THE PATIENT AS A UNIQUE INDIVIDUAL
BY: MRS. IVY ROSALES
THE PATIENT: THE REASON FOR YOUR
EXISTENCE
THE PATIENT AS AN INDIVIDUAL
o Patient – is an individual recipient of
health care services.
o Extremes of age (pediatric and geriatric)
and comorbid disease entities require
individualization of the plan of care.
The following characteristics that individualize
patients include, but are not limited to:
o They are worthwhile and unique
individuals.
o They respond psychosocially on the
basis of their personal values, beliefs,
and ethnocultural background.
o They have the capacity to adapt to their
internal and external environments.
o They have basic needs that must be met
to maintain homeostasis.
Homeostasis is a consistent internal
environment maintained by the patient’s
adaptive capabilities and has a physiologic and a
psychologic component.
PATIENT’S BASIC NEEDS
THE PATIENT WITH INDIVIDUALIZED NEEDS
THE PATIENT WITH SENSORY IMPAIRMENT
PATIENT’S REACTIONS TO ILLNESS
o Behavior
- Health and human behavior are
interdependent and often age
dependent. Regardless of age,
individuals with physiologic problems
experience some emotional change that
influences their behavior. Patients react
to a new interpersonal environment
according to their learned behavioral
pattern
o Adaptation
NCM 112
- Any deviation from a person’s normal
daily pattern of living necessitates
adaptation through innate or acquired
defenses. Adaptation may involve
physiologic or psychologic changes.
o Stress
- can be defined as a physical, chemical,
or emotional factor that causes tension,
and it may be a factor in disease
causation. It is the result of a perceived
threat and is manifested by changes in
physiologic and psychosocial behavior.
o Patients’ perception of care
- Studies have shown that a patient’s
perception is based on expectations of
high-level care. The patient’s belief
system defines what he or she
considers to be good care.
- Research has revealed that
preoperatively a patient needs
information about the surgical
procedure, how it will be performed,
and the type of anesthetic to be used.
Intraoperatively, the patient assumes a
passive role, entrusting care to the
perioperative team
o Family/significant others
- Families need preoperative instruction
to prepare for the post operative
outcomes and rehabilitation. They also
need to be kept informed of the
patient’s progress during the surgical
procedure and recovery period.
OR PHYSICAL CHALLENGE
o Sensory Impairment
- Communication is essential to assess
adequately the needs of challenged
patients and to care for them. Team
members should know about and
understand the patient’s limitations.
Patients have a right to know what will
happen during the surgical experience
and to participate in decisions about
their care.
o Language Barrier
- Nonverbal body language through eye
contact, pleasant facial expressions, and
a gentle touch can comfort the patient
who speaks a different language. Every
effort should be made to obtain an
interpreter to assist the patient and the
[Date] 1
THE PATIENT AS A UNIQUE INDIVIDUAL
BY: MRS. IVY ROSALES
health care team; many hospitals use
interpreters for the ethnic groups
within the community.
o Hearing Impairment/deafness
- The following steps should be observed
when communicating with a patient
who has a hearing impairment:
1) Make sure the room is quiet
and well lit, with minimal
distractions.
2) Greet the patient without
wearing a facemask and attract
the patient’s attention before
speaking. Make eye contact.
3) Speak clearly and slowly in a
moderate tone of voice, with
visible but not exaggerated lip
movements. Facial expressions,
touch, and body gestures can
help communicate feelings and
instructions.
4) Be sure the patient understands
and responds appropriately to
questions.
5) To help explain your actions,
show the patient any
equipment
(e.g., a safety strap) before
placing it on him or her.
6) Allow the patient to wear a
hearing aid in the perioperative
environment, if possible
o Visual impairment/blindness
- Patients who are blind feel insecure in
a strange environment; therefore the
following steps should be observed
when communicating with them:
1. Address the patient by name in
moderate tones and then introduce
yourself. Make some noise as you
approach so as not to startle the
patient.
2. Always speak to the patient
before touching him or her. A
gentle word followed by a gentle
touch can be comforting.
3. For prevention of a distressful
reaction to unexpected noises or
sensations, the patient should be
told what is going to happen
before any physical contact.
