A 13-year-old adolescent is in hospital for reconstructive surgery after a severe automobile accident. During rounds, the nurse notes that the teen is watching television and playing a video game. Which of the following should the nurse assess regarding the patient’s well-being? Select all that apply

When preparing children for invasive procedures such as a lumbar puncture, it is essential for the nurse to use developmentally appropriate communication and strategies. The nurse’s priority is to ensure safety, cooperation, and emotional support while avoiding threats, shaming, or placing the burden solely on parents.

Rationale for correct answer:

C. A lumbar puncture requires absolute immobility to avoid injury and obtain an accurate sample. A 7-year-old may understand instructions but can still become fearful and unable to stay still on their own. The safest approach is for the nurse to request help so the child can be gently but firmly held in the correct position, ensuring safety and comfort.

Rationale for incorrect answers:

A. While immobility is critical, threatening the child with possible injury increases fear and does not provide supportive guidance.

B. Parents can offer comfort, but the nurse cannot rely solely on them to manage positioning during such a critical and invasive procedure.

D. Telling the child that children who are in elementary school are big enough to be still during procedures dismisses the child’s fear and is developmentally inappropriate. Guilt or shame is not an effective strategy for cooperation.

Take home points

• During invasive procedures like a lumbar puncture, safety and immobility are top priorities.
• The nurse should provide age-appropriate explanations, use comforting techniques, and ensure adequate assistance for positioning.
• Avoid threatening, shaming, or relying only on parents to maintain control — professional staff support is essential.
• A calm, supportive approach helps reduce fear while keeping the procedure safe.

Elbow restraints are commonly used in infants after facial or cleft palate surgery to prevent them from touching or disrupting the operative site. However, restraints should never be used continuously; they must be removed periodically to allow for skin checks, circulation assessment, range of motion, and bonding with caregivers.

Rationale for correct answer:

D. The purpose of elbow restraints after facial surgery (e.g., cleft lip/palate repair) is to prevent the infant from touching or disrupting the operative site. Restraints should only be used when necessary, and they should be removed when a responsible adult can directly supervise and protect the child. This reduces risk of complications while allowing the infant comfort, mobility, and bonding time.

Rationale for incorrect answers:

A. Pain relief does not eliminate the risk of the infant reaching for or rubbing the operative site. Restraints are still necessary unless directly supervised.

B. Even while asleep, infants may reflexively move their hands to their mouth or face, risking injury to the surgical site. Restraints must remain in place if the infant is unsupervised.

C. The infant’s hands being pink with spontaneous movement and capillary refill of two seconds indicates good circulation and neurovascular status, which is important to monitor while restraints are on, but it is not a reason for removal.

Take home points

• Elbow restraints are used post-facial surgery to protect the operative site.
• They should be removed only when a responsible adult is directly supervising the infant and preventing self-injury.
• Nurses must perform regular neurovascular checks (color, warmth, movement, sensation, cap refill) to ensure restraint safety.
• Restraints should be used as minimally as possible and alternated with supervised periods of freedom to promote comfort and bonding.