UNIT 9 GRIEF AND DEATH

Question 1

Ethical; considerations of the dying child

Answer 1

Parents may struggle with decision to withhold or withdraw
medical care
– Euthanasia: action carried out by another person to end life
– Assisted suicide: providing means to patient to end their life
– Neither are allowed per ANA Code of Ethics
– Not offering treatment that could cause pain but extend life IS
ethically acceptable

Question 2

Infants and Toddler-Children’s
Understanding
of and
Reactions to
Death

Answer 2

Infants
– Death has least significance to infants younger than 6 months
– After trust is established, loss is profound
– Toddlers
– Egocentric- can only see from their point of view
– Impossible to comprehend absence of life
– May act like deceased person is still alive
– Children in this age group are mostly affected by changes
in routine
– Encourage consistent caregiver
– Keep routines

Question 3

Preschool-Children’s
Understanding
of and
Reactions to
Death

Answer 3

– Preschoolers believe their thoughts can cause death
– View illness as punishment
– Have some understanding of death
– See death as temporary, reversible
– May deny that death has occurred to cope
– Greatest fear: separation from parents
– May inappropriately giggle, laugh after death of loved
one
– Support parents, help them understand child’s behaviors
– Keep routine
– Encourage consistent caregivers

Question 4

School age- Children’s
Understanding
of and
Reactions to
Death

Answer 4

Still associate misdeeds with causing death
– Have a better understanding of death and its finality
– Personify death (monster, grim reaper)
– By age 9-10, children have an adult understanding of
death
– Have a great fear of the unknown
– Interested in funeral services
– Allow choices so child feels in control
– Encourage expression of feelings
– Help parents to honestly answer questions about deat

Question 5

Adolescent-Children’s
Understanding
of and
Reactions to
Death

Answer 5

– Have a mature understanding of death
– Least likely to accept death, especially if it is their own
– Feel alone and alienated
– Fear physical changes more than prognosis
– May criticize funeral ceremonies
– Allow for maximum control and independence
– Respect privacy and encourage expression of emotion

Question 6

Nursing Care of the Child and
Family at the end of Life

Answer 6

– Pain and symptom management
– Pain management top priority at end of life
– Parent and sibling’s need for support and education
– Encourage sibling involvement
– Empower parents
– For the nurse:
– Cultivate empathy
– Support groups
– Attend funeral services of child

Question 7

Physical Signs of Impending Death
(everything slows down)

Answer 7

– Loss of sensation and
movement
– Sensation of heat
– Loss of senses
– Confusion
– Muscle weakness
– Loss of bowel/bladder
control
– Decreased appetite and
thirst
– Change in respiratory
patterns
– Weak, slow pulse and
decreased BP