🧩 Special Needs Cram
Chapter 34 · highest-yield points
1Who these children are
Chronic condition + services beyond typical
Temporary · lifelong · progressive · terminal
Nursing priorities never change: development · independence · quality of life · family support. Care = child + family + interdisciplinary team.
2Illness hits each stage's job
Infant: attachment disrupted
Toddler: autonomy reduced
Preschool: play + peers limited
School-age: school + competence hit
Teen: body image + independence
Plus: anxiety, isolation, low self-esteem, more dependence. Responses vary by development + prior experience.
3Vulnerable child syndrome
Parents still see a RECOVERED child as fragile
Follows prematurity · serious illness · near-loss
Leads to overprotection, restricted activities, extra health care visits, stunted independence. Fix = build parental confidence.
4Parents are the experts
Assess all 4: physical · developmental · psychosocial · educational
Coordinate the team · anticipate change
Parents know the child's daily care — you know the disease, they know the child. Don't forget siblings: less attention, jealousy, worry.
5Technology at home + discharge
Ventilator · tracheostomy · tube feeds · central line
Return demonstration proves competence
Discharge starts early: supplies, meds, specialist follow-up, written care + emergency instructions, backup plan for equipment failure.
6Corrected age — the split rule
Milestones + growth: CORRECTED age (to 24 mo)
Vaccines: CHRONOLOGICAL age
Corrected = age minus weeks born early. Former preemies risk chronic lung disease, delays, vision/hearing loss — keep up developmental surveillance.
7Feeding: catch-up vs undernutrition
Catch-up growth: fortified milk · special formula
Track weight · length · head circumference
Undernutrition = high demands · swallowing trouble · gut/chronic disease · limited access. Early recognition — growth lost is hard to regain.
8IDEA: Part C vs Part B
Part C: birth–2 · IFSP (family plan) · home-based
Part B: ages 3–21 · IEP (education plan) · school-based
IFSP = Individualized Family Service Plan. IEP = Individualized Education Program. Age picks the answer: under 3 = C, school-age = B.
9Respite + transition to adult care
Respite = temporary relief for caregivers
Transition starts in EARLY adolescence
Assess caregiver burden. Transition: grow self-management, check teen's understanding, plan insurance/jobs, find adult providers, transfer records.
10DNR ≠ no treatment
DNR / AND: no CPR after arrest — that's all
Comfort care CONTINUES
AND = allow natural death. Treat pain, symptoms, everything else as ordered. Orders must be documented + communicated.
11Palliative vs hospice
Palliative: starts at diagnosis · WITH treatment
Hospice: near end of life · comfort only · eligibility required
Care alongside chemotherapy = palliative. Hospice adds bereavement care for the family.
12Comfort + talking about death
Appetite falls near death — expected, don't force intake
Oral care + lip moisture = real comfort
Death understanding: preschool = temporary/reversible + magical thinking · school-age = permanent · teen = adult-like. Never use euphemisms ("went to sleep") — kids take them literally.