Chapter 34: The Dying Child

A child who has been diagnosed with a terminal brain tumor states, "I'm dying." What is the best response by the nurse?

"Tell me more." Explanation: Making an open-ended statement will allow the child to discuss his feelings about dying. The other answers make assumptions, state a fact, or dismiss the child's feelings about dying. Reference

The parents of a 5-year-old boy who is very near death are at the bedside.The parents ask, "Can he hear what we are telling him?" Which response by the nurse would be most appropriate?

"Yes, he can hear what you are telling him and may be able to understand most of it." Explanation: A loss of consciousness occurs as children grow closer and closer to death. They may, however, remain perfectly alert until seconds before death. Because hearing is one of the last senses lost, the nurse may need to remind family members and other health care personnel that the child may not be able to respond but may be able to hear. Continue to explain procedures to unconscious children as if they were conscious because they undoubtedly do hear. Never make any comment in the child's presence that would not be made if the child were alert.

The parents of a 5-year-old child who is very near death are at the bedside.The parents ask, "Can our child hear what we are saying?" Which response by the nurse is appropriate?

"Yes, your child can hear what you are saying even though your child may not respond." Explanation: A loss of consciousness occurs as children grow closer to death. The child may, however, remain perfectly alert until seconds before death. Because hearing is one of the last senses lost, the nurse may need to remind family members and other health care personnel that the child may not be able to respond but may be able to hear. Health care personnel should continue to explain procedures to the unconscious child as if the child were conscious, because the child likely does hear.

The adolescent shares that she is afraid to tell her parents she wants to delay cancer treatment until after she attends the prom. Which action by the nurse is best?

Encourage the adolescent to speak with her parents and offer to be present. Explanation: If told, adolescents understand the medical situation and can make decisions that are best for them and fulfill their wishes before dying. The nurse's willingness to be a client advocate can help the adolescent discuss uncomfortable topics. It is not appropriate for the nurse to address the parents without the client being present to explain her wishes. Because the client confided in the nurse, the nurse's participation is appropriate

A seasoned hospice nurse is mentoring a new nurse on the unit. How does the experienced nurse help prepare the new nurse initially to deal with dying children?

Have the new nurse examine his or her own feelings and values related to dying children. Explanation: Before the nurse can offer support to children in any circumstance, the nurse must be aware of his or her own reactions and feelings. To offer support to a child who is dying, the nurse must recognize his or her own feelings, values, and beliefs about death of children. Having a new nurse observe the experienced nurse care for a dying child might be helpful, but not initially. Providing orientation and instructions is helpful also, but initially it is best to deal with the fears and emotions. Expressing thoughts about working with dying children is not the same as dealing with emotions, which will first be addressed by examining feelings and values.

A new nurse is working on a hospice unit and expresses concern about dealing with death of children. How can the nurse mentor help the new nurse cope with death and dying? Select all that apply.

Help the new nurse recognize beliefs, values, and feelings about death. Offer to provide a respite from caring for the dying child as needed. Explain that death is inevitable and not a failure on the part of the nurse. Help the nurse acknowledge his or her own grief while caring for dying children. Tell the nurse that dying clients who are resuscitated tell of feeling peaceful

The family of a terminally ill client is asking about the benefits of hospice care. Which statement by the nurse provides accurate information?

Hospice is designed to meet the individual client's needs. Explanation: The focus of hospice care is to meet the needs and wishes of the dying client. They also work closely with the caregivers to help support them, but caregivers are not the only recipient of care. Hospice care is not designed to find cures. Hospice is not a separate area in a hospital, though some hospitals do contain hospice centers

A family whose school-aged child died unexpectedly in an auto accident has agreed to donate their child's organs. Which initial action should the nurse take?

Notify the hospital's organ donor coordinator of the possible donation. Explanation: Every hospital has someone who speaks with the family about organ donation and notifies the organ donation recovery center staff. The organ donation staff then makes all arrangements to maintain the organs, test the organs, and have the organs procured. The director of the emergency room is informed of the process, but this is not the next action. The organ donation recovery staff will obtain all supplies and provide direction to keep the organs viable. Unless an autopsy is required, no autopsy is completed.

A terminally ill school-age child is awake at 2 AM and continues to put on the call light. What should the nurse do regarding this child's behavior?

Sit with the child until sleep comes. Explanation: Many children assume that they will die at night. A child may talk more freely at night about fears or an unfulfilled life ambition than during the day. Children may also be more frightened at night and enjoy having someone sit beside them until they fall asleep. The nurse should not provide the child with a sleeping aid. Encouraging the child to sleep will not meet the child's needs at this time. Putting on the television with dim lights in the room will not meet the child's needs at this time.

The nurse is caring for a preschool-age child who is aware of impending death. Based on the child's development, the nurse would incorporate an understanding of which concept into the child's plan of care?

The child has an underlying fear of being separated from parents Explanation: Preschoolers fear separation. If able to grasp the concept of dying, this child's major worry is being alone and separated. These children may need someone to stay with them constantly to reassure them that they are loved and people are caring for them. Anger, verbalization of feelings, and bargaining are not behaviors typically associated with a preschool age-child who is facing death.

