Unit 41 Special Needs/Caring for Dying child

Question 1

What is the definition of children with special needs?

Answer 1

Those who are or are at risk for chronic physical, developmental, behavioral, or emotional condition beyond needs generally required by children

Question 2

What is the impact of special needs for the child regarding erikson’s stages?

Answer 2

Infant: may fail to develop sense of trust and bonding

Toddler: may have difficulty developing autonomy

Preschooler: may have difficulty achieving sense of initiative

School-age: may have difficulty achieving industry

Adolescent: may have difficulty forming sense of identity

Question 3

What could the family experience having a special needs child?

Answer 3

• May experience grief over loss of “normal” child

- May experience all of Kubler-Ross’s grieving process

Question 4

What is important regarding special needs care for the nurse and parents?

Answer 4

• Listen to parent’s
• Coordinate care
• Routine assessments
• Referals to OT/PT

Question 5

What are long term risks for premature infants?

Answer 5

• Cognitive delays
• CP
• ADD
• Learning disabilities
• Difficulty socializing
• Vulnerable child syndrome
• Visual/pulmonary problems

Question 6

What is corrected age and how is it calculated?

Answer 6

Is it used for evaluating growth and progression

-Use corrected age for health decisions till 3 years old

Example: Born at 26 weeks gestation. So child was missing 14 weeks from full term. 14 weeks = about 3 months. If child is 9 months old the corrected age is now 6 months old.

Question 7

What is failure to thrive (FTT)?

Answer 7

• Inadequate growth in infants and children
• Not enough weight gain/ growth in height
• Loss of acquired milestones

Developmental disability can contribute

Question 8

What are organic causes of FTT?

Answer 8

• Inability to suck or swallow
• Malabsorption
• Diarrhea
• Vomiting
• Alteration in metabolism associated with illnesses such as: CP, chronic lung disease, cardiac disease

Question 9

What are FTT nursing interventions?

Answer 9

Feed 120 kcal/kg/day

Weigh daily and I and O’s

Teach/support parents

Question 10

What is important regarding the dying child?

Answer 10

• End of life decision making
• Allow natural death
• Organ/tissue donation
• Honesty with family
• Pallative care (comfort) vs hospice (they can co-exist)
• QUALITY OF LIFE

Question 11

What is the focus of palliative care/hospice?

Answer 11

Managing pain and discomfort

• ATC pain management
• comfort measures

Providing nutrition

• do not force
• small amounts as child wishes

Provide emotional support to the dying child and family

Question 12

What is true about grief?

Answer 12

Lasts forever, nature and intensity changes

Question 13

How do children of certain age groups understand death?

Answer 13

Infants:

• upset about loss and separation
• sense emotions of adults

1-3:
-Unable to distinguish death from temporary separation

3-6:
Don’t see death and life as mutually exclusive
Guilt common

6-12:

• Death is irreversible, everyone must die
• Learn to envision own death
• Concrete thinking
• Dying child can participate in decisions

12 and older:

• can reason abstractly
• peers may visit if child agrees
• may fear symptoms more than death