Chapter 25 Pediatric Surgery

Chapter 25  Pediatric Surgery

MULTIPLE CHOICE

1. 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:

1. congenital birth anomalies and conditions are the most frequent surgical diagnoses.
2. from birth onward, the child is in a continual state of development and physiologic

   change.

3. thorough knowledge of the differences between children and adults is integral to

   the provision of nursing care.

4. a proportionally large head, short neck, and large tongue influence anesthesia care.

ANS: B
From birth onward, the body and organs exist in a continual state of development, and multiple physiologic changes occur with age. A thorough knowledge of these differences is integral to the provision of nursing care for the pediatric patient in the OR.

REF: Page 1085

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

1. painful stimuli such as eye surgery or abdominal retraction.
2. anxiety stimuli such as separation from a parent.
3. environmental stimuli such as loud noise or flashes of light.
4. thermal stimuli such as ambient excessive heat or cold.

ANS: A
Young children are predisposed to parasympathetic hypertonia (increased vagal tone), which can be induced by painful stimuli such as laryngoscopy, intubation, eye surgery, or abdominal retraction.

REF: Page 1085

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

1. Anticholinergics, parasympatholytics
2. Antidysrhythmic agents
3. Opioids and hypnotics
4. Adrenergics

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 25-2

ANS: C
Drug distribution is different in neonates and infants compared with older children and adults because of an increased percentage of total body weight and extracellular body fluid. Infants have an immature blood-brain barrier and decreased protein binding, which results in an increased sensitivity to sedatives, opioids, and hypnotics.

REF: Pages 1086, 1143

4. 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.

1. Blood pressure within acceptable range
2. Bounding peripheral pulses
3. Three wet diapers in 24 hours
4. Intact mucous membranes

ANS: A
The child will maintain fluid balance as evidenced by blood pressure within expected/acceptable range, palpable peripheral pulses, moist mucous membranes, and absence of peripheral edema.

REF: Pages 1086-1089, 1091

5. 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?

1. Measure and record the amount of irrigation solution poured onto the sterile back table.
2. Weigh sponges on a gram scale and report estimated loss.
3. Provide suction collection canisters with milliliter measurement indicators.
4. Calculate the estimated total blood volume for the patient according to the

   patient’s age.

ANS: B
The following are nursing interventions directed toward protecting the patient’s fluid volume balance: maintain and protect patency of intravenous lines; review laboratory analyses for results of total blood volume; calculate estimated total blood volume using formula of 85 to 90 mL/kg of body weight if total blood volume has not been determined by laboratory tests; provide gram scales for weighing sponges discarded from operative field, weigh sponges, and report estimated loss; provide suction units with reservoirs that measure in 5- to10-mL increments; measure and record quantity of irrigating fluid used; provide appropriate amounts of intravenous fluid replacement (e.g., 250-mL containers); measure and record urinary output and output from other drainage tubes; send laboratory specimens for analysis as indicated; review results indicating fluid status.

REF: Pages 1087, 1089-1090

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 25-3

6. 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?

1. Risk for Infection related to surgical intervention
2. Fear related to unmet goals
3. Anxiety related to separation from family and friends
4. Risk for hypothermia related to loss of body surface heat

ANS: C
Nursing diagnoses related to the care of pediatric patients undergoing surgery might include the following: Anxiety related to separation from family and friends, Fear related to developmental level (fear of the unknown, fear of painful procedures and surgery), Risk for Infection related to surgical intervention and other invasive procedures, Risk for Imbalanced Fluid Volume related to invasive surgery and accompanying blood loss, Risk for Hypothermia related to loss of body surface heat to environment and immature temperature-control mechanisms.

REF: Pages 1088, 1090-1091