Virtual Supplementation: Pediatric Post-Operative Care

Introduction:

This will be an interactive and engaging week in which we will be focusing our learning on the case study of a 10-year-old child who is post-operative following an appendectomy.

We will learn about pediatric specific learning, clinical assessment of pediatric patients, pediatric pain assessment and management, focused abdominal assessment review and IV medication review.

Purpose:

The Post-Op Pediatric Clinical Simulation Game simulates a clinical experience that promotes the application of knowledge and skills for critical thinking and clinical decision making related to caring for a 10-year-old child who has just had an appendectomy and his mother.

(Centennial College, George Brown College, and Ryerson University, n.d)

Your case study:

You patient this week is a 10-year-old boy named Alexandra Kovolik, who likes to go by “Sasha”.  He was feeling unwell this morning, severe abdominal pain, nausea and vomiting so his mother brought him to the emergency department. He was diagnosed with appendicitis and he just underwent an appendectomy this afternoon. He has just arrived on your unit from the recovery room.

Sasha is otherwise healthy young boy with no past medical history and no routine medications taken at home. He lives at home with his mom.

Next Steps:

Follow along on this document and complete the required work. Submit this document as well as the post simulation activity into the drobox entitled Module Two – Respiratory Distress.

References:

About Kids Health (2010). Appendicitis retrieved from https://www.aboutkidshealth.ca/Article?contentid=818 HYPERLINK “https://www.aboutkidshealth.ca/Article?contentid=818&language=English”& HYPERLINK “https://www.aboutkidshealth.ca/Article?contentid=818&language=English”language=English

 

Centennial College, Ryerson University, George Brown College (n.d.)

Paediatric postoperative learning simulation retrieved from https://de.ryerson.ca/games/nursing/hospital/area.html#3

SickKids (2020). Pediatric Pain Assessment: Learning Module 4. retrieved from

http://www.sickkids.ca/pain-centre/Health-care-Professionals/Online%20Pain%20Curriculum/Module-4/story_html5.html

 

SickKids (2020). Non-Pharmalogical Pain Management Learning Module 

retrieved from http://www.sickkids.ca/pain-centre/Health-care-Professionals/Online%20Pain%20Curriculum/Module-6/story_html5.html

Pre-Simulation:

Step 1:

Please indicate and explain what the medical/surgical diagnosis of your virtual patient is in the text box below.

Appendicitis is an inflammation of the appendix. It is caused by a blockage in the lining of the appendix that results in infection. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture. Standard treatment is surgical removal of the appendix.

What would four assessments would you anticipate to complete

1. Vital signs
2. Level of Pain and Location
3. Assessment of the abdomen including palpation and percussion
4. Monitor Intake and output.

Please indicate four nursing interventions that you would complete during your care of Shasha

1. Monitor bowel movements.
2. Monitor laboratory results.
3. Manage pain.
4. Avoid laxatives and enema.

What patient teaching would you anticipate Sasha might require?

• – Do not eat or drink, unless your doctor says it is okay. If you need surgery, it’s best to have an empty stomach.
• – Do not take laxatives. If you have appendicitis, they can make the appendix burst.
• – Follow your doctor’s instructions about taking medicines. Your doctor may tell you not to take antibiotics or pain pills. These medicines can make it harder to tell if you have appendicitis.

Step 2:

• Please review this website on appendicitis – Appendicitis (aboutkidshealth.ca)

 

• Please complete and take a screenshot of the following short learning module – 4. Assessment and Measurement of Paediatric Pain – Overview (sickkids.ca)

 

• For your own interest – you may complete any o the following additional modules on pain relating to pediatric patients, there are a variety of options to choose from The Pain Management, Research and Education Centre | SickKids

Simulation:

Please complete the following simulation

https://games.de.torontomu.ca/post-op/#/

Post Simulation:

Please complete the following questions:

• Explain in your own words what appendicitis is.

Appendicitis is an inflammation of the appendix. It is caused by a blockage in the lining of the appendix that results in infection. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen and filled with pus. If not treated promptly, the appendix can rupture.