The nurse has been providing support to a family facing the imminent death of their child. How does the nurse know this intervention has been successful?

The parents agree to donate their child's organs after passing away. Explanation: Many parents are able to cope by searching for the meaning of life or death in philosophical, spiritual, or religious terms. For these parents, body organ donation may be a meaningful way to give themselves some solace that their child will in some way continue to live and contribute to others. Researching information about the child's illness may be helpful, but continuing to look for a cure is a form of denial. Siblings are often involved in the care of a dying child, but expressing concern about suffering shows that they need further information. Physical comfort is important during the dying process, but it does not show that parents are coming to terms with the child's imminent death.

Considering the adolescent's understanding of death and their stage of growth and development, which of the following statements is accurate? Select all that apply.

To the adolescent, death happens to others but not to them. The adolescent may engage in life-threatening, dangerous behaviors without thinking they could die. The adolescent may attempt to look attractive and like their peers even when they are extremely ill.

A child who knows his disease is terminal tells you that when he gets better he is going to be a doctor and cure everyone in the whole world. This statement is most likely a manifestation of:

a bargaining stage of grief. Explanation: The bargaining stage of grief involves making promises or "deals" to try to accomplish a better outcome.

The nurse caring for a dying pediatric client notices that the parents are sitting at the bedside sobbing. Which nursing action is most appropriate in meeting the parents' immediate needs?

Support the parents by appropriately using therapeutic touch. Explanation: When a child is close to death, the parents need unobtrusive support by the nurse. A simple touch allows the parents to know that the nurse is present. The parent can communicate any needs at that time. The parents can see that the child is resting peacefully. Performing nursing functions interrupts the last parent-child moments. It will become obvious when the child is no longer breathing. The parents usually call family after the child dies or before the final moments prior to death.

How would a nurse best advise the family to discuss the seriousness of the diagnosis with their terminally ill 6-year-old?

Tell the child, because the nurse and family are able to help the child with fears. Explanation: A school-age child is able to understand and interpret the seriousness of his or her illness. The child should be told about the diagnosis in an effort to have the child understand what is happening with his or her body and to offer the client support and education. A child has to be aware for therapeutic communication to be effective. Client autonomy depends upon developmental level. Details of the client's diagnosis may be withheld due to developmental level.

A parent asks for help explaining the death of a sibling to a 5-year-old. Which response by the nurse is most appropriate

"Explain the death using past experiences, such as when a pet died." Explanation: By relating the sibling's death to previous experiences, the child can process the death at his developmental level. The use of euphemisms and of avoidance may worsen confusion for the child.

A parent asks for help explaining the death of a sibling to a 5-year-old. Which response by the nurse is most appropriate?

"Explain the death using past experiences, such as when a pet died." Explanation: By relating the sibling's death to previous experiences, the child can process the death at his developmental level. The use of euphemisms and of avoidance may worsen confusion for the child. Reference

The best way to assist a preschool-aged child deal with death is to tell the child:

"Grandpa has died." Explanation: The best approach is to explain honestly that the person has died and is not coming back, elicit the child's understanding and questions about what has happened, and then repeat this process continually as the child gradually begins to grasp the reality of the situation.

A child hospitalized with cancer expresses fear about going to sleep, that the child might die during the night. Which is the best nursing response?

"I can sit with you while you are falling asleep tonight." Explanation: Many children assume they will die at night. Children may be afraid to fall asleep and benefit from having someone sit beside them while they fall asleep. Telling them not to worry does not acknowledge their fears. Turning on a night light may help, but all the lights may prevent sleep. Questioning if they feel they are going to die tonight may give them an opportunity to express their fears, but staying with them is a better option

The nurse is counseling a family with a 4-year-old child. The child's grandfather died 3 weeks ago. The nurse should explain to the parents that preschoolers who are grieving often:

express themselves through fantasy play. Explanation: Children of this age often express grief through fantasy play and mock funerals. They often do not express the loss openly and they grieve through somatic complaints or regression.

In which situation does the nurse anticipate symptoms of grief over the loss of a loved one to last longer than typically expected?

16-year-old who committed suicide over a break-up Explanation: Symptoms of grief last the longest when the family has little or no time to anticipate or begin grieving. This grief is also more difficult to resolve and may require professional counseling. The other options represent more long-term or chronic conditions, where anticipatory grief may have occurred.

The nurse is caring for a client diagnosed with a stage IV cancer. Due to the nature of the diagnosis and limited treatment options, which emotion from the parents does the nurse anticipate?

anticipatory grief Explanation: The death of a child is personal and unique. When death is expected, the family begins to mourn in anticipation of the death. Anticipatory grief typically shortens the period of acute grief and loss after the death. Though fatigue, panic attacks, and mood swings may occur, they are not as common as anticipatory grief.

