Death and Dying Flashcards
Sense of satisfaction that lifes productive
Integrity
Loss of hope and sense that life has no purpose
Despair
Knowing the true doctor-patient relationship
acceptance that death is part of life and doesn’t shy away from emotional pain of loss
Death is where:
Philosophy
Spirituality
Medicine
Free from avoidable distress and suffering for pts, family and care givers
Good death
Study of Death and Dying
Thanatology
Dr. Kubler -Ross studied
Stages of dying
- reactions of patients with terminal illness and pts seldom and follow a regular series of responses
- no sequences of stages established
Five stages
Denial Anger Bargaining Depression Acceptance
Death is to be avoided, not natural, death is failure of medical care and is negative reflection on doctor
Physician Barrier
What makes up a good death
no prolongued
pain and symptoms controlled
not a burder to others
control over decision making and strengthening relatioships
People want to die where:
end up dying?
prefer home but most end up dying in hospital and some nursing home. NO one wants to die in a nursing home
intentional, unintentional, subintentional
circumstnces of dying
A pts choice about end of life care
advance directive
Advance directive is legally binding
yes
Includes
living wills, health care proxy, DNR
What do hospitals use w/out advance directives
ethics committee
Is AMA okay with euthanasia?
nope
Legal and ethical to provide medically needed analgesia to terminally ill pt even if it shortens life
Euthanasia
Findings of death with dignity law
physcians more involved
no flood of people to die
people did so bc wanted control and independence
36% didn’t even fill prescription
Pallative care is/not hospice
NOT
Goals of pallitive care
provide RELIEF from suffering
comfort
pain management
CAN and SHOULD co-exsit with life prolounging interventions
Hospice
as person is nearing end of life
helps make decisions how and where to die
forgoes life prolonguing tx in favor of quiality
Necessities for hospice admission
recommendation of personal physician
left expectancy of 6 months or less
no longer seeking cure
desire to stay out of hospital
Goals of hospice
provide physical, emotional, social support
support familiy and loved ones
assit pts to live with dignity and comfort as they cope with end of life issues
Changes weeks/days before death
tired, refuse food and drink, decreased reserve for activity, change vitals, change in cognition, “last hoorah’
Unresponsive, bluish with cold hands and feet, decreaesd blood pressure, decreased breathing, “Death Rattle”
final hours of life
Lack of reflexes so swallowing reflex is less
death rattle
Two ways to Grieve
laughter and crying
Normal grief lasts
12-24 months
FEELING of loss
Grief
PROCESS of resolving grief
Mourning
the STATEof mourning the death of a loved one
Bereavement
well defined syndrome w/ known etiology and predictable symtoms
Causes distress and dysfunction associated with complications
Grief
State of being deprived
State of Mourning loss of loved one
Seems interchangable with mourning
Bereavement
Causes loss of loved one to be more painful
Grief is the price we pay
Attachment Theory
T/F grief is multifaceted
T
How long does shock/denial last
2-3 months
how long does intense concern last
6 months - 1 yr and cant focus on stuff
Includes anger, guild, sadness, anxiety
Despair/Depression
When you reorganize thoughts… accomidation and assimilate information
Recovery
Numb, cyring, sighning, sense of unreality, denial disbelief… which stage?
Denial/Shock
Phase 1
Anger/Sadness/Guilt/Dreams/Insomnia/anorexia/anhedonia/weak/fatigued
Phase 2: preoccupation with deceased and intense concern
Can think about past with pleausure, regain interest in activites and forms new relationships
Phase 3: Resolution
% that go on to complicated grief
10-20%
can treat prolounged grief as…
PTSD
When does complicated grief occur?
follows sudden or tragic death and survivors get stuck in phase of grief
men/women more at risk
men..young men
PGD
prolounged grief disorder
symptoms of PGD
extreme focus on loss
intense longing for what is lost
numb/withdrawn/life is meaningless/irritable
lack of trust/ trouble accepting loss
Increased risk for these with PGD
depression, anxiety, substance abuse, mortality rate
2 months of depression is major predictor of:
Cardiac problems and impaired immune response
increased suicide and accidents
poor self care
Grief is normal and has how many phases
3
Denial/shock
intense concern/preoccupation/
Resolution
What occurs in final hours of life
loss of swallow and cough reflexes
