chapter 36 : loss and grief Flashcards
A nurse encounters a family who experienced the death of their adult child last year. The parents are talking about the upcoming anniversary of their child’s death. The nurse spends time with them discussing their child’s life and death. Which nursing principle does the nurse’s action best demonstrate?
a. Facilitation of normal mourning
b. Pain-management technique
c. Grief evaluation
d. Palliative care
a. Facilitation of normal mourning
Anniversary reactions can reopen grief processes. A nurse should openly acknowledge the loss and talk about the common renewal of grief feeling around the anniversary of the individual’s death; this facilitates normal mourning. The nurse is not attempting to alleviate a physical pain. The actions are of open communication, not evaluation. Palliative care refers to comfort measures for symptom relief.
A patient diagnosed with terminal cancer asks the nurse what the criteria are for hospice care. Which information should the nurse share with the patient?
a. It is for those needing assistance with pain management.
b. It is for those having a terminal illness, such as cancer.
c. It is for those with completion of an advance directive.
d. It is for those expected to live less than 6 months.
d. It is for those expected to live less than 6 months.
Patients accepted into a hospice program usually have less than 6 months to live. Patients with a terminal illness are not eligible until that point. Palliative care provides assistance with pain management when a patient is not eligible for hospice care. An advance directive can be completed by any person, even those who are healthy.
A terminally ill patient is experiencing constipation secondary to pain medication. Which is the best method for the nurse to improve the patient’s constipation problem?
a. Contact the health care provider to discontinue pain medication.
b. Administer enemas twice daily for 7 days.
c. Massage the patient’s abdomen.
d. Use a laxative.
d. Use a laxative.
Opioid medication is known to slow peristalsis, which places the patient at high risk for constipation. Laxatives are indicated for opioid-induced constipation. Massaging the patient’s abdomen may cause further discomfort. Discontinuing pain medication is inappropriate for a terminally ill patient. Enema administration twice a day is not the best step in the treatment of opioid-induced constipation.
A severely depressed patient cannot state any positive attributes to life. The nurse patiently sits with this patient and assists the patient to identify several activities the patient is actually looking forward to in life. Which spiritual concept is the nurse trying to promote?
a. Time management
b. Reminiscence
c. Hope
d. Faith
c. Hope
Hope gives a person the ability to see life as enduring or having meaning or purpose. The nurse’s actions do not address time management, reminiscence, or faith. Time management is organizing and prioritizing activities to be completed in a timely manner. Reminiscence is the relationship by mentally or verbally anecdotally relieving and remembering the person and past experiences. Faith is belief in a higher power.
In preparation for the eventual death of a hospice patient, the nurse organizes a meeting of all hospice caregivers. A plan of care to be followed when this patient dies is prepared. Which information will be included in the plan?
a. Avoid discussing the death with immediate family members.
b. Discuss expectations of normal grieving with the family and friends.
c. Encourage the patient’s family and friends to verbally express their needs.
d. Assure family members they will not be expected to assist with postmortem care.
c. Encourage the patient’s family and friends to verbally express their needs.
Families and friends should be encouraged to express both their concerns and needs so the staff can effectively care for them. Avoiding the discussion of death-related issues, reinforcing expected grieving behaviors and in any way limiting contact with the patient during or after the death process is inappropriate.
Family members gather in the emergency department after learning that a family member was involved in a motor vehicle accident. After learning of the family member’s unexpected death, the surviving family members begin to cry and scream in despair. Which phase does the nurse determine the family is in according to the Attachment Theory?
a. Numbing
b. Reorganization
c. Yearning and searching
d. Disorganization and despair
c. Yearning and searching
Yearning and searching characterize the second bereavement phase in the Attachment Theory. Emotional outbursts of tearful sobbing and acute distress are common in this phase. During the numbing phase, the family is protected from the full impact of the loss. During disorganization and despair, the reason why the loss occurred is constantly examined. Reorganization is the last stage of the Attachment Theory in which the person accepts the change and builds new relationships.
A nursing assistive personnel (NAP) is caring for a dying patient. Which action by the NAP will cause the nurse to intervene?
a. Elevating head of bed
b. Making the patient eat
c. Giving mouth care every 2 to 4 hours
d. Keeping skin clean, dry, and moisturized
b. Making the patient eat
Patients should never be forced to eat so the nurse will intervene to correct this inappropriate behavior. Eating in the last days of life often causes the patient pain and discomfort. Equally, as the body is shutting down the nutrients in food are not able to be absorbed. Therefore, forcing patients to eat serves no beneficial purpose for the patient. All the rest are correct and do not need the nurse to intervene. Elevating the head of the bed is appropriate and will promote ease of breathing and lung expansion and facilitate postural drainage. Giving mouth care will protect membranes if dehydrated, nauseated, or vomiting. Keeping skin clean, dry, and moisturized will decrease skin discomfort and prevent skin breakdown.
