Week 4; SIDS and Sx Management Flashcards

1
Q

SIDS

A

unexplained sudden death of apparently healthy infant that remains unexplained after autopsy. Unpredictable, impossible to predict, sometimes referred to as “crib death”

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2
Q

SIDS patho

A

No confirmed causative factor or pathophysiology, diagnosed after. Review of child’s clinical history, examination of scene of death, autopsy that fails to find a cause of death. Data related to infant deaths are gathered and reported for research. Nurse must know procedures for gathering, reporting such data

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3
Q

SIDS etiology

A

Called syndrome because autopsy and clinical findings are varied, do not identify a disease process. Three factors that occur simultaneously lead to SIDS:
Infant must have a brainstem abnormality
Significant stressors that contribute to SIDS must be present, such as prone or side sleeping, face-down sleeping, or bed sharing. Infant must be in critical developmental period in first 6 months of life.

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4
Q

SIDS risk factors

A

Preterm and low birth weight
Race: most common among American Indians, Alaska Natives
Gender: more common in boys
Sleeping in prone or side-lying position
Maternal smoking and exposure to secondhand tobacco smoke
Overheating
Bed sharing
Loose bedding
Sleeping on soft surfaces

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5
Q

Preventing SIDS

A

Always place infants on their backs to sleep until 1 year of age
Breastfeeding associated with reduced risk
Infants should sleep in same room with parents, close to parents’ bed but not in it
No soft objects in infant’s sleep area (pillows, toys, crib bumpers, quilts, etc.)
Offer pacifier at naptime, bedtime
Avoid exposure to smoke, alcohol, illicit drugs during pregnancy, after birth
Dress infants appropriately for environment
Avoid overheating
Avoid covering face and head

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6
Q

SIDS s/s

A

No warning signs or early clinical manifestations
Cardiopulmonary arrest is first and only symptom
Deaths rarely observed
Typically, parents find infant dead in crib after no cries or other disturbances
Clinical evidence after death
Frothy, blood-tinged secretions from mouth, nares
Evidence that infant struggled or changed position

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7
Q

Education r/t SIDS

A

Importance of safe sleep recommendations
Assess older cribs, linens for safety
Modeling protective behaviors
Place newborn on back for sleeping
May need to alter behaviors learned in medical training

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8
Q

Addressing the psychosocial needs of the family

A

SIDS may occur despite following precautions
Interdisciplinary team to be empathetic and support family in grief
Range of services
Religious support
Baptism services if appropriate
Calling on services of spiritual leader in family’s belief system
Grief counseling
Assistance with funeral arrangements
Counseling on cessation of breastfeeding if appropriate
Reassure parents that they are not responsible
Counsel parents about potential reactions of siblings
Assist parents in contacting other family members for support
Support groups

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9
Q

When a death occurs…

A

Assessment in home by medical, law enforcement agents
Other potential causes have to be ruled out
Family are interviewed to determine cause, rule out homicide
Investigation may have positive effect of demonstrating family’s innocence to friends and neighbors
Process can be intimidating to grieving family members
Collaborative care for family
Grief counselors, chaplains and religious leaders, nurses working with siblings, psychotherapists
Parents should receive psychosocial assessment at each healthcare interaction

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10
Q

When caring for family who has lost infant to SIDS

A

Support parents in grieving process
Reduce feelings of guilt
Provide referrals to support groups
Help cope with loss

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11
Q

Assessment

A

Assess for risk of SIDS during pregnancy, early infancy
Observation and patient interview
Smoking by mother or other household member(s)
How and where child is put to sleep
What caregivers put child to sleep
Child’s breathing patterns
Breastfeeding or formula feeding
Previous infant death in family
Physical examination
Infant’s respiratory rate, patterns

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12
Q

May have several symptoms with multiple co-
morbitities. Majority of hospice diagnoses are non-cancer related, such as

A

associated with heavy symptom burden
 Congestive heart failure (CHF)
 Chronic obstructive pulmonary disease (COPD)
 Dementia
 Other

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13
Q

Common EOL sx

A

Respiratory: Dyspnea, cough
GI: Anorexia/cachexia, constipation, diarrhea, nausea/vomiting, xerostomia
Psychological: Depression, anxiety, post-traumatic stress disorder, delirium/agitation/confusion
General/Systemic: Fatigue/weakness, wounds, seizures, sleep disturbances, lymphedema, and urgent syndromes

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14
Q

Dyspnea in eol

A

Subjective experience; most reported symptom. Promotes disability, poor quality of life, and
suffering.

