Chapter 43 - Loss Grief and Dying Flashcards
Key Terms
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
Stages of Grieving
Kubler-Ross Denial/Isolation Anger Bargaining Depression Acceptance
Dysfunctional Grief
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
Goals of Grieving
Goals for the grief process Resolving emotions Reflecting on the dying person Expressing feelings of loss and sadness Valuing what has been shared
Three Definitions of Death
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
Respiratory System
↑ 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
Cardiovascular System
↑ heart rate Later slowing and weakening of pulse Irregular rhythm ↓ blood pressure Pitting edema Skin cold and clammy (although patient may be febrile) Cyanosis
Gastrointestinal & Urinary Systems
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
Musculoskeletal System
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
Psychosocial Manifestations
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
Components of a Good Death
Pain and symptom management Clear decision making Preparation for death Completion Contributing to others Affirmation of the whole person
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
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
Variables Affecting EOL Care Attitudes Beliefs Cultural, religious, family influences Spiritual needs Avoid stereotyping by completing assessments on an individual basis
Attitudes Beliefs Cultural, religious, family influences Spiritual needs Avoid stereotyping by completing assessments on an individual basis
Five Principles of Palliative Care
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
Advance Directives
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
