Preparing for Surgery- Pediatric Patients
This information in this section is intended for parents or guardians of children who have been scheduled for surgery at Portsmouth Regional Hospital. We encourage you to read this information carefully, and print it out for future reference.
Please call 603-433-4837 if you have any questions. We look forward to helping you through this process!
Preparing for the Experience -Age-Appropriate Information
Letter to Parents from Anesthesia
Surgery Confirmation & Cancellation
The Day of Surgery
Eating and Drinking Restrictions
Post-Surgery Hospital Stay
Insurance & Billing Issues
Referral to an appropriate surgeon is done by your child's physician or pediatrician. The office staff will set up the referral before you leave the office. The visit with the surgeon will include a physical exam and a health history. Further discussion will include the diagnosis of the problem, the surgical procedure, the advantages and risks of the surgery and pain management. The surgeon's office staff will assist in coordinating the admissions process and the visit with anesthesia before you leave.
The pre-admission visit is scheduled after you have consulted with a surgeon about the procedure your child needs. The Pre-admission office is located just inside the front entrance of the hospital on the right. The visit will take approximately one hour depending on the number of tests ordered. Your child may eat food and drink fluids before your visit.
At your visit, you will:
- Register for your day of surgery and/ or procedure
- Meet with a pre-admission nurse to discuss the surgery/procedure
- Meet with an anesthesiologist who will answer any of your questions concerning your child's surgery and pain management
- Have blood work, x-rays and /or an EKG if ordered
- Have a tour of the hospital areas involved in your hospital stay.
Remember to bring with you a listing of medications or the actual bottles of medication that your child takes.
Language Line Services are available for patients that speak a language other than English. Please notify your surgeon of this need before admission to the hospital. Services to address sign language interpreting and telecommunication devices for the hearing impaired are available. Please check with the staff on admission concerning these needs.
Preparing for the Surgery Experience
Children's understanding of the hospital experience is influenced by their age and by their developmental level. The following is a guide for helping your child prepare for the experience.
Toddlers (ages 1-3) think in the "here and now". Discussion about their trip to the hospital should occur 1-2 days before. Allowing your child to take their favorite stuffed animal or doll to the hospital provides a sense of security. A calm parental presence helps the child to stay comforted. Keeping your child as pain free as possible is important. Children at this age will say they hurt, appear restless, irritable and cry or may appear very quiet.
To calm your child, try gently rocking or holding your child, singing a favorite song or rhyme, telling stories and playing calming music. Gently massaging the back, allowing your infant to suck on a pacifier or visual distraction are helpful. Encourage your child to point to "where it hurts". The health care team will use a numbered scale to identify how much your child hurts so that the right amount of medicine is given for pain relief. Remember that you are part of the team caring for your child, so don't feel that you are "in the way".
Preschoolers (ages 3-5)
Preschoolers (ages 3-5) can be told about the surgery 3-4 days ahead of time. Explanation should be simple and the child should be reassured that this is not a punishment. Curiosity is expressed verbally with "why". Fear of injury and loss of control should be approached with honest answers to questions and reassurance by adults. Reasoning with children at this age is difficult, so it is important to be calm but firm and reassure your child that you are there by saying, for example, "Mommy will be there to hold your hand and keep you from getting too scared".
Behaviors that indicate pain include: verbalizing on the area that hurts, restlessness, irritability, regressive behaviors, and crying. The health care team will use a FACES scale with you and your child. This scale has both happy and sad faces that your child can point at. The number underneath the face gives the healthcare team an idea of how much pain your child is having, so that the right amount of medicine is given for pain relief. Encourage your children to tell you or the nurse when the pain starts.
Children's books and books for parents that focus on the hospital experience help to decrease fear. We recommend:
- A Big Operation by Richard Scarry, 1994; Simon and Schuster, New York
- Curious George Goes to the Hospital by H. Rey and M. Rey, 1996, Houghton-Mifflin, New York
- A Visit to the Sesame Street Hospital by Deborah Hautzig, 1985 Random House, New York
- Check on MORE LISTINGS
- Your Child in the Hospital: A Practical Guide For Parents by Nancy Keene and Rachel Prentice O'Reilly and Associates 1-800-775-7731
School-age Children (6-12)
For school-age children (6-12), preparation for the hospital experience should begin 1-2 weeks ahead of time. Fears and worries about body image and asking for details about this experience are very common. Independence is increasing, but behavior is influenced by set social rules and expectations. The ability to problem solve and understand cause and effect is present.