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15
Q

Dyspnea causes

A

Major pulmonary causes
Major cardiac causes
Major neuromuscular causes
Other causes

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16
Q

Assessing dyspnea

A

Use subjective report: physical exam, diagnostic tests, patient experience, underlying cause

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17
Q

Treatment of dyspnea

A

Treating symptoms or underlying cause with pharmacologic treatments: opioids or nonopioids

18
Q

Nonpharmacologic treatment of dyspnea

A

Non-invasive ventilatory support (oxygen, positive pressure ventilation) if hypoxic, interventional therapies, counseling, pursed lip breathing, energy conservation, fans, elevation, positioning

19
Q

Anorexia:

A

loss of appetite, usually with
decreased intake

20
Q

Cachexia:

A

lack of nutrition and wasting

21
Q

Causes of anorexia and cachexia

A

Primary cause: under investigation
Disease related
Psychological
Treatment related

22
Q

Treatment of Anorexia and Cachexia

A

Dietary consultation
Medications
Parenteral/enteral nutrition
Odor control
Counseling

23
Q

Treatment of Constipation

A

Medications
Other approaches
Prevention

24
Q

Treatment of diarrhea

A

Treat underlying cause
Dietary modifications
Hydration
Pharmacologic agents

25
Pharmacologic Treatment of Nausea and Vomiting
Anticholinergics Antihistamines Steroids Prokinetic agents Other
26
Non-Drug Treatment of Nausea and Vomiting
Distraction/relaxation Dietary Small/slow feeding Invasive therapies
27
Xerostomia
dry mouth
28
Pharmacologic Interventions for Depression
Goal: Focus on symptom control -Antidepressants (e.g. Amitryptiline- may take 4-6 weeks to be effective) -Steroids (e.g. Dexmethasone)
29
Non-Pharmacologic Interventions for Depression
Promote autonomy Grief counseling Draw on strengths Use cognitive strategies
30
Pharmacologic Interventions for Anxiety
Benzodiazepines Antipsychotics Antidepressants
31
Nonpharmacologic Interventions for Anxiety
Empathetic listening Assurance and support Concrete information/warning Relaxation/imagery
32
Delirium -
Acute change in cognition/awareness
33
Agitation or withdrawal -
Accompanies delirium
34
Confusion -
Disorientation, inappropriate behavior, hallucinations
35
Delirium/Agitation/Confusion: Treatment
Maintain Safety Pharmacologic – Neuroleptics – Monitor for side effects, withdrawal – Eliminate non-essential/contributing medications Reorientation Relaxation/distraction Hydration
36
General/Other Symptoms
Fatigue (at a glance) Wound Seizures Sleep disturbances (at a glance) Lymphedema (at a glance) Urgent syndromes
37
Treatment of Injuries/wounds
Frequent position changes Injury cleaning Dressings Provide analgesia Seek consultation Prevention is key
38
Assessing/Treating Injuries or Wounds in Patients with Life-Limiting Illness
Assess underlying cause What are the goals of care? Is it realistic that the wound will heal? Prevent further pressure injuries/ulcers/wounds Manage pain and odor Pressure injury (ulcer) may indicate organ failure
39
Seizure causes in EOL
Infections, trauma, HIV, tumors, medications, metabolic imbalances
40
Treatment for Seizures
Limit trauma Anticonvulsant treatments; Phenytoin, Phenobarbital, Lorazepam, diazepam, Levetiracetam
41
Lymphedema
Chronic, progressive swelling due to failure of lymph drainage