Deck 17: Pediatric Surgery

Question 1

A child's comprehension of, and responses to, the environment are based on his or her developmental age. The works of Drs. Jean Piaget and Erik Erikson provide excellent guidelines for assessing the pediatric patient's developmental level in order to use appropriate interventions. The infant develops the belief that the world can be counted on to meet basic needs through the trust vs. mistrust concept based on the stages of psychosocial and emotional needs. This theoretical framework of stages was described by ______________, while the stages based on changes in cognition and ability to think were described by _____________.

A)Dr. Erick Erikson; Dr. Jean Piaget
B)Dr. Geoffery Barns; Dr. Jules Junger
C)This statement is a combined consensus of both of their theories.
D)Neither theory is represented by this statement.

Answer 1

A
Dr. Jean Piaget described the stages by changes in cognition and the ability to think, and Dr. Erik Erikson based the stages on psychosocial and emotional needs. For example, according to Erikson, infancy to 1 year: trust vs. mistrust; infant develops belief that world can be counted on to meet basic needs. According to Piaget, infancy to 2 years: Who to trust? Identifies strangers at 7 to 8 months of age.

Question 2

Select all the injuries or conditions that reflect probable child abuse or neglect from the list below.

A)Abrasions of both knees
B)Multiple bug bites
C)Severe injuries inconsistent with the history
D)Severe diaper rash with the presence of ammonia burns

Answer 2

C, D
If a child is reported to have experienced a routine fall but appears to have severe injuries, the inconsistency of the history with the trauma sustained indicates suspected child abuse. The symptoms of neglect reflect a lack of both physical and medical care. Manifestations include failure to thrive without a medical explanation, multiple cat or dog bites and scratches, feces and dirt in the skinfolds, severe diaper rash with the presence of ammonia burns, feeding disorders, and developmental delays.

Question 3

Improvements in instrumentation and the development of equipment in smaller sizes have resulted in the evolution of minimally invasive surgery (MIS) from that of a rapidly growing field to one of routine practice in the pediatric surgical arena. The advantages of MIS for the pediatric population include which true statement?

A)There is less risk for injury or complications with pneumoperitoneum insufflation.
B)Pediatric patients having MIS procedures have less prevalence of adhesion formation.
C)There is less possibility for abdominal injury from Foley catheter decompression.
D)MIS procedures on children do not require the use of thromboembolic devices.

Answer 3

B
Advantages of minimally invasive surgery include diminished postoperative pain, improved cosmetic results, decreased prevalence of adhesion formation, and accelerated recovery periods and shorter hospital stays. Despite the technical congruence with adult MIS procedures, the pediatric populations undergoing these procedures have specific needs. Anesthesia providers must consider the size and age of the patient because of the risk of physiologic compromise related to insufflation. Likewise, steps are taken intraoperatively to decrease the likelihood of intra-abdominal injury, such as insertion of an appropriate size Foley catheter to decompress the bladder or application of thromboembolic hose or sleeves to prevent deep vein thrombosis.

Question 4

Much like the adult population, many traditional "open" pediatric surgical procedures are being replaced by minimally invasive surgery (MIS) procedures. Because the field of pediatric MIS is relatively new, surgeons are at an advantage because they are able to combine virtual reality techniques and robotics with the most current technology and instrumentation. Select all of the MIS procedures commonly performed in pediatric patients from the options listed below.

A)Living-related donor kidney transplant
B)Gastric fundoplication
C)Correction of pectus excavatum
D)Closure of patent ductus arteriosus

Question 5

Sienna Morgan is a 7-year-old girl who was involved in a hit and run accident while riding her bike to school. She is attended by paramedics and has an unstable airway; blood pressure less than 50 mm Hg (systolic); a major open, penetrating wound; and open, multiple fractures of both legs. Sienna is comatose. During transport she is intubated and demonstrates persistent physiologic demise and possible traumatic brain injury. A significant risk reduction strategy for Sienna would be to:

A)consider transport to a pediatric trauma center.
B)transport to the nearest emergency department.
C)transport immediately to a pediatric trauma center.
D)transport to the ambulatory surgery center across the street for stabilization.

Question 6

Neuropathologic conditions requiring surgical intervention can be found in any age group. What are the most common problems requiring neurosurgical procedures in infants and children?

A)Meningocele, myelomeningocele, and encephalocele
B)Craniosynostosis and hydrocephalus
C)Brain tumors and trauma
D)All of the options are correct.

Question 7

Infants and children with severe gastroesophageal (GE) reflux can have life-threatening complications, including obstructive apnea, aspiration pneumonia, esophagitis, and failure to thrive. What is the name of the procedure, performed open or laparoscopically, that is designed to create a competent antireflux barrier?

A)Nissen fundoplication
B)Roux-en-Y bypass
C)Pyloromyotomy with pyloroplasty
D)Sphincterotomy

Question 8

Children classified in the early childhood phase or who are preschool age begin to imagine and explore. Their thinking is dominated by perceptions and, often, distorted reasoning. They are magical thinkers. What would be an appropriate intervention for preschool age children?