4. Guiding the patient’s hand helps
him or her feel secure, such as
when being moved onto the
operating bed (OR bed).
o Physical challenge
NCM 112
- Patients who are physically challenged
need a highly individualized plan of
care. Physical problems such as
contractures, spinal deformity, missing
limbs, or pressure sores may make it
difficult to position the patient on the
OR bed.
o Impairment of cognitive function
- Communicating with patients who have
impaired cognitive function is
sometimes difficult. Cognitive functions
are based on intelligence and the ability
to think, learn, remember, respond, and
solve problems.
- Explanations about procedures and the
environment may seem confusing and
frightening to these patients. Verbal
communication should be attempted at
the patient’s level of understanding
and response.
THE PATIENT WITH ALTERATION OF
NUTRITION
o MALNUTRITION
- Malnutrition in the surgical patient is
caused by an inadequate intake or use
of calories and protein preoperatively
and/or postoperatively.
- The discrepancy between the intake of
essential nutrients and the body’s
demand for them creates a state of
impaired functional ability and
structural integrity.
- Patients who are undernourished have
less than 70% to 80% of ideal body
weight (IBW) and suffer greatly from
the lack of caloric intake. As a result of
malnutrition the patient may
experience the following side effects:
1. Poor tolerance of anesthetic agents
2. Altered would healing potential
3. Decreased serum electrolyte levels
associated with anorexia, bulimia,
alcoholism, and other chronic metabolic
disturbances.
4. Increased susceptibility to infection
from immunologic incompetence, with
a total lymphocyte count less than
1500/mm3
5. Sequential multisystem organ failure
6.Increased risk of morbidity and
mortality
o METABOLISM (anabolism/catabolism)
- Metabolism is the phenomenon of
synthesizing foodstuffs into complex elements
and complex substances into simple ones in the
[Date] 2
 THE PATIENT AS A UNIQUE INDIVIDUAL
BY: MRS. IVY ROSALES
production of energy. It involves two opposing
phases:
1. Anabolism - the conversion of
nutritive material into complex living
matter; tissue construction.
2. Catabolism - or destructive
metabolism: Breaking down or
dissolution by the body of complex
compounds, often with the release of
energy.
NUTRITIONAL SUPPLEMENTS
o Dietary management is used to correct
metabolic and nutritional abnormalities
before the surgical procedure.
o A chemically defined elemental diet
may be administered via the following
routes:
✓ Oral intake
✓ Nasogastric tube for enteral
nutrition
✓ Gastrostomy tube, with or without
infusion pump, for enteral nutrition
✓ Intravenous (IV) infusion of protein
and dextrose through a peripheral
vein for parenteral nutrition
✓ Central venous cannulation for
hyperalimentation for parenteral
nutrition
THE PATIENT WITH DIABETES MELLITUS
o Diabetes mellitus is an endocrine
disorder that affects glucose
metabolism and the production of
insulin in the beta cells of the pancreas.
o Insulin is a hormone that helps break
down carbohydrates.
o Three types:
a) Type 1: Insulin-dependent diabetes
mellitus.
o The pancreas produces little or no
insulin, thus necessitating regular
administration of insulin via injection.
Onset may be at any age but usually
occurs in juveniles (adolescents ages
12-16 years) and adults up to age 40
years.
b) Type 2: Non–insulin-dependent
diabetes mellitus.
- The pancreas produces varying
amounts of insulin. Onset may be at any
age but usually occurs after age 40
years in obese persons. Blood glucose
levels are controlled by diet and the
administration of oral
antihyperglycemics.
NCM 112
c) Diabetes mellitus associated with other
conditions or syndromes.
o Impaired glucose tolerance may be the
result of pancreatic or hormonal
disease, drug or chemical toxicity,
abnormal insulin receptors, or other
genetic syndromes. The diabetes may
be latent, asymptomatic, or borderline.
o The preoperative assessment of
patients with the potential for impaired
glucose metabolism includes laboratory
testing for fasting and postprandial
blood glucose levels, urinalysis,
complete blood count, BUN values, and
serum electrolyte determinations. A
chest x-ray study and electrocardiogram
(ECG) also are advisable.
COMMON COMPLICATIONS
o Patients with diabetes are prone to the
following conditions:
✓ Dehydration and electrolyte imbalance
✓ Infection
✓ Inadequate circulation
✓ Hypertension
✓ Hyperlipidemia
✓ Delayed wound healing
✓ Neuropathy
✓ Nephropathy
✓ Retinopathy
✓ Neuropathic musculoskeletal disease;
✓ Neurogenic bladder
SPECIAL CONSIDERATIONS
Assessment of these patients can minimize
potential risks:
1) Capillary blood should be tested
preoperatively for fasting serum
glucose.
