Chapter 43 Loss, Grief, and Dying Flashcards
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.
actual loss
A type of loss that is experienced by the person but is intangible to others such as loss of youth, financial independence, valued environment?
perceived loss
what is an example of physical and psychological loss?
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.
A person who is scarred but does not lose a limb may suffer from which two types of loss
perceived and psychological loss of self-image
Maturational loss
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.
A loss that is experienced as a result of an unpredictable even such as traumatic injury, disease, death.
situational loss
Anticipatory loss?
Occurs when a person displays loss and grief behaviors for a loss that has yet to take place.
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
Anticipatory loss.
describe the grief process
necessary to maintain quality in both emotional and physical well-being.
manifested in a variety of ways.
it varies from person to person.
what are the stages of grief define by Engel
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)
what are the stages of grief defined by kubler-Ross?
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)
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.”
Acceptance
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.”
Depression
Period of acceptance of loss, person learns to deal with loss, it the actions and expression of a grief
Mourning
Bereavement
state of grieving; person goes through grief reaction.
a dysfunctional grief in which a person may have trouble expressing feelings of loss or may deny them?
Unresolved grief
A state of bereavement that extends over a lengthy period.
unresolved grief
Inhibited grief?
A person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations.
unresolved ambivalent feelings toward the deceased
conflicted grief
compare and contrast three definitions of death
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)
irreversible cessation of spontaneous respiration and circulation
Traditional heart-lung death
Whole brain death?
irreversible cessation of all functions of the entire brain
The irreversible loss of all “higher brain function?
Higher brain death
list the clinical signs of approaching death
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.
what are the goals for the grief process
resolving emotions
reflecting on the dying person
expressing feelings of loss and sadness
valuing what has been shared
outline nursing responsibilities after death
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
when should the tubes be left on the body of a death patient?
when there is any autopsy scheduled
identify six factors that affect loss, grief and dying
developmental considerations, family, socioeconomic factors, cultural and gender influences, religious influences, causes of death
discuss the role of the nurse in caring for a dying patient’s family
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.
implementation for a dying patients and their families
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.
what are the components of a good death?
A good that is one that allows a person to die on his or her own terms, relatively free of pain with dignity.
what are factors important for a good death?
control of symptoms, preparation for death, opportunity to have a sense of completion of one’s life, affirmation of the whole person.
identify ethical and legal issues concerning end-of-life care
organ donation autopsy death certificate Assisted suicide active euthanasia
It means taking care of the whole person-body, mind, and spirit, heart and soul. it views dying as something natural and personal
Palliative care
what is the goal of palliative care?
To give patients with life-threatening illnesses the best quality of life they can have by the aggressive management of symptoms.
care provided for people with limited life expectancy, often in the home?
hospice
Provides specific instructions about the kinds of healthcare that should be provided or foregone in particular situations
living wills
allows patient to state in advance what their choices would be for healthcare should certain circumstances develop.
Advance directives
this act requires all hospitals to inform patients about advance directives?
Patient self-Determination Act of 1990
No attempts are to be made to resuscitate a patient who stops breathing or whose heart stops beating.
DNR-do-not-resuscitate
The goal of treatment is a comfortable, dignified death and that further life sustaining measures are no longer indicated.
comfort-measures-only order
what is the nurse’s role in terminal weaning?
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.
Active euthanasia
taking specific steps to cause a patient’s death (doing something)
assisted suicide
not doing something to preserve a patient’s life
passive euthanasia
what is the ANA position on active euthanasia
violation of the code for nurses, the ethical traditions and goals of the profession, and its covenant with society.
what is the nurse’s responsibility in death certificate
To ensure that the physician has signed the death certificate
nurse responsibilities in organ donation
review options and provide consent forms to interested patients and their families.
Autopsy
The examination of the organs and tissues of a human body after death.
what is the nurse responsibility for an autopsy?
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.
nursing assessment during loss, grief and dying
assessing the patient’s status frequently
be sensitive
assess patient’s and family’s ; knowledge, perceptions, coping strategies and resources.