Encourage your child to participate in their care. Indications of pain may be expressed with facial grimacing, tightening of muscles during movement, groaning or crying. Issues with pain/discomfort are addressed by using the numeric 0-10 scale to identify how severe the pain is. 0 means no pain, 1-3 means "mild" pain (pain that is there but does not stop activity); 4-6 is "moderate" pain (pain that is strong enough to limit your activities); 7-10 is "severe" pain (pain that completely stops activity); The FACES scale, which shows happy and sad faces, rates each face with a number so that the health care team can provide the right amount of medication.
It is helpful for parents to be present during painful procedures. Other ways to cope with pain include verbal or visual distraction, relaxation techniques, music, hot or cold packs. Encourage your child to describe the pain and ask for pain medication when they begin to feel the pain.
Adolescents (13-18) should be included in all discussions and decisions about their surgery. Adolescents are very aware of their bodies. They can be fearful of altered body image and loss of control and independence. Older children sometimes "regress" (act like a younger child) when anxious. Do not shame them into "acting their age". Encourage coping strategies like deep breathing and muscle relaxation, and listening to favorite music. Friends are a very important form of support.
Encourage your child to participate in their plan of care and to ask questions. Indications of pain or discomfort should be rated using the numeric 0-10 scale. 0 means no pain, 1-3 means "mild" pain (pain that is there but does not stop activity); 4-6 is "moderate" pain ( pain that is strong enough to limit your activities); 7-10 is "severe" pain ( pain that completely stops activity); Encourage your child to describe the pain and ask for pain medication when they begin to feel the pain.
As your child's parent or guardian, you will be required to complete the following forms:
- Consent for treatment and hospitalization
- Financial responsibility
- Surgical or Special Procedure permit
Legal Guardians must present appropriate Guardianship forms at the time that paperwork is signed for hospital admission.
Paperwork can be signed on the day of surgery or during the preoperative visit. If your child requires lab work or an EKG before surgery, admission paperwork will be completed in the Admissions Department. If your child does not require preoperative testing, the paperwork will be completed on the day of surgery in the Short Stay Unit (SSU).
The paperwork may also be witnessed and notarized and sent back through the mail in a timely fashion. Paperwork must arrive a minimum of 2 days before the day of surgery.
This pre-operative interview is arranged through the surgeon's office. If your work or personal schedule does not permit you to see anesthesia before the day of surgery, the visit occurs on the actual day of surgery in the Short Stay Department. In that case, the pre-admissions nurse will phone you several days before and ask you a number of questions about your child's medical history and complete the registration. A member of the Anesthesia Department will then visit with you before the surgery and complete the interview in person. This option works well for many families.
Information will be given on:
- Type/method of anesthesia to be used in the OR. The brochure "When Your Child Needs Anesthesia" will be available.
- Parent accompanying child to the OR. We suggest that you and your child discuss which parent will do this BEFORE you arrive the day of surgery.
- Radioflyer. Children, ages 0-12, may choose to ride into the OR in the RADIOFLYER red wagon.
- Pain management.
Letter from Anesthesia to parents of children having surgery
In a continuing effort to improve the care we provide to children, we often talk with their parents. In these discussions, we have heard that anesthesia in particular can be a scary thing for parent and child alike. To reassure you about this aspect of your child's surgical care, we encourage you to read an excellent brochure entitled, "When Your Child Needs Anesthesia" available during your Pre-Admission visit.
In addition, we would like to tell you about our own Anesthesia Department.
All of the members of Anesthesia have had specialized training in providing anesthesia to children. Our anesthesiologists and nurse anesthetists have safely administered anesthesia to thousands of children over the years.
