Chapter 43 - Loss Grief and Dying Flashcards

1
Q

Key Terms

A
Actual Loss
Perceived Loss
Physical Loss
Psychological Loss
Maturational Loss
Situational Loss
Anticipatory Loss
Grief 
***Necessary to maintain quality in both emotional and physical well-being
Individual experience (thoughts, feelings, behaviors)
Manifested in a variety of ways
Bereavement
Mourning
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2
Q

Stages of Grieving

A
Kubler-Ross
Denial/Isolation
Anger
Bargaining
Depression
Acceptance
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3
Q

Dysfunctional Grief

A

Prolonged, disruptive, unresolved or inhibited
Intensity extends over lengthy period

Inhibited grief

Conflicted grief
Bereaved person appears to be coping, carrying on as if nothing has happened

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4
Q

Goals of Grieving

A
Goals for the grief process
Resolving emotions
Reflecting on the dying person
Expressing feelings of loss and sadness
Valuing what has been shared
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5
Q

Three Definitions of Death

A

Traditional heart-lung—irreversible cessation of spontaneous respiration and circulation
Whole brain—irreversible cessation of all functions of the entire brain
Higher brain—irreversible loss of all “higher” brain function

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6
Q

Respiratory System

A
↑ respiratory rate
Cheyne-Stokes respiration 
Irregular breathing
 Slowing down to terminal gasps
Inability to cough or clear secretions 
 Grunting, gurgling, or noisy congested breathing (death rattle)
Elevated Temperature
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7
Q

Cardiovascular System

A
↑ heart rate
 Later slowing and weakening of pulse
Irregular rhythm
↓ blood pressure 
Pitting edema
Skin cold and clammy (although patient may be febrile)
Cyanosis
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8
Q

Gastrointestinal & Urinary Systems

A

Inability to swallow
Slowing of gastrointestinal and urinary tracts and possible cessation of function
Accumulation of gas
Distention and nausea
Loss of sphincter control for both systems
Bowel movement and urinary incontinence may occur before imminent death or at the time of death

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9
Q

Musculoskeletal System

A

Gradual loss of ability to move, sensation and reflexes
Sagging of jaw
Loss of facial muscle tone
Difficulty speaking
Swallowing can become more difficult
Difficulty maintaining body posture and alignment
Loss of gag reflex
Jerking seen in patients on large amounts of opioids

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10
Q

Psychosocial Manifestations

A
May or may not lose consciousness
Altered decision making
Anxiety about unfinished business/ Restlessness
↓ Socialization / Fear of loneliness/meaningless/pain
Helplessness
Life review
Peacefulness / Saying goodbyes
Unusual communication
Vision-like experiences
Withdrawal
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11
Q

Components of a Good Death

A
Pain and symptom management
Clear decision making
Preparation for death
Completion
Contributing to others
Affirmation of the whole person
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12
Q

End Of Life Care
Goals
Provide comfort and supportive care during the dying process
Improve the quality of the remaining life
Advance care planning
Help ensure a dignified death
Support bereavement needs of family

A

Goals
Provide comfort and supportive care during the dying process
Improve the quality of the remaining life
Advance care planning
Help ensure a dignified death
Support bereavement needs of family

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13
Q
Variables Affecting EOL Care
Attitudes
Beliefs
Cultural, religious, family influences
Spiritual needs
Avoid stereotyping by completing assessments on an individual basis
A
Attitudes
Beliefs
Cultural, religious, family influences
Spiritual needs
Avoid stereotyping by completing assessments on an individual basis
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14
Q

Five Principles of Palliative Care

A

Respects goals, likes, and choices of the dying person and his loved ones
Looks after the medical, emotional, social, and spiritual needs of the dying person
Supports the needs of family members
Helps to gain access to needed healthcare providers and care setting
Builds ways to provide excellent care at end of life

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15
Q

Advance Directives

A

Decide the kind of medical treatment the patient wants or doesn’t want
Decide who will make decisions for the patient in case he or she is unable
Decide how comfortable the patient wants to be
Decide how the patient will be treated by others
Decide what the patient wants loved ones to know

