Death and Dying

The mother of a 14-year-old child who recently died tells the nurse that the 10-year-old sibling has become very withdrawn, angry, and aggressive. The child has said to the mother, "It should have been me." The mother asks the nurse how to respond to the child. Which responses by the nurse are appropriate?

"A child's response to death is varied because of age and developmental level." "Your child is working through the stages of grief. Sometimes a child stays in one stage longer than others." "Your child may be experiencing survivor's guilt related to the death of your child and needs to express feelings."

The parent of a 15-year-old with terminal cancer approaches the nurse and asks what care options are available for when the child is dying. The parent states the child is very close to family and siblings and loves to be around the pet dogs. Which is the best response?

"You could use home hospice care so the child is in a comfortable and relaxed environment."

A dying child, who has been unresponsive for the past two days in hospice at the hospital, opens his eyes and softly talks to his mother. He asks his mother how she is and where his siblings are and can he see them. The mother tells the nurse, "I think he is getting better." Which response by the nurse is appropriate?

"It is not uncommon to be more alert and interested in the family right before a child dies."

A 4-year-old child with chronic sickle cell crisis is terminal and unable to walk, requires continuous oxygen administration, is moaning and crying with position changes, and has refused to eat meals for the last 2 days. The parents ask the nurse how they will care for their child and what they should do now. Which response by the nurse is appropriate?

"Learning about hospice care services would be appropriate at this time."

A 12-year-old patient has been in hospice for one month and expresses feelings of discontent and would like to go back to the hospital. The patient states missing being with other children and liking the food there better. How will the nurse respond?

"It is okay to change your mind." "Tell me more about how you are feeling." "I'll let your parents know you want to go back to the hospital."

A child is dying of sickle cell disease and parents are expressing concern over the large amounts of opiates needed to control the child's pain. The father states, "I am worried that my child will become addicted to the medication." Which statement by the nurse addresses this parent's concern?

"Our goal with your child is to effectively manage the pain and maintain an acceptable comfort level which may include using larger doses of opiates."

The hospice nurse is caring for a school-aged child who has a glioblastoma with metastasis throughout the body. The toddler has been declining in health for the past 7 days, has had no oral intake, has a labored, irregular respiratory rate of 6 breaths per minute and is bradycardic at 50 bpm. The parents ask the nurse what they can do to help the child through the process. Which is an appropriate response by the nurse?

"Tell the child it is ok to die."

A four-year-child with 6 months to live tells parents about angels who come to visit her at night. The parents are concerned and ask the nurse how they should handle this. What is the nurse's best response?

"This is a normal response for a 4-year-old child who is terminally ill. Continue to allow the child to share the experiences with you."

A parent is taking care of her child dying of cancer and asks the nurse about oral care since the child often complains of a dry mouth. What education on oral care can the nurse provide to this parent?

"You can moisten her lips with this sponge swab." "Use the artificial saliva drops as needed to provide comfort." "Petroleum jelly on the lips provides moisture for a longer period of time."

A parent of a child who has terminal cancer is concerned with the child's weight loss due to a decrease in appetite. The parent becomes frustrated and expresses to the nurse, "My child needs to be fed; she is starving!" What is the best response?

"Your child's lack of interest in food is a normal part of the dying process."

The nurse is treating a child who is approaching death within hours. Which respiratory responses are likely findings in a child who is approaching death?

Apneic episodes of 40 seconds between respirations Retraction of muscles under the sternum and ribcage Loud sighing at the end of each respiration with a loud rattle noise

At the end of every shift a nurse feels drained and begins crying, grieving the loss of patients. What can the nurse do to increase coping mechanisms?

Ask a more experienced pediatric nurse to mentor the nurse. Obtain at least 8 hours of uninterrupted sleep every night. Meet monthly with other pediatric nurses to discuss the past month's events.

Administration of diphenhydramine can help with which physiologic response expected near the time of death?

Death rattle

A nurse is caring for a child and notices that as the child's last days are approaching, the family is becoming more withdrawn. Which action is most important to ensure the child is not left alone during the dying process?

Discuss the need to talk to the child, touch the child, and remain at the bedside of the child during the last days.

A 7-year-old child has recently died after being treated for leukemia for the past 5 years. The child was unresponsive for days prior to dying and the parents were at the bedside the entire time. The nurse overhears the parents say statements such as, "I feel like this is a dream. I don't know what to do now." "Thank God it is finally over; he's at peace." "Is it wrong to feel this way?" Which emotions or reactions are being expressed?

Indifference to activities of daily living Relief that the child is no longer suffering Numbness to any emotions when around others Guilt related to being relieved over the death of the child

What is the purpose in allowing family members to interact with the body after the patient dies?

It allows the family members to say their final good-byes.

A family has decided to gather in the room of a child who has impending death. A prayer has started and then all the family members begin praying and laying their hands on the patient. What action will the nurse take?

Observe the child for restlessness, moaning, or increased muscle tension.

A 10-year-old child with leukemia is dying after a failed bone marrow transplant. The child is anxious when approached by the nurses, expresses fear about going to sleep at night, and cries when the parents are not present in the room. The nurse is concerned with the child's ability to cope with dying. Which actions should the nurse take next?

Stay in the room with the child while they fall asleep. Have a volunteer stay with the child while the parents are gone.

The nurse wishes to educate parents on what to expect as the child is approaching death. Which response regarding the child's breathing pattern is most appropriate?

The child will have Cheyne-Stokes respirations, leading to respiratory arrest.

A young nurse who does not deal well with death is looking for support. What is the best way a more experienced nurse can respond?

The experienced nurse offers to mentor the young nurse. Inform the young nurse about availability and time to talk. The experienced nurse refers the young nurse to grief programs offered at the hospital.

A mother discusses options about hospice care for an only child who has three months to live. The child has osteosarcoma (bone cancer) and has had frequent admissions to the hospital for pain control. The mother states they live on a farm 30 miles from the hospital. Which piece of information is most important in influencing the decision for hospital-based hospice care?

The family lives 30 miles from the hospital.

Which scenario reflects the type of interaction allowed in the hospital moments after a child passes away?

The family members remain in the room with the child immediately following the death of the child and the nurse provides privacy.

A young nurse developed a friendship with a teenaged patient who died. What can this nurse expect during the grieving process?

The grieving process for the nurse may take a lot longer to get over.

A sibling is noticeably upset at the death of a sister. Which is an example of an activity that allows the sibling to assist in the immediate care of the body?

The sibling washes the hands and face of the sibling alongside the nurse during death care.