Pediatrics

Question 1

2 most important aspects of peds pall care

Answer 1

symptom management

support with decision making / serious illness

Question 2

what factors influence the transition from being intellectually aware to being emotionally aware ( for parents )

Answer 2

time spent with the child
interaction with healthcare

Question 3

What are the key considerations in sharing serious illness information with a child?

Answer 3

• what to tell (and how much)
• when to tell
• who should do the telling

Question 4

2 concerns about withholding information from a child

Answer 4

• autonomy lost
• relationship may be compromised (child feels misled)

Question 5

Key consideration in child’s information preference / processing

Answer 5

• 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)

Question 6

what is the best ethical approach as is relates to childrens’ decision making

Answer 6

relational approach to autonomy

understanding the pivotal role of the family unit

Question 7

what aspect of autonomy is most important for children?

Answer 7

being in control of what information they receive
they value choosing their level of involvement

rather than making decisions themselves

Question 8

what aspects of communication are especially important in children?

Answer 8

implicit communication
non-verbal cues

Question 9

when can pediatric palliative care begin

Answer 9

in utero

Question 10

aspects of planning for neonatal EOL (expected not to survive after birth)

Answer 10

• grief support / counselling
• decision making support
• education of siblings
• financial / logistical support
• spiritual support
• birthing plan
• legacy project / creation
• funeral planning

Question 11

aspects of a birth plan for infant not expected to survive

Answer 11

• 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)

Question 12

3 tools for pain assessment in non-verbal children

Answer 12

NRS
Faces pain scale
FLACC - face, legs, activity, crying, consolability

Question 13

main worries that adolescents have about death

Answer 13

• impact on the world (fear being forgotten)
• what comes after death
• what dying process is like
• well being of family

Question 14

what are some adverse outcomes for families caring for an ill child?

Answer 14

• depression
• divorce
• financial stress
• unemployment
• grief

Question 15

what are the 3 situational factors that influence a child’s perception of pain

Answer 15

cognitive - understanding, expectations, strategies
behavioural - activities, staff/parental response, actions
emotional - anxiety, fear, depression

Question 16

non-situational factors influencing pain perception in peds

Answer 16

• age
• developmental level
• previous experiences with pain
• learned behaviours (family)
• cultural background

Question 17

how does the WHO pain ladder differ for children?

Answer 17

no weak opioids

2 steps - mild vs. mod/sever

Question 18

how is morphine 1/2 life affected in children?

Answer 18

<1yr - increased half life (dose IR q6-8h)
>1yr - decrease half life (may need more frequent dosing)

Question 19

pediatric dose of:
- tylenol
- ibuprofen
- morphine

Answer 19

• 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

Question 20

what is cerebral irritability?

which children are at risk?

Answer 20

unremitting agitation and distress (crying, incr. tone, seizure, agitation, sweating, sleep disruption, vomiting)

at risk: neurodegenerative disease, acute illness, non-verbal

Question 21

what is visceral hyperalgesia?

what is the pathophysiology / cause?

Answer 21

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

Question 22

when do kids develop a concept of death?

Answer 22

age 3

Question 23

death perceived as impermanent at these ages

Answer 23

3-6

Question 24

which age is death perceived as permanent, applies to others but not self/

Answer 24

6-10

Question 25

Which age is full understanding of death realized?

Answer 25

10-11

Question 26

which opioids should be avoided in pregnancy (birth defects)

Answer 26

codeine
oxycodone

Question 27

what is the opioid of choice for breastfeeding mothers?

Answer 27

fentanyl
(low breastmilk concentration and low oral bioavailability)

Question 28

Opioid related risks to fetus / infant:

Answer 28

• birth defects (congenital abnormality)
• neonatal respiratory depression
• neonatal abstinence syndrome

Question 29

What are the key effects of illness on young adults (impacts to maturation)

Answer 29

• psychological challenges / stress
• education and vocation training
• maturation
• social disruption

Question 30

what are some system challenges for those transitioning from pediatric to adult care?

Answer 30

• lack of complete medical records
• transition from family / community oriented model to individual model (more patient responsibility required)
• clinician discomfort with pediatric illnesses