Presentation on theme: "Metro Community College Nancy Pares, RN, MSN"— Presentation transcript:
1 Metro Community College Nancy Pares, RN, MSN NURS Unit 5Metro Community CollegeNancy Pares, RN, MSN
2 Informed Consent Healthcare provider must obtain Must be obtained for invasive procedures and some medical treatmentsMay be delayed in emergency situations
3 Nurse’s role in obtaining informed consent Assess and documentReview rights of minorsDevelop therapeutic relationshipVerify prior consentServe as witness
4 Minor Defined by Individual State Laws Until the person reaches age of adult based on state law, parent or guardian must provide informed consent.Parent or guardians have ultimate decision, with some exceptions.
5 Minors May Give Informed Consent in Certain Circumstances Emancipated minorMinor is parent of a child receiving treatment
6 Children Should Be Given Age-Appropriate Information Assent and preference by child should be obtained
7 Advances in Medical Treatment Ability to save lives of severely impaired infantsGenetic testingGene therapy
8 Ethical Guidelines Define Evaluate Identify Apply principles Make decisions
9 Increase in Ethical Issues and Decisions Nurses use four ethical principlesBeneficenceNonmaleficenceAutonomyJustice
10 Healthcare Institutions and Ethics Committees Ethics committees resolve conflicts and make recommendations
16 Verbal Communication Verbal and written words, vocalizations Speaking to anotherWriting a letterCrying, laughingInfluenced by development and cognitive level
17 Verbal Communication Influenced by culture How does the nurse use verbal communication in nursing care?
18 Nonverbal Communication Forms of Nonverbal CommunicationParalanguageGesturesTouchPersonal spaceFacial expressionBody languageEye contact
19 Nonverbal Communication Forms of Nonverbal CommunicationPhysical appearanceFacial ExpressionAmbiguityInfluence of development and cognitive levelInfluence of context—what is the situation?Influence of cultureCongruence between verbal and nonverbal message
20 Figure The nurse is sending a message to the older child, the receiver. Notice the nonverbal communication expressed by the young girl. What message is she communicating? How should the nurse respond?
21 Figure 6-2 Facial expressions are a powerful means of communication Figure Facial expressions are a powerful means of communication. What does this child’s facial expression convey? What actions can the nurse take to reduce her distress?
22 Forms of Nonverbal Communication How should nonverbal communication be applied to nursing care?
23 Influence of Physical and Psychosocial Factors on Communication Process Physical factors—language, gender, environmentPsychosocial factors—culture, health status, emotions, space, and time
24 Influence of Language Issues Language and linguistic differences and expectationsMedical terminology and medical jargonNursing strategies to minimize language barriers
25 Influence of Gender Prior experiences Expectations of women and men Cultural influencesNursing strategies to minimize gender barriers
26 Influence of Environment Environmental factorsComfortPrivacyNursing strategies to minimize environmental barriers
27 Influence of Health Status Physical conditionEmotional responsesNeed for informationNursing strategies to minimize barriers
28 Application to Nursing Care Individualized approachCaringThe nurse’s emotional investment in the child and familyEvokes a feeling of security and comfortCaring environment needed for communication
29 Application to Nursing Care EmpathyAbility to perceive another person’s experienceEmpathetic behaviors and expressions enhance communication
30 Considerations for Communication with Children Developmental levelSkillsLanguage developmentCognitive developmentEmotional/personality development
31 Newborns Primary mode of communication is nonverbal Express self through cryingRespond to human voice and presenceTouch has a positive effectNursing strategies include: encourage parent to touch infant
32 Infants Communication is still primarily nonverbal Begin verbal communication with vocalizationsCommunicate through crying, facial expressionAttentive to human voice and presence although no comprehension of words
33 Infants Respond to touch through patting, rocking, stroking Nursing strategies include: speak in high-pitched voice, cuddle, pat, rub to calm
34 Toddlers and Preschoolers Evolving verbal skillsUse of language to express thoughtsGreater receptive than expressive languageConcrete and literal thinking,may misinterpret phrasesVocabulary depends on development and family’s useMay ask many questions (preschooler)
