Week 4; SIDS and Sx Management Flashcards
SIDS
unexplained sudden death of apparently healthy infant that remains unexplained after autopsy. Unpredictable, impossible to predict, sometimes referred to as “crib death”
SIDS patho
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
SIDS etiology
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.
SIDS risk factors
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
Preventing SIDS
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
SIDS s/s
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
Education r/t SIDS
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
Addressing the psychosocial needs of the family
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
When a death occurs…
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
When caring for family who has lost infant to SIDS
Support parents in grieving process
Reduce feelings of guilt
Provide referrals to support groups
Help cope with loss
Assessment
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
May have several symptoms with multiple co-
morbitities. Majority of hospice diagnoses are non-cancer related, such as
associated with heavy symptom burden
Congestive heart failure (CHF)
Chronic obstructive pulmonary disease (COPD)
Dementia
Other
Common EOL sx
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
Dyspnea in eol
Subjective experience; most reported symptom. Promotes disability, poor quality of life, and
suffering.
Dyspnea causes
Major pulmonary causes
Major cardiac causes
Major neuromuscular causes
Other causes
Assessing dyspnea
Use subjective report: physical exam, diagnostic tests, patient experience, underlying cause
Treatment of dyspnea
Treating symptoms or underlying cause with pharmacologic treatments: opioids or nonopioids
Nonpharmacologic treatment of dyspnea
Non-invasive ventilatory support (oxygen, positive pressure ventilation) if hypoxic, interventional therapies, counseling, pursed lip breathing, energy conservation, fans, elevation, positioning
Anorexia:
loss of appetite, usually with
decreased intake
Cachexia:
lack of nutrition and wasting
Causes of anorexia and cachexia
Primary cause: under investigation
Disease related
Psychological
Treatment related
Treatment of Anorexia and Cachexia
Dietary consultation
Medications
Parenteral/enteral nutrition
Odor control
Counseling
Treatment of Constipation
Medications
Other approaches
Prevention
Treatment of diarrhea
Treat underlying cause
Dietary modifications
Hydration
Pharmacologic agents
Pharmacologic Treatment of Nausea and Vomiting
Anticholinergics
Antihistamines
Steroids
Prokinetic agents
Other
Non-Drug Treatment of Nausea and Vomiting
Distraction/relaxation
Dietary
Small/slow feeding
Invasive therapies
Xerostomia
dry mouth
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)
Non-Pharmacologic Interventions for
Depression
Promote autonomy
Grief counseling
Draw on strengths
Use cognitive strategies
Pharmacologic Interventions for Anxiety
Benzodiazepines
Antipsychotics
Antidepressants
Nonpharmacologic Interventions for Anxiety
Empathetic listening
Assurance and support
Concrete information/warning
Relaxation/imagery
Delirium -
Acute change in cognition/awareness
Agitation or withdrawal -
Accompanies delirium
Confusion -
Disorientation, inappropriate
behavior, hallucinations
Delirium/Agitation/Confusion: Treatment
Maintain Safety
Pharmacologic
– Neuroleptics
– Monitor for side effects, withdrawal
– Eliminate non-essential/contributing medications
Reorientation
Relaxation/distraction
Hydration
General/Other Symptoms
Fatigue (at a glance)
Wound
Seizures
Sleep disturbances (at a glance)
Lymphedema (at a glance)
Urgent syndromes
Treatment of Injuries/wounds
Frequent position changes
Injury cleaning
Dressings
Provide analgesia
Seek consultation
Prevention is key
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
Seizure causes in EOL
Infections, trauma, HIV, tumors, medications, metabolic imbalances
Treatment for Seizures
Limit trauma
Anticonvulsant treatments; Phenytoin, Phenobarbital, Lorazepam, diazepam, Levetiracetam
Lymphedema
Chronic, progressive swelling due to failure of
lymph drainage
