death and dying Flashcards
1
Q
thanatology
A
the study of death and dying
2
Q
psychological death
A
- begins when the person is told they have a terminal illness
- start the grieving process (crying, mourning, disbelief, sadness)
3
Q
physiological death
A
- starts when the body processes decline in function
- cessation of breathing and heartbeat do not necessarily constitute death (they can be restored through resuscitation)
4
Q
brain death
A
- irreversible cessation of all activity in the brain and the brain stem
- Used in the US to define death
- Brain stem for reflexive actions such as heartbeat and breathing
5
Q
persistent vegetative state
A
- cerebral cortex no longer working, but brain stem is.
- cerebral cortex responsible for higher level of function — thinking, personality
6
Q
physical decline during death
A
- less interest in communicating, eating, drinking, moving
- body temp declines
- blood flow to extremities declines
- blood pressure starts to go down
- extremities becomes cool and take on a duller hue
- decreased urine output
7
Q
transition from life to death: final three phases
A
- Agonal phase: struggle to breath, lung congestion
- Clinical death: heartbeat, circulation, breathing stops but resuscitation may still be possible
- Mortality: Passage to permanent death
8
Q
“death with dignity”
A
- quick, agony free end during sleep
- clear-minded to say farewell and review their life
9
Q
dignity of death: compassionate care
A
- care and treatment with respect
- address the patient’s greatest concerns
10
Q
dignity of death: communication
A
- Candid approach about the certainty about death
- This allows for end-of-life planning and decision
making - Allows the person to make reasoned decisions and choices
11
Q
attitude toward death
A
- death avoidant society
- reluctant to talk about it
- death anxiety: fear and apprehension of death (lowers as we age)
12
Q
Kubler-Ross: 5 Stages (Reactions) to Death
A
- denial: Refusing to accept the diagnosis and avoiding discussion about it. Trying to escape the
prospects of death - anger: Resentment and fury that time is short and their goals will be left unattained. Unfairness of death
- bargaining: Striking bargains with anyone (and God) for more time
- depression: Realization of the inevitability of death. Despondency about impending loss of life
- acceptance: Reaching a state of peace. Disengaging from most except for a few close family members or friends
13
Q
what influences dying and death?
A
- the nature of the disease affects the context of dying
> the course of illness affects the person
> the toll of the disease often results in
depression - Personality and Coping Style of the Individual affects the context of dying
> How individuals have coped with prior stress
> How they have viewed prior life events
> Poorly adjusted individuals and many life
disappointments are usually more distressed
14
Q
the home
A
- 80% prefer to die in the home
- Offers an atmosphere of intimacy
- Feel less abandoned or humiliated by the loss of dignity with dying
- Only 1 in 4 die in home
- Not necessarily easy on the family physically or emotionally
15
Q
the hospital
A
- 40% of deaths occur in the hospital
- Nearly 30% of those over 65 will die in the ICU
- Hospital not equipped to handle the emotions
- Hospital environment is impersonal—in the hospital, death is often seen as failure.
- Nurses and doctors are not always trained in management of chronically ill and my engage in life prolonging procedures
16
Q
nursing homes
A
- About 20% will die in a long term care facility
- Little research available about what it is like to die there.
- Inattention to spiritual and emotional needs and
untreated pain often occur
17
Q
hospice – comprehensive program of support services for terminally ill
A
- Not a place, a philosophy
- Focus on quality of life
- Provides emotional, spiritual, physical care
- Focus on palliative care (reduces pain and suffering)
- Interdisciplinary team that provides 24 hour support and family services after the death
- Most insurances cover as well as Medicare and Medicaid.
- No curative goals
18
Q
palliative care
A
- have some medications focused on cure
- Approach that improves quality of life in those facing a life-threatening illness
- Prevention and relief of suffering
- Addresses the person as a whole.
- Can be accessed at any point in the illness continuum
- During treatment as well as end of life
- Focuses on physical symptoms, emotional and spiritual needs and assistance for caregivers.
- Goal: best quality of life
19
Q
hospice care
A
- palliative care but with no curative goals and patients do not seek curative treatments
- comfort for family/patient
20
Q
voluntary euthanasia
A
- At a patient’s request, a doctor actively takes the patient’s life in a painless way for the purpose of relieving suffering.
- This is a criminal offense in all states and most countries
- Opponents stress there is a moral difference between letting someone die and purposefully ending their life early.
21
Q
helpful communication
A
- “Tell me how you are feeling”
- “It is ok to cry”
- “I am here if you want to talk”
- Silence is fine
- Warm touch, presence
- “I am sorry for your loss”
- “Would you like to talk?”
- “Tell me about……”
22
Q
not helpful communication
A
- “You need to be strong for your family”
- “Don’t cry”
- “It is God’s Will”
- “You will be out of pain soon”
- “Was she in a lot of pain?”
- “Where you expecting him to die”
23
Q
the right to die
A
- 70% of adults/95% of physicians support the right of patients or family members to end treatment
- The AMA endorses withdrawing treatment from those who are terminally ill
or those in permanent vegetative state. - Religious and cultural views may play a role in these decisions
24
Q
Advanced Directives
A
- Durable Power of Attorney–Assign someone to make decisions should you
not be able to - Living Will–You identify what treatments you would want and not want
- Do Not Resuscitate Order
25
medical aid in dying
- at an incurably ill patient’s request the HCP provides a prescription for lethal dose of medication
- The patient then self administers this to themselves
- 2 doctors need to agree
- there is a waiting period for the prescription
- very controversial
26
bereavement
- Involves grief and mourning
- Experience of losing a loved one by death
27
grief
- Emotional response to loss
- Intense physical and psychological distress
28
mourning
- Outward expression of grief
- Culturally specified expression of the thoughts
and feelings.
29
anticipatory grief
grief that occurs before the loss is known
30
delayed grief
- when emotions are postponed
- may be triggered later by another life event
31
how much experience moderate distress, depression and difficulty in functioning over the next year?
15-25%
32
how much experience severe, prolonged distress,
depression and lack of acceptance for years?
5-15%
33
infants and toddlers view on death
* Do not understand death
* React to changes in the family routine when someone dies
* Do not understand implications of their own death
34
preschoolers view on death
* Do not understand the permanence of death
* Magical thinking. May think they are “asleep”
* May continue to ask about the person
* Do not really understand much about their own death
35
school age view on death
* Understand the finality of death
* Understands death is forever, they are not coming back
* May be interested and curious about the rituals related to death
36
adolescents view on death
* Understand death in abstract manner
* Adult view and understanding of death of themselves and others.
37
health care providers
* Increase understanding of physical and psychological changes that accompany dying
* Enhancing awareness of end-of-life options, funeral services, memorial rituals
* Promoting understanding of advance directives, living wills, euthanasia, organ donation
* Improving student’s ability to communicate effectively about death and dying
* Helping prepare for the professional role in caring for the dying
* Fostering appreciation of lifespan development and how that interacts with death and dying
* Communication is key
38
personal and situation variations of grieving
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