Your surgeon's office will arrange for you to have a pre-operative interview with a member of the anesthesia department. The purpose of this interview is to alert us to any medical condition that could influence the administration of anesthesia. We also encourage you to bring along any questions you might have about anesthesia.
Although the person who interviews you may not be performing the anesthesia, we all work together as a team and carefully review every case on the morning before surgery. In addition to this review, the professional administering your child's anesthesia will meet you and your child before surgery. He or she will also have a complete written record of your pre-operative interview.
If your work or personal schedule does not permit you to see us before the day surgery, we will be glad to see you and your child in the Surgical Services Short Stay Unit on the actual day of surgery. In that case, one of our staff will phone you several days before and ask you a number of questions about your child's medical history. Thus, your registration will be done by phone. A member of the Anesthesia team will then see you on the day of surgery and complete the interview in person. The option works well for many families. It is important to remember that on the day of surgery, your child cannot have food or breakfast, but may have clear liquids (water, juice, soft drinks) up until two hours before the time of surgery.
We have made special arrangements to help prepare children for their hospital experience. For children being admitted overnight to the hospital, a tour of pediatrics is encouraged. We will be happy to arrange this for you at the time of your pre-operative interview.
On the day of surgery, we have also made special arrangements for parents.We invite parents of children up to twelve years of age to accompany their child into the operating room and be present until their child is asleep. This frequently helps to reassure and relax children before anesthesia begins. Some people can be a little nervous about entering the operating suite. We want to assure you that, if you choose this option, you will be present only until your child is asleep. You do not need to worry about seeing anything else, much less any part of the surgery. We want you to know that it is very common for child just going under anesthesia to look confused or even struggle slightly. This is normal. We will be there to help your child off to sleep.
After surgery is over, one of the nurses from our Post Anesthesia Care Unit (PACU) will bring you to this unit to see your child. As children wake up, they may be fussy but usually calm down quickly. The medical equipment here can be a little intimidating, but it is all necessary to provide high quality care. If you have any questions, the nurse caring for your child will be happy to help you.
We hope that this letter, the brochure about anesthesia, and your interview with us will answer your questions and ease your concerns about your child's anesthesia.
Surgery Confirmation & Cancellation
The surgeon's office will provide instructions on how to obtain your arrival time for surgery. We routinely schedule pediatric clients as first on the operative schedule to alleviate undue stress from waiting and having food withheld before surgery.
Change of Surgical Schedule:
PRH takes great pride in keeping on schedule with surgeries and procedures; however, on rare occasions, an emergency surgery may require that the planned surgery schedule be changed to accommodate that need.
Your surgery may be canceled and rescheduled for the following reasons:
- If instructions concerning eating or drinking before surgery are not followed.
- If your child develops an illness; ie., cold, sore throat or flu symptoms. Call the surgeon as soon as possible if your child becomes ill or if you have questions or concerns.
The Day of Surgery
When you arrive in the Short Stay Unit with your child on the day of surgery, an employee will begin the preoperative admission process which includes taking vital signs, listening to heart and lungs, asking health history questions and answering any questions.
The health care team (anesthesia, surgeon, nurses in the SSU) will also be able to provide information and answer your particular questions such as:
- Estimated time of surgery and recovery
Surgery and recovery time can vary depending on the type of procedure done.
- Where the surgical waiting room and cafeteria are located
A SSU nurse will accompany you to the waiting room. After surgery, the surgeon will come to the waiting room to speak with you. Shortly after that, a recovery nurse will accompany you to where your child is recovering and will answer any questions that you may have.
- Where your child will be recovered: Your child will either recover in the Post Anesthesia Care Unit (PACU) or the Short Stay Unit (SSU). Length of stay in the recovery room is about 1-2 hours depending on the child's comfort level and ability to drink and urinate.
Age appropriate videos can be viewed while awaiting surgery.
Eating and Drinking Restrictions
Children ages 0-12 years may have liquids up to 2 hours before surgery. Medications maybe taken with sips of water.
Children ages 13-18 may have liquids up to 4 hours before the surgery.
Solid food should not be eaten after midnight. Medications taken with food that are required the morning of surgery should not be taken until after surgery.