35 Toddlers and Preschoolers Short attention spanLimited memoryCognitive developmentEgocentricMagical thinkingAnimism
36 Toddlers and Preschoolers Nonverbal communicationExpress self through dramatic play and drawingNursing strategies
38 School-Age Children Cognitive development now able to use logic Begin to understand others’ viewpointsBegin to understand cause-effectUnderstanding of body functions
39 School-Age Children Verbal communication Nonverbal communication Vocabulary is largeReceptive and expressive language balancedMisinterpretations of phrases still commonNonverbal communicationCan interpret nonverbal messagesExpression of thoughts and feelings
40 Adolescents Abstract thinking without full adult comprehension Interpretation of medical terminology is limitedDrive for independence
41 Adolescents Trust and understanding build rapport Need for privacy Nursing strategies include: straightforward approach, talk in private area
42 If unable to communicate,may feel helplessness, fear, anxiety Communicating with Children Who Have Physical and Developmental DisabilitiesIf unable to communicate,may feel helplessness, fear, anxietyFamily may become anxiousStrategiesNonverbal—use gestures, picture boards, writing tabletsCommunication augmentation—system of head nods, eye blinks
43 Communicating with Children Who Have Altered Vision Approach to child—identify self as you enter room, announce departureOrient child to objects in roomSpeak before touchingExplain any unfamiliar sounds
44 Communicating with Children Who Have Altered Hearing Approach to child—face child when speaking, enter room slowlyAssess degree of impairment—may need interpreter
45 Communicating with Non-English-Speaking Children Cultural implications—need to develop plan of care in respect of cultureUse of interpretersFamily—could result in errors and inconsistencyUse professional translators trained for patient encountersOther strategies include: communication with pictures, speaking in normal tone
46 Communication Assessment for Child and Family DevelopmentLanguagePhysical skillsCultureBarriers
47 Figure Most hospitals have designated interpreters that you should use. If not available, find a professional interpreter whom you have identified beforehand and who knows medical terms and the cultural norms of the family. The interpreter should be positioned to improve communication. Maintain eye contact with the parent or patient, not the interpreter. To ensure confidentiality of information for parents, avoid using a family member for history taking.
66 Psychosocial Data Family composition Home environment, housing, neighborhoodSchool or childcareDaily routines
67 Psychosocial DataChanges in family or family life since last healthcare encounterSeparation, divorce, or death of a parentWho lives in the household?Age-specific issuesNewbornsAdolescents
68 Psychosocial Data Developmental status, history, and patterns Motor CognitiveLanguageSocial
69 Facilitating Examination of Infants Praise parental presence and responsesPromote physical comfort and relaxationDistract infant with colorful toysAuscultate when quiet or sleepingDo procedures that provoke crying at end of exam
70 Facilitating Examination of Toddlers Parent’s lapPlaySecurity objectInstrumentsControl and choice
71 Facilitating Examination of Preschoolers SequenceGames and activitiesDemonstrate and let them touch instrumentsDistraction
72 Facilitating Examination of Older Children and Adolescents Ensure modesty and privacyOffer choicesExplain body parts and functionsDecide on parental presence or absenceConsider need for nonparent chaperonesReassure adolescents of normalcy
73 Head Chest Abdomen Spine Skin imperfections Physiologic differences in children may produce normal variations in physical assessmentHeadChestAbdomenSpineSkin imperfections
74 Figure Mongolian spots are large patches of bluish skin often seen on the buttocks. They are a normal occurrence in a large majority of Native American, Asian, Black, and Hispanic infants, but are sometimes mistaken for bruises.
75 General Appraisal Appearance Behavior Interaction with parents Interaction with examiner
76 Anthropometric Measurements LengthBirth to 24 monthsMeasuring board
77 Figure 7-4 Measuring infant length Figure Measuring infant length. Have an assistant hold the infant’s head in the midline while you gently push down on the knees until the legs are straight. Position the heels of the feet on the footboard, and record the length to the nearest 0.5 cm or 1/4 inch.
