Nursing Clinical Practice Guide
Clinical Scenario: You are the nurse admitting Maya, a 15-year-old high school soccer player, for limb-salvage surgery on her left tibia. She is quiet, avoids eye contact, and is scrolling on her phone while her parents answer all the questions.
Nursing Intervention Strategy:- 1AssessmentPull up a chair and sit at eye level. Use open-ended questions: "Maya, tell me in your own words what you understand about the surgery tomorrow." Assess her coping: "How are you feeling about all this?" Observe for non-verbal cues (tearfulness, clenched fists). Assess her support system and her fears about returning to school and sports.
- 2Nursing DiagnosisAnxiety related to impending surgery and threat to body image; Deficient Knowledge regarding surgical procedure and postoperative course.
- 3Planning & Implementation* Provide clear, honest information using diagrams or models. Involve her in the conversation.
* Validate her feelings: "It's completely normal to feel scared or worried about how your leg will look and work after this."
* Connect her with a child life specialist or a peer who has undergone similar surgery, if available.
* Encourage her to express concerns through drawing, writing, or music.
- 4Patient Education & EvaluationEvaluate understanding by asking her to teach-back the procedure. Provide resources on scar management and physical therapy. The goal is a patient who feels heard, informed, and psychologically prepared.
Patient Safety and Precautions:
* Informed Consent: Verify that both the adolescent (assent) and the legal guardian have signed the consent form after a thorough explanation by the surgeon.
* NPO Status: Strictly enforce preoperative fasting guidelines to prevent aspiration.
* Pain Assessment: Use age-appropriate pain scales (e.g., FACES scale) and medicate appropriately, but remember pain control is part of the plan, not always the initial priority in pre-op assessment.
Nursing Procedure & Medication Flow
Preoperative Checklist (Abbreviated):
1. Psychosocial/Developmental Assessment → 2. Verify Informed Consent → 3. Health History & Physical Assessment → 4. NPO Status Confirmation → 5. Administer Pre-op Medications (e.g., antibiotics) → 6. Patient/Family Education.Chemotherapy Precautions: Postoperatively, nurses administering chemo must use personal protective equipment (PPE) (gloves, gown) and follow safe handling procedures to avoid exposure. Monitor for side effects: myelosuppression (neutropenia, anemia, thrombocytopenia), mucositis, nausea/vomiting, nephrotoxicity.
A Word from Your Senior Nurse
"Teenagers are some of the bravest and most vulnerable patients we care for. They understand everything, but their world is turned upside down by a diagnosis like cancer. That phone she's glued to? It's her lifeline to her friends and her identity. Your priority isn't to take the phone away; it's to connect with the person behind it. By making her understanding and her fears your first concern, you're not just preparing her for surgery—you're building a therapeutic relationship that will support her through the entire grueling journey of chemo and recovery. That's holistic, patient-centered nursing."