2) Preoperative insulin dose may be
reduced or eliminated.
3) Continuous IV access is vital.
4) A metabolic crisis in an unconscious
patient is difficult to detect without
frequent blood tests.
5) Nasogastric suction may cause acidosis,
dehydration, or electrolyte imbalance.
6) Antiembolic stockings are usually worn
by the patient during the surgical
procedure and postoperatively.
7) Skin integrity must be guarded to avoid
breakdown.
[Date] 3
 THE PATIENT AS A UNIQUE INDIVIDUAL NCM 112
BY: MRS. IVY ROSALES

✓ Increased operating time because of

mechanics of the surgical procedure
THE PATIENT WITH DIABETES MELLITUS ✓ Thromboembolic complications
✓ Delayed healing

THE PATIENT WITH CANCER

o Cancer is a broad term that
encompasses any malignant tissue change and
is potentially curable.

Extent of Disease
▪ Carcinoma in Situ
- In carcinoma in situ, normal cells are
replaced by anaplastic cells, but the growth
disturbance of epithelial surfaces shows no
behavioral evidence of invasion and metastasis.
- Carcinoma in situ is also referred to as
intraepithelial or preinvasive cancer.
- Common sites for in situ carcinoma
include:
• Uterine cervix
• Uterine endometrium
• Vagina
• Anus
• Penis
THE OBESE PATIENT • Lip
- The condition is referred to as morbid • Buccal mucosa
obesity when weight exceeds 100 lbs (45.4 kg) • Bronchi
over the ideal weight and the patient’s body • Esophagus
mass index (BMI) exceeds 25 to greater than 30 • Eye
kg/m2. • Breast
- It may be of one of two origins:
1. Endocrine: Usually associated with ▪ Localized Cancer
biliary, hepatic, or endocrine disease. - Localized cancer is contained within the
2. Nonendocrine: Commonly associated organ of its origin.
with excessive caloric intake. ▪ Regional Cancer
- In regional cancer the invaded area
COMPLICATIONS extends from the periphery of the organ or
✓ Increased demand on the heart tissue of origin to include tumor cells in
✓ Hypertension adjacent organs or tissues (e.g., the regional
✓ Varicose veins and edema in the lower lymph nodes).
extremities ▪ Metastatic Cancer
✓ Pulmonary function abnormalities - In metastatic cancer the tumor extends
✓ Respiratory compromise sleep apnea by way of lymphatic or vascular channels to
✓ Disease of digestive system tissues or organs beyond the regional area.
✓ DM type 2 ▪ Disseminated Cancer
✓ Osteoarthritis - In disseminated cancer,
✓ Malnutrition multiple foci of tumor cells are
dispersed throughout the body.
SPECIAL CONSIDERATIONS
✓ Transporting and lifting the patient CANCER TREATMENT MODALITIES
✓ Keeping bodily exposure to a minimum ▪ Adjuvant Therapy
as with all patients - Surgical resection, endocrine therapy,
✓ Induction, intubation and maintenance radiation therapy, chemotherapy,
of anesthesia immunotherapy, hyperthermia, or
✓ Positioning, prepping, and draping on combinations of these procedures are used to
the OR bed treat cancer.

[Date] 4
 THE PATIENT AS A UNIQUE INDIVIDUAL
BY: MRS. IVY ROSALES
- In determination of the most
appropriate therapy the following factors are
considered:
• Type, site, and extent of tumor and
whether lymph nodes are involved
• Type of surrounding normal tissue
• Age and general condition of the
patient, including nutritional status and
whether other diseases are present
• Whether curative or palliative therapy
is possible
o Surgical Resection
- Surgical resection is the modality of
choice to remove most solid tumors.
o Endocrine Therapy
- Tumors that arise in organs that are
usually under hormonal influence (e.g., breast,
ovary, and uterus in female patients; prostate
and testes in male patients) may be stimulated
by hormones produced in the endocrine glands.
- Hormonal Receptor Site Studies.
Identification of the hormonal dependence of
the primary tumor through studies of the
receptor site is a fairly reliable way of selecting
patients who will benefit from preoperative or
postoperative endocrine manipulation.
