Dwight is a 4 year old who lives with his parents and 18 month old sister. Dwight’s parent decided to send him to preschool when he turned 3

QUESTION

Dwight is a 4 year old who lives with his parents and 18 month old sister. Dwight’s parent decided to send him to preschool when he turned 3 years old to provide him with contact and interaction with other preschoolers. Dwight love’s going to school; however, over the past year Dwight has experienced recurrent episodes of otitis media (OM) secondary to respiratory infections. Following his last episode of OM, his pediatrician suggested to his parents that Dwight should have “tubes put in his ears.” On a follow up visit, Dwight’s parents discuss the surgery and decide to have it performed. Dwight’s surgery is scheduled in 5 days.

When should the preoperative teaching begin for Dwight and what topics should be addressed?

Dwight is admitted to the hospital in the morning and his surgery is scheduled for 2:00 PM Discuss the stressors for the preschooler who is hospitalized in terms of their priority.

What are the priorities of care for Dwight on admission?

Describe therapeutic nursing interventions that can lesson Dwight’s stressors.

The nurse discusses with Dwight’s parents that he needs to have an intravenous access initiated. Dwight is visibly upset and begins to cry, telling his mother, ” Don’t let them hurt me!” What measures should the nurse take prior to preforming Dwight’s venipuncture?

Discuss the difference between the parents informed consent and Dwight’s assent for surgery.

Discuss the importance of including Dwight in the surgical preparation process.

ANSWER

 Preoperative Preparation and Care for a Preschooler Undergoing Surgery

Introduction

This essay discusses the case of Dwight, a 4-year-old boy scheduled to undergo surgery for the insertion of ear tubes due to recurrent otitis media. The essay explores the appropriate timing and topics for preoperative teaching, identifies the stressors experienced by a hospitalized preschooler in terms of priority, discusses the priorities of care for Dwight on admission, describes therapeutic nursing interventions to alleviate his stressors, suggests measures for addressing Dwight’s anxiety during venipuncture, explains the difference between parents’ informed consent and Dwight’s assent for surgery, and emphasizes the importance of including Dwight in the surgical preparation process.

Preoperative Teaching for Dwight

Preoperative teaching should begin several days before Dwight’s surgery to allow adequate time for him and his parents to process the information and ask questions. Topics that should be addressed include a child-friendly explanation of the surgical procedure, what to expect on the day of surgery, the need for fasting, the use of anesthesia, and the presence of healthcare providers. Teaching should be age-appropriate, using simple language and visual aids to enhance understanding.

 Stressors for a Hospitalized Preschooler

The stressors experienced by a preschooler who is hospitalized can vary in terms of priority (Feriante, 2023). Key stressors for Dwight may include separation anxiety from his parents and familiar environment, fear of the unknown and medical procedures, disrupted routines and sleep patterns, and limited autonomy and control over his surroundings.

Priorities of Care for Dwight on Admission

The priorities of care for Dwight on admission involve ensuring his emotional well-being, safety, and comfort. It is crucial to establish a trusting and therapeutic nurse-child relationship, provide a child-friendly environment, and involve Dwight’s parents in his care. Assessing and addressing his anxiety, providing age-appropriate explanations, maintaining a consistent routine, and encouraging play and distraction can help alleviate his stress.

Therapeutic Nursing Interventions to Lessen Stressors

To lessen Dwight’s stressors, the nurse can implement therapeutic interventions such as providing developmentally appropriate play materials and activities, engaging in therapeutic play to familiarize Dwight with medical equipment, involving him in decision-making when appropriate, maintaining clear and consistent communication, and promoting a sense of control and mastery through choices and routines (Senko, 2019). Additionally, the nurse can offer age-appropriate explanations, use distraction techniques during procedures, and ensure Dwight’s comfort and safety.

Measures to Address Dwight’s Anxiety During Venipuncture Prior to performing the venipuncture, the nurse should take several measures to address Dwight’s anxiety. These include using age-appropriate language to explain the procedure, providing a distraction or comfort item, involving Dwight’s parents in providing emotional support, ensuring privacy and a calm environment, using appropriate pain management techniques such as topical anesthetics or cold packs, and performing the procedure quickly and efficiently.

 Difference Between Parents’ Informed Consent and Dwight’s Assent

Parents’ informed consent refers to the legal and ethical responsibility of parents or guardians to provide consent for medical treatment on behalf of their child. Dwight’s assent, on the other hand, acknowledges his developmental capacity to understand and participate in the decision-making process regarding his own healthcare (Muirhead, 2004). While parents provide informed consent, Dwight’s assent signifies his agreement or willingness to undergo the surgery, considering his age, maturity, and ability to comprehend the situation.

Importance of Including Dwight in the Surgical Preparation Process

Including Dwight in the surgical preparation process is crucial for several reasons. It empowers him, fosters his sense of autonomy and control, reduces anxiety, and promotes his cooperation and adherence to medical procedures. By actively involving Dwight, healthcare providers can help him develop a sense of trust, establish a positive attitude towards healthcare experiences, and potentially minimize the negative psychological impact of hospitalization and surgery (National Academies Press (US), 2023).

Conclusion

Providing comprehensive preoperative teaching, identifying and addressing the stressors experienced by hospitalized preschoolers, prioritizing care to ensure emotional well-being and safety, implementing therapeutic nursing interventions, and involving Dwight in the surgical preparation process are essential for optimizing his experience and outcomes. By recognizing Dwight’s developmental needs, addressing his anxieties, and including him in decision-making to the extent possible, healthcare professionals can facilitate a positive surgical experience and support his overall well-being.

References

Feriante, J. (2023, February 26). Separation Anxiety Disorder. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK560793/ 

Muirhead, P. (2004). When parents and physicians disagree: What is the ethical pathway? Paediatrics and Child Health, 9(2), 85–86. https://doi.org/10.1093/pch/9.2.85 

National Academies Press (US). (2023, February 15). Evidence Supporting Whole Health’s Foundational Elements. Achieving Whole Health – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK591721/ 

Senko, K. (2019, May 5). PLAY THERAPY: An Illustrative Case. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659989/ 

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