Child undergoing surgery.

CHILD UNDERGOING
SURGERY
Presented by:
Ms. Muhsinath. A. R

INTRODUCTION:
• Surgery involves the cutting into the skin
or other organ to accomplish restoring the
body to a healthful state.
• This may include further exploration of the
condition for the purpose of diagnosis,
taking a biopsy of a suspicious lump, or
removing diseased tissues or organs.
• In addition, it surgery may be conducted to
remove an obstruction, reposition
structures to their normal position, redirect
channels, or transplant tissue or whole
organs.

DEFINITION:
• Surgery, as defined by the American
Medical Association, is the treatment of
disease, injury, or other disorders by direct
physical intervention, usually with
instruments.

THE DIFFERENT TYPES OF
SURGERY:
Surgery can be
classified as major or
minor, depending on
the seriousness of the
illness, the parts of
the body got affected,
the complexity of the
operation, and the
expected recovery
time
Major Surgery
Minor Surgery
Elective Surgery
Required Surgery
Urgent or emergency
surgery

The different methods of
surgery:
• Open Surgery
• Minimally Invasive
Surgery
• Laparoscopy
• Endoscopy
• Arthroscopy
• Bronchoscopy
• Cystoscopy
• Gastroscopy
• Laryngoscopy
• Sigmoidoscopy

THE HOSPITAL SETTING:
• Surgery may be performed at a physician's
office, a clinic, an outpatient surgery center,
or the hospital, depending on the following:
• the reason for surgery
• whether the surgery is considered major or minor
• whether or not the surgery is an emergency
• physician's preferences
• the child’s parents preferences

The duration of hospital stay of
the child after minor surgery:
• Many surgeries performed on children are done
as an outpatient.
• With minor surgeries, the child will return to the
outpatient surgery center after spending the
required time in the recovery room.
• When the child is fully awake, able to drink some
fluids, and meet all discharge criteria required by
child's surgeon, he/she will be discharged home.
• Some surgeries require that the child stay
overnight to allow observation by the nursing
staff.

The duration of hospital stay of
the child after major surgery:
• With a major surgical procedure, the time
in the hospital is determined by the nature
of the surgery and the health of the child.
• Some surgeries will require a stay in
intensive care for close monitoring before
child is moved to a regular inpatient bed.
• On the pediatric unit, the child's recovery
will continue to be monitored and
immediate medical attention will be
provided in case of complications.

Preparing for the preoperative
visit:
• There are several things that should bring
with the parents to enable the surgeon to
develop a complete picture of the
problem/condition, including the following:
copies of any x-rays, CT scans, or MRI
scans already performed
results of lab tests

complete medical history record (this can
be sent by the child's physician in
advance)
list of all medications, including
prescription and over-the-counter, the
child is taking (or has recently taken), or
the medications themselves
list of all allergies the child has (especially
latex allergy)

Why are blood transfusions
performed?
• an anticipated loss of blood during the
surgery
• a low blood count before, during, or after
surgery
• severe heart or lung disease
• bone marrow failure
• moderate to severe anemia

Symptoms of a latex allergy:
• watery or itchy eyes
• wheezing
• hives
• flushing of the skin or a skin rash
• itching of the skin
• swelling of the skin

INFORMED CONSENT:
• Prior to surgery, physician will give a
careful explanation of what procedure will
be performed and the risks involved.
• The parents will be asked to sign an
informed consent form which states in
detail that the parents understand the risks
and benefits of the surgery.

Who may sign the informed
consent?
• One or both parents usually sign for a
minor surgery.
• However, if the child is living with a legal
guardian, the physician will ask the legal
guardian to sign.
• Legal guardians will be asked to show
documentation to prove this legal
relationship exists.

Adolescents and informed
consent forms:
• Parental (or legal guardian) consent is
required for any diagnostic or surgical
procedure on a person under the age of
18.
• Since adolescents are able to contribute to
informed decisions about their health and
the treatment they will receive, they should
be included in discussions about surgery.

