Death and Grief Flashcards
Define each of the following: -bereavement -grief -complicated grief -Mourning -
Bereavement: situation in which someone who is close dies, redefine goals and plans
Grief: natural response to bereavement, hallmark is intense focus on the thoughts and memories of the deceased person, accompanied by sadness and yearning*
Complicated Grief: form of acute grief that is usually prolonged, intense, and disabling
Mourning:
-process of adapting to a loss and integrating grief
Grief:
- sx of separation distress
- sx of trauma/stress rxn
- course
Separation Distress:
- yearning
- loneliness
- crying, sadness, other painful emotions
Trauma/stress:
- disbelief and shock
- numbness
- impaired attention, concentration, or memory
Course: 6months
Bereavement:
-types of loss
- type of lost relationship (losing a child, spouse, partner, may experience survivor guilt)
- sudden lost (higher rate of PTSD or depression, substance abuse disorder)
- Chronic illness
- Terminal Illness
Management of Grief and Bereavement
- summon families prior to an expected death
- call immediate family members
- support (family, friends, and clergy)
- encourage patients to maintain regular patterns of activity, sleep, exercise, and nutrition.
Complicated grief
- clinical features
- adverse consequences
- course of disorder
- management
Clinical features:
- maladaptive rumination about the circumstance of the death
- intense emotional and/or physical reactions
- dysfunctional behaviors
- inadequate regulation of emotions
- yearning*
- feeling upset by memories of decreased*
- suicidality
- recurrent disbelief of inability to accept death
- anger or bitterness about death
Consequences:
- increase use of alcohol and tobacco
- poor quality of life
- general medical illnesses and suicide
Course:
-sx last at least 1 mo after 6mos of bereavement who are significantly and functionally impaired
Management:
- CBT is first line
- if failure of CBT they should be re-evaluated to determine the dx
What are the signs of death?
Cessation of breathing, cardiac arrest, palor mortis (white), livor mortis (blood separates), Algo mortis (decreased body temp), rigor mortis, decomposition
Physiologic changes while dying?
What are the signs of dying within 48hrs
- increasing weakness, fatigue
- decreasing appetite/food intake
- decreasing blood perfusion (tachycardia, hypotension, cyanosis, mottling of skin, diminished urine output)
- neurologic dysfunction
Last 48hrs:
- orderly loss of the senses and desires
- noisy moist breathing
- urinary incontinence/retention
- pain and dyspnea
- restlessness andd agitation
describe the attitude toward death for each of the following age groups:
- under 5 yo
- 5-10yo
- after 9-10yo
- adolescents
- adults
under 5: awareness of death only in the sense of a separation similar to sleep
5-10: developing sense of inevitable human mortality and often fear that parent will die and that they will be abandoned.
After 9-10yo: realize taht death can happen to them and recognize death as universal, irreversible, and inevitable.
Adolescents: understand death is inevitable and final, broad range of emotions that mirror teenage angsts: loss of control, being imperfect, being different.
Adults:
- often readily accept that their time as come
- may talk or joke openly about dying and sometimes welcome it
What are the stages of grief:
Denial: defense mechanism that buffers the immediate shock
Anger: as denial fades, reality and its pain re-emerge. May resent the person causing pain for leaving.
Bargaining: normal rxn to feelings of helplessness and vulnerability to regain control, secretly make a deal with god or higher power to postpone the inevitable.
Depression: feel like we dont care much of anything and wish life would just hurry up and pass on by.
Acceptance: means we are ready to move on.
