Ped 5

PREOPERATIVE
PSYCHOLOGICAL
PREPARATION OF PEDIATRIC
PATIENTS
Prepared by
Tufail Ahmad
PREOPERATIVE PSYCHOLOGICAL
PREPARATION OF PEDIATRIC PATIENTS
 The pediatric surgical patient should be considered as a whole person with individual physical
and psychosocial needs assessed in relation to the natural stages of development.
 Equally important are the adjustment and attitude of the parents toward the child, the illness,
and the surgical experience.
 Parental anxiety about the impending surgical procedure may be transferred to the child.
 Emotional support and education of the patient and the parents are important aspects of
preoperative preparation to help them cope.
PREOPERATIVE
PSYCHOLOGICAL
PREPARATION OF PEDIATRIC
PATIENTS
 When an event is threatening, the patient changes cognitive and behavioral responses to deal
with the specific demands of the situation.
 Most adults face stress with more control when fear of the unknown is eliminated.
 parents need to be informed of events that will occur and to be taught how to care for their
child preoperatively and postoperatively.
 If children are informed of sensations to be experienced, cognitive control of the event may
occur.
 Children do not differ from adults in this respect. However, understanding varies with age
 The following are general considerations:
 Correction of a congenital anomaly as soon after birth as possible may be better
psychologically for both the infant and the parents.
 The infant younger than 1 year does not remember the experience. Parents gain confidence in
learning to cope with a residual deformity as the infant learns to compensate for it.
 Fear of body mutilation or punishment may be of paramount importance to a preschool or
young schoolage child
 Children from 2 to 5 years of age have great sensitivity and a tenuous sense of reality.
 They live in a world of magic, monsters, and retribution, yet they are aggressive.
 Schoolage children have an enhanced sense of reality and value honesty and fairness.
 Their natural interest and curiosity aid communication.
 These children need reassurances and explanations in vocabulary compatible with their
developmental level.
 Words should be chosen wisely. Negative connotations should be avoided, and the positive
aspects should be stressed. The nurse should talk on the child’s level about his or her interests
and concerns.
 Words should be chosen wisely.
 Negative connotations should be avoided, and the positive aspects should be stressed.
 The nurse should talk on the child’s level about his or her interests and concerns.
 Anxiety in the schoolage child may be stimulated by remembrance of a previous experience.
 Many children undergo two or more staged surgical procedures before the deformity of a
congenital anomaly or traumatic injury is cosmetically reconstructed or functionally restored.
 Familiarity with the nursing staff reassures the child.
 Ideally, the same circulating nurse who was present for the first surgical procedure should
visit preoperatively and be with the child during subsequent surgical procedures.
 Fear of the unknown about general anesthesia may become exaggerated into extreme anxiety
with fantasies of death.
 The schoolage child and adolescent need facts and reassurances.
 General anesthesia should not be referred to as “putting you to sleep.”
 The child may equate this phrase with the euthanasia of a former pet that never returned home.
Instead, the nurse should say, “You will sleep for a little while” or “You will take a nap.”
 Tell the child about the “nice nurses” who will be in the “wakeup room after your nap.”
 Parents should be encouraged to also display confidence and cheerfulness to avoid
transmitting anxiety.
 Parents should be honest with their child but maintain a confident manner.
 The perioperative nurse should do the same. However, a school age child should not be given
information not asked for; questions should be answered, and misunderstandings should be
corrected.
 The nurse should be especially alert to silent, stoic, non communicative children, many of
whom have difficult induction and emergence from anesthesia.
 Children who have lost a sibling or friend to death often fear hospitalization.
 Some facilities hold parties or gettogethers for children and their parents before or after
admission to explain routines and procedures before the surgical experience.
 At other facilities, personnel take children to the OR with their teddy bears so that they can see
the different attire, lights, tables, anesthesia machine, and other equipment that might interest
them.
 A child size anesthesia mask becomes a toy that they are allowed to handle and place on the
teddy bear.
 A clear plastic mask is less psychologically traumatic to a child than is an opaque black rubber
mask.
 An effective method of explaining procedures to children is to use the child’s teddy bear and
dress it as the child will look postoperatively. For example, a bandage is put on the bear if the
child will have one postoperatively.
 Separation from parents or a trusted guardian is traumatic for infants older than 6 months,
toddlers, and preschool children.
 Infants require cuddling and bonding.
 Toddlers are only reaching the autonomy stage when hospitalization forces them into passive
behavior, and thus their separation anxiety is greatest.
 Young children may fear strangers.
 The parent’s presence is necessary for the toddler, and the parent should be encouraged to
stay with the hospitalized child as much as possible.
 The child should be permitted to bring a toy or other security object to the OR suite if a parent
cannot be present.
 Many anesthesia providers encourage parents to accompany an infant or child to the OR and
to stay through induction if they wish.
 The presence of a parent can significantly reduce anxiety and ease induction.
 Some facilities allow parents to accompany the child to the holding area but restrict entrance
into the OR.
 Highly anxious parents who have difficulty coping with stress may cause an increase in the
child’s anxiety level.
 Ambulatory surgery, if feasible, is an advantage because the child enters the facility 1 to 2
hours before the surgical procedure and returns home after recovery from anesthesia.
 This minimizes the trauma of separation.
 A preoperative visit by a perioperative nurse should be planned to get to know the child,
confirm appropriate consents, and provide emotional support to the family.
 Parents should be taught to provide postoperative care, especially before and after an
ambulatory procedure.
 Verbal instructions may be supplemented with a videotape or storybook to reinforce
understanding for both the child and the parents.
 The perioperative nurse should bring the patient to the OR in a crib or on an appropriatesize
cart.
 Carrying a child into the OR presents the risk for dropping or bumping the child.
 Each situation should be determined by the patient’s need.
 Some facilities use toy wagons for child transport.

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PREOPERATIVE

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