APRIL 1985, VOL 41, NO 4 A O R N J O U R N A L

Ambulatorv SurPerv J U J

A caring approach to the pediatric myringotomy patient

ara Adams, age 4, is having lunch and watching her favorite czirtoons at home with S her brother and mother. It is turning into

a routine day, but it started far from routine. This morning Sara went to a freestanding ambulatory surgery center for a bilateral myringotomy with insertion of pressure equalization tubes.

By incising the tympanic membrane, fluid is removed from the middle ear. Tiny tubes are inserted into the eardrum to equalize pressure in the middle ear and to prevent fluid from accumulating again. The surgical treatment is used after prolonged middle ear effusions and/or recurrent otitis media that is unresponsive to medication. This, Sara’s first surgical experience, is positive because of the time the nurses and physicians took to prepare her.

Preoperative Preparations

ara’s pediatrician referred her to an otolaryngologist after the antibiotics were S unsuccessful in treating the recurrent otitis

media. Although the surgery is in two weeks, the preparation began right away.

The ENT specialist meets with Sara and her mother to obtain a current history and physical and a blood workup. Because Sara is otherwise healthy, the otolaryngologist schedules the surgery at a freestanding ambulatory surgery center. The nurse at the physician’s office calls the ambulatory surgery center to arrange for Sara and her mother to tour the facility.

The day of the tour, Sara and her mother are greeted by the receptionist, and then a nurse comes

to show them the center. The tour begins in the area where Sara will select a hospital gown to wear the day of surgery. The nurse shows Sara the toys and books that she can play with while waiting to go into the operating room with the anesthesiologist. She chooses the book she wants read to her the day of surgery. The nurse introduces Sara and her mother to the anesthesiologist and operating room and recovery room nurses, who answer questions. Before leaving the facility, the nurse tells Sara’s mother that she will be contacted the day before surgery for instructions, but that she should call if she has questions in the meantime.

A nurse from the ambulatory surgery center calls Sara’s mother the day before surgery to confirm the time, give instructions, and answer questions. She is told not to give Sara anything to eat or drink after midnight and to bring Sara to the center one hour before the surgery is scheduled. In this hour, the nurse will obtain admission and preoperative data. Sara’s mother is to collect a urine specimen from Sara for testing the morning of surgery. The telephone call ends with the nurse answering questions.

Day of Surgery

pon arrival at the ambulatory surgery center, Sara’s mother fills out the necessary U forms and then meets with the nurse, who

takes Sara and her mother to the admitting area. Sara selects a hospital gown, and her mother helps her into it.

The nurse notes Sara’s height and weight and then inquires about any present or past medical

d- 765

A 3 N J O U R N A L APRIL 1985, VOL 41, NO 4

problems, current medications, allergies, and the last time Sara ate or drank. Before meeting with the anesthesiologist, the nurse takes Sara’s vital signs, tests the urine sample, and reviews the laboratory data from the otolaryngologist’s office.

The anesthesiologist uses toys and finger puppets when talking to Sara and her mother about the anesthetic and surgery to keep them as calm and comfortable as possible. He obtains a more detailed history. The surgeon then comes to answer any other questions and reassure Sara’s mother.

The anesthesiologist leads Sara by the hand to the operating room. She is able to walk on her own because she has not had preoperative medication or an IV. The OR n u m greet Sara, and to avoid frightening her, they keep their masks down. While sitting on the anesthesiologist’s lap and listening to him read, she is induced with halothane. This agent is used because it is quick, smooth, and has a low incidence of coughing. The inside of the mask is coated with a strawberry- scented gloss; Sara chose strawberry over the raspberry and bubblegum scents. The anesthesi- ologist holds the mask to Sara’s face as the nurse reads.

Following induction, the nurses lift Sara onto the operating table and place her in the supine position. A safety belt is strapped across the top of her thighs. To maintain her body temperature, the circulating nurse wraps Sara in a blanket, and she/he also positions the electrocardiogram leads, blood pressure cuff, and temperature monitoring equipment. The chart is checked one more time for any allergies Sara might have.

Sara’s head is turned to expose the ear to be operated on, and the microscope is wheeled into place. The surgeon makes a small incision in the tympanic membrane, suctions the fluid, and inserts

Cathleen Harrison, lW is an OR staff nurse at Harrford (Conn) Surgical Center. She received her diploma from St Francis Hospital School of Nursing, Hartford.

the tubes. Sara is repositioned so the procedure can be done on the other ear too. The surgeon then instills antibiotic drops into Sara’s ears.

The procedure takes about 15 minutes and after it is completed, the nurses remove the monitoring equipment. Once the anesthesiologist directs the nurses that it is safe to transfer the patient to the recovery area, they lift Sara onto a stretcher. The anesthesiologist and circulating nurse take Sara to the recovery room, and as she emerges from the anesthesia, Sara’s mother comes into the room.

The recovery room nurses monitor Sara’s vital signs, assess for pain, check for ear drainage, and observe for signs of nausea or vomiting. When awake, Sara is offered fruit juice or ginger ale, and the nurses administer pain medication if it is necessary. She sits on her mother’s lap to drink the juice, and as the time for discharge nears, which varies according to the patient’s course of recovery, postoperative teaching begins.

The recovery room nurses and surgeon instruct Sara’s mother about diet, activities, pain control, and ear care. The instructions are given verbally and on a printed sheet from the surgeon. Sara then dresses and goes home with her mother.

The day after surgery, the recovery room nurse calls to check on Sara’s progress and answer any questions. She also informs Sara’s mother of the scheduled follow-up visit with the surgeon.

Even in optimal conditions, the ambulatory surgery center staff cannot guarantee that each child‘s experience will be as positive as Sara’s, but this article emphasizes ways to make it as positive as possible. It is important to remember each child is an individual, and factors, such as environment, temperament, and family relation- ships, contribute to the child‘s personality and experience.

CATHLEEN HARRISON, RN KATHLEEN UPSON, RN

Kathleen Upson, RN, is an OR’staflnurse at Hartford Surgical Center. She received her diploma from Hartford Hospital School of Nursing.

768