A 14-year-old adolescent admitted to the hospital is diagnosed with a terminal illness. Which nursing intervention would be most effective in fostering communication about the terminal illness?

encouraging the adolescent to attend a peer support group Explanation: An adolescent will relate to the situation better when interacting with peers who are experiencing a similar situation. Playing with a doll and reading a book are not developmentally appropriate interventions. Keeping a journal may help the adolescent work through thoughts, depending on the adolescent's age; however, this action most likely will not encourage communication with others.

The health care provider is prescribing a pain medication for a pediatric client at the end stage of life. Which route would the nurse suggest?

intravenous Explanation: Medications for pain are best provided intravenously, because the medication is absorbed directly and its effects are immediate. Due to poor circulation at end of life, topical and intramuscular routes are not recommended. Typically, the oral route is not an option due to an altered consciousness.

The adolescent shares that she is afraid to tell her parents she wants to delay cancer treatment until after she attends the prom. Which action by the nurse is best?

Encourage the adolescent to speak with her parents and offer to be present. Explanation: If told, adolescents understand the medical situation and can make decisions that are best for them and fulfill their wishes before dying. The nurse's willingness to be a client advocate can help the adolescent discuss uncomfortable topics. It is not appropriate for the nurse to address the parents without the client being present to explain her wishes. Because the client confided in the nurse, the nurse's participation is appropriate.

Which interventions should the nurse implement to strengthen a caregiver's coping skills as the terminally ill child approaches death? Select all that apply.

Offer reassurance that the caregivers are providing loving care. Encourage caregivers to rest and eat properly throughout the day. Explain that everything is being done to keep the child comfortable. Educate the caregivers on the visible signs of the approaching death.

The parents of a dying child have expressed the desire to have hospice care at home. What is the nurse's priority responsibility at this time?

Provide names of area hospices. Explanation: In this situation, the nurse needs to respect the family's decision and provide names of hospice agencies in the area. It is not necessary to contact the hospital chaplain unless the family requests a visit. At this point, the parents have most likely reviewed all available options and have come to the decision about hospice care. Reviewing the options again might give the impression the nurse does not approve of the decision. Expressing sorrow is helpful, but it is not the priority when parents have made this difficult decision for their child

When working with the family who has just learned that their child is dying, which of the following nursing interventions would be the highest priority for the nurse to do for this family?

The nurse encourages the family to express their feelings and anxieties. Explanation: Family caregivers may need encouragement to discuss their feelings about the child. It is important to acknowledge emotions and fears and reassure caregivers that their reactions are normal. In most cases, families do not need details about the dying process or post-death recovery as they struggle to accept the diagnosis

If the nurse has not looked at his or her own feelings about dying and death, which of the following is likely to occur when/if they are in a situation in which they are working with a child who is dying?

The nurse may avoid the child for fear of being asked questions they can't answer. Explanation: Health care workers often are uncomfortable with dying patients, so they avoid them and are afraid that the patients will ask questions they cannot or should not answer.

Which situation requires parental permission to perform an autopsy on a child who has died?

medical research and progress Explanation: An autopsy that is used only to further medical progress and research requires parental consent. In all the other situations listed here, an autopsy may/will be performed without consent.

A child who knows about her terminal disease tells the nurse of plans to recover and become a doctor to cure everyone in the whole world. What is the child demonstrating to the nurse?

bargaining stage of grief Explanation: Bargaining, a stage of the grief process, is attempting to work out a deal to prevent death from occurring. This child is not demonstrating anxiety, immature thinking, or a poor opinion of the care that has been received.

A hospice nurse contacts the mother of a child who died a year ago to see how she is doing. The mother begins to cry and says that she is still so sad and does not feel that she can return to her normal activities. The nurse recognizes which nursing diagnosis as priority?

complicated grieving Explanation: This is complicated grief, when the person is unable to resolve his or her chronic sorrow and return to some level of normalcy. It could also include all of the other diagnoses, but complicated grief is the priority.

The nurse should be aware that the preschooler thinks of death as:

punishment for thoughts and actions. Explanation: The egocentric thinking of preschool children contributes to the belief that they may have caused a person or pet to die by thinking angry thoughts.

The intravenous infusion line infiltrates on a child who is terminally ill, and the child's mother tells the nurse that the nursing care in this hospital is the worst she has ever seen. What is the nurse's best response to her?

"You seem angrier today than before. Is something going on?" Explanation: Anger is a common stage of grief. Recognizing this improves parent-nurse relations and helps the parent work through stages of grief.

The nurse is caring for a terminally ill 14-year-old adolescent. What nursing intervention is most important ?

Promote open communication to the adolescent about what to expect. Explanation: When caring for a terminally ill adolescent, open communication is the most important action. At the adolescent stage of development, clients are usually largely aware of the prognosis. Maintaining an honest relationship is key. Hospice care may become a part of the plan of care but that is not the most important item. The client and family may benefit from counseling to discuss feelings about the pending death but that does not have a higher priority than open communication. It is helpful that the parents have a large role in the care of the adolescent. Providing information does not rise to a higher level than open communication. Pain management is a goal for end-of-life care. It is not possible to promise that there will be no pain at all.