Let parents make those decisions even though not always what we think is best for the child Supporting the family Encourage family participation at death o Holding, touching, snuggling o Provide PRIVACY Keep visitors away if family wants! Some parents feel the need to give permission to go Organ-tissue donation Postmortem care o Some will want to have part in the bath Hand and foot molds, lock of hair, hand prints o Will do hand and foot molds, hand prints, lock of hair (cut from back) o Make two copies! 50% chance of divorce after child death… Child Life o Will go in and take pictures of everything in the patient room Will take far away & up close picture Show sibling & tell what they are doing and why sibling needs it so that when sibling walks in door they are more prepared & less likely to have PTSD from experience Common nurse reactions Physical o Disturbances in eating and sleep patterns o Difficulty concentrating o Headache/fatigue o Nausea/vomiting/ diarrhea o Tachypnea/tachycardia
o Muscular tension Psychological o Fear, grief, remorse o Isolation o Frustration, anger, irritability o Depression o Self-doubt o Flashbacks Coping for the Nurse EAP – employee assistance program o Help provide you with emotional support that you need to continue being a nurse forYOU – debriefing o after codes, pt deaths, everyone who wants to go who had contact with pt and their care talk in safe space o discuss problems, what went well or didn’t, what could have helped Positive coping o Debriefs o Physical exercise o Routines o Give yourself permission to feel o Do something nice for yourself Neonatal Intensive Care Unit Pt has not been home since being born NICU Prematurity – number one reason Ill neonates – sepsis, GBS positive mothers, meconium aspiration, hyper/hypothermia, feeding difficulties, gestational diabetes/hypoglycemia Congenital defects – chromosomal abnormalities, hypothyroidism, cleft lip/palate, heart defects, birth defects – spina bifida, omphaloceles o TPN/lipids – complications = infection risk HIGH Liver very under developed – problem with lipids – liver labs monitored closely Hyper/hypoglycemia issues & electrolyte imbalances NICU Parent bonding issues o Mom in different hospital Separation issues o Kids at home Breastfeeding o Babies not big enough or not capable of breast feeding o Mom has to pump – hard to get milk to come in Family liaison or counselor o Social workers very important to be involved
o Parents will need help & support Neonatal Resuscitation They forget to breathe – floppy airway ABCs vs. CAB Thermoregulation o Premie Bag – Ziploc bag with hole cut for head Prevents evaporative heat loss because thin skin with no vernix o Trouble keeping temp when so small Developmental care o Get pt as advanced in development as we can o Adjust for their age o Born 32 weeks – 8 weeks early
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- Spring '17