARTICULAR PURPOSE. This publication may be photocopied for noncommercial purposes of scientific use or educational advancement. The following credit line must appear on the front page of the photocopied document: Reprinted with permission from The Association of periOperative Registered Nurses, Inc. Copyright 2012 “ CARE OF THE PEDIATRIC PATIENT IN SURGERY: NEONATAL THROUGH ADOLESCENCE ” All rights reserved by AORN, Inc. 2170 South Parker Road, Suite 400, Denver, CO 80231-5711 (800) 755-2676 www.aorn.org Video produced by Cine-Med, Inc. 127 Main Street North, Woodbury, CT 06798 Tel (203) 263-0006 Fax (203) 263-4839 www.cine-med.com 2 CARE OF THE PEDIATRIC PATIENT IN SURGERY : N EONATAL THROUGH ADOLESCENCE Care of the Pediatric Patient in Surgery: Neonatal through Adolescence TABLE OF CONTENTS PURPOSE/GOAL .............................................................................................................................5 OBJECTIVES ....................................................................................................................................5 OVERVIEW ......................................................................................................................................6 Developmental Stages .......................................................................................................................6 Resources used in table .....................................................................................................................7 Neonate: .............................................................................................................................................8 Toddler ...............................................................................................................................................8 Pre-School .........................................................................................................................................9 School Age .........................................................................................................................................9 Adolescence .......................................................................................................................................9 Fear and Anxiety ..............................................................................................................................10 Anxiolytic Premedications ..............................................................................................................10 Parent Present Induction ..................................................................................................................11 Rapid Sequence Induction ...............................................................................................................11 Inhalation Induction .........................................................................................................................12 Patient Positioning ...........................................................................................................................12 Pressure Injury Prevention ..............................................................................................................12 Electrosurgical Considerations ........................................................................................................13 Maintenance of Normothermia ........................................................................................................13 Fluid and Electrolyte Balance .........................................................................................................14 Emergence Delirium ........................................................................................................................15 Pain Control .....................................................................................................................................15 Patient-controlled Analgesia ............................................................................................................16 Sedation ...........................................................................................................................................16 Discharge Teaching .........................................................................................................................16 Cast Care .........................................................................................................................................17 SUMMARY .....................................................................................................................................17 REFERENCES ................................................................................................................................18 POST-TEST .....................................................................................................................................23 POST-TEST ANSWERS .................................................................................................................26 3 CARE OF THE PEDIATRIC PATIENT IN SURGERY : N EONATAL THROUGH ADOLESCENCE PURPOSE/GOAL The purpose of this video and study guide is to review pediatric developmental stages, the importance of preoperative assessment in providing safe care, the basic principles of patient centered care and parent present induction, and critical aspects of intraoperative and postoperative care. OBJECTIVES After viewing the video and reviewing the accompanying study guide, participants will be able to: 1. Discuss the importance of pediatric developmental stages. 2. List the essential aspects of the preoperative assessment. 3. Identify the basic principles of parent present induction. 4. Relate the critical aspects of postoperative care. 4 CARE OF THE PEDIATRIC PATIENT IN SURGERY : N EONATAL THROUGH ADOLESCENCE OVERVIEW on an outpatient basis, home care concerns related to pain Care of children in the perioperative environment is complex control and wound surveillance are presented. and must take into account the fact that children are not just small adults. A thorough understanding of the stages of DEVELOPMENTAL STAGES development from the neonate throughout childhood and A basic understanding of pediatric developmental stages is culminating in adolescence is essential. In addition, the preop, essential to all phases of perioperative nursing care and affects intraop, postop, and discharge phases of pediatric patient care how the nurse interacts with the large variety of patients in the are multifaceted and include many factors that must be pediatric population. It is important for the nurse to establish considered. Aspects addressed within this study guide include a connection with the parents as this will help establish trust the effect of developmental stages, psychological preparation with the child. The nurse must also remember that chronologic of the child and parents, medication safety, thermoregulation, age is not always the same as developmental age; this can be and pain control. Pediatric patients come in a wide range of particularly important for children with developmental issues, sizes. Because of this, equipment must be appropriately sized whose chronological age may have no relationship to their for the pediatric patient and should be quickly obtainable. Care cognitive stage. Several fears that seem almost universal of the pediatric patient is a team effort, best accomplished throughout the pediatric population include separation anxiety through collaboration among anesthesia providers, surgeons, and fear of pain, disfigurement, and loss of control. The and the nursing staff throughout the continuum of care. Lastly, following table delineates some of the key differences given the frequency with which pediatric surgery is performed throughout the various developmental stages and typical age ranges for each stage. Stage of Life Neonate Infant Toddler Pre-school School age Adolescent Age Range First 30 days 1-12
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