- Endocrine ablation. The surgical
removal of the endocrine glands.
o Photodynamic (Laser) Therapy
- also referred to as photoradiation, an
argon tunable dye laser is used to destroy
malignant cells via photochemical reaction.
o Radiation Therapy
- Radiation is the emission of
electromagnetic waves or atomic particles that
result from the disintegration of nuclei of
unstable or radioactive elements.
- Ionizing Radiation. Ionization is the
physical production of positive and negative
ions capable of conducting electricity. Ionizing
radiation is radiation with sufficient energy to
disrupt the electronic balance of an atom.
- Implantation of Radiation Sources. All
radiation sources for implantation are prepared
in the desired therapeutic dosages by personnel
in the nuclear medicine department.
• Interstitial Needles. Interstitial
needles are hollow sheaths and are
usually made of platinum or Monel
metal. Radium salts or
radionuclides are encased in
platinum or platinum-iridium short
units or cells, which in turn are
sealed in the metal sheath of the
NCM 112
needle for implantation into tumor
tissue.
• Interstitial Seeds. Sealed
radionuclide seeds may be
implanted permanently or
temporarily.
- Brachytherapy - also known as internal
beam radiation comes from a Greek term
meaning “short-range treatment.” Tiny titanium
cylinders that contain a radioactive isotope are
implanted to deliver a dose of radiation from
the inside out that kills cancer cells while
sparing healthy tissue.
- External Beam Radiation Therapy -
Ionizing radiations of gamma rays or x-rays
generated from machines are used externally to
alter tumor cells within the body. This type of
radiation therapy is noninvasive.
CONSIDERATIONS FOR INTRAOPERATIVE CARE
1. The skin over the site of a soft tissue tumor
should be handled gently during hair removal
and antisepsis.
2. Gowns, gloves, drapes and instruments may
be changed after biopsy.
3. Instruments placed in direct contact with
tumor cells may be discarded immediately after
use.
4. Some surgeons prefer to irrigate the surgical
site with sterile water instead of normal saline
solution.
5. As a prophylactic measure, antibiotics are
administered preoperatively, intraoperatively
and postoperatively.
6. Time-honored precautions such as handling
tissue gently, keeping blood loss to a minimum,
and avoiding an unduly prolonged surgical
procedure influence the outcome.
SAFETY RULES FOR HANDLING
RADIATION SOURCES
1. The intensity of radiation varies inversely
with the square of the distance from it.
2. Radiation sources are prepared by personnel
in the nuclear medicine department.
3. When radiation sources are delivered to the
OR, each needle, seed, or capsule is counted by
the surgeon with the radiation therapist. This
number is recorded.
4. Glutaraldehyde solution is poured into the
lead carrier to completely submerge the
radiation sources.
5. All radiation sources are handled with special
long, ring handled forceps from behind a lead
protection shield.
6. Radiation sources are handled as quickly as
possible.
[Date] 5
 THE PATIENT AS A UNIQUE INDIVIDUAL
BY: MRS. IVY ROSALES
7. All radiation sources are accounted for before
and after use, and any loss is immediately
reported to the OR nurse manager.
8. Radiation documentation sheet is completed
and put in the patient’s chart.
9. Radiation source is removed by surgeon at
the exact time indicated.
10. Radiation is neither seen nor felt.
PERIOPERATIVE PEDIATRICS
Considerations in Perioperative
o Chronologic Age
The following terminology is used to
approximately categorize ages of pediatric
patients:
1. Embryo: Not compatible with life
2. Fetus: In utero after 3 months of gestation
3. Newborn infant, referred to as a neonate:
a. Potentially viable: Gestational age more
than 24 weeks; birthweight more than 500
g; capable of sustaining life outside the
uterus (as defined by the WHO)
b. True preterm: Gestational age less than
37 weeks; birthweight 2500 g or less
c. Large preterm: Gestational age less than
38 weeks; birthweight more than 2500 g
d. Term neonate: Gestational age 38 to 40
weeks; birthweight greater than 2500 g,
usually between 3402 and 3629 g (if less
than 2500 g, the neonate is considered
small for gestational age [SGA])
e. Postterm: Gestational age extended by
more than 8 weeks
4. Neonatal period: First 28 days of
extrauterine life
5. Infant: 28 days to 18 months
6. Toddler: 18 to 30 months
7. Preschool age: 2 ½ to 5 years
8. School age: 6 to 12 years
9. Adolescent: 13 to 18 years
PERIOPERATIVE ASSESSMENT PEDIATRIC
PATIENT
Pediatric Psychosocial Assessment
▪ Based on age related criteria
▪ Environmental and parental influences
can cause variance in affect, attitude,
and social skills.