78 Anthropometric Measurements HeightAfter age 2 yearsStadiometer
79 Anthropometric Measurements WeightInfant scaleKilograms, grams, and pounds and ouncesStanding scaleDiapers and clothing
81 Figure 7-6 Measuring head circumference Figure Measuring head circumference. Wrap the tape around the head at the supraorbital prominence, above the ears, and around the occipital prominence, the point of largest circumference of the head.
82 Anthropometric Measurements Centimeters and inchesPaper tapeMeasure twiceUp to age 2 to 3 yearsAround supraorbital and occipital prominences
83 Anthropometric Measurements Body mass indexLess than 5th percentileGreater than 85th percentileGreater than 95th percentileCalculation: weight in kg/m2 of height
86 Figure Draw an imaginary line down the middle of the face over the nose and compare the features on each side. Significant asymmetry may be caused by paralysis of cranial nerve V or VII, in utero positioning, or swelling from infection, allergy, or trauma.
88 Figure The sutures are fibrous connections between the bones of the skull that have not yet ossified. The fontanels are formed at the intersection of these sutures where bone has not yet formed. Fontanels are covered by tough membranous tissue that protects the brain. The posterior fontanel closes between 2 and 3 months after birth. The anterior fontanel and sutures are palpable up to the age of 18 months. The suture lines of the skull are seldom palpated after 2 years of age. After that time, the sutures rarely separate.
90 Figure Draw an imaginary line across the medial canthi and extend it to each side of the face to identify the slant of the palpebral fissures. When the line crosses the lateral canthi, the palpebral fissures are horizontal and no slant is present. When the lateral canthi fall above the imaginary line, the eyes have an upward slant. A downward slant is present when the lateral canthi fall below the imaginary line. Epicanthal folds are present when an extra fold of skin partially or completely covers the caruncles in the medial canthi. What type of slant does this child have? Are epicanthal folds present?
91 Figure 7-17 The eyes of this boy with Down syndrome show an upward slant.
93 Figure 7-18 Inspection of the extraocular movements Figure Inspection of the extraocular movements. Have the child sit at your eye level. Hold a toy or penlight about 30 cm (12 in.) from the child’s eyes and move it in all six directions indicated. Both eyes should move together, tracking the object.
94 EyesInspectionStrabismusLight reflexCover-uncover test
95 Figure 7-19 Cover–uncover test Figure Cover–uncover test. With the child at your eye level, ask the child to look at a picture on the wall. A, As you cover one eye with an index card or paper cup, observe for any movement of the uncovered eye. If it jumps to fixate on the picture, the uncovered eye has a muscle weakness. B, As you remove the cover from the eye, observe the covered eye for any movement to fixate on the picture. If an eye has a muscle weakness, it will drift to a relaxed position when covered.
124 Genitalia and Perineal Areas PositioningTiming in examinationFemalesMalesAnus and rectum
125 Genitalia and Perineal Areas Puberty and sexual maturationFemalesMalesTanner ScaleSexual maturity rating (SMR)
126 Musculoskeletal System InspectionPalpationRange of motionMuscle strength
127 Figure 7-54 Inspection of the spine for scoliosis Figure Inspection of the spine for scoliosis. Ask the child to slowly bend forward at the waist, with arms extended toward the floor. Run your forefinger down the spinal processes, palpating each vertebra for a change in alignment. A lateral curve to the spine or a one-sided rib hump is an indication of scoliosis.
128 Musculoskeletal System Posture and spinal alignment
129 Figure 7-52 Normal development of posture and spinal curves Figure Normal development of posture and spinal curves. A, Infant 2 to 3 months—Holds head erect when held upright; thoracic kyphosis when sitting.
130 Figure 7-52 (continued) Normal development of posture and spinal curves. B, 6 to 8 months—Sits without support; spine is straight.
131 Figure 7-52 (continued) Normal development of posture and spinal curves. C, 10 to 15 months— Walks independently; straight spine.
132 Figure 7-52 (continued) Normal development of posture and spinal curves. D, Toddler—Protuding abdomen; lumbar lordosis.
133 Figure 7-52 (continued) Normal development of posture and spinal curves. E, School-age child—Height of shoulders and hips is level; balanced thoracic convex and lumbar concave curves.
