1. The team of doctors want to discuss Mikey’s long term options with the family. Discuss how the team (including doctors, nurses, social workers) can collaborate and implement interventions that can best support the family while having such an important discussion.

2. The parents are very concerned about if Mikey is comfortable or not. How would you educate the parents on how nurses assess for pain in this population? Discuss the pain scale that you would use. What kind of pain control do you think is appropriate for this patient? Do you think he may require sedation? What might be the risks of using sedation and/or pain medication? How would you educate the family about the use of sedation? Use a reference to support your rationale.

3. The physician orders morphine for to help manage Mikey’s pain. He orders 0.1mg/kg/dose IV every 4 hours. Calculate the final dose you will administer to Mikey as well as how much volume of medication you will administer. Mikey weighs 24 pounds. The concentration of morphine is 0.5mg/1ml.

4. Now discuss the action of morphine, its potential side effects, nursing considerations, and how fast you can administer it to a child this age.  

5. The team informs the family that Mikey has suffered from a submersion injury. Discuss the pathophysiology of this type of brain injury, risk factors, possible outcomes, and prognosis. How might the nurse offer some resources and support to this family, including the sibling during this time of diagnosis and prognosis? What are some common responses in parents who face situations like this?

The team informs the family of a few different treatment options for Mikey. They tell the family that after some tests, they believe Mikey to be in a prolonged coma with absence of brain reflexes. They are not sure if Mikey’s brain activity is ever going to return. They explain to the family that they can continue to keep Mikey alive by placing a tracheostomy tube to provide his breathing support long-term, but that it may mean he might have to live in a facility for children that need extensive medical care, or they would have to provide extensive care at home. They continued to explain that if they want to consider this option that Mikey would physically be comfortable, but his quality of life would be different and developmentally, they are expecting him to not progress. Another option would be to allow Mikey to die peacefully and comfortably in the hospital by withdrawing active support, such as nutrition and the breathing tube.

6. Discuss Mikey’s sibling’s response to the hospitalization and family stressor. What kind of behavior is she demonstrating? Describe which developmental stage she is likely is in and its implications on her response and behaviors.

7. Discuss the criteria for establishing brain death in Mikey’s age group. Explain the process of evaluation as if you are teaching Mikey’s parents who do not have any medical background. Discuss how a family may be impacted by having a child with a tracheostomy tube. Use a family theory (Bowen Family Systems Theory, Duvall’s Developmental Theory, or Family Stress Theory) to evaluate how the family system may be impacted.

Mikey’s parents decide they want to continue to care at this time at the hospital and not implement any new interventions or withdrawing interventions. They would like for the team to re-evaluate his brain function in 2 more weeks.

8. Create a nursing care plan starting with a nursing diagnosis appropriate for this patient and/or family for the next two week of the hospitalization. Include your assessment that supports your nursing diagnosis, goals for outcomes, interventions (supported by peer-reviewed rationales), planning, implementation, and evaluation.

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