▪ Environmental influences on
psychologic development include
ethnic, cultural, and socioeconomic
factors.
Pediatric Physical Assessment
Metabolism and Nutrition considerations
NCM 112
- Infants have relatively greater nutritional
requirements than do adults for minimizing loss
of body protein.
- The resting metabolic rate of an infant is two
to three times that of an adult, which results in
rapid metabolic imbalances in infants.
- Neonates require 100 to 200 calories per
kilogram of weight per day to maintain
homeostasis.
- Infants are prone to hypovolemia and
dehydration
Fluid and Electrolyte Balance Considerations
- IV infusion should be administered with the
following precautions so that dehydration
would be avoided
- Blood volume loss should be measured as
accurately as possible and promptly replaced
- IV fluids and blood should be infused through
pediatric size cannulated needles are catheters
connected to drip chamber adaptors and small
solution containers
Body temperature Considerations
- Neonates, infant and children are kept warm
during the surgical procedure to minimize heat
loss and to prevent hypothermia
- Room temp should be maintained at 29 C
- Continuous core body temperature monitoring
should be performed
Cardiopulmonary Status Considerations
- The heart rate fluctuates widely among
infants, toddlers, and preschool children and
varies during activity and at rest.
- Infants are particularly susceptible to
respiratory obstruction because of their
anatomic structure.
Pediatric Infection Risk Considerations
- Newborns and infants are susceptible to
nosocomial infection.
- Many preterm infants who have respiratory
distress and circulatory problems survive
because of advances in perinatal medicine,
which has increased the population of infants
who are at high risk.
Pediatric Pain Management Considerations
- Neonates and infants can be assessed for pain
with physiologic parameters such as heart rate
and oxygen saturation and with facial
expressions such as brow bulge, eye squeeze,
and nasolabial furrow and body movements.
- Another method of measuring pain is the
FLACC behavioral pain assessment scale (Face,
Legs, Activity, Cry, and Consolability) developed
by nurses and physicians at C. S. Mott Children’s
Hospital at the University of Michigan Health
System in Ann Arbor. The chart measures and
scores five categories of behavior in pediatric
[Date] 6
 THE PATIENT AS A UNIQUE INDIVIDUAL
BY: MRS. IVY ROSALES
patients ages 2 months to 7 years in
relationship to pain.
- School-age children may refer pain to a part of
the body not involved in the disease process.
WongBaker FACES pain rating scale can be
used to determine the severity of pain
experienced by a pediatric patient.
PREOPERATIVE PSYCHOLOGIC PREPARATION
PEDIATRIC PATIENT
General Considerations
1. Psychologically it may be better for both the
infant and parents if the congenital anomaly is
corrected as soon as afterbirth as possible.
2. Some facilities hold parties for children and
their parents before or after admission to
explain routines and procedures before surgical
experience.
3. Separation from parents or trusted guardian
is traumatic for infants older than 6 months,
toddlers and preschool children.
4. Ambulatory surgery, if feasible is an
advantage because children enters the facility
1-2 hours before the surgical procedure and
returns home after recovery from anesthesia.
5. A preoperative visit by a perioperative nurse
should be planned to get to know the child,
confirm appropriate consents and provide
emotional support to the family.
PEDIATRIC ANESTHESIA
- The patients age, developmental stage,
psychologic characteristics and history are
considered to determine the patients probable
response to the anesthesia experience.
- No ideal premedication exist but the following
drugs are commonly used:
1. Sufentanil citrate
2. Fentanyl citrate
3. Diazepam
4. Midazolam Hydrocholoride
5. Scopolamine Hydrobromide
6. Atropine sulfate
INDUCTION
Types of Induction:
1. Inhalation
If asleep from premedication on arrival
in the OR, the child can be anesthetized
quickly. If the child is awake, induction
may be initiated with inhalant
anesthetic.
NCM 112
2. Rectal
Rectal induction is not frequently used.
Given by enema, methohexital
(Brevital), 15 mg/kg of 1% solution,
produces sleep in 6 to 8 minutes and
lasts 45 to 60 minutes.
3. Intravenous
Intravenous infusion is often preferred
for patients older than 9 or 10 years.
