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Recovering the Paediatric patient

Recovering the Paediatric patient. Presented by Sally Moon Clinical Nurse Specialist . SESSION OVERVIEW -. How do Children differ from Adults Principles of Post Anaesthetic Nursing Care Complications in Recovery Recovery discharge criteria Practical tips and ideas.

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Recovering the Paediatric patient

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  1. Recovering the Paediatric patient Presented by Sally MoonClinical Nurse Specialist

  2. SESSION OVERVIEW - • How do Children differ from Adults • Principles of Post Anaesthetic Nursing Care • Complications in Recovery • Recovery discharge criteria • Practical tips and ideas

  3. HOW ARE CHILDREN DIFFERENT ?

  4. RESPIRATORY SYSTEM • Smaller airways • Narrow nasal passages • Large tongue • Larger prominent occiput / short neck • Larynx high & anterior ( level c2-c3) • Cricoid ring narrowest point • Compliant rib cage

  5. CARDIOVASCULAR SYSTEM •  Metabolic rate •  Cardiac Output •  Heart Rate / Oxygen consumption • Fixed stroke volume • Smaller circulating volume •  Glucose requirement

  6. TEMPERATURE REGULATION •  Surface area per kg • Children lose heat more rapidly •  Metabolic rate • Insufficient body fat • Infants cannot shiver

  7. RENAL SYSTEM • Decreased capacity to excrete free water • Neonatal kidney  GFR •  sodium excretion / concentrating ability

  8. POST ANAESTHETIC CARE • Conscious state • Oxygen saturations • Heart rate • Respiratory rate • Temperature • Blood pressure • Wound site / iv site • Pain score

  9. COMPLICATIONS IN RECOVERY • Airway obstruction • PONV • Pain • Hypothermia • Hypovolaemia • Emergence Delirium

  10. RESPIRATORY ASSESSMENT • Patency of Airway • Rate / depth respirations • Symmetry of Chest Expansion • Gag protective reflexes • Colour • Presence stridor /wheeze • Oxygen Saturation

  11. SIGNS & SYMPTOMS AIRWAY OBSTRUCTION • Inspiratory stridor • Snoring • Increased work of breathing • Absent /silent respirations • Head bopping • CAUSES…..

  12. MAINTAINING AIRWAY PATENCY • Backward head tilt • Chin lift • Jaw support • Suction airway secretions • Positioning • Oral / nasal airway • Bag & mask

  13. LARYNGOSPASM • Defined by forceful closure of vocal cords which prevents respiration • More common in children • More common if URTI • More common if laryngeal stimulation • Managed by positive airway ventilation/100% oxygen • Remove stimulus • Drugs

  14. PONV • Distressing for paediatric patients • More common after 2 of years age • Prophylactic anti-emetics regularly used • Additional therapy prescribed “just in case” • More common in children who suffer motion sickness • Squint surgery / ENT

  15. PONV - • Metoclopramide • Dexamethasone • Granisetron • Droperidol • Promethazine • Post-operative Nausea & Vomiting guideline available on RCH website/Anaesthesia & Pain Management

  16. PAIN MANAGEMENT • Pain is subjective and can be influenced by many factors • Anxiety • Previous experience • Peri operative education • Anaesthetic & pain relief given • Childs age

  17. PAIN • Appropriate pain tools for assessment • Wong-Baker / Flacc • Premedication • Local anaesthetic • Regional block /Epidural • Opioid infusions / pca

  18. PAIN SCALE TOOL

  19. PAIN

  20. HYPOTHERMIA • Children more susceptible • Greater surface area • Can result in delayed awakening, cardiac irritability & respiratory depression • Neonates ,cerebral palsy, extensive surgery at greatest risk

  21. HYPOTHERMIA • CAUSES – • Intraoperative exposure • Deliberate cooling (Neuro/Cardiac) • Poor thermoregulatory systems (Neonates) • TREATMENT – • Active warming ( Blanket /Bair hugger) • Warm fluids • Constant monitoring

  22. HYPOVOLAEMIA • Pre op factors • Intra op fluid management • WATCH FOR • Obvious bleeding, wound / drain • Tachycardia (SMALLER CIRCULATING VOLUME) • Hypotension • CRT prolonged

  23. EMERGENCE DELIRIUM • State in which the child is agitated,inconsolable,typically thrashing • Children do not recognise people /familiar objects • Greater incidence in children (1-5 years) • Safety • Carers

  24. PSYCHOSOCIAL  Waking up in Recovery can be frightening  Separation anxiety  Re-orientate / Reassure  Use child’s name • Reunite family as soon as safe to do so

  25. RECOVERY DISCHARGE CRITERIA • Sedation score 2 or less ( UMSS ) • Pain under control • No active vomiting • Vital sign assessments within MET Criteria

  26. RECOVERY DISCHARGE CRITERIA • If vital sign assessments are outside MET Criteria then MET discharge Criteria form completed • Oxygen order completed if necessary • Surgeon has spoken to parents

  27. TIPS & TRICKS !!!

  28. Questions

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