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Chapter 22 - Prenotes
Chapter 22 - Prenotes
SURGICAL PROCEDURES
Intraoperative Care
Preoperative Care
role of the pediatric operating room nurse:
IMPORTANT CONCERN: to advocate for care of the patient in surgery
restriction of food and fluids before surgery to through the verification of procedure and
avoid pulmonary aspiration during anesthesia laterality, implants, skin preparation,
necessary instrumentation, and supplies
Results of fasting too long:
discomfort Postoperative Care
headache
dehydration Postanesthesia complications:
hypoglycemia airway obstruction
can delay recovery and hospital discharge postextubation croup
laryngospasm
nurse’s responsibility if surgical procedures are bronchospasm
DELAYED:
to communicate with the surgical team to important aspects of immediate postoperative care:
adjust fasting guidelines appropriately Monitoring the patient’s oxygen saturation
and providing supplemental oxygen as needed
Stress points before and after surgery: maintaining body temperature
admission process promoting fluid and electrolyte balance
blood tests
administration of preoperative medication (if malignant hyperthermia (MH)
prescribed) - a potentially fatal pharmacogenetic disorder
transport to the operating room of muscle metabolism
mask on the face during induction
stay in the postanesthesia care unit Symptoms of MH:
hypercarbia (increasing end-tidal carbon
Reasons why children are at higher risk of ineffective dioxide)
response to anesthesia and complications in the elevated temperature
recovery period: tachycardia
higher anxiety in the preoperative period tachypnea
associated with stranger anxiety (infants) acidosis
separation anxiety (toddlers and muscle rigidity
preschoolers) hyperkalemia
fear of injury or death (adolescents) rhabdomyolysis
Gastrostomy tube
After feedings, the infant or child is positioned Major nursing responsibilities are the same as for
on the right side or in the Fowler position any IV therapy and include:
control of sepsis
If a Foley catheter is used as the gastrostomy tube, monitoring of the infusion rate and
apply very slight tension. assessment of the patient