Nursing Care Plans

4 Dying Child Nursing Care Plans

April 16, 2018

Meeting the physical, emotional, and psychosocial need of a dying child is important to support the totally dependent child and grieving family in experiencing the best quality of life possible. The child’s terminal illness and care can affect the whole family, hence, the nurse initial role is to establish rapport in order to build and develop effective communication that assists in alleviating unnecessary fears and anxiety about impending death and supporting anticipatory grieving.

Nursing Care Plans

Nursing care plan for a dying child involves providing substantial and appropriate age-related information about death and dying to allay anxiety, providing optimal pain relief through pharmacological and non-pharmacological methods, assisting the child to move through the stages of awareness and acceptance, and helping the family cope through the stages of grieving.

Here are four (4) nursing care plans (NCP) and nursing diagnosis (NDx) for a dying child:

Acute Pain

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

May be related to

Biologic, physical, psychological injuring agents

Possibly evidenced by

Communication [verbal or coded] of pain descriptors
Age-related expression of pain behaviors
Crying, moaning
Facial grimacing
Guarding, protective behavior
Withdrawal
Increase in heart rate, breathing rate, and blood pressure
Irritability, restlessness
Tension or flexion of muscles

Desired Outcomes

Child will appear relaxed and is not crying, grimacing, and moaning.
Child will experience less pain.

Nursing Interventions	Rationale
Assess intensity of pain, fear of receiving pain medication, anxiety and coping mechanisms related to pain, ability to rest and sleep.	Provides information as a basis for analgesic administration. Developmentally-based pain scales provide an accurate assessment of child’s discomfort.
Administer intermittent or continuous analgesic as prescribed based on the severity of the pain, and administer prior any painful procedure or care is performed.	Provides coverage of pain medications to guarantee freedom from any type of pain and discomfort including administration of analgesic for quick relief if given intermittently.
Educate child and parents of the route of medication administration and expected side effect; that pain will be monitored continuously and medication adjusted as needed to control pain.	Provides assurance that pain will be controlled continuously whether or not the child is able to express pain.
Support coping mechanisms of child and family and modify analgesic accordingly, with input from child, parents, and physician.	Promotes child’s comfort, supports coping abilities and includes parents and child in decision making regarding care.
Provide familiar toys/blankets to the child; Encourage parents and significant others to stay with the child at all times.	Reduces fear and supports comfort of the child.
Provide nonpharmacologic pain management strategies: therapeutic touch, soothing baths; massage therapy to painful areas; distraction techniques (e.g., guided imagery, hypnosis, biofeedback, breathing techniques, music, reading, journal writing, gentle movement, aroma, humor, prayer,, hypnosis, relaxation techniques).	Reduces pain perceptions and may foster a sense of control.
Dim lights, avoid noise, maintain clean, comfortable bed with loose sheets and clothing, disturb for care only when needed to promote comfort.	Provides an environment free of stimuli that increase anxiety and pain.
Assist with position changes as tolerated, use pillows to support position, move slowly with gentle handling, give a backrub.	A nonpharmacologic measure to reduce the pain.
Discuss with child and parents that verbalizing fear and feelings about pain and its control is common.	Decreases anxiety by recognizing fear of pain and encouraging to express feelings and concerns about methods of control.
Educate parents and child that care and treatment will only be palliative.	Lessens anxiety and stress caused by apprehension of painful interventions.