The nurse is assessing whether or not an 8-year-old child has given assent for a scheduled painful procedure. Which of the following statements by the child would reflect that the child has given assent?

Postoperative care for toddlers requires close monitoring of safety, fluid balance, pain control, and equipment management. Since 18-month-old children are active and curious, they may try to pull at tubes or IV lines, so nurses must anticipate needs and prevent complications.

Rationale for correct answers:

B. Accurate I&O monitoring is essential for a post-op child with IV fluids and an NG tube to assess hydration, kidney function, and fluid balance.

C. An elbow restraint prevents the child from pulling out the NG tube or IV line or interfering with the abdominal dressing. Always requires a provider’s order. A nurse cannot apply it independently.

D. At 18 months, the child cannot use a numeric scale. The nurse should use a validated tool such as the FLACC (Face, Legs, Activity, Cry, Consolability) scale to assess pain.

E. Safe practice requires verification of IV solution and rate against the provider’s orders before continuing infusion. This prevents medication or fluid errors.

Rationale for incorrect answers:

A. NSAIDs are not typically first-line in immediate post-op care for an 18-month-old with abdominal surgery due to risk of bleeding and gastric irritation. Stronger analgesics (opioids, acetaminophen IV/PO) are often ordered instead.

Take home points

• Post-op care for toddlers focuses on safety (verify orders), comfort (age-appropriate pain assessment), and monitoring (I&O, vital signs, wound care).
• Pain assessment tools must be developmentally appropriate (e.g., FLACC scale for infants and toddlers).
• NSAIDs are not routine post-op measures and require careful consideration of risks and alternatives.
• Nurses should always double-check IV solutions against provider orders to prevent errors.

Separation behaviors in children hospitalized for extended periods often reflect their emotional response to being away from familiar caregivers, routines, and environments. These behaviors vary by developmental stage but they all result in distress from disrupted attachment and loss of control.

Rationale for correct answers:

A. Provide the child with the child’s favorite transitional object: Transitional objects (blankets, stuffed animals, dolls) provide comfort, familiarity, and security in the hospital environment, helping reduce anxiety related to separation.

B. When possible, assign the same nurse to care for the child each day: Consistency of caregivers fosters trust and security, reducing feelings of abandonment and fear of strangers.

D. Tape pictures of the child’s friends and family members to the walls of the child’s hospital room: Familiar images help the child feel connected to loved ones, reducing separation distress and promoting a sense of security.

Rationale for incorrect answers:

C. Admit the child to the patient room that is closest to the nurse’s station: While this increases staff observation, it does not reduce separation behaviors. Proximity to nurses does not replace parental presence or emotional comfort.

E. Inform the parents that at least one person must stay with the child at all times during the hospitalization: While encouraging parental presence is beneficial, making it a requirement is unrealistic and may place undue stress on families who have other obligations (work, siblings, etc.). Instead, flexible visitation policies and supportive measures should be encouraged.

Take home points

• Key strategies to prevent separation distress in hospitalized children include transitional objects, consistent caregivers, and family photos.
• Parental presence is valuable, but nursing care plans should support families without imposing unrealistic expectations.
• Nurses play a central role in promoting continuity, familiarity, and emotional security to minimize long-term effects of separation anxiety.