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72 Cards in this Set
- Front
- Back
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What conditions are the major contributors to childhood death?
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1. Cancer
2. Complications of prematurity 3. Congenital anomalies (i.e. Down's) 4. Cystic fibrosis 5. HIV / AIDS 6. Congenital heart defects, liver defects, renal failure 7. Neurodegenerative diseases 8. Trauma etc......... |
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What is palliative care?
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1. Active total care of patients whose disease is not responsive to curative treatment
2. Make a disease less painful, without curing it |
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What is the function of palliative care?
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Interventions do not serve to hasten death; rather, they provide pain and symptom management, attention to issues faced by the child and family with regard to death and dying, and promotion of optimal functioning and quality of life during the time the child has remaining
(basically, to improve quality of life) |
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What is considered the hallmark of palliative care?
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The child and family are considered a single unit
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What does palliative care seek to create?
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A therapeutic environment, as homelike as possible, if not in the child's own home.
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What is provided with palliative care?
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Through education and support of family members, an atmosphere of open communication is provided regarding the child's dying process and its impact on all members of the family
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What are many parents and health care providers concerned with?
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That not offering treatment that would cause potential pain and suffering, but might extend life, would be considered euthanasia or assisted suicide
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What is euthanasia?
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An action carried out by a person other than the patient to end the life of the patient suffering from a terminal condition
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What is assisted suicide?
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When someone provides the patient with a means to end his or her life and the patient uses that means to do so
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Does the ANA Code for Nurses allow nurses to participate in euthanasia or assisted suicide?
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NO, but nurses can withhold or withdraw treatments that may cause pain and suffering and instead provide interventions that provide comfort and quality of life
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What factors influence physicians' decisions to discuss end-of-life issues and options for children with terminal illnesses?
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1. Child's age
2. Premorbid cognitive condition and functional status 3. Pain or discomfort 4. Probability of survival 5. Quality of life 6. Prognosis |
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What is the nurse's first responsibility regarding family-centered end-of-life care?
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To explore the family's wishes, while remaining neutral
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How should death be discussed with children?
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1. Discuss at the child's level
2. Let the child's questions guide 3. Provide opportunities for the child to express feelings 4. Encourage feedback 5. Use other resources 6. Use the child's natural expressive means to stimulate dialog 7. Be honest 8. Include the child in all aspects of their care |
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How should nurses answer a child's inquiry about when he or she will die?
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Provide answers that are straightforward, yet caring. In telling children that a cure is no longer possible, one must also leave room for hope. The hope is redirected from cure to quality of life and comfort.
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What variables influence a child's understanding of death?
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1. Age
2. Nationality 3. Religion |
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When do most children understand the key bioscientific components of death?
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By age 7
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When do children have an adult-like understanding of death?
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Between ages 4 to 12 years
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What are the greatest threats to ill toddlers?
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1. Immobilization
2. Regression to less independent levels of behavior 3. Separation 4. Intrusive or painful procedures 5. Alterations in ritualistic routine |
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What can promote palliative care?
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1. Encouraging parents to stay in the hospital as much as possible with their child
2. Participating in their child's care 3. Providing physical comfort (e.g. hugging, rocking) 4. Providing consistent providers, consistent routines, and familiar objects (e.g. blankets, toys) |
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What characteristics of a preschooler affect his or her concept of death?
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1. Egocentricity that implies a tremendous sense of self-power and omnipotence
2. Belief that their thoughts are sufficient to cause events, which results in feelings of guilt, shame, and punishment |
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How do children ages 3 to 5 interpret "death"?
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Possibly a type of sleep, so avoid using euphemisms because preschoolers who are told that "grandma has gone to sleep" may fear of going to sleep themselves
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How do preschoolers react to death and dying?
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They tend to believe that illness and/or death as punishment for their thoughts and actions
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What is a preschooler's greatest fear concerning death?
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Separation from parents
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What are some helpful interventions for preschoolers?
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1. Minimize separation from parents
2. Clarify misconceptions of illness and death as punishment 3. Use accurate, simple language repeated as often as the child needs |
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What is the concept of death for school-age children?
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1. Personification of the devil, God, ghost, or bogeyman
2. Death is universal, irreversible, and nonfunctional 3. "Decay of body in the ground" |
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What is a school-age child's greatest fear concerning death?
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The unknown - so provide honest, real explanations of the nature of the disease will help them to achieve independence, self-worth, and self-esteem, and to avoid a sense of inferiority
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What techniques provide a means for school-age children to deal with the expression of their anger and fear?
