NU 352 Peds Death
What are a child's understanding of death and their reactions to death influenced by?
People around them
Experience with loss
Reaction of others
Relationship with deceased
Circumstances surrounding the loss
Religious and cultural beliefs
What is the concept of death to infants and toddlers? What will their reactions be based on? What are some appropriate nursing interventions for this age group?
Concept of death: No concept or understanding of death. For most part, very egocentric.
Reactions based on parental response. Parents get upset, toddler gets upset.
NI: Encourage parents (or consistent care giver) to be w/ kid as much as possible to be a source of comfort, provide familiar objects for child, try to help parents cope w/ their own feelings (if they can cope, the child can cope).
What is the concept of death to preschool children? What will their reactions be based on? What are some appropriate nursing interventions for this age group?
Concept: It’s temporary or reversible, often they think the deceased person will wake up. They also have an immature concept of time. They don’t understand forever or how long it lasts.
Reactions; Don’t look at it as a long term event. Also may perceive as punishment. May feel guilty or responsible especially if it’s a sibling where the kids have been sick for a long period of time.
NI: Reassure them that they’re not the cause, minimize separation from parents, clarify any misconception (punishment), don’t use words like “went to sleep.” They may be terrified to go to sleep. Use accurate language but describe as simple as possible.
What is the concept of death to school aged children? What will their reactions be based on? What are some appropriate nursing interventions for this age group?
Concept: Starting to understand death in a concrete form, do understand what forever means. Tend to personify death as God or ghosts. They start seeing death as something that’s universal and inevitable.
Reactions: based on fear of the unknown, oftentimes they’re very curious, they want to understand it better and why it happens. They ask a lot of questions about what happens after death, what happens w/ the body.
NI: Give anticipatory guidance if death is on the horizon, tell them what to expect, give honest and logical explanations, encourage them to talk about their feelings and fears. Use play therapy. For the child that’s grieving, offer them choices when possible.
What is the concept of death to adolescent children? What will their reactions be based on? What are some appropriate nursing interventions for this age group?
Concepts: Much more mature understand of death, start associating death w/ spiritual symbolism (especially if religious), even though they understand death they think that they cannot die (leads to risk taking behavior), will have the most difficulty actually coping w/ death bc they understand the permanence of death, especially their own!
Reactions: Often feel alone, if they’re the patient, they’re worried about the physical process of dying like not being attractive or being different than peers.
NI: Maximum self-control and independence, allow them to do things themselves, answer questions honestly, encourage parents to be truthful w/ the child, identify any support groups that are available.
What are the principles of pain management and symptom control for the dying child?
Pain management: Priority is pain and symptom support, use opioids and alternative methods like guided imagery and distraction. When providing pain management, give it through the least traumatic route. We do not worry about addiction if we know the child is dying and we will expect tolerance. Assess pain frequently, if having breakthrough pain get an order for another pain med. Tolerance will occur.
Symptom control: Palliative chemo or radiation – shrinks the tumor to decrease the pain for the child. Reinforce to the parents that this is a comfort measure, not curative. Might be extremely anemic to the point where the anemia is causing discomfort – might have blood transfusions to help them feel better.
What are the educational needs of the family of the dying pediatric client?
Educate as the need arises. Too much info causes overload on an already stressed brain.
Practical: Want to know about costs, what hospice covers,
Personal: How do I feed them, give them a bath,
Physical: Gonna want to know about meds, how to give, when to give, how to treat n/v, what to expect w/ breathing
Emotional: Validate and assist the parents to express their feelings, refer to therapy or support group offered.
Spiritual: Assess and coordinate any needs that have w/ a clergyman or a pastor
What physical changes are associated with dying? What nursing care should a nurse anticipate?
Overall: Help parents recognize any changes that signal that death is near, helps them cope if death is how they expect it to be, often the child will sleep more, have decreased appetite, decreased urine output,
Final stages: Less responsive, respirations are slow and shallow, pale, blue, periods of apnea, difficulty swallowing even basic secretions, Last hours: Sometimes don’t even have concept of pain,
Reassure: always want to reassure that these are normal.
Nursing care: Keep as comfortable as possible, provide oral care, continue only meds that provide comfort, limit care to essentials, play soothing movies or music in the background for parent and child.
What should a nurse teach about end of life hallucinations?
Assure parents that this is normal, can be a sign of readiness or acceptance that death is near. Most of the time, they’re very pleasant hallucinations.
Nursing care: Discuss openly with the child and parents about it. If the child does seem upset, use calm reassuring voice, provide w/ familiar objects.
What does a nurse need to know about handling unexpected childhood death?
More traumatic for the parent than for anybody, no anticipatory grief. Many times they’re not with their child when the event happens.
Neonatal or still: Grieve not only the loss of child but loss of experiences that would have w/ the child. Will even do this w/ miscarriages or post-abortion. Still-birth – Encourage visualization of the baby.
NI: Provide detailed explanations of what will happen before it happens, make sure they’ve gone through family process or spiritual processes, allow them time to say good-bye, provide privacy during and after, provide little things (tissues, a Bible, a pastor, a phone to
How should a nurse handle the body after death?
Want to prepare parents if possible, private room, remove as many apparatuses as you can (don’t if it’s being investigated), make them presentable to look at.
How should a nurse handle the topic of organ donation?
Best candidates for organ donation are those who’ve died in a traumatic accident and are brain dead. Want to bring it up before death. They might get upset when you talk to them about it. Best to provide w/ written materials. Don’t expect an immediate response. Does not mutilate the body, doesn’t cause suffering, you can have an open casket, no delay in funeral, no extra cost to donor family.
Always be culturally sensitive, some religions do not believe in organ donation. Never push it on the family.
What should a nurse know about parental grief and mourning?
It’s intense, long-lasting, and complex. Lost not only their child, but all the future experiences and dreams they associated with the child. Also have a huge role change especially if it’s an only child. The LOSE their role. They don’t know what to do without the child. Or they’re dealing w/ grief of siblings
What is the nurse's role in caring for the dying child?
Provide effective care for dying child, make the decision to become involved and personally invested in order to make their experience better.
Evaluate your own feelings about loss.