 

• What are the two main ways to treat appendicitis?

1. Removal of the appendix/appendectomy (surgery)
2. Antibiotics

• What type of diagnostic imaging is done to diagnose appendicitis?

1. computed tomography (CT)
2. magnetic resonance imaging (MRI)

However, ultrasound is the first imaging test when checking for possible appendicitis in infants, children, young adults, and pregnant women.

• Place in correct order an abdominal assessment? Auscultation, Palpation, Percussion, Inspection.

1. Inspection
2. Auscultation
3. Percussion
4. Palpation

 

• What pain scale should you use for post-operative pain assessment for pediatric patients?

If patient has numerical competency or is able to communicate, then the numerical and PQRST scale otherwise FLACC (Face, Legs, Arms, Cry, Consolability) or the visual analog scale will be more suitable.

 

• How does assessing and managing pain in pediatric patients differ than adults?

Pediatric patients experience pain that is more difficult to assess and treat than adults. Children may not be able to communicate their pain effectively due to their age or developmental stage. This can make it difficult for healthcare providers to assess the severity of the pain and determine the best course of treatment.

 

• What is the purpose of deep breathing and coughing post-operatively? What is the benefit of using a pillow?

deep breathing and coughing post-operatively help keep the lungs clear and prevent complications. Using a pillow can help support the incision site when coughing or deep breathing. It can also help reduce pain and discomfort when moving around.

 

• What are two effective ways to develop a therapeutic relationship with your pediatric patient, and two effective ways to develop a therapeutic relationship with your patient’s guardian?

Pediatric patient

1. Building trust
2. Active listening

Patient’s guardian

1. Build rapport.
2. Effective communication

Please complete either the Self Debrief questions located in the D2L module or attend the debrief session you signed up for.

 

 

 

Pediatric Post Op – Debrief Questions

1. What were your thoughts and feelings as you assumed the role the pediatric nurse Gabe during the simulation?

A pediatric nurse must know how to correctly assess a child and be able to address the concerns of both the patient and the caregiver.

2. Please summarize what happened during the scenario from your perspective.

I was a registered nurse named Gabe, who works on a pediatric surgical unit at a community hospital. The OR called to say they were bringing up Sasha Kovalik a post-op appendectomy patient to the unit. I then received report, which included his vitals (T- 38.1 BP- 105/70 HR- 104 R-18 Sp02- 98 RA), his consciousness level (awake, alert and oriented x3), I was also told his chest was clear, he remained NPO, he had faint bowel sounds, he voided clear urine once, he had a bit of an incision on his lower quadrant and steri strips 4×4 dry and intact, pedal pulses were present bilaterally 2+, pain was a 6/10 and morphine was given which seemed to help. The report continue with MD orders which include vs q4h, sips to diet tolerated, activity is tolerated, Iv with 75cc/h normal saline and more. After report an assessment was done and treatment as well as patient education was provided.

3. What did you learn in relation to establishing a therapeutic nurse–client relationship with Sasha and his mom? What did you realize you needed to do differently for each client?

I learned that when a pediatric patient is in the room it is important to explain what is happening, what you are doing and why to reduce both the anxiety of the parent and patient. As well as the need to directly communicate with the patient, even with a guardian in the room.

4. Not everyone works their way through this scenario perfectly. What learning can you take from the incorrect decisions/responses you made?

When assisting a patient with deep breathing and coughing exercises, it is important to keep in mind the pain of the patient and do anything that could help reduce the pain to ensure full patient cooperation. As well as the importance of asking open-ended questions when unsure about specific patient behavior.

5. What did you learn in relation to completing post-operative care for a pediatric patient?

I learned that behaviour of a patient can quicky change as a result of pain ad that patient may prefer to have a parent or guardian by their side when a nurse is communicating to them.

 

6. What questions remain unanswered for you in relation to this pediatric post-operative simulation scenario?

If the caregiver is a distraction to the assessment or the nurse suspects of abuse, How can you ask the parent to leave the room in a way that it won’t offend them or cause anyone problems?