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1. Talk about their feelings
2. Allow control whenever possible and appropriate 3. Provide outlets for aggression through play |
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How do adolescents react to death?
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Although they have a level of adult comprehension of death, they are least likely of all age groups to accept cessation of life, especially their own. Developmentally, the rejection of death is understandable because adolescents' tasks are to establish an identity, so any suggestion of being different or of not being is a tremendous threat to the task.
(Identity vs. Role Confusion) |
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How can nurses provide constructive care for adolescents?
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1. Answering their questions honestly
2. Treating them as mature individuals 3. Respecting their needs for privacy, solitude, and personal expressions of emotions such as anger, sadness, and fear |
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What is the major concern of the terminally ill?
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Pain management
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How can nurses alleviate the fear of pain and suffering?
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By providing interventions aimed at treating the pain and symptoms associated with the terminal process
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What factors will shape the type of interventions used to relieve pain?
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The child's and family's views of quality of life, religious and cultural values, and level of acceptance of the terminal prognosis
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What must be given the highest priority in palliative care?
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Pain control for children in the terminal stages of illness or injury
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What is palliative chemotherapy?
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Treatment that increases comfort by slowing the progression of an incurable tumor
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What is palliative radiation?
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Treatment that reduces swelling or pressure from a tumor that is causing pain
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What is the current standard for treating children's pain (according to World Health Organization)?
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1. Pain should be assessed frequently
2. Medications should be given on a regular schedule and adjusted accordingly 3. Extra doses for "break through pain" should be available to maintain comfort 4. Opioid drugs should be given for severe pain and increased as necessary to maintain relief 5. Techniques such as distraction, relaxation, and guided imagery should be combined with drug therapy to provide the child and family with strategies to control pain |
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What are the common symptoms experienced by dying children?
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1. Visceral pain, bone pain, neuropathic pain
2. Cough, congestion, SOB, wheezing 3. Anorexia, N/V, constipation, diarrhea 4. Fever, chills, sleep disturbance, restlessness, agitation, seizures 5. UTIs, urinary retention 6. Anemia, bleeding 7. Dry skin, rash, itching, pressure sores, edema 8. Fear, anxiety, depression |
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What information should pain assessment include?
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Symptom's onset, severity, duration, and effect on child's quality of life
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What is the greatest comfort for the dying child?
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The security and closeness of a parent
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What are the physical signs of approaching death?
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1. Increased sleeping
2. Loss of sensation and movement in the lower extremities, progressing toward upper extremities 3. Sensation of heat although body feels cool 4. Mottling of skin 5. Loss of senses - decreased tactile sensation, sensitivity to light, hearing is the last sense to fail 6. Confusion, loss of consciousness, slurred speech 7. Muscle weakness 8. Decreased urination, more concentrated urine 9. Loss of bowel and bladder control 10. Decreased appetite and thirst 11. Difficulty swallowing 12. Change in respiratory pattern - Cheyne-Stokes, "death rattle" |
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What are Cheyne-Stokes respirations?
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Waxing and waning of depth of breathing with regular periods of apnea
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What is "death rattle"?
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Noisy chest sounds from accumulation on pulmonary and pharyngeal secretions
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What needs of the family should the nurse support at the time of a child's death?
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1. Providing child's favorite books for family to read
2. Recite prayers 3. Light candles 4. Play music significant to the child 5. Other religious and family rituals |
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What is the nursing care postmortem?
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1. Facilitate parent's wishes with regard to time with their child
2. Give family time to say good-bye 3. When parents are ready, offer to bathe and dress the body for removal from home or hospital room |
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What happens if sudden, unexpected death occurs?
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The family is deprived of the advantages of anticipatory grief, and the initial denial may be very strong
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What information should be provided to parents regarding DNR orders?
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If parents choose DNR, they must be aware of exactly what will and will not be done for the child and assured that this does not mean "no care"
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What is grief?
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PROCESS, not an event, of experiencing physiologic, psychologic, behavioral, social, and spiritual reactions to the loss of a child (loved one)
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What are the normal, necessary, and expected grief reactions to death?
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1. Hearing the dead person's voice
2. Feeling distant from others 3. Seeking reassurance that they did everything possible for the lost person |
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What are complicated grief reactions?
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Those that continue for more than a year after the loss
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What symptoms are considered as complicated grief reactions?
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1. Intense intrusive thoughts
2. Pangs of severe emotion 3. Distressing yearnings 4. Feelings of being excessively alone and empty 5. Unusual sleep disturbance 6. Maladaptive levels of loss of interest in personal interests |
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What is presentation of parental grief?