What part about surgery is most
stressful for an infant?
• separation from parents
• having many different caregivers
• seeing strange sights, sounds, and smells
• new and different routines
• interrupted sleep
• day and night confusion

How to prepare an infant for
surgery?
• Make sure the baby and family are well
rested.
• Bring the baby's favorite security item and
perhaps some soothing music to the
hospital. This will help create a more
familiar environment for the baby.
• Let the nursing staff know what the baby's
usual schedule is, including sleep patterns
and feeding habits.

surgery? CONTN…
• Make plans for at least one parent to be
with the baby as much as possible so that
he/she will have familiar touch, voice, and
smile.
• The most important part about preparing
the infant for surgery is to try to remain
calm.

surgery? CONTN…
• Be patient with the baby. It is normal for
him/her to cry and be fussy during this
stressful time. He/she may be very clingy
and become hard to comfort and console.
• The brief period before surgery when the
baby cannot eat or drink can be difficult.
Plan to distract, rock, walk, and comfort
him/her during this time.

Most stressful part of
Surgery for a toddler:
• being left alone
• having to stay in a strange bed or room
• loss of comforts of home, family, and
possessions
• being in contact with unfamiliar people
• painful procedures
• medical equipment that looks and sounds scary
• feeling helpless

How to prepare the toddler for
surgery?
• Read books to the toddler about going to
the hospital.
• Interactive play with dolls and stuffed
animals can help the child be more secure
in the hospital environment. The child life
department in the hospital can provide this
service directly or provide guidance to
parents preparing their children at home.

surgery? CONTN…
• Give very simple explanations and be
careful of the words you use. For example,
say, "The doctor is going to fix the arm."
Do not say, "The doctor is going to make a
cut on the arm."
• Let the child decide which security item
he/she wants to bring to the hospital.
Include a favorite book and soothing
music.

surgery? CONTN…
• Ask the parents to stay with the child
during hospitalization - their touch and
voice will comfort him/her more than
anything else. Let the nurses know about
the child's usual schedule and his/her likes
and dislikes.

surgery? CONTN…
• Educate the parents to be patient with the
child. It is normal for toddlers to cry and be
fussy during this stressful time. The child
may be very clingy and become hard to
comfort and console. It is not unusual for
the child to regress and have angry
outbursts and tantrums.

stressful for a preschool child?
• fear of being away from family and home, or of
being left alone
• thinking he/she is in the hospital because he/she
is in trouble or being punished
• fear of having a part of the body damaged
• fear of needles and shots
• fear of waking up during surgery
• fear of pain (or the possibility of pain)
• fear of the dark

How to prepare preschool
child for surgery?
• The child may enjoy reading books about
the hospital with the family.
• Allow the child to help pack his/her own
suitcase. Bringing a favorite security item,
pictures of family and pets, and a special
toy can be very comforting.
• Explain the benefits of the surgery in terms
the child can understand.

How to prepare preschool
child for surgery? CONTN…
• Make sure that parent to stay with the
child as much as possible.
• Be patient with the child. It is normal for
him/her to require more attention. The
child may have temper tantrums or be
uncooperative. The regressive behavior
will usually improve after the stress of the
procedure has passed.

stressful for a school-aged
child?
• being away from school and friends
• thinking he/she is in the hospital because he/she
is bad or is being punished
• having a part of the body destroyed or injured
• loss of control
• pain (or the possibility of pain)
• needles and shots
• dying during surgery

How to prepare school-aged
child for surgery?
• Give as many choices as possible - to
increase the child's sense of control.
• Emphasize that the child has not done
anything wrong and that surgery is not a
punishment.
• Explain the benefits of the surgery in terms
the child can understand.
• Let the child know that it is acceptable to
be afraid and to cry.

child for surgery? Contn…
• Encourage the child's friends to visit the
hospital, or to keep in touch with the child
by telephone or with letters and cards.
• A family member should stay with the child
as much as possible.
• When the child is stressed, they may start
regressing and/or displaying new fears,
such as being afraid of the dark. Give
many compliments and hugs.

child for surgery? Contn…
• Parents should always hold their child's
hand (not restrain) during tests or
procedures.

