ATI Pedi Book Ch 11 Death and Dying

Palliative care

Multidisciplinary approach that focuses on process of dying rather than prolonging life in cases in which cures are no longer possible. Manages manifestations and offers supportive care. May include VNA and respite care for family.

Timeline for when hospice care is given

Generally when child only has 6 months to live.

Characteristics of hospice care

Family members are primary caregivers. Nursing focus is pain control and comfort. Family and client needs are equal. Provide support for family grieving process, which can continue after client's death.****

Factors affecting loss, grief, and coping

Interpersonal relationships and social support.
Type and significance of loss.
Culture, ethnicity.
Spiritual, religious beliefs.
Prior experience with loss.
Socioeconomic status.
Stage of development.****

Types of grief and mourning

Anticipatory: When death is possible outcome.
Complicated: Extends for more than a year following loss.

Characteristics of complicated grief

Intense thoughts, distressing yearning, loneliness, distressing emotions, disturbances in personal activities like sleep. May require referral for grief counseling.

Characteristics of parental grief

Intense, long-lasting, complex. Includes secondary losses like absence of hope and dreams, disruption of family unit, loss of identity as parent. Maternal and paternal grief are different.

Differences between maternal and paternal grief

Mothers tend to be more verbal and seek counseling. Fathers tend to draw inward. Mothers will always acknowledge loss of child no matter how much time passes.****

Characteristics of sibling grief

Differs from adult or parental grief. Depends on age and developmental stage.

Infants' and toddlers' reactions to death and dying

Little to no concept of death. Toddlers' egocentric thinking prevents understanding of death. They mirror parents' emotions. React to changes brought about by being in hospital. May regress.****

Preschoolers' reactions to death and dying

Egocentric thinking. Magical thinking: Believe thoughts can cause events like death and feel guilt. Interpret separation from parents as punishment for being bad. View death as temporary because of poor concept of time and thinking dead person may have at

School-age children's reactions to death and dying

Starts to respond to factual explanations. Older children (9-12) begin to have adult concept of death (inevitable, universal, irreversible). Fear of disease, death, unknown, loss of control. Often manifest fear by not cooperating. May be curious about fun

Adolescents' reactions to death and dying

May feel isolated because peers cannot relate to their situation. May have adultlike concept of death. May have difficulty accepting death because they are discovering who they are, establishing identity, dealing with issues of puberty. Rely more on peers

Factors that contribute to dysfunctional grieving after loss of child

Lack of support system.
Inadequate coping skills.
Violent death or suicide.
Sudden or unexpected death.
Lack of hope, pre-existing mental health issues.

Assessment for death and dying

Physical manifestations of death.
Knowledge of diagnosis, prognosis, care.
Perceptions and desires regarding diagnosis, prognosis, care.
Nutritional status, growth and development patterns.
Activity and energy level.
Wishes regarding end-of-life care.

Physical manifestations of dying

Sensation of heat when body feels cool.
Decreased sensation and movement of lower extremities.
Loss of senses.
Confusion or loss of consciousness.
Decreased appetite and thirst.
Swallowing difficulty.
Loss of bowel and bladder control.
Bradycardia, hypote

Which sense is last to go in dying


Nursing interventions for death and dying

Allow opportunity for anticipatory grief.
Consistency among caregivers.
Encourage parents to remain with client.
Maintain normal environment.
Communicate honestly, respectfully.
Encourage independence.
Stay with client as much as possible.
Pain control.

Nursing interventions for palliative care

Clients, siblings, and parents are units of care.
Provide homelike environment.
Seek client's and family's desires.
Respect cultural and religious preferences.
Provide and clarify explanations.
Encourage physical contact. Address feelings. Empathy and sup

Pain control in palliative care

Give scheduled medications.
Control breakthrough pain.
Increase dose as necessary to control pain.
Help manage pain with relaxation, distraction, imagery.

Nursing interventions for family during dying

Provide information about disease, medications, procedures, expected events. Support parents' participation in care. Encourage parents to remain near child.
Encourage independence in client as much as possible. Allow visits of family and friends as much a

Nursing interventions after death

Let family stay with body as long as they wish. Allow them to rock infant/toddler. Remove tubes and equipment. Offer to let family assist with preparation of body. Assist with preparations for death rituals. Encourage parents to prepare siblings for funer

Caring for the nurse caring for a dying child

Express feelings of loss to supportive person. Maintain general health. Develop ability for empathy. Take time off when needed. Develop well-rounded interests. Professional and social support systems. Focus on positive aspects of caring for dying patients

True or false: A nurse caring for a dying child should develop feelings of sympathy toward the family.

False. It should be empathy.

Bereavement resources

Hospital that cared for the child, VNA, social services, 211, Mary's Place CT (support groups in Windsor for children of various ages).

The nurse is preparing to care for a dying child, and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with family. Select all that apply:
A. Discourage reminiscing.
B. Make the decis

C, E, F. Not D: The nurse must determine if there is a spokesperson for the family and how much the family wants to know (HIPPA).