The Child with a Chronic Condition or Terminal Illness

Denial is a common reaction to the diagnosis of a disability or chronic illness. Which statement best applies to denial as a defense mechanism?
It is a necessary cushion to prevent disintegration. Adaptive denial is effective as the family begins to learn the effect that the diagnosis will have on the family.

A nurse is caring for a child dying from cancer. Which physical sign indicates that the child is approaching death?
Change in respiratory pattern. In the final hours of life, the respiratory pattern may become labored, with periods of apnea.

A case manager is assigned to coordinate the care of a child with a complex medical condition, including controlling cost. What term should the nurse use when explaining the need for controlling cost?
Realistic. Controlling cost is one part of care management. With a case manager providing coordination and continuity across care settings and facilitating access to needed medical services, cost control is a potential outcome.

A pediatric nurse is counseling parents regarding the home care of a child with a cardiac defect before corrective surgery. What information should the nurse stress?
Promoting normalcy within the limits of the child’s condition. The child needs to have social interactions, discipline, and appropriate limit setting. Parents need to be encouraged to promote as normal a life as possible for their child.

What is an important nursing consideration when caring for a child with end-stage renal disease (ESRD)?
Multiple stresses are placed on children with ESRD and their families because the children’s lives are maintained by drugs and dependent on technology. ESRD is a chronic, progressive disease with dependence on technology. Families need to arrange for continuing examinations and procedures that are painful and may require hospitalization.

What is the most important goal when caring for a child diagnosed with anorexia nervosa?
Correct malnutrition. Correcting malnutrition is the priority goal of treatment.

A nurse is caring for an 8-year-old child who has a chronic illness. The child has a tracheostomy and a parent is rooming-in during this hospitalization. The parent insists on providing almost all the child’s care and tells the nurses how to care for the child. Based on the nurse’s knowledge of family-centered care, the nurse recognizes that the parent has what need at this time based on concepts of family-centered care?
To be the expert in care of the child. The nurse recognizes that the philosophy of family-centered care states that the parents are the experts in the care of their child.

The potential effects of chronic illness or disability on a child’s development vary at different ages. Which is a threat to a toddler’s normal development?
Hindered mobility. The inability to move about and master the environment will inhibit the toddler’s developing autonomy.

Home care is being considered for a child with a serious chronic illness. In preparing the family for discharge, the case manager has the family provide total care for the child while the child is still hospitalized. What is the most important expectation as a result of this strategy?
The family learns the essential elements of providing care before going home. Having the family provide total care for the child while the child is still hospitalized is very appropriate, but the eagerness depends on the specific family. At least two family members should be comfortable with caring for the child before discharge.

A 10-year-old girl requires daily medications for a chronic illness. The girl’s mother tells the nurse that she has to nag her child to take her medicine before school. What is the most appropriate nursing intervention to promote the child’s compliance?
Establish a contract with the child that includes rewards for taking her medicine. For school-age children, behavior contracting associated with desirable rewards is an effective method for achieving compliance.

A school-age child recently diagnosed with type 1 diabetes mellitus asks the nurse, “Can I still swim and play soccer and baseball?” What should the nurse’s response be?
“Exercise is not restricted unless indicated by other health conditions.” Exercise is encouraged for children with diabetes because it lowers blood glucose levels. Insulin and meal requirements require careful monitoring to ensure that the child has sufficient energy for exercise.

Which activity is an appropriate nursing intervention when caring for a child with chronic osteomyelitis?
Move the child carefully and gently to minimize pain. Osteomyelitis is extremely painful. Movement is carried out carefully, gently, and only as needed.

A nurse is caring for a child with a life-threatening chronic illness in the progressive care unit. A family member is always with the child. What approaches would be most supportive to the family during this time? (Select all that apply).
A. Listen to what the family members are saying about their ability to cope with the situation. (Listening to what the family members are saying about their ability to cope with the situation is very important).
F. Allow the family members to provide the level of care they feel comfortable with. (Allowing the family members to provide the level of care they feel comfortable with provides them a sense of purpose and helps them feel they are doing something positive for their child. Make certain the family member(s) doing the care do it correctly by instruction and monitoring).

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