CPN(C) Perioperative flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Pediatric NPO intervals

Per ASA guidance, children should fast 2 hours for clear liquids, 4 hours for breast milk, and 6 hours for formula, nonhuman milk, or a light meal before anesthesia.

Upper respiratory infection timing

A viral upper respiratory infection within the preceding 2 to 4 weeks raises the risk of laryngospasm, bronchospasm, and cancellation. Assess fever, secretions, and wheeze on the day of surgery.

Postconceptional age apnea risk

Former premature infants whose postconceptional age is under 60 weeks are at increased risk of postoperative apnea after general anesthesia. They often require extended monitoring for 12 to 24 hours.

Pediatric assent

Assent is the child's own agreement to participate in care, sought from developmentally able children, usually age 7 and older. Legal consent still comes from a parent or guardian.

Infant airway narrowest point

In infants and young children, the narrowest portion of the airway is the cricoid ring, not the vocal cords. This makes the cricoid a natural physiologic cuff during intubation.

Infant oxygen consumption

Infants consume about 6 to 8 mL/kg/min of oxygen, higher than adults, while their functional residual capacity is lower. This combination causes rapid desaturation during apnea.

Pediatric blood volume

Estimated blood volume is about 85 to 90 mL/kg in neonates, 75 to 80 mL/kg in infants, and 70 to 80 mL/kg in children. A 10% loss in a neonate is roughly 8 to 9 mL/kg.

Rate-dependent neonatal cardiac output

Because neonatal stroke volume is relatively fixed, cardiac output depends heavily on heart rate. Bradycardia therefore causes a marked drop in perfusion and must be corrected promptly.

Uncuffed endotracheal tube sizing

For children older than 2 years, uncuffed tube internal diameter in millimeters is estimated as age in years divided by 4, plus 4. Confirm fit by leak and by nares or finger size.

Laryngospasm management

Laryngospasm causes stridor, retractions, and absent air movement. Remove the stimulus, apply 100% oxygen with continuous positive airway pressure, and deepen anesthesia; use succinylcholine if it persists.

Emergence delirium

Emergence delirium is inconsolable agitation occurring 10 to 30 minutes after awakening, most often in preschool children. Unlike pain, it is not relieved by analgesics and resolves with time.

Malignant hyperthermia triggers

Volatile anesthetic agents such as sevoflurane and the muscle relaxant succinylcholine can trigger malignant hyperthermia in susceptible patients. Susceptible children require nontriggering anesthesia with dantrolene available.

Surgical antibiotic timing

To prevent surgical site infection, prophylactic antibiotics are given within 60 minutes before incision, with weight-based pediatric dosing and redosing during long procedures.

Sterile field principles

Sterile items may touch only sterile items. Sterile personnel stay within the sterile field, and nonsterile personnel never reach over it or turn their back to it.

Intraoperative time-out

Before incision, the whole team confirms patient identity, procedure and site, side, consent, allergies, antibiotic administration, imaging availability, and equipment readiness in a standardized verbal pause.

Pediatric maintenance fluids

The 4-2-1 rule gives hourly maintenance fluid: 4 mL/kg for the first 10 kg, 2 mL/kg for the next 10 kg, and 1 mL/kg for each kilogram above 20 kg.

Aldrete recovery score

The Aldrete score rates activity, respiration, circulation, consciousness, and oxygen saturation from 0 to 2 each. A total of 9 to 10 generally permits transfer from phase I recovery.

Signs of pediatric hemorrhage

Children compensate for blood loss with tachycardia before hypotension appears. Falling urine output, delayed capillary refill, narrowing pulse pressure, and dropping hematocrit suggest significant postoperative hemorrhage.

Malignant hyperthermia treatment

Malignant hyperthermia presents with rising end-tidal carbon dioxide, tachycardia, muscle rigidity, and hyperthermia. Stop triggering agents, give dantrolene 2.5 mg/kg IV, cool the patient, and treat hyperkalemia and acidosis.

FLACC pain scale

The FLACC scale scores face, legs, activity, cry, and consolability from 0 to 2 each for a total of 0 to 10. It is used for infants and young children unable to self-report pain.

Acetaminophen pediatric dosing

Acetaminophen is dosed at 10 to 15 mg/kg every 4 to 6 hours, with a maximum of 75 mg/kg per day. Intravenous acetaminophen is 15 mg/kg every 6 hours with the same daily ceiling.

Morphine monitoring

Intravenous morphine is dosed at 0.05 to 0.1 mg/kg every 2 to 4 hours. Monitor respiratory rate, sedation level, and oxygen saturation, and keep naloxone available for respiratory depression.

Multimodal analgesia

Multimodal analgesia combines acetaminophen, NSAIDs, local anesthetics, and opioids acting at different sites. This approach improves pain relief while reducing opioid dose and related side effects.

Separation anxiety peak

Separation anxiety peaks between about 8 and 18 months of age. Parental presence during induction, when appropriately prepared, reduces distress and improves cooperation in these children.

Preschool illness beliefs

Children aged 3 to 6 often interpret illness or surgery as punishment for misbehavior. Honest, simple explanations and nonjudgmental reassurance reduce guilt, fear, and uncooperative behavior.

Child life specialist role

Child life specialists use developmentally appropriate play, preparation, and distraction to reduce anxiety and distress before, during, and after pediatric procedures and surgery.

Parental anxiety effect

Parental anxiety tends to correlate with child anxiety before surgery. Clear information, opportunities to ask questions, and proximity to the child reduce distress in both parent and child.

Kilogram weight safety

Weight in kilograms is the key pediatric dosing parameter. Converting pounds to kilograms errors, such as using 2.2 incorrectly, are a leading cause of pediatric medication overdose.

Structured handoff

Structured handoff tools such as SBAR and I-PASS organize transfer of essential information during shift changes and transfers, reducing omission, miscommunication, and patient harm.

Operating room fire triad

Operating room fires require an oxidizer such as oxygen, an ignition source such as electrosurgery, and fuel such as drapes or hair. Response includes stopping gas flow and removing burning material.

Informed consent elements

Valid informed consent requires capacity, disclosure of risks, benefits, and alternatives, patient understanding, and voluntariness. The surgeon obtains consent, and the nurse witnesses and verifies it.

Pediatric advocacy duty

Advocacy obligates the perioperative nurse to protect the child's best interests by speaking up about unsafe conditions, verifying consent, and supporting family involvement in decisions.