What part about surgery is
most stressful for a teenager?
• loss of control
• being away from school and friends
• having a part of his/her body damaged or
changed in appearance
• fear of surgery and its risks
• pain
• dying during surgery
• fear of the unknown
• fear of what others will think about them being
sick or in the hospital

Intra operative period:
• Intra operative care lasts from the time the
child enters the operating room to when
the surgery is complete and the child goes
to the recovery room. During most of this
time, the child will be asleep.

The operating room:
• The operating table in the center of the
room can be raised, lowered, and tilted in
any direction.
• The operating room lights are over the
table to provide bright light, without
shadows, during surgery.

The operating room: contn…
• The anesthesia machine is at the head of
the operating table. This machine has
tubes that connect to the patient to assist
him/her in breathing during surgery, and
built-in monitors that help control the
mixture of gases in the breathing circuit.

• The anesthesia cart is next to the
anesthesia machine. It contains the
medications, equipment, and other
supplies that the anesthesiologist may
need.
• Sterile instruments to be used during
surgery are arranged on a stainless steel
table.

• An electronic monitor (which records the heart
rate and respiratory rate of the child by adhesive
patches) are placed on his/her chest.
• The pulse oximeter machine attaches to the
patient's finger with an elastic band aid. It
measures the amount of oxygen contained in
the blood.
• There will be an automated blood pressure
measuring machine that automatically inflates
the blood pressure cuff on the child's arm.

• An electro cautery machine uses high
frequency electrical signals to cauterize or
seal off blood vessels and may also be
used to cut through tissue with a minimal
amount of bleeding.
• If surgery requires, a heart-lung machine,
or other specialized equipment, may be
brought into the room.

SURGICAL TEAM:
• Surgeon
• Anesthesiologist
• Certified Registered Nurse Anesthetist
(CRNA)
• Operating Room Nurse/Circulating Nurse

TYPES OF ANESTHESIA:
• anesthesia - medication administered for
the relief of pain and sensation during
surgery.
• Local Anesthesia
• Regional Anesthesia
• Spinal Anesthesia
• Epidural Anesthetic
• General Anesthesia

POST OPERATIVE CARE:
• Postoperative care lasts from the time the child
enters the recovery room until discharge from
the hospital.
• The length of this phase depends on the type of
surgery and the child's medical condition.
• Most children with minor surgical procedures
may be discharged the same day of the
procedure.
• Major surgeries will require longer recovery
times and, perhaps, a stay in intensive care.

RECOVERY ROOM/POST
ANESTHESIA CARES UNIT:
• In the recovery room, registered nurses,
anesthesiologists, and other healthcare
professionals will closely monitor the child
as he/she "awakens" from anesthesia.
• The length of time spent in recovery
depends on the type of surgery performed,
the child's response to surgery and
anesthesia, and the child's medical
condition.

RECOVERY ROOM/POST
• While the child is in recovery, the staff will
(when applicable) complete the following:
 Monitor the vital signs
 Monitor any signs of complications
 Monitor the level of consciousness
 Check tubes or drains
 Check the wound
 Check IV infusions
 Monitor the urine output

RECOVERY ROOM/POST
• Maintain child’s comfort with pain
medications and body positioning.
• Make sure the child is awake enough to
swallow effectively before offering any
drinks.

INTENSIVE CARE:
• Intensive care is needed for children who
have had certain types of major surgery
such as heart operations, organ
transplants, or neurosurgery.
• ICUs are equipped with complex machines
and monitoring devices designed for the
unique needs of critically ill and
postoperative children.