After surgery, your child will be taken to the Post Anesthesia Care Unit (PACU) or the Short Stay Unit for their initial recovery. We always encourage one parent to be present when their child awakens. The staff will talk to you about:
- Waking up from anesthesia
- Pain control and ways to assist your child with coping
- Discharge instructions on activity, diet and pain control
If needed, your child will be transferred to Pediatrics for recovery/overnight stay.
Important points for parents to remember:
Pain intensity can be greater with surgical procedures. Pain prevents your child from feeling better and healing quickly. Encouraging your child to take the prescribed medication will help to keep "on top" of the pain.
During the first 60-90 minutes after surgery, your child may appear drowsy, mildly confused or irritable, but these behaviors will disappear after the anesthetic agent wears off. Patient reassurance and support is helpful at this time.
Post Surgical Hospital Stay
Children who require an overnight stay will be transferred to the Pediatrics unit on the 4th floor. Upon arrival, a pediatric nurse will accompany you and your child to a room. After getting your child settled, the nurse will review the plan of care and answer your questions about the following:
The FACES scale (ages 3-12) and the Behavioral Scale (ages 0-2) are used to rate your child's pain. Please encourage your child to report pain or discomfort as it begins to be noticeable. Effective pain relief helps your child to move, cough, eat, drink and sleep more comfortably. Pain medication is given through the IV for the first 24-36 hours. Once your child is tolerating fluids and food, oral medications are then offered.
Intravenous (IV) Fluids:
The IV catheter that is placed inside your child's arm to deliver fluids will remain for 24-36 hours after surgery. This catheter will also be used to administer pain medication and other medications that are ordered.
A liquid is offered for the first post- operative day to allow the child's stomach and gut to recover from the effects of anesthesia. Soft solids will follow on the next day.
Your child will be encouraged take deep breaths and cough postoperatively as well as begin physical activity like moving in bed, sitting at the side of the bed and getting out of the bed to walk.
Length of Stay(LOS):
Length of stay on the pediatric unit ranges from 1- 4 days depending on the type of surgery done. Physicians and surgeons make daily rounds to check on the progress of recovery. If you have any questions for your child's doctor or surgeon, please let the nurse on the unit know so that she can either contact him or leave a message for him to call you.
The Portsmouth Regional Hospital staff will make every effort to make your child's stay comfortable.
Patient rooms on Pediatrics are private. Each room has a television with a wide selection of channels. Each bed is equipped with electronic controls for bed position and paging the nurse.
There is a telephone for each patient in a room. Outside calls made to a patient on Pediatrics are connected through the operator. On occasion, a pediatric patient may stay on the Maternal-Child Unit. Patients on that unit can receive calls directly to the room. Your loved ones may call you toll free by dialing 1-800-685-8282 or by dialing the local number 603- 436-5110 and asking for your room number.
Local calls: Dial 9 + phone number
Long Distance: Have your calling card or home phone number available and dial "O" and the operator will connect you with an outside line.
Language Line Services are available for patients that speak a language other than English. Please notify your surgeon and pre-op nurse of this need before admission to the hospital. Services to address sign language interpreting and telecommunication devices for the hearing impaired are available. Please check with the staff on admission concerning these needs.
The hospital cannot be liable for any loss or damage of personal items unless placed in the designated security safe at PRH. We encourage you not to bring money, jewelry and other items of value to the hospital.
Smoking is not allowed in the hospital. Designated covered smoking areas are available outside of the hospital.
Insurance and Billing Issues
Most insurance plans require a telephone call to approve an overnight stay in the hospital. Please review the requirements and restrictions of your insurance plan. Patients who do not have insurance should discuss this matter at pre-registration with financial counselors so that arrangements can be made.
Charges from Radiology, Anesthesia and Pathology are billed independently of the hospital bill. If there are charges owed, you will be sent a separate bill.
For More Information
If you need additional information about your child's hospital experience, please call:
- Short Stay Unit: 433-4033
- Pre-op Nurse: 433-4837
- Anesthesia Office: 433-4045
Respecting your rights is critical to providing you with the best possible care and therefore is an inherent part of our mission. These rights are fundamental and are intended to safeguard your personal dignity while a patient at Portsmouth Regional Hospital.
