603 Peds Final P13: terminal illness, pediatric rehab

What are the stages of grief?

denial, anger, bargaining, depression, acceptance

feeling of loss, including sadness, frustration, anger, loneliness

grief

an expression or display of feeling related to the loss, including funeral, crying

mourning

a process that occurs with the loss - adjusting, moving on, addressing

bereavement

What is a primary loss?

the loss of the person

What is a secondary loss?

loss of hopes/dreams, plans, etc.

What is the goal when working with coping infants?

develop sense of trust and constancy

List some intervention strategies when working with coping infants displaying crying, irritability, clinginess, sleep disturbances, skin rashes

stick to routines, give extra attention, seek support

How do preschool age children view loss?

temporary, punishment, worry it will happen to them

List some intervention strategies when working with preschool age children displaying regression, separation anxiety, grief in short bursts, repetitively asking about loss

tell them what to expect, use the term died, answer questions honestly & simply, maintain routines

How do school age children perceive loss?

understand finality, show interest in physical aspects

List some intervention strategies when working with school age children displaying withdrawal, poor attention, decline in performance, physical complaints, exaggerated fears, separation anxiety, anger, fear, denial, crying spells

help them understand the grief process, prompt and honest answers, ceremonial usage, listen

How do adolescents view loss?

tend to view themselves as immortal, suicidal thoughts, understand/cope more like adults

List some intervention strategies when working with adolescents displaying anger, risk-taking, denial, preoccupation with loss, idolization of lost, criticism of others' grief

offer reassurance, keep informed of affects of loss, encourage and invite communication, suggest journaling, professional counseling

What is a major aspect of working with death & dying?

identifying primary/secondary losses, addressing psychosocial factors

What are the focus of goals with terminally ill patients?

comfort care, variation for independence, knowing how hard to push

Describe the continuum of care of pediatric rehab

ER --> ICU --> transfer --> inpatient rehab --> outpatient rehab --> school therapy --> home based therapy --> outpatient clinics --> community resources

Describe pediatric rehabilitation transitional services related to school

re-entry, video of progress, neuropsych eval, modified schedule

What is the focus of inpatient rehab?

foundational ADL skills, awareness of environment, caregiver comfort, basic transfer skills, sitting balance, tolerance for out of bed activity, general UE mobility, foundational visual perceptual/cognitive skills

what is the focus of outpatient rehab?

complex A/IADLs, complex functional interactions, caregiver comfort, increased independence, complex functional UE mobility & strength, more complex client factors