Chapter 43 Loss, Grief, and Dying

Question 1

A type of loss that can be recognized by others as well as by the person sustaining the loss such as loss of money, limb, spouse.

Answer 1

actual loss

Question 2

A type of loss that is experienced by the person but is intangible to others such as loss of youth, financial independence, valued environment?

Answer 2

perceived loss

Question 3

what is an example of physical and psychological loss?

Answer 3

A person who loses an arm in an automobile crash suffers from the physical loss of the arm and the psychological loss that may be caused by an altered self-image and the inability to return to his or her occupation.

Question 4

A person who is scarred but does not lose a limb may suffer from which two types of loss

Answer 4

perceived and psychological loss of self-image

Question 5

Maturational loss

Answer 5

A loss that is experienced as a result of natural developmental process. Example, the first child may experience a loss of status when her sibling is born.

Question 6

A loss that is experienced as a result of an unpredictable even such as traumatic injury, disease, death.

Answer 6

situational loss

Question 7

Anticipatory loss?

Answer 7

Occurs when a person displays loss and grief behaviors for a loss that has yet to take place.

Question 8

Loss often seen in the families of patients with serious and life-threatening illness and may lessen the effect of the actual loss of a family member

Answer 8

Anticipatory loss.

Question 9

describe the grief process

Answer 9

necessary to maintain quality in both emotional and physical well-being.
manifested in a variety of ways.
it varies from person to person.

Question 10

what are the stages of grief define by Engel

Answer 10

shock and disbelief (refusal to accept the fact of loss “No, not me”)
developing awareness(physical and emotional responses such as anger “why me”)
restitution (the rituals surrounding loss)
resolving the loss (dealing with the void left)
idealization (exaggeration of the good qualities that the person had)
outcome (dealing with loss as a common life occurrence)

Question 11

what are the stages of grief defined by kubler-Ross?

Answer 11

denial (they made a mistake in the diagnosis)
Anger (“why me”)
Bargaining (barter for more time, make wills, fulfilling last wishes)
Depression (crying and not speaking much)
Acceptance (patient feels tranquil)

Question 12

At this stage of grief patient may say, “I’ve tied up all the loose ends: made the will, made arrangements for my daughter to live with grandparents. Now i can go in peace knowing everyone will be fine.”

Answer 12

Acceptance

Question 13

The nurse knows that, a patient is in this stage of grief when he/she starts, “I waited all these years to see my daughter get married. And now i may not be her to see her walk down the aisle. I can’t bear the thought of not being there for the wedding-and not seeing my grandchildren.”

Answer 13

Depression

Question 14

Period of acceptance of loss, person learns to deal with loss, it the actions and expression of a grief

Answer 14

Mourning

Question 15

Bereavement

Answer 15

state of grieving; person goes through grief reaction.

Question 16

a dysfunctional grief in which a person may have trouble expressing feelings of loss or may deny them?

Answer 16

Unresolved grief

Question 17

A state of bereavement that extends over a lengthy period.

Answer 17

unresolved grief

Question 18

Inhibited grief?

Answer 18

A person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations.

Question 19

unresolved ambivalent feelings toward the deceased

Answer 19

conflicted grief

Question 20

compare and contrast three definitions of death

Answer 20

Traditional heart-lung (irreversible cessation to spontaneous respiration and circulation)
Whole brain (irreversible cessation of all functions of the entire brain).
Higher brain (irreversible loss of all "higher" brain function)

Question 21

irreversible cessation of spontaneous respiration and circulation

Answer 21

Traditional heart-lung death

Question 22

Whole brain death?

Answer 22

irreversible cessation of all functions of the entire brain

Question 23

The irreversible loss of all “higher brain function?

Answer 23

Higher brain death

Question 24

list the clinical signs of approaching death

Answer 24

cheyne-stokes respiration
irregular breathing, increase RR, HR, grunting, gurgling, or nosiy congested breath (death rattle), elevated temp, decrease BP, pitting edema,skin cold and clammy, cyanosis, inability to swallow, slowing of GI and urinary tracts, incontinence, gradual loss of ability to move, loss of gag reflex.