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16
Q

Special Orders

A
Do-Not-Resuscitate
Limited Code Orders
Comfort measures only
Do-not-hospitalize
Terminal weaning
17
Q

Legal and Ethical Issues

A
Organ Donation
Autopsy
Death Certificate
Assisted Suicide 
Active Euthanasia
18
Q

Factors that Affect Grief & Dying

A
Developmental Considerations
Family
Socioeconomics factors
Cultural & Gender Influences
Religious Influences
Causes of Death
19
Q

Nursing Assessment

A

Be sensitive
Do not impose repeated, unnecessary assessments
Use health history data available in chart
Important to assess the patient’s status frequently
Assess patient’s & family’s:
Knowledge
Perceptions
Coping strategies
Resources

20
Q

Nursing Diagnosis

A

Response to Loss as the problem
–Impaired adjustment r/t newly diagnosed terminal illness
–Caregiver role strain r/t demands of caring for dying wife
–Impaired skin integrity r/t immobility
–Impaired gas exchange r/t ventilation-perfusion imbalance
Response to Loss as the Etiology
–Anxiety r/t unpredictability of the course of illness
–Nausea r/t effects of chemotherapy
–Fatigue r/t constant demands of caring for dying husband

21
Q

Outcome Identification & Planning

A

Patient/family will
Verbalize feelings, needs, fears, and concerns
Identify and use effective coping strategies
Accept need for help and use available resources
Participate in decision-making process
Report sufficient relief of pain
Experience a dignified and comfortable death
Resolve grief and resume meaningful roles and daily activities

22
Q

Nursing Implementation

A

Develop a trusting nurse-patient/family relationship
Holistic (psychosocial, physical needs)
Assess patient’s and family’s grieving process
Explain the patient condition & treatment
Teach self-care & promote self-esteem
Teach family to assist in care
Meet patient’s and family’s needs
Provide postmortem care

23
Q

Physical Care

A

Symptom management

  • -Priority is to meet physiologic and safety needs
    • (Pain, Mobility, Elimination, Nutrition, Skin care)
  • -Pain relief / Oxygen
  • -Deserve same care as people who are expected to recover
24
Q

Psychosocial Care

A

Anxiety
Frequently related to fear
Management (Pharmacologic & Nonpharmacologic interventions)
Encouragement, support, and education to ↓ anxiety
Fear
Typical feeling
Nurse assists with coping
Three specific fears (Pain, loneliness and abandonment, meaninglessness)
Communication
Therapeutic communication is an important nursing intervention
Empathy and active listening are essential
Allow patients and families time to express their feelings, thoughts
Grief
Provide an environment that allows the patient to express feelings
Patient should be free to express feelings of anger, fear, or guilt without judgment
Let patient and family know that the grief reaction is normal
Respect for patient’s privacy and need or desire to talk (or not talk) is important
Honesty in answering questions and giving information is essential
Grief
Families and patients need encouragement to continue their usual activities as much as possible
Planning for the future or for the funeral may be needed based on patient’s or family’s coping abilities
Anger is a common and normal response
Nurses are sometimes the target of anger
Do not react on a personal level
Feelings of hopelessness, powerlessness are common

25
Q

Providing Postmortem Care

A
Care of the body
Care of the family
Discharging legal responsibilities
Death certificate issued and signed
Labeling body
Reviewing organ donation arrangements if any
Care of other patients
26
Q

Postmortem Care of the Body

A

Prepare body for discharge
Place body in anatomical position, replace dressings, and remove tubes (unless there is an autopsy scheduled)
Place identification tags on the body
Follow local law if patient died of communicable disease

27
Q

Postmortem Care of the Family

A

Listen to family’s expressions of grief, loss, and helplessness
Offer solace and support by being an attentive listener
Arrange for family members to view the body
In the case of sudden death, provide a private place for family to begin grieving
It is appropriate for the nurse to attend the funeral and make a follow-up visit to the family

28
Q

Special Needs of Nurses

A

Common for nurse to feel helpless and powerless when dealing with death
Feelings of sorrow, guilt, frustration need to be expressed
Recognize and acknowledge what can and cannot be controlled
Recognize personal feelings to allow openness
Okay to cry with the patient or family during the grieving process