Ch 43 Loss, Grief And Dying Flashcards
What is grief?
Internal emotional reaction to loss.
What is bereavement?
State of grieving from loss of a loved one.
What is mourning?
Actions and expressions of that grief (ceremonies, symbols).
What are the 5 stages of grieving?
1) Denial and isolation = “
2) Anger
3) Bargaining
4) Depression
5) Acceptance
What situations can lead to errors in death certifications?
- Hypothermia
- Drug or metabolic intoxication
- Circulatory shock
- Requires close assessment
What are the 3 different definitions of death?
1) Traditional heart-lung = irreversible cessation of spontaneous respiration and circulation
2) Whole brain = irreversible cessation of all functions of the entire brain
3) Higher brain = irreversible loss of all “higher” brain function
What are the S x S of the Respiratory System before dying?
- increase resp rate
- Cheyne-Stokes respirations
- irregular breathing –> slowing down to terminal gasps
- inability to cough or clear secretions –> grunting (death rattle)
- elevated temperature
What are the S x S of the Cardiovascular System before dying?
- elevated HR –> later slowing and weakening of pulse
- irregular rhythm
- decreased BP
- pitting edema
- skin cold and clammy (although pt may be febrile)
- cyanosis
What are the S x S of GI and GU systems before dying?
- inability to swallow
- slowing of GI and urinary tracts and possible cessation of function
- accumulation of gas
- distention and nausea
- loss of sphincter control for both systems
- bowel movement and incontinence may occur before imminent death or at time of death
What are the S x S of the Musculoskeletal System before death?
- gradual loss of ability to move, sensation and reflexes
- sagging of jaw –> loss of facial muscle tone
- difficulty speaking
- difficulty maintaining body posture and alignment
- loss of gag reflex
- jerking seen in pts on large amounts of opioids
What are the psychosocial S x S before death?
- may or may not lose consciousness
- altered decision making
- anxiety about unfinished business/ restlessness
- fear of loneliness/ pain
- helplessness
- life review
- vision-like experiences
What is “Palliative Care”?
Taking care of the whole person - body, mind, spirit, heart and soul.
What are the 2 different types of advance directives?
1) Living Will = provides specific instructions about the kinds of healthcare that should be provided or foregone in particular situations and is stated by patient himself.
2) Durable Power of Attorney = an agent representative chosen by the patient himself becomes in charge of the healthcare decision making, in the event if subsequent incapacity.
What is “Terminal Weaning”?
Gradual withdrawal of mechanical ventilation from a patient with a terminal illness or an irreversible condition with a poor prognosis.
What are the special orders in terms of medical care?
- Do-Not-Resuscitate = DNR
- Limited Code Orders
- Comfort measures only
- Do-Not hospitalize
- Terminal weaning
What are the priorities in the physical care of a dying patient?
- symptoms management
- PRIORITY is to meet physiologic and safety needs
- pain relief/ oxygen
- deserve same care as patients expected to recover
What does the psychosocial care entitle?
- providing safe environment that allows pt to express his feelings
- assist pt and family w/ grief experience
- respect pt’s privacy
- honesty in answering questions and giving information is essential
- Be careful to make sure RN is aware of how much patient wants the family to know
What are the 2 different types of dysfunctional grieves?
1) Inhibited grief = a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations.
2) Unresolved grief = describes a state of bereavement that extends over a lengthy period.
What are the 4 criteria to certify a death?
1) Cessation of breathing
2) No response to deep painful stimuli
3) Lack of reflexes (such as gag or corneal reflex) and spontaneous movement
4) Non reversible loss of brain function
(T/F) Is it the nurse’s responsibility to ensure that the physician has signed the death certificate?
True
Who needs to sign the patient’s death certificate?
1) Physician
2) Pathologist