134 Figure Does this child have legs of different lengths or scoliosis? Look at the level of the iliac crests and shoulders to see if they are level. See the more prominent crease at the waist on the right side? This child could have scoliosis.
135 Musculoskeletal System Upper extremitiesShouldersArms and elbowsHands and wrist
137 Figure 7-55 (continued) B, Transverse crease associated with Down syndrome. Source: Photo B from Zitelli, B. J., & Davis, H. W. (Eds.). (2002). Atlas of pediatric physical diagnosis (4th ed.). St. Louis, MO: Mosby-Year Book.
139 Figure Flex the infant’s hips and knees so the heels are as close to the buttocks as possible. Place the feet flat on the examining table. The knees are usually the same height. A difference in knee height (Allis sign) is an indicator of hip dislocation (see also Chapter 35). Source: Courtesy of Dee Corbett, RN, Children’s National Medical Center, Washington, DC.
140 Figure 7-57 Ortolani-Barlow maneuver Figure Ortolani-Barlow maneuver. A, Place the infant on his or her back and flex the hips and knees at a 90-degree angle. Place a hand over each knee with the thumb over the inner thigh, and the first two fingers over the upper margin of the femur. Move the infant’s knees together until they touch, and then put downward pressure on one femur at a time to see if the hips easily slip out of their joints or dislocate.
141 Figure 7-57 (continued) Ortolani-Barlow maneuver Figure 7-57 (continued) Ortolani-Barlow maneuver. B, Slowly abduct the hips, moving each knee toward the examining table. Keep pressure on the hip joints with the fingers in a lever-type motion. Equal hip abduction, with the knees nearly touching the examining table, is normal. Any resistance to abduction or a clunk felt on palpation can be an indication of a congenital hip dislocation.
142 Musculoskeletal System Lower extremitiesLegs and kneesFeet and ankles
143 Figure To evaluate the child with knock-knees, have the child stand on a firm surface. Measure the distance between the ankles when the child stands with the knees together. The normal distance is not more than 5 cm (2 in.) between the ankles.
144 Nervous System Cognitive functioning Behavior Communication skills MemoryLevel of consciousness
145 Nervous System Cerebellar function Balance Coordination Locomotion, gait
151 Table 7-20 (continued) Techniques for Assessing Selected Primitive Reflexes, with Normal Findings and Their Expected Age of Occurrence
152 Secondary Sex Characteristics Onset of secondary sex characteristics varySexual maturity rating (SMR)Females: average of breast and pubic hair developmentMales: average of genital and pubic hair development
153 Secondary Sex Characteristics Tanner stages: rating between 2–5, stage 1 is prepubertalInspection and palpation to assign a tanner stage
154 Analyzing Health Assessment Findings Identify normal findingsIdentify abnormal findingsSort normal from abnormal findingsGroup normal and abnormal findings togetherRecognize patterns from normal and abnormal findingsIdentify health concerns, problems, conditions
155 Planning and Implementation Appropriate referral for treatmentDetermination of nursing diagnoses based on health assessment findingsCollaboration with child, family, other healthcare providers to develop goalsIdentification and implementation of appropriate interventions
156 Assessment of the Newly Born Transition to extrauterine lifeInitiation of respirationsTransition from fetal to adult circulation
157 Immediate Assessment After Birth Physiologic condition and needsResuscitationApgar scoreAdaptation to extrauterine life1 and 5 minute scoreApgar criteria
159 Gestational Age Assessment Ballard gestational age assessment toolPhysical characteristicsSkinLanugoPlantar surfaces
160 Figure 7-75 Ballard scoring system to assess gestational maturity Figure Ballard scoring system to assess gestational maturity. Source: Reprinted from Ballard, J. L., Khoury, J. C., Wang, L., Eilers-Walsmann, B. L., & Lipp, R. (1991). New Ballard score, expanded to include extremely premature infants. Journal of Pediatrics, 119 (3), 417–423. Used with permission from Elsevier. Copyright Elsevier, 1991.
161 Figure Sole creases. A, At a gestational age of approximately 35 weeks, the newborn has few sole creases only on the anterior portion of the foot.
