NURS 232- Exam Three (Cancer/EOL, Hematology, GI)

How can the nurse support development in a preschooler with a chronic condition?

-explaining purpose and procedures in simple terms and emphasize this is not punishment for wrongdoing -encourage self care and interaction with peers -give positive feedback

True or false: when telling parents about their child's chronic condition, the nurse should give them all of the information at once

False; present info in small amounts at level of parents

True or False: Preschool aged children often understand that their chronic condition was caused by external factors

False; they often believe disease/illness is a form of punishment for something they did or thought

True or False: the school aged child with a chronic condition often understands they are different and knows why they are left out

False; they understand they are different than their peers but still feel left out do to physical limitations

How can a nurse assist parents of a toddler with a chronic condition?

Help parents recognize the child's capabilities, allow time to practice and learn skills, teach strategies to offer learning opportunities

What can a nurse do to promote a sense of security?

-encourage parental presence -consistency of staff -pictures from home -favorite blanket or toy -music tapes

What information should be included when discussed a child's chronic condition with the parent?

-accurate, up to date info -diagnosis -treatment options -referrals -community resources

When assessing a child hospitalized for a criitcal illness, what must the nurse assess?

-child's physical and psychosocial needs -family's psychosocial needs -emotional support

What are some nursing actions that can assist the adolescent with a chronic condition?

-education of condition -care needed to manage their condition -problem solving skills for integrating self care into daily life -encourage to build a safety net of friends who know about the condition and can help in a crisis -educate on sexual maturation and importance of protection -allow the adolescent to express feelings and concerns

How can the nurse assist parents/caretakers of a school aged child with a chronic condition?

-identify what aspects of care the child can complete under parental supervision -explain benefits of special camps to promote recreation, social interaction, and learning skills of self care

What nursing interventions should be implemented for a child hospitalized for a critical condition?

-psychosocial care -sense of security -education and preparation for procedures -use of play -sense of control

What are the parental reactions to life-threatening illness or injury?

-shock and disbelief -anger and guilt -deprivation and loss -anticipatory waiting -readjustment or mourning

What information should be included ABOUT the child with a chronic illness to the parents?

-strengths and positive attributes -limitations and characteristics due to illness, disability

What are the four common nursing diagnoses for a child admitted for a critical illness?

1. communication: verbal, impaired r/t effects of endotracheal intubation and mechanical ventilation 2. spiritual distress r/t crisis of illness or suffering 3. sleep pattern, disturbed, r/t circadian rhythm asynchrony, excess stimulation, pain, and anxiety caused by enviroment 4. activity, deficient diversional r/t forced inactivity

The nurse overhears the parent of a critically injured child who is praying at the child's bedside saying, "I will stop drinking and smoking." The nurse understands that the parent is in which stage of the grieving process? A. denial B. accceptance C. bargaining D. anger

C (bargaining)

The parents of a 10 year old child with an inoperable brain tumor insist that the child not be informed of his condition. Parents are reluctant to a tell a child he's dying due to: A. fear B. anger C. denial D. shock

C (denial)

The nurse is assigned to a child with ALL who has a platelet count of 35,000. The nurse should implement which of the following interventions? A. provide a soft toothbrush for mouth care B. isolation precautions should be started immediately C. the child's VS monitored Q4hr D. all visitors should be discouraged from coming to the hospital

A (soft toothbrush)

A 6 year old girl has been receiving chemotherapy. She is also receiving TPN via a central line. Which of the following nursing diagnoses is of HIGHEST priority? A. imbalanced nutrition: less than requirements B. risk for deficient fluid volume C. risk for infection D. activity intolerance

C. (risk for infection)

The nurse is caring for a child with leukemia. The nurse should be aware that children being treated for leukemia may experience which of the following: (SATA) A. anemia B. infection C. bleeding tendencies D. bone deformities E. polycythemia

A, B, C

A nurse is caring for a 5 year old who has terminal cancer. Which of the following statements are true? (SATA) A. parents may be at different stages in dealing with the child's death B. the child is thinking about the future and knows he may not be able to participate C. the dying child may become clingy and act like a toddler D. whispering in the room will help the child cope E. death of a child my have long term disruptive effects on a family F. child doesn't fully understand concept of death

A, C, E, F

How can the nurse assist a parents anxiety during the anticipatory waiting period?