Induction with a small dose of
barbiturate or ketamine is rapid.
Studies have shown that IV induction
causes less psychologic trauma than do
inhalant methods.
4. Epidural block
A caudal epidural block may be used in
combination with general anesthetic for
orthopedic, abdominal, and thoracic
procedures.
5. Intubation or airway placement
Intubation - placement of an
endotracheal tube in the trachea of a
newborn or infant differs from
placement in a child or adolescent.
When anesthesia deepens, oral airway
insertion is essential after assisted
ventilation with oxygen. Assisted or
controlled ventilation reduces the labor
of breathing and therefore reduces
metabolism.
INTRAOPERATIVE PEDIATRIC CARE
CONSIDERATIONS
Basic principles of patient care and OR
techniques used for adults apply to pediatric
surgery. Points specific to pediatric surgery:
1. Hair is not removed with a depilatory or
shaved, except for cranial procedures and as
ordered by the surgeon for an adolescent.
2. Diagnostic studies may be done in the OR
with the patient under local anesthesia before
induction of general anesthesia for an open
surgical procedure.
3. The patient is protected from injury.
4. Catheters as small as 6 Fr are available for
use as needed in newborns and infants.
5. Positioning principles are essentially the
same as those described for adults.
6. A disposable drape sheet without a
fenestration is sometimes used: The surgeon
can cut an opening of the desired size to expose
the site of intended incision.
7. Blood loss on sponges is measured by
weighing them while they are still wet.
8. Adhesive tape is abrasive to tender skin and
should be avoided when possible.
[Date] 7
 THE PATIENT AS A UNIQUE INDIVIDUAL
BY: MRS. IVY ROSALES
9. Dressings on the face or neck should be
protected from vomitus and food particles and
from an infant’s or toddler’s hands.
10. A stockinette pulled over dressings on an
extremity protects them from becoming soiled
and helps keep them in place.
COMMON SURGICAL PROCEDURES
A. GENERAL SURGERY
1. Endoscopic Procedures
- Prepare for laparoscopy by emptying the
bladder by catheterization and inserting NGT
2. Anastomosis within the Alimentary Tract
(Biliary Atresia, Esophageal Atresia)
Biliary Atresia – a form of intrauterine
cholangitis that results in progressive fibrotic
obliteration of bile ducts, biliary atresia may
cause jaundice and acholic stool in the
newborn.
Esophageal atresia - with or without
tracheoesophageal fistula, is an acute
congenital anomaly characterized by
esophageal obstruction, accumulation of
secretions, gastric reflux, and respiratory
complications.
3. Imperforate anus - anorectal malformation
generally occurs during the 4th to 12th week of
fetal development.
4. Intussusception - occurs when a portion of
bowel slides into another segment and causes
obstruction. The most common site is the
ileocolic junction.
5. Pyloromyotomy - pyloric stenosis is a
congenital obstructive lesion in the pylorus of
the stomach. The opening becomes
hypertrophic and prevents food from entering
the intestine.
6. Herniorrhaphy - Herniorrhaphy (i.e., hernia
repair) is the most frequently performed
elective surgical procedure in infants and
children by general surgeons.
7. Omphalocele - failure of abdominal viscera to
become encapsulated within the peritoneal
cavity during fetal development results in
herniation through a 4- to 10-cm defect in the
abdominal wall at the right paraumbilical area.
8. Appendectomy - may be performed with
laparoscopy or open laparotomy.
Appendectomy was one of the earliest
procedures performed endoscopically on
pediatric patient.
B. ORTHOPEDIC SURGERY
1. Fractures - fractures that occur in infants and
children generally are treated as they are in
adults. Closed reduction of long bone fractures
is preferable.
NCM 112
2. Tendon Repair - lacerated tendons are
repaired to restore function. A tourniquet is
used to control bleeding.
3. Congenital Dislocated hip - if dysplasia is
diagnosed early in infancy, closed reduction
with immobilization usually corrects the
dislocation
4. Leg length Discrepancies - the orthopedic
surgeon may correct leg length discrepancies,
usually in excess of 1 inch (2.5 cm), with
epiphyseal arrest (i.e., stopping growth of the
bone). This is done in the contralateral leg to let
the shorter extremity catch up. The longer leg
may be shortened with a closed intramedullary
procedure.
