5.) End of Life (part 2) Flashcards
An 8-year-old girl has been uncooperative and angry since the diagnosis of cancer was made. Her parents tell the nurse that they do not know what to do “because she is always so mad at us.” What nursing action is most appropriate at this time?
a. ) Explain to child that anger is not helpful.
b. ) Help the parents deal with her anger constructively.
c. ) Ask the parents to find out what she is angry about.
d. ) Encourage the parents to ignore the anger at this time.
b.) Help the parents deal with her anger constructively.
To school-age children, chronic illness and dying represent a loss of control. This threat to their sense of security and ego strength can be manifested by verbal uncooperativeness. The child can be viewed as impolite, insolent, and stubborn. The best intervention is to encourage children to talk about feelings and give control where possible. Verbal explanations would not be “heard” by the child. The child may not be cognizant of the anger. Ignoring the anger will not help the child gain some control over the events.
What nursing intervention is most appropriate when providing comfort and support for a child when death is imminent?
a. ) Limit care to essentials.
b. ) Avoid playing music near the child.
c. ) Whisper to the child instead of using a normal voice.
d. ) Explain to the child the need for constant measurement of vital signs.
a.) Limit care to essentials.
When death is imminent, care should be limited to interventions for palliative care. Music may be used to provide comfort to the child. The nurse should speak to the child in a clear, distinct voice. Vital signs do not need to be measured frequently.
What explanation best describes how preschoolers react to the death of a loved one?
a. ) Grief is acute but does not last long at this age.
b. ) Children this age are too young to have a concept of death.
c. ) Preschoolers may feel guilty and responsible for the death.
d. ) They express grief in the same way that the adults in the preschoolers’ life are expressing grief.
c.) Preschoolers may feel guilty and responsible for the death.
Because of egocentricity, the preschooler may feel guilty and responsible for the death. Preschoolers may need to distance themselves from the loss. Giggling or joking and regression to earlier behaviors may help them until they incorporate the loss. The preschooler’s concept of death is more a special sleep or departure.
How might the quality of life for a terminally ill child and his family be enhanced by nurses?
a. ) Tell the family what is best.
b. ) Leave the family alone to deal with their tragedy.
c. ) Remain objective and uninvolved with family grieving.
d. ) Advocate for and implement pain and symptom relief measures.
d.) Advocate for and implement pain and symptom relief measures.
By increasing personal remembering, the nurse can advocate for and provide the best possible care for the child and family. This is supportive for the family and helps the nurse reduce the stress of caregiving. If the nurse tells the family what is best, this removes the decision making from the parents. It also increases pressure on the nurse to be the expert. The nurse is in a supportive role. The nurse should not leave the family alone to deal with their tragedy. Becoming involved is an objective, deliberate choice. Ideally, the nurse achieves detached concern, which allows sensitive, understanding care because the nurse is sufficiently detached to make objective, rational decisions.
A child in the terminal stage of cancer has frequent breakthrough pain. Nonpharmacologic methods are not helpful, and the child is exceeding the maximum safe dose for opiate administration. What approach should the nurse implement?
a. ) Add acetaminophen for the breakthrough pain.
b. ) Titrate the opioid medications to control the child’s pain as specified in the protocol.
c. ) Notify the practitioner that immediate hospitalization is indicated for pain management.
d. ) Help the parents and child understand that no additional medication can be given because of the risk of respiratory depression.
b.) Titrate the opioid medications to control the child’s pain as specified in the protocol.
The child on long-term opioid management can become tolerant to the drugs. Also, increasing amounts of drugs may be necessary for disease progression. It is important to recognize that there is no maximum dosage that can be given to control pain. Acetaminophen will offer little additional pain control; it is useful for mild and moderate pain. Immediate hospitalization is not necessary; increased dosages of pain medications can be administered in the home environment. The principle of double effect allows for a positive intervention—relief of pain—even if there is a foreseeable possibility that death may be hastened.
What statement is most descriptive of a school-age child’s reaction to death?
a. ) Very interested in funerals and burials
b. ) Little understanding of words such as “forever”
c. ) Imagine the deceased person to be still alive
d. ) Can explain death from a religious or spiritual point of view
a.) Very interested in funerals and burials
School-age children are interested in naturalistic and physiologic explanations of why death occurs and what happens to the body. School-age children do have an established concept of forever and have a deeper understanding of death in a concrete manner. Adolescents may explain death from a religious or spiritual point of view.
A 12-year-old boy is in the final phase of dying from leukemia. He tells the nurse who is giving him opiates for pain that his grandfather is waiting for him. How should the nurse interpret this situation?
a. ) The boy is experiencing side effects of the opiates.
b. ) The boy is making an attempt to comfort his parents.
c. ) He is experiencing hallucinations resulting from brain anoxia.
d. ) He is demonstrating readiness and acceptance that death is near.
d.) He is demonstrating readiness and acceptance that death is near.
