C - Management & Care of young children undergoing surgery

Question 1

Whats the family-centre management for preparing a child for surgery?

Answer 1

• Be respectful of individual families’ needs and values
• Recognize that family is important for patient’s recovery
• Prepare family members for decision-making and caregiving demands
• Sharing decision making responsibility
• Effective and frequent open communication with family
• Facilitate participation in care
• Family involved in care provides emotional and social support and comfort
  for patient
• Family knows patient best, is the one constant throughout the critical illness
  experience and most often represents the patient’s best interest.
• Family being increasingly recognized as key stakeholders in patient safety

Question 2

Nurses role in pain assessment & management POST-OP?

Answer 2

Pain assessment:
* Children don’t verbalize pain because their level of language is insufficient
* Variety of pain assessment scales
* Consider patient’s age, intellectual ability and conscious level of patient

Physiological indexes of pain
* In acute pain, there will be elevated HR, RR, BP
* Useful during surgery or when child is comatose
* When clinical signs are unclear, therapeutic trials of comfort measures, feeding and
analgesics may clarify the sources of distress

PAIN MANAGEMENT
- Local: Topical formulations (Eg. AMETOP Gel/EMLA cream)
* Nonopioids: Oral Paracetamol, Ibuprofen, Ketamine, Glucose
* Opioids: Morphine
* Epidural analgesia
* Patient controlled analgesia (PCA) for > 7years old
* Use of alternative method of pain control

Question 3

What Pain Scale is used for neonates?

Answer 3

1. Neonatal Infant Pain Score (NIPS)

How to assess?
Facial Expression
Crying
Breathing Patters
Arm and Leg Movements
Arousal

2. CRIES
   C – Crying
   R – Requires Oxygen to maintain saturation >95%
   I – Increased Vital signs
   E – Expression (facial)
   S – Sleeplessness
3. Neonatal Facial Coding
   - Facial expression
   - Cry

Question 5

When is the FLACC scale used and how isit used?

Answer 5

1. Behavioral scale for assessment of post-op pain.
2. Score (0-2) : look at their behaviour
3. For patients who intubated, sedated or with developmental disabilities.

Face:
0: No particular expression
or smile
1: Occasional grimace or
frown, withdrawn, disinterested
2: Frequent to constant frown, clenched jaw,
quivering chin

Legs:
0: Normal position or relaxed
1: Uneasy, restless, tense
2: Kicking or legs drawn up

Activity:
0: Lying quietly, normal position, moves easily
1: Squirming, shifting back & forth, tense
2: Arched, rigid or jerking

Cry
0: No cry
1: Moans or whimpers, occasional complaints
2: Crying steadily, screams or sobs, frequent
complaints

Consolability
0: Content, relaxed
1: Reassured by occasional touching, hugging/distraction
2: Difficult to console/comfort

Question 6

When is the Wong-Baker FACES Pain Scale used & how isit used?

Answer 6

• Recommended for 2 years and older
• The child will point to describe how they are feeling

0 No pain (happy)
2 Hurts just a little bit
4 Hurts a little more
6 Hurts even more
8 Hurts a whole lot
10 Hurts as much as you can imagine

Question 7

How to use the paeds Glasgow Coma Scale?

Answer 7

max score 15
eye opening 4
motor response 6
verbal 5

Question 8

Describe & explain the types of head injuries.

Answer 8

1. Concussion - impact to head
2. Fractures
3. Hematoma - localised blood collection in specific spaces around or within the brain
4. Contusion - small bleeds & bruising of the brain tissue

Question 9

Signs & symptoms of the different head injuries?

Answer 9

1. concussion
   - lose consciousness
   - headache, dizziness
   - nausea, vomiting
2. hematoma
   - lose consciousness
   - headache
   - focal deficits: impairments that affect a specific fxn of the body
3. contusion
   - lose consciousness
   - CNS dysfunction
   - seizures

Question 10

What is the nursing management for Head Injury? (2++)

Answer 10

1 Perform neurological assessments!!!
* Conscious Level
* Motor responses: Muscle tone and Limb movement
* Brainstem reflexes: Pupillary reflex to Light

2 Monitor for complications
* Increased ICP
* Vital Signs (Cushing’s Triad)
- Observe for CSF/blood drainage from nose or ears
- If not contraindicated (eg. Spinal Collar), to keep head up 15-30 degrees - to improve venous return & decrease ICP
- Pain management
- Provide child and family teaching to allay anxiety

Question 11

What is the Discharge Advice for Head Injury? (7)

Answer 11

1. Monitor for unusual behaviors or speech
2. Increasing headache
3. Difficulty seeing or breathing
4. Persistent vomiting
5. Unsteady gait/balance
6. Seizures
7. Always sleepy or cant wake up from sleep