Death and Dying

palliative care

active total care of a patient whose disease is not responsive to a curative treatment

does palliative care mean child dying the next day

no, it is when the treatment is not working and there is not very many options

interventions of palliative care

control pain, social psychological and spiritual needs are met, promote optimal function of the child 

primary focus of palliative care 

symptom contorl, supporting the family, improving their quality of life 

end of life care

very end of palliative phase

nursing care considerations for the child

fear of pain and suffering, fear of dying alone, actual death

how to prevent fear of pain and suffering

providing interventions aimed at treating the pain

how to know how much pain medication to give to the child

tailor pain interventions to the child’s pain level

why are children usually undermedicated during palliative care

fear of addiction and overmedicating

ethical considerations when treating a child in end of life care

pain medications can lead to death quicker but makes them comfortable

pain interventions

assess frequently, adjust as necessary, make sure child is comfortable as much aspossible with no feelings of discomfort 

why is the fear of dying alone exhausting

parents expect what is going to happen and not wanting to leave their child alone

nursing interventions to manage parents staying with the child during end of life care 

arrange shifts to be with the child, educate whoever is sitting with the child needs to notify the parents of any changes, adovate for parents to be with the child 

how to prevent the fear of dying alone in a hospital 

let parents have full access to the child, if parents leave keep a pager or have a way to contact them for any immediate needs

actual death at home

majority of children will die in hospice in their own room with their toys and stuffed animals, the most comfortable place they can be 

normal changes to patients status when they are slowly dying

respiratory status, SOB, labored breathing, pauses in breathing, less alert

what happens when a child is taken off of life support

nurse will remove all lines, families are allowed to assist

education about dying in the hospital

supportive equipment, siblings need to be told what to expect

nursing interventions when the child actually died 

burial services, allow private time to say goodbye, answer questions siblings might have 

pain medication

medications are given on a regular schedule, along with extra doses for breakthrough pain, allowed to use opioids, no maximum dose 

what happens if the child becomes tolerant of high doses of opioids in long term

give them more, don’t worry about addiction

parent education when child is dying

medications and how to administer them, keep room comfortable and quiet, help make parents feel empowered, involving the siblings 

grief and mourning

process neceassary for healing, different for everyone

grief reactions

hearing dead person’s voice, feeling distant from others, needing to seek reassurance

complicated grief

greater than 1 year

complicated grief signs

impulsive thoughts, distress, excessive loneliness and emptiness, severe emotion, sleep disturbances, maladaptive level of loss 

parental grief

experience secondary loss, cause strain on marriage, hinder communication and support 

sibling grief

depends on their developmental level, grieve in little spurts, exhibit same emotions

nursing grief

okay to have the same grieving process, keep healthy mental and physical space

what does the nurse have to have in the process of grieving for a child

good general health, using support systems, good coping mechanisms

comfort care priority problems

pain management, prepare for death, postdeath grief

physical signs of imminent death

confusion, slurred speech, muscle weakness, loss of GI control, decreased appetite and thirst, dysphagia, cheyne stokes, weak slow pulse, loss of sensationa dn movement in lower extremities, sensation of heat 

comfort symptoms

fatigue, n/v, constipation, dyspnea, anxiety

fatigue interventions

sleep, transfer in wheelchair to the playroom, paln activites with frequent rest periods, find age appropriate activites that requires less energy

n/v in comfort symptoms

related to pain medicaine, assess and give zofran or ice chips

constipation comfort symptoms

fiber diet, increase hydration, laxatives

dyspnea comfort symptoms 

O2 as needed, narcotics to lessen respiratory drive

anxiety comfort symptoms

give space to talk about death, mirror based on child’s family’s beliefs, don’t be vague, afraid to talk to parents about death

nursing interventions for preparing for death for the family

give information based on their developmental stages, educate differently

pain management assessments

pain scale, flat scales for each group, vitals

when should the nurse assess for pain

based on how frequently the meds are given

what not to worry about when assessing for pain 

addiction, lengthening the child’s life 

what to consider during the pain assessment

child wants to spend time with family before dying, thier goals, how to time their medicaiton so they can spend quality time with family while being comfortable 

when should you assess vitals

once a shift, check the HR and RR but not the whole set, if there is an intervention attached to it check 

reaction of infants and toddlers to sibling death 

continue to act as though the person is alive, anxiety, reacts more to the pain and discomfort of a serious illness than fatal prognosis, reacts to parental anxiety and sadness

preschool reaction to siblings death

believes illness is punishment for their thoughts or actions, feels guilty and responsible for death, behavioral reactions, react outwardly to a less significant loss than significant loss 

behavior reactions to sibling death as a preschooler

giggling, joking, attracting attention, regression

school aged reaction to death

fear, unknown is the greatest fear, threat to their security and ego, exhibit fear through verbal uncooperativeness, interested in postdeath services, questions what happens to the body 

adolescents reaction to death

difficult to cope with death, least likely toa ccept cessation of life, concern in the present less than future, feeling isolated, worry about physical changes, criticize funeral rites as barbaric, money making and unnecessary