NUR379 Evolve: Chronic Conditions - Death and Dying

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."

Parents of a 12-year-old child with cancer ask the nurse about the policy on discussions of death with their child. Which is the most appropriate response by the nurse?

"I will not lie to the child as lying may harm our nurse-patient relationship."

A 4-year-old patient has died and the nurse is extremely distraught because of the strong bond the nurse developed with the child. Which statement provides an example of how the nurse can cope better in the future?

"In the future I will spend equal amounts of time with each patient."

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."

What are the cardiovascular signs that death of a child is approaching?

-Cool hands and feet. -Weak peripheral pulses. -Cyanosis in the hands and feet.

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 child with osteosarcoma (bone cancer) rates her pain 10/10 despite narcotic administration, has lost 20 lb since starting chemotherapy, and cries with every movement and position change. The parents approach the nurse and ask how the pain can have an emotional impact on the child. Which response by the nurse is appropriate?

"The child's thoughts of having to stay alive while living in pain are worse than the thoughts regarding dying."

Parents of a child with a terminal illness are choosing hospice care for their 7-year-old child. The child has difficulty swallowing, is bedridden, and requires frequent morphine administration to keep the pain at a 4/10 level. An interdisciplinary team meeting has been scheduled with hospice and the parents to discuss the child. The parents ask the nurse what to expect at this meeting. Which response by the nurse is appropriate?

"The health care providers, child life specialist, social workers, nurses, home health aides, case managers, and grief counselors meet to discuss your child's plan of care."

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."

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 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."

A 4-year-old child is dying of an inoperable brain tumor. The child is conscious for only a few hours out of every day and doesn't talk much when awake. The parents tell the nurse what the child has told them. "Don't be sad when I die. I will go to sleep and then wake up and be here with you." The parents ask the nurse how to respond to the child's statements. Which response by the nurse is appropriate?

"Your child's perception of death is that death is reversible and temporary and is appropriate for the developmental age."

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."

Parents are devastated that their child is dying of cancer and express to the nurse that "they are going to do everything to keep their child alive." Which are the most appropriate responses by the nurse?

-"As the child's advocate, the health care team must work together with the family to provide reasonable treatments for the child." -"Together the family and the health care team must look at the child's needs to ensure we are not prolonging or worsening the child's condition with the treatments."

A 14-year-old child with terminal brain cancer has months left to live. The child's pain is increasing, along with problems ambulating due to unsteady gait and increasing difficulty in swallowing. The parents ask the nurse about hospice care. Which response by the nurse is appropriate?

-"Hospice care can be provided in your home." -"With hospice care, your family is able to receive respite care." -"Hospice care allows for a comfortable death while ensuring the dignity of your child."

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 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."

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.

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.

A mother of a dying 14-year-old is trying to decide whether to order a do not attempt resuscitation (DNAR) order on her child. Which are the next best actions for the nurse to take?

-Inform the mother that the DNAR order can be stopped at any time. -Inform the mother that DNAR order prevents interventions from being performed after the child stops breathing.

Which environment would the nurse prepare for a child in the dying process?

-Low lighting and soft music playing. -Quiet space away from a lot of activity. -Multiple opportunities to create cherishing moments. -An environment conducive to allowing family members to stay with the child.

A 5-year-old patient with a terminal illness is expressing sadness and confusion about dying. What can the nurse do to help the child cope and understand the dying process?

-Read the book "Fall of Freddy the Leaf" with the child. -Review the dying process using appropriate terms with the child when the child is awake. -Access the Children's Hospice International website for information on hospice for the child.

Two healthy siblings of a child with chronic illness are talking with a nurse about the expected death of the child. One sibling begins to cry and the other sibling punches the crying sibling in the arm. The parent expresses concern over the differences in coping. How should the nurse respond?

-Reassure the parents that differences in grieving are normal. -Explain what resources are available for children experiencing grief. -Explain that grief presents differently according to the developmental stage of the child.

The parents of a 4-year-old child have decided to try an herbal remedy to help relieve their child's suffering. After observing this, what should the nurse do next?

-Research the herb to see if it is appropriate to use. -Provide emotional support and comfort to the family members. -Report the herbal supplement use to the primary care provider.

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.

A 4-year-old child is expected to die within the week. The child sleeps all day and has not eaten in 2 days. What should the nurse communicate to the child?

-That the child will not be left alone to die. -That the child is loved and supported by the nurses and family members. -That the illness and impending death are not the child's fault or a result of poor judgement.

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.

Which is an example of an activity that can help the child who is going through the dying process?

-Writing a letter to the child's mother and father. -Journaling about a favorite memory with the family. -Creating a scrapbook of pictures from the last family vacation.

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 5-year-old child has been placed in hospice care for terminal cancer. The child overhears the parents discussing a local hospice center for placement of the child. The child asks the nurse, "Why do I have to go away? I don't want to be away from my parents and pets." What action should the nurse take in response to the child's concern?

Discuss the option of home hospice care with the parents, after sharing the concerns of the child with them.

An oncology nurse experiences exhaustion at the end of every shift and is looking for a way to cope. Which is an example of the best way the nurse's needs can be met?

Encourage the nurse to talk with other nurses about what they are experiencing.

A child has passed away and it is now time to clean the body. Which should the nurse do next?

Invite the parents and siblings to assist in preparing the body.

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.

The nurse is caring for a 17-year-old who has been ill for many years. The child is told that she is expected to have 12 months left to live. What action by the nurse is most appropriate?

Support the child as they experience feelings of denial.

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 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 nurse is tending to the emotional needs of the parents who have just lost a child. What is an example of the type of communication necessary during this time?

The nurse tells the family members that the nurse is available to talk if they desire and will return when needed or requested.

Which scenario accurately reflects a parent experiencing anticipatory grief?

The parents cry when holding their sleeping child.

A patient is dying with a rare disorder and an autopsy will be required. At what stage of the dying process will the parents be notified that an autopsy will occur?

The parents should be made aware of the autopsy request prior to the death of the child.

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.