162 Figure 7-64 (continued) Sole creases Figure 7-64 (continued) Sole creases. B, At term, the newborn has deep creases down to and including the heel as the skin loses fluid and dries after birth.
163 Gestational Age Assessment Ballard gestational age assessment toolPhysical characteristicsBreasts
164 Figure Breast tissue. To assess breast tissue, gently compress the tissue between the middle and index fingers and measure the tissue in millimeters. A, At a gestational age of 38 weeks, the newborn has a visible raised area that is 4 mm in diameter on palpation.
165 Figure 7-65 (continued) Breast tissue Figure 7-65 (continued) Breast tissue. To assess breast tissue, gently compress the tissue between the middle and index fingers and measure the tissue in millimeters. B, At a gestational age of 40 to 44 weeks, the newborn has 10 mm breast tissue.
166 Gestational Age Assessment Ballard gestational age assessment toolPhysical characteristicsEar cartilage and eyelid fusion
167 Gestational Age Assessment Ballard gestational age assessment toolPhysical characteristicsGenitals
168 Gestational Age Assessment Ballard gestational age assessment toolNeuromuscular characteristicsPosture
169 Figure 7-69 Resting posture Figure Resting posture. A, At a gestational age of approximately 31 weeks, there is extension of the upper extremities and beginning flexion of the thighs.
170 Figure 7-69 (continued) Resting posture Figure 7-69 (continued) Resting posture. B, At term, the newborn exhibits hypertonic flexion of all extremities.
171 Gestational Age Assessment Ballard gestational age assessment toolNeuromuscular characteristicsSquare window
172 Figure 7-70 Square window sign Figure Square window sign. A, At approximately 28 to 32 weeks’ gestation, the angle is 90 degrees.
173 Figure 7-70 (continued) Square window sign Figure 7-70 (continued) Square window sign. B, At a gestational age of approximately 39 to 40 weeks, the angle is commonly 30 degrees.
174 Gestational Age Assessment Ballard gestational age assessment toolNeuromuscular characteristicsArm recoil
175 Figure Elicit the arm recoil by flexing the arms at the elbows to the chest for 5 seconds. A, Then extend the arms at the elbows.
176 Figure 7-71 (continued) Elicit the arm recoil by flexing the arms at the elbows to the chest for 5 seconds. B, Release the arms to see the amount of recoil. In healthy newborns, the angle of flexion is usually less than 90 degrees followed by rapid recoil to the flexed position.
177 Gestational Age Assessment Ballard gestational age assessment toolNeuromuscular characteristicsPopliteal angle
178 Figure To assess the popliteal angle, flex and hold the thigh to the abdomen while extending the leg at the knee.
179 Gestational Age Assessment Ballard gestational age assessment toolNeuromuscular characteristicsScarf sign
180 Figure Scarf sign. A, Until approximately 30 weeks’ gestation, the elbow moves past midline with no resistance.
181 Figure 7-73 (continued) Scarf sign Figure 7-73 (continued) Scarf sign. B, The elbow will not reach midline after 40 weeks’ gestation.
182 Gestational Age Assessment Ballard gestational age assessment toolNeuromuscular characteristicsHeel-to-ear extension
183 Figure 7-74 Heel-to-ear scoring Figure Heel-to-ear scoring. Move the infant’s foot as near to the head or ear as possible and determine the distance between the heel and head.
184 Size for Age Small for gestational age Appropriate for gestational age Large for gestational ageGrowth curvesAccuracy of anthropometric measures in newborns
185 Figure 7-76 Measuring the length of the newborn.
186 General Appearance and Behaviors Head/body ratioPositionMotor activityCry
187 General Appearance and Behaviors Vital signsThermoregulationRespirationsPulseBlood pressure
188 Physical Assessment of Newborn SkinPeelingLanugoNormal color variationsJaundiceCommon alterations
190 Physical Assessment of Newborn HeadMoldingCaput succedaneum
191 Figure 7-78 Caput succedaneum Figure Caput succedaneum. Following vaginal birth, some newborns develop swelling and a collection of serous fluid in the scalp due to birth trauma. The swelling often crosses the suture lines.
