Chapter 34: The Dying Child Prep U PEDS

The nurse is caring for a 14-year-old client who has a gunshot wound and whose prognosis is poor. The client will have testing to determine if brain death has occurred. The parents ask if organ donation will be an option if the client is determined to be brain dead. How will the nurse reply?

"Organ donation may be an option; we can discuss this with your child's primary health care provider." Explanation: Organ donation is possible with parental consent; this should be discussed with the primary health care provider. It is possible to donate organs after traumatic injury. In the case of a minor, the parent/guardian may provide consent for the organ donation. Advance registration or advance directives are not required

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.

The nurse is caring for a preschooler with a terminal illness. Which intervention would facilitate the child to address feelings about the illness?

Have the child draw a picture about the illness. Explanation: Art therapy is a tool for expressing emotions without having to verbalize them. It is one way to help children express their feelings in difficult situations. Preschoolers are not going to benefit from talk therapy, as they are too young to verbalize their emotions. They are very dependent on their parents, so asking the mother to take breaks leaves the child alone. Although reading a book might be helpful, it will not help address his feelings.

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.

To be an effective nurse with a female child who is dying, it is first necessary to:

identify your own reactions and feelings about death. Explanation: It is difficult for a nurse to help children and parents deal with dying and grief until the nurse understands it personally for himself or herself.

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.

When caring for a recently deceased client, when should the nurse anticipate an autopsy to be performed?

when medical causes and treatment can be benefited Explanation: An autopsy is anticipated when a death is unexpected/unexplained, the result of violence, or when medical advancement may occur as a result of understanding the cause of the death. An autopsy is not anticipated for organ donation or if the client has a chronic condition.

A 10-year-old child is receiving end-of-life care at home (above). The home care nurse recommends repositioning the client every 2 hours. The caregiver responds, "My child has been through so much already! Why can't we just let the child stay in a comfortable position?" How will the nurse address the parents' concerns?

"A pressure injury could cause additional pain; we can gently reposition your child to reduce this risk." Explanation: The reddened skin that does not blanch on the coccyx demonstrates that the client is at risk for a pressure injury that could cause pain; repositioning regularly will decrease this risk. Turning and repositioning should be done slowly and gently in end-of-life care due to decreased perfusion distally. The slow repositioning allows the circulatory system to accommodate. The repositioning provides minimal mobility and is not intended to decrease the risk of constipation. Repositioning every 4 hours is too infrequent to prevent pressure injuries; this answer also does not explain the rationale for the parents to make an informed choice.

A family is dealing with the approaching death of their child. Which nursing response would address their spiritual needs?

"Does your faith provide you with support in times of need?" Explanation: It is best for the nurse to ask the parents about their faith first, before offering interventions. The nurse should not assume they go to a church, as some may go to a temple or other place of worship. Contacting a pastor or chaplain might be helpful once the nurse determines their faith. Asking about taking communion presumes that they belong to a faith which practices this, and nurses need to avoid making assumptions.

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.

An 8-year-old child is receiving end-of-life care for a terminal illness. The nurse observes that the caregivers are sitting nervously at the side of the room. What suggestion(s) will the nurse make to the caregivers to support the needs of the child? Select all that apply. Gently touch or hold the child's hand. Speak softly to the child. Turn on the ceiling lights. Apply lip balm to the child's lips. Play quiet music.

Gently touch or hold the child's hand. Speak softly to the child. Apply lip balm to the child's lips. Play quiet music. Explanation: The caregivers can be encouraged to play quiet music and to speak softly to the child, as hearing remains as one of the final senses at the end of life. Gentle touch and hand-holding are also felt by the child. The lips are often dry at the end of life, and the caregiver can apply lip balm to moisturize. Ceiling lights are typically bright and should be avoided when possible. A lamp is preferred.

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. Acknowledge it is challenging, but nurses need to control their emotions. 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.

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. Explanation: All of these are helpful in preparing new nurses to deal with death and dying, with the exception of the statement that nurses need to control their emotions. 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. End-of-life care for children can be an emotionally distressing experience for health care providers as well as family members. Although it is best that nursing assignments be consistent so a child has meaningful support, there is a point at which a health care provider may need a respite from caring for the child or providing support for the parents. At the point that death becomes unpreventable, the only failure that can exist is the failure of health care professionals to help a child die with dignity and consideration, and free of pain. Because nurses develop such close bonds with terminally ill children, they may experience profound grief when a child dies or no longer requires their care. People who were declared dead and then resuscitated by heroic measures report that death was not at all frightening but actually involved a feeling of exceptional calm and comfort. It is incorrect to tell a nurse to control their emotions, as it is very difficult caring for dying children. If feelings are not acknowledged, then they cannot be addressed.

Which roles should be assumed by the nurse caring for a dying pediatric client and the family? Select all that apply. Keep the family informed about the client's condition. Remain disconnected so as to provide emotional support. Provide sufficient private time once the child has passed. Maintain comfort measures and pain relief until death. Remain quietly supportive while providing client care. Focus on supporting the family in this time of grief.

Keep the family informed about the client's condition. Provide sufficient private time once the child has passed. Maintain comfort measures and pain relief until death. Remain quietly supportive while providing client care. Focus on supporting the family in this time of grief.

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.

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.

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.

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.

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.