Exam 26: Pediatric Surgery

A child's comprehension of,and responses to,the environment are based on his or her developmental age.Many theorists have provided excellent guidelines for assessing the pediatric patient's developmental level to use appropriate interventions.The infant develops the belief that the world can be counted on to meet basic needs through the trust versus mistrust concept based on the stages of psychosocial and emotional needs.This theoretical framework of stages based on emotional needs was described by ______________,while the stages based on changes in cognition and ability to think were described by _____________.

The immature blood-brain barrier and decreased protein binding in infants increase their sensitivity to which group of drugs?

Baby Boy Doe is a newborn found outside of the emergency department (ED).He is hypothermic and has several deep lacerations across his back,abdomen,and legs that will require surgical repair.He is transferred to the surgical bay of the ED and prepared for anesthesia induction.Which risk reduction strategies are appropriate during the preanesthetic phase to achieve and maintain normothermia?

Neuropathologic conditions requiring surgical intervention can be found in any age group.What are the most common problems requiring neurosurgical procedures in infants and children?

The toddler uses symbols and engages in creative play.Toddlers are beginning to develop free will and control over their bodies.Which of the interventions below is age-appropriate for toddlers?

Much like the adult population,many traditional "open" pediatric surgical procedures are being replaced by MIS procedures.Because the field of pediatric MIS is relatively new,surgeons are at an advantage because they can combine virtual reality techniques and robotics with the most current technology and instrumentation.Select the MIS procedures commonly performed in pediatric patients.

A 14-year-old boy is scheduled for spinal fusion with implantation of rods from T₁0 to L2.During the preoperative interview and assessment,he asks the perioperative nurse how bad his pain will be when he wakes up and if he will have enough pain medicine available.He also wonders how the nurse will know when his pain is severe enough to give him pain medicine.The perioperative nurse assures the patient that he will have many options available to him to manage his pain after the surgery.An appropriate risk reduction strategy that the nurse can implement during the preoperative assessment is to:

Select all the injuries or conditions that reflect probable child abuse or neglect.

Vascular access in pediatric patients may be established intraoperatively for short-term (weeks)or long-term (months,years)use.Select all the examples of a long-term (months,weeks)use vascular access catheter.

The perioperative nurse explained to the child at a developmentally appropriate level,what he or she will experience in the preoperative,intraoperative,and postoperative phases of care.The nurse briefly described the roles of various staff members who will be a part of the team responsible for the child's care in the operating room (OR).She explained to the child and family the length of time that they will be separated from each other during the procedure and when they can be reunited in the postanesthesia care unit (PACU).She addressed the child within a developmental framework,considering the child's cognitive and psychosocial abilities.She used medical play items,audiovisual aids,puppets,and photographs in the education process.While the nurse addressed the need for knowledge of the impending surgical procedure and provided education,she also employed interventions aimed at which nursing diagnosis?

Children classified in the early childhood phase or who are preschool age begin to imagine and explore.Their thinking is dominated by perceptions and,often,distorted reasoning.They are magical thinkers.What would be appropriate interventions for preschool age children?

A 12-year-old boy is scheduled for a laparoscopic hernia repair.During the preoperative assessment and interview,the perioperative nurse notes that he has mild myotonia congenita.The patient's mother states that she is worried about the anesthesia because her husband's brother died many years ago when he became very feverish during surgery and they could not cool him.The perioperative nurse's appropriate risk reduction strategy in this situation would be to:

Children are more prone to foreign-body ingestion than adults.What is the most significant risk?

The pediatric patient is at risk for surgical site infection related to surgical intervention.Select the outcome indicator that would best reflect that the goal of freedom from signs and symptoms of infection was attained.

Improvements in instrumentation and the development of equipment in smaller sizes have resulted in the evolution of minimally invasive surgery (MIS)from that of a rapidly growing field to one of routine practice in the pediatric surgical arena.The advantages of MIS for the pediatric population include which true statement?

Cleft lip is usually associated with a notch or cleft of the underlying alveolus and a cleft of the palate.Cleft lip repair is most often performed when the infant is about 3 months of age.Cleft lip is described as:

Any misalignment of the eyes is called strabismus.The goal for treatment of strabismus is to straighten the eyes so that binocular vision functions appropriately.Surgery may be recommended to change the alignment of the eyes relative to each other by:

An orchiopexy is the surgical placement and fixation of the testicle in a normal anatomic position in the scrotal sac.If the testis fails to descend into the scrotum during gestation,it is considered undescended.Which statement regarding indications for orchiopexy is true?

Young children are predisposed to parasympathetic hypertonia (increased vagal tone),which can be induced by:

During the planning process,the perioperative nurse determines nursing interventions that will assist in meeting the appropriate goal statement of the desired nursing outcome.What nursing interventions are appropriate,when implemented,in protecting the pediatric patient from hypothermia?