Ask for the cell phone number and ensure they will be notified of any changes

Which of the following interventions by the nurse should have the HIGHEST priority for the family following the death of their child? A. verbalizing sorrow and sadness for the loss of their child B. discouraging the family from holding or touching their child C. asking the family to immediately leave the room so that all medical equipment can be removed D. allowing the family time to be alone with their child

D (alone time)

Which of the following nursing interventions is the most appropriate when working with a school-aged child who has a terminal disease? A. give factual explanations of the disease, medications, and procedures B. perform all care for the child C. tell the child everything will be okay D. reinforce that being in the hospital is not punishment for any thoughts or actions

D (not their fault)

Which of the following factors plays a significant role in a nurse's ability to provide safe and effective care to a terminally ill child? A. knowledge of advanced psychomotor skills B. understanding of the dying process C. experience with terminally ill adults D. acknowledgement of own feelings about dying and death

D (own feelings about dying and death)

The universal first reaction of a parents to a child's life threatening illness or death is: A. acceptance B. anger C. depression D. shock

D (shock)

How can you encourage parent-child bonding for a newborn or infant with a chronic condition?

Encourage them to spend time with their child, including face to face interactions when stable: offer opportunity to touch, soothe, care for infant

True or false: When talking about a child with a chronic condition, you should label them with their condition (ie-diabetic child)

False; always use "person first" language (ie- the child with diabetes)

True or False: The nurse caring for a toddler with a chronic condition should not offer choices

False; offering choices can promote development

Why might an adolescent with a chronic condition engage in risk behaviors (smoking, drinking, foods that interfere with therapy)?

They are unable to cope with their differences from their peers and want to be accepted

True or False: school aged children are capable of participating and monitoring their care

True

True or false: parents must be re-educated multiple times during the shock and disbelief period

True

True or false: preschoolers understand association between body parts and problems associated with their chronic condition

True

True or false: use simple, direct language when informing parent's of a child's chronic condition

True

True or False: Parents often hinder independence in toddlers with a chronic condition

True; parents often do tasks for their child because they believe they are incapable

True or false: the adolescent can understand the short and long term consequences of their chronic condition

True; they are developing cognitive and abstract thinking skills

For toddlers with a chronic illness,what is often affected?

achievement of autonomy and self-control

What feelings might a child have when admitted to the hospital for a critical illness?

anxious, fearful, withdrawn, solemn,, preoccupied with condition

What are newborns and infants with a chronic condition at risk for?

brain injury, oxygen deprivation, respiratory problems

When a child experiences a hospitalization for an acute exacerbation of an existing condition, what is the concern?

depression and hopelessness

What influences a child's response to hospitalization?

developmental level, past experiences, type of illness(s), coping mechanisms, emotional support

When a child experiences an unanticipated hospitalization, what will be the concern?

emotional risks: lack of preparation, uncertainty, unpredictability, unfamiliarity, heightened parental anxiety

How can the nurse support development of a school aged child with a chronic condition?

encourage interaction with same age group (support group, rooming with a child with same condition, encourage contact from classmates when in hospital and completing assignments)

What must school aged children do to develop a sense of industry?

gain social skills, learn to cope with stress, interact with peers, master new info, and acquire skills for self sufficiency

Examples of ways older school aged children with a chronic condition can manage their own care

glucose monitoring, intermittent self cath, monitoring skin under braces

What may interfere with preschooler who has a chronic condition ability to develop independence?

hospitalization; including treatment regimen and new medications

What is repression?

involuntary forgetting

What items can you give an infant with a chronic condition to encourage sensory stimulation?

mobiles, soft music, different textures

What affects does the critical illness bring upon the child?

pain, decreased energy, changes to LOC

What defense mechanisms do children display when hospitalized?

regression, denial, repression, postponement, bargaining

What is regression?

return to an earlier behavior

What challenges does an adolescent with a chronic condition have?

sexual maturation, development of identity, body image, self concept

What influences a child's coping ability?

temperament, previous coping experiences, availability of support systems

True or false: Because newborns in the NICU are exposed to an aggravating environment, their development can be affected

true