Nursing Care For The Pediatric Surgical Patient 49194s

AN OVERVIEW

Esther A. Saguil MD Clinical Associate Professor, UP College of Medicine

The child is a miniature adult, whose fluids and electrolytes needs may be determined based on ratio and proportion, and whose management parallel that of the adult.

TRUE OR FALSE?

The child is not a little adult……..





Large head : body ratio High total body water content Immature organ systems- kidneys, hematopoietic system, lungs, immune system Small glycogen stores Pliant body cavities Rapid metabolic rates



THERMOREGULATION FLUID BALANCE EASILY DEPLETED NUTRTIONAL STORES CARDIORESPIRATORY CONCERNS COMMUNICATION DEFICIENCIES PAIN PERCEPTION AND REPORTING

THERMONEUTRALITY: TEMPERATURE WHERE NEONATE MAINTAINS ITS BASAL METABOLIC RATE • Large skin surface area • Large head • High % of total body water • Poorly developed shivering mechanism • Inability to perform heat conserving motions



Hyperthermia - > 37.5% Increase TFI by 10% for every degree above normal Dehydration Electrolyte problems Seizures



Hypothermia - temp < 36.5 shift to anaerobic metabolism metabolic acidosis- pallor, poor activity impaired peripheral perfusion-mottling, poor urine output



Incubators, radiant warmers, heating pads Blankets Plastic or cloth wraps Warm gastric and rectal lavages Warm intravenous fluids



High total body water content Small volumes in children e.g. 3 kg baby only needs 300ml of fluids daily Total body water: 2.4 kg Total blood volume: 240 ml





Use of Solusets, measuring devices for accurate fluid istration, infusion and syringe pumps Urine output monitoring Measurement of all losses (gastric, diarrhea, fistulae, drains, bleeding), replacing with the appropriate fluids as necessary







Select a vein which can be stabilized easily with splints and secure with tapes. Extravasation - dehydration, loss of therapeutic effects of medications, burns Gentle IV push Report “out” IV lines in NPO patients ASAP Avoid using scissors during the removal of IV catheters









The neonate only has glycogen reserves for 3 hours . A 10% glucose solution is usually needed for patients on NPO. Hypoglycemia is very common so frequent glucose monitoring is needed Dire consequences of hypoglycemia in neonates



Obligate nasal breathers Pliant abdominal wall and diaphragm Easily fatigued respiratory muscles Inability to clear secretions effectively Incoordinated swallowing reflexes High metabolic rates





History is provided by caregiver Patient is unable to express or interpret his symptoms Caregiver interprets the patient’s symptoms NEED TO HAVE A PATIENT’S TRUSTED COMPANION AT BEDSIDE DURING PROCEDURES

Coned twins are considered as 2 separate patients. TRUE OR FALSE?





The FIFTH vital sign VISUAL ANALOG SCALE Allows the older child to determine his pain levels Neonates also have pain receptors! Pain medications review





ABDOMINAL WALL DEFECTS ANORECTAL ANOMALIES INGUINOSCROTAL CONDITIONS COMMON GASTROINTESTINAL CONDITIONS SOFT TISSUE PROBLEMS



Omphalocoele Gastroschisis Cloacal exstrophy, bladder exstrophy



PROLONGED FASTING STATE FLUID BALANCE/ I AND O MONITORING ABDOMINAL DISTENSION AND ILEUS RESPIRATORY COMPROMISE SEPSIS, INFECTION CONTROL NUTRITIONAL



HIRSCHSPRUNG’S DISEASE IMPERFORATE ANUS ANAL FISTULA PERIANAL ABSCESS





Abdominal distension (air, retained feces, ascites) Fecaloid vomitus or gastric tube output I and O monitoring Perineal care Stoma care – difficult fluid and electrolyte management with high output stomas and fistulas, peristomal excoriations





Properly sited and constructed colostomies Use of stomal appliances Avoidance of spillage or leakage of feces to skin Prevention of stomal trauma



HERNIAS AND HYDROCOELES UNDESCENDED TESTES HYPOSPADIAS INTERSEX ANOMALIES

MALE OR FEMALE?



DRESSING CHANGES, URINE STASIS CATHETER CARE COUNSELLING /PSYCH OUTPUT MONITORING AND REPORTING



Appendicitis Intussusception Intestinal obstruction – bands, malrotation, Esophageal surgery Feeding stomas (gastrostomies and jejunostomies)







Post-operative ileus is usually prolonged in pediatric patients – abdominal circumference monitoring. Longer duration of IV line More rigorous electrolyte and fluid management Replacement of losses Care of tubes



NASOGASTRIC TUBE ENDOTRACHEAL TUBE URETHRAL CATHETERS FEEDING GASTROSTOMY/JEJUNOSTOMY DRAINS





Check patency (inflow and outflow) Secure anchorage Protect from pull and mobile body parts Report change in quality of output and /or aspirate. depth, length of inserted tubes, and if these may be reinserted if accidentally removed.



Disfiguring masses









High cribs,, fall prevention Side rail management, slipping through the cracks Eye , neck, gonad protection during phototherapy Asphyxia from pillows and blankets items on the bed Burns from heating lamps Wet beddings





Sensitivity Avoid trauma Disclosure of information to other people other than immediate family Trust and non accusatory behavior