Chapter 43 Loss, Grieving, and Death

Question 1

What are the two types of loss?

Answer 1

Actual and perceived loss

Question 2

Actual loss

Answer 2

Can be recognized by others

Question 3

Perceived loss

Answer 3

Is experienced by one person but cannot be verified by others.

Question 4

Anticipatory Loss

Answer 4

Is experienced before the actual loss occurs.

Example: A woman whose husband is dying may experience actual loss in anticipation of his death.

Question 5

The loss of an aspect of self changes a persons body image even though the loss?

Answer 5

May not be obvious

Question 6

Examples of Aspect of self:

Answer 6

Loss of part of the stomach or loss of ability to feel emotion may not be as obvious.

Question 7

Loss of external objects includes:

Answer 7

1. Loss of intimate objects that have importance to the person, such as the loss of money or the burning down of a families house.
2. Loss of animate (live) objects such as pets that provide love and companionship.

Question 8

What is grief? What is grief manifested in?

Answer 8

The total response to the emotional experience related to loss. It is manifested in thoughts, feelings, and behaviors associated with overwhelming distress or sorrow.

Question 9

What is bereavement?

Answer 9

Is the subjective response experience by the surviving loved ones.

Question 10

What is mourning? What is it influenced by?

Answer 10

The behavioral process through which grief is eventually resolved or altered; it is often influenced by culture, spiritual beliefs, and custom.

Question 11

What kind of grief is experienced in advance of the event such as the wife who grieves before her husband dies?

Answer 11

Anticipatory grief

Question 12

What kind of grief is unhealthy and exists when the strategies to cope with the loss are maladaptive?

Answer 12

Complicated grief

Question 13

What are the behavioral responses and nursing implications for the stage of denial? (Kubler-Ross’s)

Answer 13

Behavioral Responses: Refuses to believe that loss is happening. Is unready to deal with practical problems, such as prosthesis after the loss of a leg. May assume the artificial cheerfulness to prolong denial.
Nursing implications: Verbally support client but do not reinforce denial. Examine your own behavior to ensure that you do not share in clients denial.

Question 14

What are the behavioral responses and nursing implications for the stage of Anger? (Kubler-Ross’s)

Answer 14

Behavioral Responses: Client or family may direct anger at nurse or staff about matters that normally would not bother them.
Nursing Implications: Help client understand that anger is a normal response to feelings of loss and powerlessness. Avoid withdrawal or retaliation; do not take anger personally. Deal with needs underlying any anger reaction. Provide structure and continuity to promote feelings of security. Allow clients as much control as possible over their lives.

Question 15

What are the behavioral responses and nursing implications for the stage of Bargaining? (Kubler-Ross’s)

Answer 15

Behavioral Responses: Seeks to bargain to avoid loss (Ex. let me just live until __ and then I will be ready to die)
Nursing Implications: Listen attentively, and encourage client to talk to relieve guilt and irrational fear. If appropriate, offer spiritual support.

Question 16

What are the behavioral responses and nursing implications for the stage of Depression? (Kubler-Ross’s)

Answer 16

Behavioral Responses: Grieves over what has happened and what cannot be. May talk freely (Ex. reviewing past losses such as money or job), or may withdraw.
Nursing Implications: Allow client to express sadness. Communicate nonverbally by sitting quietly without expecting conversation. Convey caring by touch.

Question 17

What are the behavioral responses and nursing implications for the stage of Acceptance? (Kubler-Ross’s)

Answer 17

Behavioral Responses: Comes to terms with loss. May have decreased interest in surroundings and support people. May wish to begin making plans (Ex. Will, prosthesis, altered living arrangements.).
Nursing Implications: Help family and friends understand clients decreased need to socialize. Encourage client to participate as much as possible in the treatment program.

Question 24

Loss of a job, or death of a child are examples of?

Answer 24

Situational Loss

Question 25

Departure of children from home, retirement, health and physical vitality are examples of what kind of loss?

Answer 25

Developmental Loss

Question 26

What if abbreviated grief?

Answer 26

Brief but genuinely felt

Question 27

List 8 Factors affecting Grief Response?

Answer 27

Age, significance of the loss, culture, spiritual beliefs, gender, socioeconomic status, support systems, and cause of death

Question 28

What age group experiences the same emotions of grief as adults. Often pushed aside and protected; can lead to feelings of fear and abandonment.

Answer 28

Children

Question 29

What age group expects to lose a parent?

Answer 29

Middle aged adults

Question 30

What age group experiences many losses. Health problems of widows/widowers often increase following the death of a spouse

Answer 30

Late adulthood

Question 31

What age group may no longer have living peers, nurse may need to provide that support.

Answer 31

Older adult

Question 32

Diagnosis of grieving include:

Answer 32

Grieving, fear, hopelessness, and powerlessness

Question 33

What are 4 guidelines for physicians as indicators of death:

Answer 33

Total lack of response to external stimuli, no muscular movement especially breathing, no refluxes*, and flat encephalogram (brain waves)

Question 34

3 death related religious and cultural practices

Answer 34

Autopsy, organ donations ( Buddhists encourage it, Jehovah don’t believe in it), and cremation (no for Catholics, Hindus prefer it and cast ashes in a holy river)

Question 35

Hospice Care

Answer 35

Care focuses on support care of the dying.

Question 36

Palliative Care

Answer 36

Is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.

Question 37

End of life Care

Answer 37

Care provided in the final weeks of death.