Question

A child is scheduled for surgery. Which are nursing actions to be carried out prior to surgery? (Select all that apply.) A. Check the child for loose teeth. B. Remove finger nail polish from fingers and toes. C. Have appropriate lab reports available on the chart. D. Verify that the parents have signed an informed consent. E. Check that the child has been NPO for a specified period of time.

Short answer

Appropriate nursing actions prior to surgery include checking the child for loose teeth (A), ensuring no nail polish is present on fingers and toes (B), having lab reports available (C), verifying informed consent has been signed (D), and checking NPO status (E).

Step-by-step solution

Understanding Preoperative Checks

In preparation for surgery, certain preoperative checks must be performed to ensure the safety and readiness of the patient. These checks include verifying the physical readiness of the child, ensuring legal documents are in order, and confirming that preoperative procedures have been followed correctly.

Assessing Physical Readiness

Assess whether the child has any loose teeth (Option A) that could pose a risk during intubation or surgery, as well as ensuring that no nail polish (Option B) is present to allow for accurate monitoring of circulation and oxygen saturation through pulse oximetry.

Confirming Preoperative Procedures and Documentation

Confirm that all necessary lab reports (Option C) are available to aid in assessing the child’s health status and potential surgical risk factors. Verify that informed consent (Option D) has been signed by the parents, which is a legal requirement before any surgical procedure. Check that the child has been NPO, meaning 'nothing by mouth,' (Option E) for the required period before surgery to reduce the risk of aspiration.

Key concepts

Pediatric Surgery Preparation

When preparing a child for surgery, it's essential to consider both the physical and emotional needs unique to pediatric patients.

Firstly, ensuring the child is physically ready for surgery is paramount. This involves several crucial steps beginning with the identification of any loose teeth (Option A). Children may have loose teeth due to their natural dental progression, and these can present a choking hazard during procedures requiring intubation. It's equally important to remove nail polish (Option B) from both fingers and toes. This may seem minor, but clear visual access to the nail beds allows healthcare professionals to monitor vital signs accurately, such as blood oxygen levels, during surgery.

Another key aspect of pediatric surgery preparation involves clear communication with both the child and the parents. Children require explanations suitable to their development level to alleviate fears and anxiety about the upcoming procedure. Engaging in preparatory talks, providing educational materials, and in some cases, offering a tour of the surgical area can greatly assist in reducing stress.

Pre-Surgery Safety Checks

Safety checks prior to surgery are critical to avoid perioperative complications and enhance the child's safety.

Confirming that the patient has been NPO (Option E), which stands for 'nil per os' or 'nothing by mouth,' is one of these safety considerations. This reduces the risk of aspiration pneumonia, which can occur if the child vomits during sedation and subsequently inhales stomach contents. The duration of NPO status varies depending on age, type of surgery, and the anesthesia used, and it's crucial for nurses to adhere to and verify these fasting guidelines.

Additionally, having the appropriate laboratory reports (Option C) readily available on the child's chart is necessary. These reports may include blood tests, urinalysis, or other screenings that give surgeons a clear understanding of the child's health status and potential risks associated with the surgery. Such preparation aids in making informed decisions throughout the surgical process and future care planning.

Informed Consent Process

The informed consent process is a cornerstone of ethical medical practice, especially when the patient is a child.

Before surgery, it is the nurse's responsibility to verify that informed consent (Option D) has been obtained and signed by the parents or legal guardians. This process goes beyond merely acquiring a signature; it involves ensuring that the parents have been thoroughly educated about the surgery, including the risks, benefits, potential complications, and alternative treatments if any exist. The parents must also have the opportunity to ask questions and must make the decision to proceed in the absence of pressure.

Informed consent is not a one-off event but a continuous, communicative process that requires reverification at each significant step leading up to the surgical procedure. This process ensures that the child's guardians are actively engaged in the decision-making process, providing the best possible care with respect for the family's values and wishes.