MATERNAL CHILD NURSING CARE CHAPTER 36 CHRONIC ILLNESS, DISABILITY, AND END-OF-LIFE-CARE.

The parents of a terminally ill child are speaking with the nurse to learn about palliative care and how it differs from hospice care. What should the nurse tell them? "Palliative care: 1 Requires that a patient be a Medicare recipient." 2 Does not provide care for hospitalized patients." 3 Is provided when no effective cure is available." 4 Does not provide spiritual support to the family." 3 RATIONALE The terms palliative care and hospice care are associated with end-of-life care. Palliative care may be provided when no cure is available. Palliative care seeks to prevent, relieve, reduce, or soothe the symptoms of disease or disorder without effecting cure. Hospice care supports the patient and the family during the dying process (medical prognosis of 6 months or less) and the surviving family members through the process of bereavement. It provides total care for the patient in the hospital, home, and nursing home when the patient's disease is unresponsive to the curative treatment. To qualify for hospice care, the patient does not need to be a Medicare recipient. Most insurance programs cover hospice care. However, for palliative care, the patient needs to be a Medicare recipient. Palliative care can be provided to patients in a variety of settings, including hospitals. Both palliative care and hospice care include spirituality in order to provide holistic care. Nurses need to familiarize themselves with the attitudes and needs of various religious groups so that they can address the spiritual needs of their patients, families, and other members. The parents of a 12-year-old child are informed that the child is in the terminal stages of osteosarcoma. The nurse explains to the parents about the care that needs to be provided for the child. Which characteristics in the parents indicate that they are in denial? Select all that apply. 1 Want the child to be admitted for more treatment 2 Refuse to believe the results of the tests 3 Pleased to receive the medical diagnosis 4 Ask questions about treatment or prognosis 5 Insist that nobody is telling them the truth CORRECT ANSWER 1, 2, 3, 5 RATIONALE The initial diagnosis of a terminal illness in a child is met with shock or denial. Parents experience this reaction, and it can last for days, weeks, or months. If the parents ask questions about the child's treatment or prognosis, this indicates that they have accepted the diagnosis. Parents in denial may want the child to be admitted for more medical treatment. They may feel the terminal diagnosis is wrong and refuse to believe the test results. People are usually not pleased to receive a terminal diagnosis; they are upset and angry. Insisting that nobody is telling them the truth is also an indicator of denial. Read More Which child behaviors indicate maladaptive coping toward chronic illness? Select all that apply. 1 Is irritable both at home and during school 2 Demonstrates feelings of pessimism and inadequacy 3 Expresses feelings of worthlessness to others 4 Expresses anxiety during remissions 5 Demonstrates confidence during an exacerbation CORRECT ANSWER 1, 2, 3 RATIONALE Children with negative and declining attitudes toward their chronic illness use maladaptive coping patterns. These maladaptive coping patterns are characterized by irritability at home and school. The child has a pessimistic outlook toward the disease and feels inadequate in managing it. The child may feel different, withdrawn, and less worthy than others. The child who has healthy coping skills may expresses appropriate emotions, such as anxiety, sadness, and anger, during periods of illness exacerbations. Demonstrating confidence during remissions indicates healthy coping skills The parents of a terminally ill child are overwhelmed with the volume of telephone calls asking about the child's condition. What suggestion should the nurse give to the family to make communication easier? 1 "Allow open visiting hours for all family members and the child's friends." 2 "Designate one family member or friend to relay information to everyone else." 3"Instruct the family to create a website for information and to post updates." 4"Tell the parents that answering calls and e-mails will help keep them busy." 2 RATIONALE To minimize stress on parents, the family should designate one family member or friend to relay information to others. Open visiting hours would increase the workload of the staff and interfere with care. In addition, the parents would not get any rest because of the continual need to entertain friends and family. Suggesting that the family create a website to post updates or asking parents to answer calls to keep busy may not be helpful. The parents do not need more work to do while dealing with the child's condition.