This is a case Tommy Douglas, a 6-year old male, was admitted with a head injury and secondarily with respiratory failure. His parents, who are with him, stated that he fell from a swing and hit his head on concrete. His injury is a blunt trauma injury. Tommy Douglas was placed on a ventilator, and a ventriculostomy was performed for massive posterior cerebral edema. His vital signs were: HR – 112, RR – 24, BP – 80/60. Tommy Douglas was given bolus infusions of medications and IV fluids, all medications were ordered STAT. GCS score was 5 on admission. The score dropped to 4 and is now 3 with pupils nonreactive. There is no spontaneous respiratory effort. This is indicative of an extremely poor prognosis. Tommy Douglas manifest hypotonic extremities and flexion in response to deep pain.

 

 

His medications are Cefazolin, Dopamine, Heparin, Norepinephrine, Sodium bicarbonate (NaHCO3), Vasopressin. Tommy Douglas’ provider ordered his Norepinephrine @ 2 mcg/min and later the order was changed to increase the rate to 3 mcg/min.

 

He was admitted to the Pediatric Intensive Care Unit in preparation for organ donation. He is status post ventriculostomy with negative cerebral blood flow and requires extensive monitoring and support.

 

“Allowing” a child to die is a very difficult concept. Parents go through several stages of emotion as their child dies.

1.    Discuss what parents go through when their child experiences a life-threatening injury or illness that then becomes terminal.

 

2.    Parents frequently need to talk about what is happening while their child is dying. Why?

 

3.    What signs are present during the dying process that are indicative of imminent death?

 

4.    Assume that you enter the room and find parents sobbing as they sit with their dying child. Does this mean you have not been effective with your teaching and care?

 

5.    How might you guide parents at the time of death? (Hint: Remember that allowing a child to die is tremendously difficult for parents and is often perceived as out of the order of natural events.)

 

6.    What are your thoughts about how you would provide care for the family members after the death of the child?

 

7.    Discuss ways that nurses who care for dying children cope with their own grief.

 

8.    Tommy Douglas has been certified as “brain dead,” and a family conference has been arranged to inform his parents that he will not be helped by further intervention. Who are the usual participants in such a conference? What does each person bring to the discussion?

 

9.    What intervention can the nurse provide to the parents after the family conference?

 

10. What if Tommy Douglas’ parents say that they want him to live “at all costs”? How would you feel about this?

 

11. Discuss how your response to the previous question might affect your care for Tommy Douglas’ parents.

 

12. Tommy Douglas’ parents have agreed to organ donation. Does this provide evidence of progression with anticipatory grieving?

 

13. Visit the website for United Network for Organ Sharing (www.unos.org) and discuss the criteria for donation and management of a potential donor.

 

14. Tommy Douglas is to receive hospice care. Compare palliative and hospice care. (Hint: You may want to refer to your medical dictionary).

 

15. Tommy Douglas has a brother who is 8 years old. Which description best expresses his likely understanding of death and dying?

a.    Recognizes death as final

b.    Has a grasp of the abstract concept of death

c.    May have feeling of self-responsibility for sibling’s death

d.    May view death as temporary

 

16. When interacting with Tommy Douglas’ 4-year-old sister, which approach will be most effective?

a.    Encouraging the parents to allow the child to participate in the funeral

b.    Encouraging communication and discussion

c.    Offering reassurance to the child

d.    Recognizing the child is primarily responding to the anxiety and sadness being expressed by the parents

 

17. How are siblings of a dying child likely to view death?

 

18. The parents of a child who has died have a higher rate of divorce. (True or False)

 

19. For parents who have lost a child, what anticipatory guidance could you offer for dealing with other children in their family?