5. Talipes Deformities
* Talipes Varus - known as clubfoot, is the most
common of the talipes deformities; it may be
unilateral or bilateral. The forefoot is inverted
and rotated, accompanied by shortening
* Talipes Equinovarus - idiopathic true clubfoot
deformity, almost always necessitates surgical
intervention for correction. Talipes equinovarus
includes an incomplete dislocation (subluxation)
of the talocalcaneonavicular joint with
deformed talus and calcaneus bones, a
shortened calcaneal tendon, and soft tissue
contractures.
C. OPHTHALMOLOGY
1. Congenital Obstruction of the Nasolacrimal
duct
- An obstruction, usually at the lower end of the
nasolacrimal duct that enters the inferior
meatus of the nose, often results in dilation and
infection of the lacrimal sac.
2. Oculoplastic Procedures of the eyelids
- Congenital malformations such as ptosis
(drooping of the upper or lower eyelid) are
corrected with extraocular procedures.
3. Extraocular Muscle Procedures
- These procedures on extraocular muscles are
done to correct muscle imbalance and promote
coordination either by strengthening a weak
muscle or by weakening an overactive one.
4. Intraocular Muscle Procedures
D. OTORHINOLARYNGOLOGIC SURGERY
1. Myringotomy - an incision in the tympanic
membrane (eardrum) for drainage. Through
aspiration of fluid and pus, pressure is released,
pain is relieved, and hearing is restored and
preserved.
2. Middle Ear Tympanoplasty - congenital fused
ossicles in the middle ear often are associated
with stenosis or absence of an external auditory
canal. Depending on the deformity,
[Date] 8
 THE PATIENT AS A UNIQUE INDIVIDUAL
BY: MRS. IVY ROSALES
tympanoplasty may be performed with a
temporalis fascia graft.
3. Correction of the Choanal Atresia - Bone or
fibrous tissue blocking the posterior choanae
usually is excised via a transseptal approach to
create an opening into the nasopharynx. A CO2
laser may be used to develop appropriate
apertures.
4. Adenoidectomy – a child usually is at least 2
years old before adenoid tissue in the
nasopharynx is removed, but he or she can
undergo an adenoidectomy at an earlier age.
5. Tonsillectomy - the excision of hypertrophied
or chronically infected tonsils, is not generally
advised before the child is 3 years of age.
6. Esophageal Dilation - long-term gradual
esophageal dilation with balloon catheters or
bougies (pronounced boogee) may be
necessary to restore adequate oral intake of
food after the acute phase of traumatic injury.
7. Laryngeal Papilloma - Laryngeal papillomas
are benign wartlike lesions caused by the
human papillomavirus (HPV).
8. Tracheal or Laryngeal Stenosis - some
accidental injuries result in a narrowing (i.e.,
stenosis) of the trachea or larynx. Of greater
concern are the injuries that result from
therapy for respiratory problems, especially in
newborns.
9. Tracheotomy - incision into the trachea and
insertion of a tracheostomy tube, is advisable in
cases of severe inflammatory glottic diseases.
E. PLASTIC AND RECONSTRUCTIVE SURGERY
1. Cleft Lip - lack of fusion of the soft tissues of
the upper lip creates a cleft or fissure. The
degree of cleft lips varies from simple notching
of the lip to extension into the floor of the nose.
2. Cleft Palate - failure of tissues of the palate
to fuse creates a fissure through the roof of the
mouth.
3. Hemangioma - are the most common of all
human congenital anomalies. A hemangioma is
a benign tumor (angioma) made up of blood
vessels that may pigment or appear as a growth
on the skin.
4. Otoplasty - abnormally small or absent
external ears can be reconstructed in several
surgical stages.
5. Syndactyly - a congenital anomaly
characterized by fusion of two or more fingers
or toes.
6. Polydactyly - a congenital anomaly
characterized by the presence of more than the
normal number of fingers or toe.
NCM 112
F. NEUROSURGERY
1. Craniosynostosis
- if one or more of the suture lines in the skull,
normally open in infancy, fuses prematurely
(craniosynostosis), the skull cannot expand
during normal brain growth.
2. Encephalocele
- is the herniation of brain and neural tissue
through a defect in the skull. This is present at
birth as a sac of tissue on the head. Usually,
these lesions can be removed 6 to 12 weeks
after birth, unless the condition is complicated
by hydrocephalus.
3. Hydrocephalus
- occurs when the passages between the
ventricles are blocked and are dilated by
accumulated cerebrospinal fluid.
