# A 9-year-old child is hospitalized for appendectomy. Which nursing intervention is most important to ensure the child's safety during the postoperative period? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541755 > language: ko > subject: Growth & Development ## 문제 A 9-year-old child is hospitalized for appendectomy. Which nursing intervention is most important to ensure the child's safety during the postoperative period? ## 보기 1. Allow the child to ambulate independently to promote normal development 2. Ensure the call light is within reach and teach proper use before allowing independent movement **✔ 정답** 3. Restrict the child to bed rest for the first 24 hours postoperatively 4. Have parents stay at bedside continuously to supervise the child **정답: 2** ## 해설 Teaching proper call light use ensures safety by preventing unsupervised ambulation while respecting school-age children's developmental need for independence. Other options either compromise safety (allowing independent ambulation, bed rest restriction) or are not the nurse's primary responsibility (continuous parental supervision). ## 심화 해설 Postoperative Safety in the Pediatric Appendectomy Patient Following an appendectomy, a 9-year-old child is in a vulnerable state due to the residual effects of anesthesia, the presence of surgical incisions, and the administration of opioid and non-opioid analgesics. The immediate postoperative period carries significant safety risks, primarily falls and accidental dislodgement of lines or dressings. The most critical nursing intervention is to ensure the child can reliably summon help before attempting any movement, making the correct answer option 2. Why the Other Options Pose a Safety Risk - Option 1: Independent Ambulation. While promoting normal development is a valid long-term goal, allowing a 9-year-old to ambulate independently in the immediate postoperative phase is unsafe. The child’s sensorium and motor coordination may be compromised by residual anesthetic agents and postoperative analgesics, including opioids. Even with an opioid-sparing technique like an erector spinae plane block (ESPB), which reduces but does not eliminate systemic opioid use, the child may still experience sedation, orthostatic hypotension, or dizziness [1]. A child’s judgment regarding physical limitations is also not fully mature, increasing fall risk. - Option 3: Bed Rest for 24 Hours. Restricting a child to strict bed rest for 24 hours is not an evidence-based practice and contradicts enhanced recovery principles. Early mobilization is a key component of reducing postoperative complications, such as atelectasis and venous stasis. Research into advanced surgical techniques, such as gasless single-port transumbilical extracorporeal laparoscopic-assisted appendectomy (gasless-TULAA), demonstrates a focus on reducing physiological disturbance and nursing burden specifically to facilitate a faster recovery, not to enforce prolonged immobility [2]. The goal is safe, supervised mobilization, not restriction. - Option 4: Parents at Bedside Continuously. While parental presence is invaluable for emotional support, relying on parents for continuous supervision is an inappropriate delegation of a core nursing responsibility. The nurse is accountable for establishing a safe environment through reliable systems, such as a functioning call light. Parental vigilance can lapse due to fatigue, and they may not recognize the subtle signs of a clinical deterioration or a safety hazard that a trained professional would. The safety net must be a fail-safe nursing system, not a surrogate for one. The Pathophysiology of Postoperative Risk The safety imperative is rooted in the physiological impact of surgery and its management. Conventional laparoscopic appendectomy creates a CO₂ pneumoperitoneum, which can cause residual shoulder pain, diaphragmatic irritation, and altered respiratory mechanics, potentially leading to sudden dizziness upon position change [2]. Furthermore, the primary source of postoperative pain is somatic pain from the abdominal wall incisions and, in cases of complicated appendicitis, visceral pain from peritoneal inflammation. Opioid analgesics, while effective, carry a high risk of sedation, nausea, and altered mental status in the pediatric population. Even when an ESPB is utilized to provide effective analgesia and reduce opioid consumption, the child is not risk-free; the block itself can cause temporary motor weakness or sensory deficits that impair safe movement [1]. The nurse must therefore assume that any child in the immediate postoperative phase has a compromised ability to safely navigate their environment. The call light system is the single most effective tool to bridge this gap, ensuring that a healthcare professional is present to assess the child's readiness and provide the necessary physical assistance before any ambulation or activity occurs.References (research sources) - [1]Erector spinae plane block for opioid sparing in children undergoing laparoscopic appendectomy: a randomized controlled trial.RCT/clinical trialYang MW, Cai YZ, Zhang LL, Wang J, Tang R, Sun YY. (2026) · DOI: 10.3389/fped.2026.1803495 - [2]Reduced Nursing Burden and Enhanced Recovery: Gasless Single-Port Transumbilical Extracorporeal Laparoscopic-Assisted Versus Conventional Laparoscopic Appendectomy in Children.Research articleYin H, Wan J, Lu J, Cui L, Zheng P, Hong Z. (2026) · DOI: 10.1177/10926429261434122 ## 임상 시나리오 Pediatric Postoperative Fall PreventionImmediate Safety After Appendectomy The most critical safety intervention is ensuring the call light is within reach and the child is taught how to use it before any independent movement. This prevents falls and accidental dislodgement of IV lines or dressings. A child's sensorium and motor coordination are often compromised for hours due to residual anesthesia and analgesics, including opioids. Even with regional blocks, sedation and orthostatic hypotension can occur, making independent ambulation unsafe. CautionDo not rely solely on family presence for safety. The child must be able to actively summon a nurse. Strict bed rest for 24 hours is contraindicated; early mobilization should be supervised and guided, not independent. ## 핵심 개념 - **Erector Spinae Plane Block (ESPB)** — A regional anesthesia technique that reduces opioid requirements but may still carry risks of sedation or motor weakness postoperatively. - **Enhanced Recovery After Surgery (ERAS)** — An evidence-based multimodal perioperative care pathway designed to achieve early recovery by maintaining physiological function and reducing surgical stress. - **Postoperative Sensorium** — A patient's state of consciousness and awareness, often altered by residual anesthetics and analgesics, increasing safety risks. - **Orthostatic Hypotension** — A form of low blood pressure that happens when standing up from sitting or lying down, a common postoperative risk factor for falls. ## 같은 주제 문제 - [A 10-year-old child is hospitalized for acute appendicitis and scheduled for an appendecto…](https://mymerci.kr/pages/nclex_q.php?qn_id=541751) - [A 9-year-old child is hospitalized for acute appendicitis and will undergo an appendectomy…](https://mymerci.kr/pages/nclex_q.php?qn_id=541752) - [A 4-year-old preschooler is recovering at home for 5 days following a tonsillectomy. 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