- You Have the Right to Reasonable Access to Care and Treatment
- You Have the Right to Care that is Considerate of Personal Values and Beliefs
- You have the Right to Security, Personal Privacy and Confidentiality of Information
- You Have the Right to Receive Care in a Safe Setting
- You Have the Right to Know Who is Caring for You
- You Have the Right to be Informed and Participate in Decisions Regarding Your Care
- You Have the Right to Unobstructed Access to Communication
- You Have the Right to Consent
- You Have the Right to Refuse Treatment or Seek Other Medical Care
- You Have the Right to Make Your Wishes Known Regarding Advanced Directives and End- of-Life Care
- You Have the Right to Effective Pain Management
- You Have the Right to Continuity of Care when You are Discharged from Portsmouth Regional Hospital or Transferred to another Facility
- You Have the Right to Know About your Charges
- You Have the Right to Participate in Ethical Questions and to Know the Hospital Rules and Regulations and Ethical Practices
- You Have the Right to Voice Your Complaints
Patient Responsibilities and Rights are provided on admission and are also found in the Patient Services Booklet in each patient room.
Parent/Guardian Responsibilities for the Pediatric Patient
At Portsmouth Regional Hospital, we consider you the most important member of your care Team. We rely on you to help us do what we do best-care for people. With this in mind, we ask that you review the following responsibilities so that you will understand our expectations.
1. Provision of Information
- We ask that you provide the physician and staff involved with your child's care the personal information necessary to deliver and administer care. This personal information, provided upon admission, may include information about past hospitalizations, previous and concurrent health problems, medications and treatment (including any vitamins or herbal supplements), insurance data, executed Advance Directives, and all other matters pertaining to your health status.
- Communicating in a direct and honest manner with doctors, nurses, and other hospital staff members about matters or conditions that concern your child's health will help us to care for him or her.
- We ask that you assume responsibility for your child's discharge.
- Please immediately inform the staff of any perceived unsafe, unclear or unreasonable request or situation.
- Please inform the staff of your child's whereabouts and probable return time if you leave the patient unit.
2. Compliance with Instruction
- So that we can serve you/ your child and others better, we ask that you keep your appointments or schedules, and notify the appropriate individual when you cannot keep them.
- You/your child are the most important member of your care team and we expect you to fully participate in your plan of care and to follow the prescribed therapies and treatments ordered.
3. Refusal of Treatment
By following your physician's instructions, your child is doing his/her part to get well. If you/your child refuse treatment and fail to follow your physician's instructions, you are responsible for the outcome.
4. Hospital Charges
Your financial obligations for healthcare provided are your responsibility and we ask that you address them promptly.
5. Hospital Rules and Regulations
- Please respect and follow the rules and regulations regarding patients while your child is admitted to the hospital.
- Please refrain from social behavior that may offend others or be dangerous to health, including the use of alcohol, tobacco products, non-prescribed medications or drugs.
6. Respect and Consideration
- We ask that you, your child and your visitors be considerate of other patients. Additional respect pertains to the hospital's rules regarding visiting hours, smoking, noise, and the use of non- hospital medications.
- Please respect hospital property, treat such property with reasonable care and be waste conscious.
7. Process Improvement
We rely on your input so we can continually improve upon your care and the care of others. Please share your perceptions about the care and treatment you received with hospital staff to aid them in our pursuit of excellence.
8. Conflicts Concerning Patient Care
Please inform the Unit Managero or a designee should a conflict concerning your care develop between your child, the parent/guardian, the hospital staff or physician. If there is a conflict, the Unit Manager or designee will try to resolve the matter for you. Failing this, the matter will be referred for resolution to the Vice President of Patient Services/Chief Nursing Officer, who will review the matter with you (or your guardian), Administration and the physician. You will be continuously informed during the resolution process. Please be aware that presenting a complaint will not serve to compromise your future access to care in any way.
For additional information about your child's surgery, contact the surgeon. For information about your child's hospital experience, call:
- Short Stay Unit: 603-433-4033
- Pre-Op Nurse: 603-433-4837
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