An Orthodox Jewish rabbi has been pronounced dead. The nursing assistive personnel respectfully ask family members to leave the room and go home as postmortem care is provided. Which statement from the supervising nurse is best?
a. I should have called a male colleague to handle the body.‖
b. Family members stay with the body as part of the mourning ritual.
c. I wish they would go home because we have work to do here.
d. Family will quietly leave after praying and touching the rabbi’s head.
b. Family members stay with the body as part of the mourning ritual.
Jewish culture calls for family members or religious officials to stay with the body until the time of burial. A male provider is unnecessary. Requesting or expecting the family to home is not providing culturally sensitive care. Hindus and Muslims usually have persons of the same gender handle the body after death. Buddhists often say prayers while touching and standing at the head of the deceased.
A palliative team is caring for a dying patient in severe pain. Which action is the priority?
a. Provide postmortem care for the patient.
b. Support the patient’s nurse in grieving.
c. Teach the patient the stages of grief.
d. Enhance the patient’s quality of life.
d. Enhance the patient’s quality of life.
The primary goal of palliative care is to help patients and families achieve the best quality of life. Providing support for the patient’s nurse is not the primary obligation when the patient is experiencing severe pain. Not all collaborative team members on the palliative team would be able to provide postmortem care, as is the case for nutritionists, social workers, and pharmacists. Teaching about stages of grief should not be the focus when severe pain is present.
A veteran is hospitalized after surgical amputation of both lower extremities owing to injuries sustained during military service. Which type of loss will the nurse focus the plan of care on for this patient?
a. Perceived loss
b. Situational loss
c. Maturational loss
d. Uncomplicated loss
b. Situational loss
Loss of a body part from injury is a situational loss. Maturational losses occur as part of normal life transitions across the life span. A perceived loss is uniquely defined by the person experiencing the loss and is less obvious to other people. Uncomplicated loss is not a type of loss; it is a description of normal grief.
―I know it seems strange, but I feel guilty being pregnant after the death of my son last year,‖ said a woman during her routine obstetrical examination. The nurse spends extra time with this woman, helping her realize bonding with this unborn child will not mean she is replacing the one who died. Which nursing technique does this demonstrate?
a. Providing curative therapy
b. Promoting spirituality
c. Facilitating mourning
d. Eradicating grief
c. Facilitating mourning
The nurse facilitates mourning in family members who are still surviving. By acknowledging the pregnant woman’s emotions, the nurse helps the mother bond with her fetus and recognizes the emotions that still exist for the deceased child. The nurse is not attempting to help the patient eradicate grief, which would be unrealistic. Curative therapy (curing a disease) and spiritual promotion (belief in a higher power or in the meaning of life) are not addressed by the nurse’s statement.
A patient has had two family members die during the past 2 days. Which coping strategy is most appropriate for the nurse to suggest to the patient?
a. Writing in a journal
b. Drinking a little alcohol to go to sleep
c. Exercising vigorously rather than sleeping
d. Avoiding talking about the deaths with friends
a. Writing in a journal
Coping strategies may be healthy and effective like talking, journaling, and sharing emotions with others. They may also be unhealthy and ineffective like increased use of alcohol, drugs, and violence. Although exercise is important for self-care, sleep is also important. Shutting oneself away from friends and family by not talking about the sadness is not effective; the patient should spend time with people who are nurturing.
A nurse is called into the supervisor’s office regarding deteriorating work performance since the loss of a spouse 2 years ago. The nurse begins sobbing and says, ―I’m falling apart at home as well‖. Which type of grief is the nurse experiencing?
a. Normal grief
b. Perceived grief
c. Complicated grief
d. Disenfranchised grief
c. Complicated grief
In complicated grief, a person has a prolonged or significantly difficult time moving forward after a loss. Normal grief is the most common reaction to death; it involves a complex range of normal coping strategies. Disenfranchised grief involves a relationship that is not socially sanctioned. Perceived grief is not a type of grief; perceived loss is a loss that is less obvious to other people.
A nurse is caring for a patient in the last stages of dying. Which finding indicates the nurse needs to prepare the family for death?
a. Redness of skin
b. Clear-colored urine
c. Tense muscles tone
d. Cheyne-Stokes breathing
d. Cheyne-Stokes breathing
Altered breathing such as Cheyne-Stokes pattern, apnea, labored, or irregular breathing is a sign of impending death. Cyanotic, pallor, or mottling of skin occurs. Urine is decreased and a dark color. Decreased muscle tone, relaxed jaw muscles, and sagging mouth also occur.
The mother of a child who died recently keeps the child’s room intact. Family members are encouraging her to redecorate and move forward in life. Which type of grief will the home health nurse recognize the mother is experiencing?
a. Normal
b. End-of-life
c. Abnormal
d. Complicated
a. Normal
Family members will grieve differently. One sign of normal grief is keeping the deceased individual’s room intact as a way to keep that person alive in the minds of survivors. This is happening after the family member is deceased, so it is not end-of-life grief. It is not abnormal or complicated grief; the child died recently.