192 Physical Assessment of Newborn HeadCephalohematomaSuturesFontanelsSymmetry
193 Figure 7-79 Cephalhematoma Figure Cephalhematoma. Following vaginal birth, some newborns develop a collection of blood between the surface of the cranial bone and the periosteal membrane due to birth trauma. The swelling is usually confined to one cranial bone and does not cross the suture lines. Source: Photo from Zitelli, B. J. & Davis, H. W. (Eds.). (2007). Atlas of pediatric physical diagnosis (5th ed., p. 42, Fig. 2-30). From: Anonymous (2006). Cephalhematoma, Consultant for pediatricians, 5(7), 444. Reprinted with permission. Copyright Elsevier, 2007.
194 Physical Assessment of Newborn EyesChemical conjunctivitisBlink reflexRed reflex vs. opacitiesScleraeTrackingDoll’s eye phenomenon
195 Physical Assessment of Newborn EarsPositionSkin lesions or tagsHearingNoseAppearancePatency of naresFlaring
206 Health/Illness Understanding: Toddler/Preschooler Sees illness as punishmentHas incorrect cause-and-effect perceptionsBegins to understand concept of germsKnows outside body-part namesHas vague knowledge of internal organs
207 Health/Illness Understanding: School-age Knows cause and effect of illnessBeginning understanding of body functionsOlder school age can understand explanations
208 Health/Illness Understanding: Adolescents Understands complex nature of illnessMultiple causes and effectsKnows location and function of major organsConcerned withEffects of illness on appearanceBody image
209 Stages of Separation Anxiety ProtestScreaming, crying, clingingResists attempts to comfortDespairSad, withdrawn, quietCries when parents return
210 Stages of Separation Anxiety DenialProtest subsides, shows interest in settingAppears happy and content
212 Illness/Hospitalization Effects SeparationAll ages affectedFear of the unknownInjections, blood, being touched by strangersPain, disfigurement, invasive procedures, deathLoss of controlMobility, autonomy, privacy
218 Adaptation to Hospitalization Assess familyRoles, knowledge, support systemsPlanned hospitalizationTours, videos, books to prepareUnplanned hospitalizationGreat stress on child and familySiblings may feel guilt, fear, or neglect
220 Sibling Reactions Depend on Age Developmental level Perception and severity of illnessPrior experience and copingKnowledge and understanding of illness
221 Strategies for siblings HonestyReassurance: they did nothing wrong to cause the illnessAllow questions and discussion of feelingsEncourage visits: prepare patient and siblings to minimize adverse reactions
222 Stress Reduction: The 4 Rs Recreation: toys, games, activities, physical activityRest: calm, quiet; bedtime ritualsRelationships: family members, siblings, peers, support groupsRoutines: follow normal routine, provide transition objects, provide consistent caregivers
223 Enhancing Hospitalization Rooming in24/7 parental visitation/family timeParental involvement with careCommunicationPhones, beepers, location of family membersContact for change in condition, proceduresEducation
224 Minimizing Stressors Maximize control Therapeutic play Give choicesEncourage independenceTherapeutic playAddress fears, concernsTherapeutic recreationInteractive activities
225 Nursing Care Focus Minimize fears and anxieties Incorporate familiar routines into hospitalizationSupport family and loved onesMinimize loss of control; promote autonomy
226 Preparation for Procedures AssessmentKnowledge and previous experiencesDevelopmental ageCoping abilitiesFeelings: fears, concerns
227 Preparation for Procedures Communication based on developmental levelClearHonestAge appropriate
228 Psychological Preparation Assess: knowledge, perception, and feelingsPurposePast experienceWill it be painful?Coping techniquesWill parents be present?