A)Allow them to play with a saline-filled syringe to decrease their fear of injections.
B)Allow them to play with their own mask and place on their stuffed bunny's face.
C)Tell them a scary story during anesthesia induction.
D)Draw faces on inflated latex gloves and give each glove a name of a surgical team member.

Question 9

Baby Boy Doe is a newborn found outside of the emergency department (ED). He is hypothermic and has several deep lacerations across his back, abdomen, and legs that will require surgical repair. He is transferred to the surgical bay of the ED and prepared for anesthesia induction. What risk reduction strategies are appropriate during the preanesthetic phase to achieve and maintain normothermia?

A)Adjust room temperature to 23 to 24 C (73.4 to 75.2 F).
B)Provide a radiant heat lamp during placement of monitoring lines and induction.
C)Wrap lower extremities in elastic bandages and encase in a plastic bag for newborns.
D)Keep child exposed as much as possible to benefit from the heat lamp.

Question 10

Personal comfort or security items should be permitted to accompany children to the OR who are in which developmental age?

A)Infancy to 1 year
B)Toddler to early childhood
C)Adolescence
D)All of options are correct.

Question 11

The immature blood-brain barrier and decreased protein binding in infants increase their sensitivity to which group of drugs?

A)Anticholinergics, parasympatholytics
B)Antidysrhythmic agents
C)Opioids and hypnotics
D)Adrenergics

Question 12

Pharyngeal obstruction is revealed by a history of sleep-disordered breathing. Mouth breathing, snoring, pauses in breathing, restless sleep, waking at night, and enuresis may be related to obstruction. Pharyngeal obstruction may also be caused by recurrent pharyngitis or tonsillitis. Select all the procedures that are designed for the relief of pharyngeal obstruction from those listed below.

A)Tonsillectomy
B)Adenoidectomy
C)Flexible nasolaryngoscopy
D)Pharyngotomy

Question 13

An orchiopexy is the surgical placement and fixation of the testicle in a normal anatomic position in the scrotal sac. If the testis fails to descend into the scrotum during gestation, it is considered undescended. Which statement regarding indications for orchiopexy is true?

A)The normal path of the testis becomes obstructed.
B)The testis is strangulated by contraction of the cremaster muscle.
C)All testes that are undescended after 1 year require surgical placement in the scrotum.
D)Retractile testes require surgical or hormonal treatment.

Question 14

This orthopedic diagnosis is a complex deformity that is diagnosed prenatally through ultrasound or at birth. It may occur unilaterally or bilaterally and may be idiopathic or one in a combination of other syndromes with associated anomalies. The general characteristic for all cases includes inversion of the foot such that the anterior foot is located in the typical position of the posterior foot; often there is a deep crease in the midfoot. Select the orthopedic diagnosis.

A)Foot dystonia
B)Clubfoot
C)Orthopedia
D)Subtalar orthopnea

Question 15

Young children are predisposed to parasympathetic hypertonia (increased vagal tone), which can be induced by:

A)painful stimuli such as eye surgery or abdominal retraction.
B)anxiety stimuli such as separation from a parent.
C)environmental stimuli such as loud noise or flashes of light.
D)thermal stimuli such as ambient excessive heat or cold.

Question 16

Cleft lip is usually associated with a notch or cleft of the underlying alveolus and a cleft of the palate. Cleft lip repair is most often performed when the infant is about 3 months of age. Cleft lip is described as:

A)two skin ridges situated near the midline of the central philtrum of the lip.
B)absence of one or both philtral clefts with a notch in the alveolus.
C)a deficiency of tissue (skin, muscle, and mucosa) along one or both sides of the upper lip.
D)disarrangement of existing lip tissues associated with a cleft of the palate.

Question 17

Any misalignment of the eyes is called strabismus. The goal for treatment of strabismus is to straighten the eyes so that binocular vision functions appropriately. Surgery may be recommended to change the alignment of the eyes relative to each other by:

A)strengthening the eye muscles
B)weakening the eye muscles
C)repositioning the eye muscles
D)All of the options are correct.

Question 18

It is important to recognize that the difference between pediatric care and adult care is not just a size issue. Major areas of distinction are the airway and pulmonary status, cardiovascular status, temperature regulation, metabolism, fluid management, and psychologic development. The most significant consideration when caring for pediatric patients that is not of concern when caring for adults is:

A)congenital birth anomalies and conditions are the most frequent surgical diagnoses.
B)from birth onward, the child is in a continual state of development and physiologic change.
C)thorough knowledge of the differences between children and adults is integral to the provision of nursing care.
D)a proportionally large head, short neck, and large tongue influence anesthesia care.

Question 19

Vascular access in pediatric patients may be established intraoperatively for short-term (weeks) or long-term (months, years) use. Select all the examples of a long-term (months, weeks) use vascular access catheter from the list below.

A)Central venous line
B)Implanted port
C)Peripherally inserted central venous catheter (PICC)
D)Power injection port

Question 20

The toddler uses symbols and engages in creative play. Toddlers are beginning to develop free will and control over their bodies. Which of the interventions below is age-appropriate for toddlers?

A)Sing songs from your own childhood that the child may be able to learn.
B)Give only simple choices and involve them in actions when possible.
C)Make up a story about their personal comfort item as you give it to their parent to keep.
D)Ask them about their concerns and offer information to decrease their fears.