ICU EQUIPMENTS:
• Cardio Respiratory Or Heart Monitor
• Blood Pressure Monitor
• Pulse Oximeter
• Transcutaneous Oxygen/Carbon Dioxide
Monitor
• X-Ray
• Endotracheal Tube (ET Tube)
• Respirator Or Mechanical Ventilator
• Intravenous (IV) Pumps

DISCOMFORTS AND
COMPLICATIONS AFTER
SURGERY:
 Nausea and vomiting
 Soreness in throat
 Soreness and swelling near the incision
site
 Restlessness and sleeplessness
 Thirst
 Constipation and flatulence

What complications may
occur after surgery?
• Shock
• Hemorrhage
• Wound infection
• Pulmonary (lung) complications
• Urinary retention
• Reaction to anesthesia

PAIN CONTROL:
• After surgery, there may be physical causes of
pain, but the sensation of pain also depends on
complex mental and emotional factors.
• If the child has moderate to severe pain, he/she
will most likely receive narcotics during and after
surgery. If the child is in the ICU after surgery,
he/she may also receive sedatives along with
analgesics (pain medications.)

Epidural pump
• This type of anesthesia is given through a
small catheter into the "epidural space"
surrounding the spinal cord. The catheter
can be connected to a pump that will give
a constant flow of medication. After
surgery, this catheter can be left in for one
or two days.

PCA pump
• PCA stands for patient-controlled
analgesia.
• Children as young as 4 years old have
been shown to use PCA pumps
effectively.

PLAY THERAPY:
• Play therapy is used to help meet the
emotional needs of children who have an
illness or surgery that requires
hospitalization.
• The goal of play therapy is to provide a
family-centered approach to help the child
adjust to hospital care.

DISCHARGE FROM THE
HOSPITAL:
• If the child is having minor surgery, he/she may
be discharged home a few hours after the
procedure.
• After major surgery, the child will need to stay in
the hospital. Some children may be in the ICU
for one or more nights.
• From the ICU, the child will be transferred to the
regular pediatric unit. After the surgeon has
determined the child may be discharged.

NURSING
CONSIDERATIONS IN
PERIOPERATIVE CARE

PERIOPERATIVE NURSES
• A perioperative nurse is a nurse who
provides patient care, manages, teaches,
and studies the care of patients
undergoing operative or other invasive
procedures.

What Does a Perioperative
Nurse Do?
• Provides specialized nursing care to patients
before, during, and after their surgical and
invasive procedures
• Helps plan, implement, and evaluate treatment
of the patient
• Acts as a patient advocate for patients
undergoing surgical and invasive procedures
• Works closely with all members of the surgical
team (Surgeon, anesthesiologist,
• surgical technologist, etc.)

Roles of Perioperative Nurses
• Scrub Nurse
• Circulating Nurse
• Registered Nurse First Assistant (RNFA)
• Perioperative Educator
• OR Manager/Director

Scrub Nurse
• Selects and handles instruments and
supplies used for surgery
• Works directly with surgeon
• In the sterile field

Circulating Nurse
• Manages the individual operating room
and care of the patient in the OR
• Creates and maintains comfortable, safe
environment
• Helps all team members work together
• Works in the OR in the area outside the
sterile field

RN First Assistant
• Directly assists surgeon
• Controls patient’s bleeding
• Provides wound exposure and suturing
• Involved in care before, during, and after
surgery
• Requires additional education

Perioperative Care
Immediate Anesthetic Care
(PACU)
• Respiratory Status - patent airway
• Cardiovascular - regular, strong heart rate
and stable BP (VS); peripheral pulses;
Homan’s Sign
• Neurological – level of consciousness;
orientation, sensation
• Fluid and Electrolyte, Acid Base Balance

Post – Operative Care
Nutrition
• Clear Liquids
• Full Liquids
• Soft
• Regular

• Throughout Perioperative Care, the nurse
will always:
–Monitor patient’s response to
therapeutic regime, prevent
complications, patient education and
promote optimum well-being

• Nursing Interventions specific to each
phase; some nursing interventions are
throughout perioperative care as in other
areas of nursing.
• Always optimum level of well-being -
physical, mentally and spiritually.
• Assessment is on-going.

Child undergoing surgery.

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