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The grief of parents after the death of a child has been found to be a more intense, complex, long-lasting, and fluctuating grief experience than that of other bereaved individuals. It can be very stressful on a marriage.
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What is presentation of sibling grief?
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Grief occurring in spurts, can be emotional and sad one moment and then, just as quickly, off and playing. Children express their grief through play and behavior.
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What emotions are seen during the immediate phase of grief?
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Shock, numbness, and disbelief
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What are the characteristics of intense grief?
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Yearning and loneliness for the deceased, and feelings of guilt and anger
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What is mourning?
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Grief work
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What are the phases of mourning?
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1. Shock and disbelief
2. Expression of grief 3. Disorganization and disbelief 4. Reorganization |
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What happens during the stage of disorganization and despair?
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Pain is replaced by emptiness, apathy, and deep depression. There is a feeling that life has no meaning and that the pain will never end.
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What is reorganization?
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A gradual process of recovery from the loss
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What happens during reorganization?
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The survivors again find meaning in living, readjust to life without the deceased, develop new or renewed relationships, and learn to live with the memory of the deceased with much less pain
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What is the significance of denial?
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Although this increases the nurse's comfort in caring for the dying child and may be necessary to prevent feelings of failure, it does little to provide the family members an opportunity to progress beyond denial and begin anticipatory grieving
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How should nurse's deal with stress related to the dying patient?
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The nurse can cope successfully through self-awareness, knowledge and practice, available support systems, maintenance of general good health, and focus on positive rewards of involvement with dying children and their families
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Palliative Care Overview
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1. Enhancing quality of life –focus on symptom control
2. Holistic approach 3. Honors individual cultural, spiritual values 4. First pediatric palliative hospital program – 2002 5. Care of a child with life-threatening disease, doesn’t have to be a terminal disease necessarily 6. Confusion still exists - Not necessarily hospice or end of life care |
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What are the principles of palliative care?
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1. Ideally begins with diagnosis of life-threatening disease
2. Family centered care 3. Multidisciplinary – spiritual included 4. Open communication 5. Active, individualized care focused on the patient 6. Family support 7. Optimize function (add life to child’s years, not necessarily to years to child’s life) |
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How is communication maintained with families?
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1. Engage as human-to-human
2. Listening to parent about uniqueness of their child 3. Shift between expert and humanness of child 4. Demonstrate respect and caring of patient and family 5. Two-way conversation 6. Entering into an ongoing relationship with family 7. Ongoing self-reflection in order to be aware of how values, thoughts impact our communication of news 8. Willingness to be humble 9. Use common words |
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What is an infant's response to death?
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1. Least significant
2. Caretaker loss, bonding, prolonged separation 3. May include crying, clinginess and/or resist touch |
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What is a toddler's response to death?
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1. Egocentric - can’t comprehend
2. Separation, loss of mobility, parental rxn 3. May regress, sleep disturbance, including clinginess |
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What is a preschooler's response to death?
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1. Death is temporary, sleep, not universal or inevitable
2. Assumption that thoughts caused death, impairs social development, body limitations, guilt from failures, morbid focus on death, out of control, regress, fear of sleep |
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What is a school-age child's response to death?
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1. Preoccupied with death rituals
2. Experience loneliness, including dependence results in hostility & non-compliance, body mutilation, by 9/10y understand universality, fears, vulnerabilities 3. May act out, psychosomatic, difficulty with school, sleep |
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What is the adolescent's response to death?
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1. Most difficulty coping
2. Interferes w/personal & sexual development, not able to conform, non-compliant, limit jobs, more worried about physical changes, most mature understanding but still think invincible, depression 3. As above with school-age = May act out, psychosomatic, difficulty with school, sleep |
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What family support should be provided prior to death?
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1. Education regarding treatment, disease trajectory, how to care for child
2. Supportive care 3. Encourage use of support systems, professional resources 4. Facilitate spiritual support 5. Include siblings in the process and provide support |
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What family support should be provided at the time of death?
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1. Provide for child’s comfort
2. Time alone with child, but still be available for the family when needed 3. Allow to hold as long as desire 4. Obtain clerical support if wanted 5. Photographs 6. May need assistance with funeral arrangements |
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How is successful bereavement established for families?
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1. Highly individualized
2. Accept reality of loss 3. Significant loss, out of sequence 4. Experience pain of grief - stages 5. Adjust to environment without child 6. Withdraw emotional energy from deceased and re-invest in other relationships 7. Encourage participation in bereavement program |
