Anna is a 4-year-old autistic preschooler who lives at home with her parents and three older siblings.

Anna is a 4-year-old autistic preschooler who lives at home with her parents and three older siblings. Anna is nonverbal, although she intermittently cries out while playing and can be disruptive at home. She attends a Head Start educational program in town and, according to her teacher, her behavior at school has gradually become less disruptive. Over the past year, she has experienced three episodes of tonsillitis. With each episode she was treated with antibiotics that seemed to effectively treat the problem until the next episode occurred. Following treatment for her last episode a month ago, her pediatrician recommended a tonsillectomy. Her parents are quite anxious at the thought of Anna having surgery and being hospitalized. The surgery is scheduled for the following week. 

During her preoperative visit Anna is very quiet and clings to her mother. Her parents express their concerns about Anna having surgery.  They have avoided talking about Anna's situation at home because they don't want to increase the child's anxiety. They state she would be very afraid if surrounded by strangers. They explain to the nurse that Anna has autism and express their concerns about the child's response to hospitalization because her behavior worsens when she is in an unfamiliar environment. 

1. Discuss the potential impact Anna's autism may have on her hospital experience.

2. How can the nurse interact to address the family's anxiety?

3. Anna is admitted to the same-day surgical unit and is accompanied by her parents. When approached, her parents verbalize that Anna is afraid that the "people are going to hurt her". How should the nurse respond to Anna and her parents?

4. Discuss the appropriate priority nursing interventions for Anna.

5. Discuss the discharge teaching for Anna and her parents.