Perioperative Care of the Child

Linda Shields is Professor of Paediatric and Child Health Nursing at Curtin University, and the Child and Adolescent Health Service, Western Australia. Prior to that, she was Professor of Nursing at Hull University and Honorary Professor at the University of Queensland, Australia and Northumbria University, UK.

"This book offers not only an excellent introduction for the new pediatric nurse but also a good review for the experienced nurse." (AORN Journal, October 2010)

• Contributors ixIntroduction xiAcknowledgements xiiiAbbreviations xiv                                                                                                                                                                                                                                                                                                           1 The history of children’s perioperative care – Jeremy Jolley 1Why history is important 1What is perioperative nursing? 1  A brief history of perioperative nursing 2The development of perioperative nursing 5Key discoveries in perioperative care 6Early beginnings of surgery for children 7The growth of paediatric surgery 9Conclusion: perioperative nursing of children 10References 112 The psychosocial care of children in the perioperative area – Linda Shields 13Children’s perceptions of the operating theatre 13The effect of hospitalisation on children 14Models of care 16The presence of parents 19Play in the operating theatre suite 20Emotional, social and spiritual needs of the patient 20Conclusion 21References 213 Care of the child in the operating room – Linda Shields and Ann Tanner 23Preparation of children for theatre 23Admission prior to surgery 24Observation 25Weight 25Surgical history 25Medical history 25Medications 27Body/site preparation 27Pre-admission clinic 27Emergency admission 28Day of surgery admission 29Reception in the operating suite 30Registration on entrance to the OR 31Fasting 31Other things to check on admission to the OR 32Safety of children in the operating theatre 33Specific safety issues for children during induction 33Post anaesthetic/post operative 34Standing orders 36Conclusion 37References 374 Nursing care and management of children’s perioperative pain – Bernie Carter and Denise Jonas 39Introduction 39Preparing and teaching children and parents about pain 41Agency, education and training of health care professionals 42Assessing children’s pain 43Core approaches to pain assessment 44What tools to consider using with particular groups of children 46Non-pharmacological interventions 46Overview of pharmacological intervention 47Routes of administration 48Other local anaesthetic infusions 55Discharge home 55Conclusion 56References 565 Surgical procedures on children – Linda Shields and Ann Tanner 66Introduction 66Common surgical procedures performed on children 66Acknowledgement 96References 966 Day surgery for children – Ann Tanner 101Day procedure centres 101Pre-admission preparation 105Admission to the day procedure centre: preparations for surgery 105Compartment syndrome 112Admission to theatre 112Ward stage recovery: post-operative care 113Conclusion: support at home 116References 1167 Anaesthesia in children – Wendy McAlister 119Introduction: What is anaesthesia? 119The anaesthetic nurse 119Children undergoing anaesthesia 120Anaesthetic equipment 121Airways 124Anaesthesia 127Analgesia 130Patient preparation 130Fasting 130Premedication 131Loose teeth and nail polish 131Hearing aids and glasses 132Jewellery 132Preparation prior to patient arrival 132Patient arrival in theatre 133Induction 133Rapid sequence induction 135Fluids 135Monitoring 135Documentation 136Anaesthetic emergencies 136Anaphylaxis 138Suxamethonium apnoea 138Malignant hyperthermia 139Emergence 139Regional anaesthesia 140References 1418 The paediatric post-anaesthetic care unit – Eunice Hanisch 144Introduction 144In the PPACU 144The post-operative environment 147Oxygen delivery 149Suction 151Physiological assessment and management of the paediatric post-anaesthesia patient 151A – Airway management and B – Breathing 151Respiratory complications and nursing interventions 152C – circulation 155Thermoregulation and temperature abnormalities 156Post-operative nausea and vomiting 160Pain management in the PPACU 164Infection control 165Fluid and electrolyte balance 166Wounds and dressings 168Patient positioning 168Latex allergy 169Children with epilepsy 170Delayed emergence 170Emergence delirium 171Discharge of the patient from the PPACU 171Psychological assessment 172References 1759 Fetal surgery – Roy Kimble 179Introduction 179History 179The risks of fetal surgery 180Fetal conditions amenable to fetal surgery 181Ex utero intrapartum treatment (EXIT) 183The future 184References 18410 Perioperative care of children with burns – Roy Kimble and Julie Mill 185Introduction 185History 185Epidemiology of burns in children 186A multidisciplinary service approach 187Clinical assessment of burn severity 188A – Airway 189B – Breathing 189C – circulation 190D – Neurological disability 190E – Exposure with environment control 190Classification of burn depth 190Determination of burn depth 191Laser Doppler scanning 191Electrical burns 192Chemical burns 193Calculation of burn surface area 193Management 193Burn wound care 195Preparation for theatre 197Pain management via acute pain service 199Post-operative care 200Physiotherapy 200Infection control 200Toxic shock syndrome 201Tetanus 202Human immunodeficiency virus (HIV)-positive children 202Scar management 202Discharge planning 202References 20411 Paediatric transplantation – Rebecca Smith and Susan Tame 208Introduction 208Becoming an organ donor 208Types of donation 209Role of the transplant co-ordinator 213Donor care and management 215Making the donation request 215Preoperative care of a potential paediatric donor 216Perioperative care 222Recipient management and care 229Cardiothoracic organs 230Immediate post-operative care 233Liver 234Kidneys 235Small bowel, liver and multivisceral 237Reducing the risk of rejection of the new organ 238Longer-term post-operative care 239The future 240References 242Further reading 24312 The care of children having endoscopic procedures – Janet Roper and Linda Shields 245Introduction 245The perioperative nurse’s role 246Preparing children for endoscopic procedures 248Perioperative care 248Service perspectives 249Equipment for MIS and endoscopy 251Conclusion 258References 25813 Ethical and legal issues in paediatric perioperative care – Linda Shields 261Patients’ rights 261Self-determination 262Privacy 262Confidentiality 262Consent 263Legal perspectives 264Medical futility 265Conclusion 265References 266Index 267