Question 25

what are the goals for the grief process

Answer 25

resolving emotions
reflecting on the dying person
expressing feelings of loss and sadness
valuing what has been shared

Question 26

outline nursing responsibilities after death

Answer 26

prepare body for discharge
place body in anatomical position, replace dressing, and remove tubes (unless there is an autopsy scheduled)
place identification tags on the body
fellow local law if patient died of communicable disease

Question 27

when should the tubes be left on the body of a death patient?

Answer 27

when there is any autopsy scheduled

Question 28

identify six factors that affect loss, grief and dying

Answer 28

developmental considerations, family, socioeconomic factors, cultural and gender influences, religious influences, causes of death

Question 29

discuss the role of the nurse in caring for a dying patient’s family

Answer 29

listen to family’s expressions of grief, loss and helplessness, offer solace and support by being an attentive listener, arrange for family to view the body.

Question 30

implementation for a dying patients and their families

Answer 30

develop a trusting nurse-patient/family relationship, holistic, assess patient’s family’s grieving process, explain the patient condition and treatment, teach family to assist in care, meet patient’s and family’s needs, teach self-care and promote self-esteem, provide postmortem care.

Question 31

what are the components of a good death?

Answer 31

A good that is one that allows a person to die on his or her own terms, relatively free of pain with dignity.

Question 32

what are factors important for a good death?

Answer 32

control of symptoms, preparation for death, opportunity to have a sense of completion of one’s life, affirmation of the whole person.

Question 33

identify ethical and legal issues concerning end-of-life care

Answer 33

organ donation
autopsy
death certificate
Assisted suicide
active euthanasia

Question 34

It means taking care of the whole person-body, mind, and spirit, heart and soul. it views dying as something natural and personal

Answer 34

Palliative care

Question 35

what is the goal of palliative care?

Answer 35

To give patients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms.

Question 36

care provided for people with limited life expectancy, often in the home?

Answer 36

hospice

Question 37

Provides specific instructions about the kinds of healthcare that should be provided or foregone in particular situations

Answer 37

living wills

Question 38

allows patient to state in advance what their choices would be for healthcare should certain circumstances develop.

Answer 38

Advance directives

Question 39

this act requires all hospitals to inform patients about advance directives?

Answer 39

Patient self-Determination Act of 1990

Question 40

No attempts are to be made to resuscitate a patient who stops breathing or whose heart stops beating.

Answer 40

DNR-do-not-resuscitate

Question 41

The goal of treatment is a comfortable, dignified death and that further life sustaining measures are no longer indicated.

Answer 41

comfort-measures-only order

Question 42

what is the nurse’s role in terminal weaning?

Answer 42

participate in the decision-making process by offering helpful information about the benefits and burdens of continued ventilation and a description of what to expect if terminal weaning is initiated. Supporting the family and managing sedation and analgesia.

Question 43

Active euthanasia

Answer 43

taking specific steps to cause a patient’s death (doing something)
assisted suicide

Question 44

not doing something to preserve a patient’s life

Answer 44

passive euthanasia

Question 45

what is the ANA position on active euthanasia

Answer 45

violation of the code for nurses, the ethical traditions and goals of the profession, and its covenant with society.

Question 46

what is the nurse’s responsibility in death certificate

Answer 46

To ensure that the physician has signed the death certificate

Question 47

nurse responsibilities in organ donation

Answer 47

review options and provide consent forms to interested patients and their families.

Question 48

Autopsy

Answer 48

The examination of the organs and tissues of a human body after death.

Question 49

what is the nurse responsibility for an autopsy?

Answer 49

Notifying the coroner if death is caused by accident, suicide, homicide, illegal therapeutic practice and death that occurs within 24 hours of admission to the hospital.

Question 50

nursing assessment during loss, grief and dying

Answer 50

assessing the patient’s status frequently
be sensitive
assess patient’s and family’s ; knowledge, perceptions, coping strategies and resources.