Exam 25: Pediatric Surgery

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?

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

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

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?

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 an appropriate intervention for preschool age children?

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.

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.What risk reduction strategies are appropriate during the preanesthetic phase to achieve and maintain normothermia?

The pediatric patient is at risk for imbalanced fluid volume related to invasive surgery and accompanying blood loss.Select the outcome indicator that would best reflect that the goal of maintained fluid balance was attained.

Sienna Morgan is a 7-year-old girl who was involved in a hit and run accident while riding her bike to school.She is attended by paramedics and has an unstable airway;blood pressure less than 50 mm Hg (systolic);a major open,penetrating wound;and open,multiple fractures of both legs.Sienna is comatose.During transport she is intubated and demonstrates persistent physiologic demise and possible traumatic brain injury.A significant risk reduction strategy for Sienna would be to:

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?

Personal comfort or security items should be permitted to accompany children to the OR who are in which developmental age?

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 intervention is appropriate,when implemented,in protecting the pediatric patient from fluid volume imbalance?

Pharyngeal obstruction is revealed by a history of sleep-disordered breathing.Mouth breathing,snoring,pauses in breathing,restless sleep,waking at night,and enuresis may be related to obstruction.Pharyngeal obstruction may also be caused by recurrent pharyngitis or tonsillitis.Select all the procedures that are designed for the relief of pharyngeal obstruction.

Sheldon Swanson is a 14-year-old boy scheduled for spinal fusion with implantation of rods from T₁₀ to L2.During the preoperative interview and assessment,Sheldon asks the perioperative nurse how bad his pain will be when he wakes up,and if he will have enough pain medicine available.Sheldon also wonders how the nurse will know when his pain is severe enough to ask for pain medicine.The perioperative nurse assures Sheldon 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:

Infants and children with severe gastroesophageal (GE)reflux can have life-threatening complications,including obstructive apnea,aspiration pneumonia,esophagitis,and failure to thrive.What is the name of the procedure,performed open or laparoscopically,that is designed to create a competent antireflux barrier?

It is important to recognize that the difference between pediatric care and adult care is not just a size issue.Major areas of distinction are the airway and pulmonary status,cardiovascular status,temperature regulation,metabolism,fluid management,and psychologic development.The most significant consideration when caring for pediatric patients that is not of concern when caring for adults is:

Carlos Gracia is a 12-year-old boy scheduled for a laparoscopic hernia repair.During the preoperative assessment and interview,the perioperative nurse notes that Carlos has mild myotonia congenita.Carlos' 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:

This orthopedic diagnosis is a complex deformity that is diagnosed prenatally through ultrasound or at birth.It may occur unilaterally or bilaterally and may be idiopathic or one in a combination of other syndromes with associated anomalies.The general characteristic for all cases includes inversion of the foot such that the anterior foot is located in the typical position of the posterior foot;often there is a deep crease in the midfoot.Select the orthopedic diagnosis.

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:

Donna Antonio,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.Donna briefly described the roles of various staff members who will be a part of the team responsible for the child's care in the 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 PACU.Donna addressed the child within a developmental framework,taking into account the child's cognitive and psychosocial abilities.She used medical play items,audiovisual aids,puppets,and photographs in the education process.While Donna addressed the need for knowledge of the impending surgical procedure and provided education,she also employed interventions aimed at which nursing diagnosis?