Near the time of death, many children experience visions of “angels” or people and talk with them. The children mention that they are not afraid and that someone is waiting for them. If the child has built a tolerance to the opioids, side effects are not likely. At this time, many children do begin to comfort their families and tell them that they are not afraid and are ready to die, but the visions usually precede this stage. There is no evidence of tissue hypoxia.
A school-age child is diagnosed with a life-threatening illness. The parents want to protect their child from knowing the seriousness of the illness. The nurse should provide which explanation?
a. ) This attitude is helpful to give parents time to cope.
b. ) This will help the child cope effectively by denial.
c. ) Terminally ill children know when they are seriously ill.
d. ) Terminally ill children usually choose not to discuss the seriousness of their illness.
c.) Terminally ill children know when they are seriously ill.
The child needs honest and accurate information about the illness, treatments, and prognosis. Because of the increased attention of health professionals, children, even at a young age, realize that something is seriously wrong and that it involves them. Thus, denial is ineffective as a coping mechanism.
The nurse should help parents understand the importance of honesty. Parents may need professional support and guidance from a nurse or social worker in this process. Children will usually tell others how much information they want about their condition.
Parents tell the nurse they do not want to let their school-age child know his illness is terminal. What response should the nurse make to the parents?
a. ) “Have you discussed this with your health care provider?”
b. ) “I would do the same thing in your position; it is better the child doesn’t know.”
c. ) “I understand you want to protect your child, but often children realize the seriousness of their illness.”
d. ) “I praise you for that decision; it can be so difficult to be truthful about the seriousness of your son’s illness.”
c.) “I understand you want to protect your child, but often children realize the seriousness of their illness.”
Terminally ill children develop an awareness of the seriousness of their diagnosis even when protected from the truth. Acknowledging parents feelings but giving them truthful information is the appropriate response. Asking about discussing this with the health care provider is avoiding the issue. Sharing your own feelings by stating “I would do the same thing” and giving praise for the decision is nontherapeutic.
A 7-year-old child is in the end stages of cancer. The parents ask you how they will know when death is imminent. What physical sign is indicative of approaching death?
a. ) Hunger
b. ) Tachycardia
c. ) Increased thirst
d. ) Difficulty swallowing
d.) Difficulty swallowing
The child begins to have difficulty swallowing as he or she approaches death. The child’s appetite will decrease, and he or she will take only small bites of favorite foods or sips of fluids in the final few days. The pulse rate will slow.
At which developmental period do children have the most difficulty coping with death, particularly if it is their own?
a. ) Toddlerhood
b. ) Preschool
c. ) School age
d. ) Adolescence
d.) Adolescence
Adolescents, because of their mature understanding of death, remnants of guilt and shame, and issues with deviations from normal, have the most difficulty coping with death. Toddlers and preschoolers are too young to have difficulty coping with their own death. They fear separation from their parents. School-age children fear the unknown such as the consequences of the illness and the threat to their sense of security.
The nurse has attended a professional development program about palliative care for the pediatric population. What statement by the nurse should indicate a correct understanding of the program?
a. ) “Palliative care provides interventions that hasten death.”
b. ) “Palliative care promotes the optimal functioning and quality of life.”
c. ) “Palliative care does not provide pain and symptom management like hospice care.”
d. ) “Palliative care is not well received in hospitals that provide end-of-life care for children.”
b.) “Palliative care promotes the optimal functioning and quality of life.”
Palliative care is designed to promote optimal functioning and quality of life during the time the child has remaining. Palliative care does not provide interventions that are intended to hasten death. The care does provide pain and symptom management and is well received in hospitals that provide end-of-life care for children.
At which age do most children have an adult concept of death as being inevitable, universal, and irreversible?
a. ) 4 to 5 years
b. ) 6 to 8 years
c. ) 9 to 11 years
d. ) 12 to 16 years
c.) 9 to 11 years
By age 9 or 10 years, children have an adult concept of death. They realize that it is inevitable, universal, and irreversible. Preschoolers and young school-age children are too young to have an adult concept of death. Adolescents have a mature understanding of death.
What are common respiratory symptoms dying children experience? (Select all that apply.)
a. ) Cough
b. ) Eupnea
c. ) Wheezing
d. ) Shortness of breath
e. ) Decrease in secretions
a.) Cough
c.) Wheezing
d.) Shortness of breath
Common respiratory symptoms dying children experience include cough, wheezing, and shortness of breath. Eupnea is normal breathing, and secretions increase not decrease.
A preschooler is found digging up a pet bird that was recently buried after it died. What is the best explanation for this behavior?
a. ) He has a morbid preoccupation with death.
b. ) He is looking to see if a ghost took it away.
c. ) He needs reassurance that the pet has not gone somewhere else.
d. ) The loss is not yet resolved, and professional counseling is needed.
c.) He needs reassurance that the pet has not gone somewhere else.
The preschooler can recognize that the pet has died but has difficulties with the permanence. Digging up the bird gives reassurance that the bird is still present. This is an expected response at this age. If the behavior persists, intervention may be required.