4. Myelomeningocele
- a saclike protrusion may bulge through a
defect in a portion of the vertebral column that
failed to fuse in fetal development.
5. Spina Bifida
- incomplete closure of the paired vertebral
arches in the midline of the vertebral column,
may occur without herniation of the meninges.
G. THORACIC SURGERY
1. Pectus Carinatum
- is a protrusion of the breastbone. The cartilage
buckles and causes pain. The condition
progresses during periods of growth.
- In mild cases the patient wears a brace across
the chest for 12 to 18 months. In moderate to
severe cases a transverse incision is made
across the chest for an open correction.
2. Pectus Excavatum
- a congenital malformation of the chest wall, is
characterized by a pronounced funnel-shaped
concave depression over the lower end of the
sternum beginning at the angle of Lewis and
extending to the xyphoid.
H. CARDIOVASCULAR SURGERY
1. Anomalous Venous Return
- Failure of any one pulmonary vein or a
combination of these veins to return blood to
the left atrium precludes the full complement of
oxygenated blood from entering the systemic
circulation.
- The anomalous pulmonary vein or veins are
transferred and anastomosed to the left atrium.
2. Coarctation of the Aorta
- a coarctation is a narrowing or stricture in a
vessel. It usually occurs in the aortic arch.
- It may cause hypertension in the upper
extremities above the obstruction and
hypotension in the lower extremities from
slowed circulation below the coarctation.
[Date] 9
 THE PATIENT AS A UNIQUE INDIVIDUAL NCM 112
BY: MRS. IVY ROSALES

3. Patent Ductus Arteriosus (PDA) 7. Tricuspid Atresia

- During fetal life the ductus arteriosus carries - absence (atresia) of a tricuspid valve between
blood from the pulmonary artery to the aorta to the right atrium and ventricle prevents normal
bypass the lungs. Normally this vessel closes in blood flow through the chambers of the heart.
the first 24 hours after birth to prevent Blood flows through an ASD, into an enlarged
recirculation of arterial blood through the body. left ventricle, and through a small rudimentary
- If closure does not occur, blood flow may be right ventricle to the pulmonary artery.
reversed by aortic pressure, which causes
respiratory distress. POSTOPERATIVE PEDIATRIC PATIENT CARE
4. Septal Defects (ASD, VSD, Atrioventricular 1. Patient is taken to a post anesthesia care unit
Canal Defect) (PACU).
- An open-heart procedure with 2. Vital signs are taken.
cardiopulmonary bypass is necessary to close 3. Cardiac monitoring and pulse oximetry are
abnormal openings in the walls (septa) done.
separating the chambers within the heart. 4. Fluid intake and output are evaluated.
o Atrial Septal Defect - an opening in the 5. Surgical site are inspected.
septum between the right and left atria 6. Recovery is evaluated at 5-15 minutes
may be sufficiently large to allow intervals as the patient emerges from
oxygenated blood to shunt from left to anesthesia to a more alert stage.
right and return to the lungs. 7. Pediatric patient is never to be left
o Ventricular Septal Defect - usually unattended.
located in the membranous portion of 8. Parents are instructed in postoperative home
the septum between the right and left care and are informed about the signs and
ventricles. symptoms that should be reported to the
- It is the most common of the congenital physician.
heart anomalies (25%-30% of all
congenital cardiac defects).
o Atrioventricular Canal Defect - it is
present if the atrioventricular canal of
connective tissue that normally divides
the heart into 4 chambers has failed to
develop.
- The result is a large central canal that
permits blood flow between any of the
four chambers of the heart.
- A corrective procedure referred to as
the Rastelli procedure involves repair
of mitral and tricuspid valves and patch
grafts to close septal defects.
5. Tetralogy of Fallot
- Tetralogy of Fallot is a combination of four
defects:
A. VSD (large)
B. Stenosis or atresia of the pulmonary
valve or outflow tract into the
pulmonary artery
C. Hypertrophy of the right ventricle
D. Dextroposition (displacement) of the
aorta to the right so that it receives
blood from both ventricles
6. Transposition of Great Vessels
- In a transposition the aorta arises from the
right ventricle and the pulmonary artery arises
from the left ventricle.
- This creates essentially two separate
circulatory systems, one systemic and the other
pulmonary, but they are not interconnected as
in normal anatomy.

[Date] 10