Pediatrics Flashcards
2 most important aspects of peds pall care
symptom management
support with decision making / serious illness
what factors influence the transition from being intellectually aware to being emotionally aware ( for parents )
time spent with the child
interaction with healthcare
What are the key considerations in sharing serious illness information with a child?
- what to tell (and how much)
- when to tell
- who should do the telling
2 concerns about withholding information from a child
- autonomy lost
- relationship may be compromised (child feels misled)
Key consideration in child’s information preference / processing
- age and emotional development
- many want the information to be filtered through parents
- parental knowledge translates to a sense of security, decision confidence
- parents help to understand the information (shared learning)
what is the best ethical approach as is relates to childrens’ decision making
relational approach to autonomy
understanding the pivotal role of the family unit
what aspect of autonomy is most important for children?
being in control of what information they receive
they value choosing their level of involvement
rather than making decisions themselves
what aspects of communication are especially important in children?
implicit communication
non-verbal cues
when can pediatric palliative care begin
in utero
aspects of planning for neonatal EOL (expected not to survive after birth)
- grief support / counselling
- decision making support
- education of siblings
- financial / logistical support
- spiritual support
- birthing plan
- legacy project / creation
- funeral planning
aspects of a birth plan for infant not expected to survive
- understand family values, hopes, fears
- counsel on EOL (incl. misconceptions) and what to expect
- create a symptom management plan
- discuss possible scenarios
- reassess (possibility of living longer than expected, for example)
3 tools for pain assessment in non-verbal children
NRS
Faces pain scale
FLACC - face, legs, activity, crying, consolability
main worries that adolescents have about death
- impact on the world (fear being forgotten)
- what comes after death
- what dying process is like
- well being of family
what are some adverse outcomes for families caring for an ill child?
- depression
- divorce
- financial stress
- unemployment
- grief
what are the 3 situational factors that influence a child’s perception of pain
cognitive - understanding, expectations, strategies
behavioural - activities, staff/parental response, actions
emotional - anxiety, fear, depression
non-situational factors influencing pain perception in peds
- age
- developmental level
- previous experiences with pain
- learned behaviours (family)
- cultural background
how does the WHO pain ladder differ for children?
no weak opioids
2 steps - mild vs. mod/sever
how is morphine 1/2 life affected in children?
<1yr - increased half life (dose IR q6-8h)
>1yr - decrease half life (may need more frequent dosing)
pediatric dose of:
- tylenol
- ibuprofen
- morphine
- tylenol 10-15mg/kg/dose q4-6h (max 4g/d)
- ibuprofen 5-10mg/kg/dose q6-8h (max 3.2g/d)
- morphine 0.1mg/kg/dose (PO) q2-4h
what is cerebral irritability?
which children are at risk?
unremitting agitation and distress (crying, incr. tone, seizure, agitation, sweating, sleep disruption, vomiting)
at risk: neurodegenerative disease, acute illness, non-verbal
what is visceral hyperalgesia?
what is the pathophysiology / cause?
altered response to visceral stimulation, causing pain - despite treatment of GI pathology
pathophysiology - abnormal GI sensory input / development of pain pathways (plasticity). potentially motility d/o
when do kids develop a concept of death?
age 3
death perceived as impermanent at these ages
3-6
which age is death perceived as permanent, applies to others but not self/
6-10
Which age is full understanding of death realized?
10-11
which opioids should be avoided in pregnancy (birth defects)
codeine
oxycodone
what is the opioid of choice for breastfeeding mothers?
fentanyl
(low breastmilk concentration and low oral bioavailability)
Opioid related risks to fetus / infant:
- birth defects (congenital abnormality)
- neonatal respiratory depression
- neonatal abstinence syndrome
What are the key effects of illness on young adults (impacts to maturation)
- psychological challenges / stress
- education and vocation training
- maturation
- social disruption
what are some system challenges for those transitioning from pediatric to adult care?
- lack of complete medical records
- transition from family / community oriented model to individual model (more patient responsibility required)
- clinician discomfort with pediatric illnesses