229 Psychological Preparation CommunicationUse understandable languageGear to cognitive level and past experienceShare ways to cope during the procedure
230 Parental Presence Physical preparation Depends on age and procedure NPO?Procedural checklistPain management
231 Child Life Programs Focus on psychosocial needs Age-appropriate play Medical play/acting out proceduresTherapeutic playDramatic play
232 Techniques for Therapeutic Play StorytellingDrawings, body outlinesMusic, tape-recorded messagesPuppetryDramatic playAnimal-assisted therapy
234 Special Units and Types of Care General pediatric unitsEmergency department (ED)Neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), or special care unitsPreoperative and postoperative units, post-anesthesia care units (PACU)
235 Special Units and Types of Care Short-stay, outpatient, or ambulatory surgical unitsIsolationRehabilitation
236 Parental Involvement and Presence Provides feelings of controlPrepares family for care required at homeReduces emotional stress and anxietyPromotes feelings of value, worth, and competence to care for their childPromotes parents feeling fully informed, trust of nursing staff
238 Discharge Considerations Family ability to provide careEquipment, trainingFinancial burdensEducational needsParent teachingReturn to schoolwork
239 Preparation for Home Care Plans for school, recovery, adaptationIndividualized education plan (IEP)Individualized transition plan (ITP)Prepare the familyProcedures, medications, emergenciesPrepare parents to act as case managers
240 Preparation for Surgery PreoperativeTeach purpose, sensationsAllow transition objects: teddy bears, blanketsParental presence during anesthesia induction
251 Table 22-1 (continued) The Child’s Developmental Understanding of Death, Potential Behaviors, and Nursing Considerations
252 Sources of Loss for Children ParentGrandparentFriendPets or objectsLoss of an aspect of selfLoss of an object or petSeparation from an accustomed environment
253 Sources of Loss for Children Losses not directly related to the childCrimeDisastersTerror attacks
254 Factors Affecting a Child’s Response to Loss Cultural traditions and practicesReligion and spiritualitySocial support systems
255 Communicating with the Dying Child Promote open communicationStruggle with emotions is commonIdentify what is known, how much child wants to knowListen and give support
256 Withdrawing or Withholding Treatment Decision is extremely difficultParents or nurses may feel that aggressive therapies extend child’s suffering
257 Parental Refusal of Treatment Parents and healthcare providers may disagree regarding interventionsRefusal may be based on religious beliefs or desire to provide peaceful deathTechnical interventions may cause emotional stress to parents
258 Parental Refusal of Treatment Court interventions may be usedConsultation with hospital ethics committee
259 End-of-Life Decisions Palliative care—an approach to improve QOLHospice care—care focusing on ensuring comfortDo Not Resuscitate requestTissue and organ donationAutopsy
260 Informing Parents of a Child’s Prognosis or Death PrivacyBody languageSocial supportResponse to emotionsTiming
261 Physiological Changes in the Dying Child Illness- or injury-dependent changes
262 Physiological Changes in the Dying Child Universal changesCardiovascular systemRespiratory systemNeurological systemMusculoskeletal systemRenal systemAltered nutritionFluid and electrolyte imbalance
263 Assessment of the Dying Child and Family Fears and concernsCoping skillsAwarenessClosed awarenessMutual pretenseOpen awarenessSpiritual needs
264 Nursing Diagnosis for the Dying Child and Family FearHopelessnessRisk for caregiver role strainInterrupted family processesAnticipatory grieving
265 Planning and Implementation Goal settingCompetencies for high-quality end-of-life care
268 Planning and Implementation Special concernsPain managementTrustAngerEducationDesired religious or cultural practices
269 Arrange for Parents and Others to Say Good-bye Allow as much time as needed for farewellsProvide privacy
270 Provide Mementos Save clothing and personal items Collect footprints, locks of hair, and so onPreserve the last clothes worn in a sealed bag to retain the child’s scent
271 Postmortem CareIdentify and implement any religious or cultural practices desired by the familyClean and position the body
272 Psychosocial SupportHelp parents predict when they may expect increased griefRemind parents to care for themselves mentally and physicallyTell parents that people progress through grief at different rates
273 Psychosocial SupportRemind parents that grief puts a tremendous stress on relationshipsEncourage parents to provide for ongoing support of siblingsArrange for continued follow-up for families after the acute period of grief
274 Nurses Who Work with Dying Children May Feel: HelplessThat they failed the dying childSadGrief
275 Stress Management Special preparation is required for the nurse Mentorship with hospice nurseDebriefing sessions with mental health professional